Cláudia Maria Bógus

Considerações sobre a metodologia qualitativa como recurso para o estudo das ações de humanização em saúde

Abstract Health humanization is one of the major politics ofthe health sector, currently being implemented in ourcountry. The authors relate humanization with healthpromotion. Promoting health and humanizing healthcare are long term and continuous efforts, which aredynamic and closely related with the context in whichthey are brought in. The diagnosis is critical for theproposition of actions and for adequate interventions,while monitoring and evaluating these interventionscan guarantee the actions support. As the actions andactivities involved are much complex, diagnosing,monitoring and evaluating must be approached in anamplified way that includes the process’s “reasons”and “means”. In order to achieve that, the article high-lights the utility of multiple methods (quantitativeand qualitative), focusing on the qualitative approach.Some considerations concerning this research metho-dology are presented, including “sampling” strategies,the most used techniques (interview, focal group andobservation) and material analysis. In that way, theauthors intend to contribute to administrators’ andhealth professionals’ improvement in situation diag-noses (which aid decisions on future strategies) aswell as in accompanying and evaluating the imple-mented actions in order to bring about adequatemodifications.Key Words: Health Humanization; Health Promotion;Qualitative Research; Program Monitoring; PoliticsEvaluation; Situation Diagnosis.

O parto como eu vejo... ou como eu o desejo? Expectativas de gestantes, usuárias do SUS, acerca do parto e da assistência obstétrica

Explanations for increased cesarean section rates in Brazil have focused on the organization of obstetric care, training of health professionals, and womens demand for surgical deliveries. This study aimed to identify pregnant womens expectations towards childbirth. Three focus groups were conducted in a public hospital in the city of São Paulo. Analytical categories were: vaginal birth, forceps, c-section, prenatal care, and obstetric care. The desire for c-sections was associated with a demand for tubal ligation, and although women feared labor pains, they were more afraid of how the obstetric team might react to their complaints. Lack of information on reproductive issues was associated with a demand for more information. There was a preference for vaginal births, since most women feared c-sections due to risks associated with this surgical intervention. The authors propose that the demand for cesareans among women should be reconsidered as one of the main factors in the rise in surgical deliveries in the Brazilian health care system.

Breastfeeding training for health professionals and resultant changes in breastfeeding duration

CONTEXT Promotion of breastfeeding in Brazilian maternity hospitals. OBJECTIVE To quantify changes in the breastfeeding duration among mothers served by hospitals exposed to the Wellstart-SLC course, comparing them with changes among mothers attended by institutions not exposed to this course. DESIGN Randomized Institutional Trial. SETTING The effects of training on breastfeeding duration was assessed in eight Brazilian hospitals assigned at random to either an exposed group (staff attending the Wellstart-SLC course) or a control group. SAMPLE For each of the eight study hospitals, two cohorts of about 50 children were visited at home at one and six months after birth. The first cohort (n = 494) was composed of babies born in the month prior to exposure to the Wellstart-SLC course, and the second cohort (n = 476) was composed of babies born six months subsequent to this exposure. MAIN MEASUREMENTS Kaplan-Meier curves were plotted to describe the weaning process and log-rank tests were used to assess statistical differences among survival curves. Hazard ratio (HR) estimates were calculated by fitting Cox proportional hazard regression models to the data. RESULTS The increases in estimated, adjusted rates for children born in hospitals with trained personnel were 29% (HR = 0.71) and 20% (HR = 0.80) for exclusive and full breastfeeding, respectively. No changes were identified for total breastfeeding. CONCLUSION This randomized trial supports a growing body of evidence that training hospital health professionals in breastfeeding promotion and protection results in an increase in breastfeeding duration.

Cuidados oferecidos pelas creches: percepções de mães e educadoras

OBJECTIVE: The objectives of this study were to (a) know how mothers of infants (0 to 2 years) perceived the care provided to their children by daycare centers and (b) know how educators perceived their roles in the care provided to infants and their families. METHODS: The quantitative approach to research was used together with the focus group technique. Five focus groups were conducted with mothers and two with educators from public daycare centers of the municipality of Sao Paulo. RESULTS: Three themes were identified in the material collected from the mothers: family relationship with the daycare center, care provided to the infant by the daycare center and the public policy on daycare. Among educators, the themes were: difficulties in the work routine, relationship with the infants family, relationship with the coordinators of the daycare facility, professional training and starting a career. CONCLUSION: Since the mothers considered themselves privileged to be able to leave their infants in a free-of-charge daycare facility, they were not very demanding of the quality of care provided to their infants. What they value the most are the aspects associated with feeding, hygiene and administration of medications. Regarding the educators, there are many limitations in their working conditions, especially regarding the shortage of educators. The relationship between the educator and the family is ambiguous: sometimes the educators consider the mothers to be careless and irresponsible and sometimes longing for attention and help. Two issues deserve to be investigated in future researches: the relationship between the daycare centers and the health services and the working conditions of the educators.

Práticas corporais/atividade física e políticas públicas de promoção da saúde

A promocao da saude, entendida como estrategia de producao social de saude, deve articular e permear politicas publicas que influenciem o futuro da qualidade de vida urbana. Esse grande desafio envolve arranjos intersetoriais na gestao publica, empoderamento da populacao, desenvolvimento de competencias e habilidades, capacitacao, acesso a informacao, estimulo a cidadania ativa, entre outros, para que a populacao reconheca seus problemas e suas causas, a fim de que ela possa advogar por politicas publicas saudaveis. Para esse proposito, e necessario que o governo operacionalize uma forma de gestao publica que considere a melhoria nas condicoes de vida, de trabalho e de cultura, estabelecendo uma relacao harmoniosa com o meio ambiente, com o corpo que envolva a participacao social na cogestao e na democracia. Nesse contexto, a insercao de um programa de praticas corporais/atividade fisica direcionada a populacao deve estar fundamentada em uma concepcao da Promocao da Saude apoiada em processos educativos que vao alem da transmissao de conhecimentos. Ela deve estar focada no enfrentamento das dificuldades, no fortalecimento da identidade e na incorporacao de solucoes criativas e saberes saudaveis. Este artigo tem o objetivo de refletir sobre politicas de promocao da saude relacionadas as Praticas Corporais/Atividade Fisica, alem de apresentar um breve relato sobre o trabalho desenvolvido nessa area no municipio de Sao Paulo.

Agendas urbanas intersetoriais em quatro cidades de São Paulo

Este artigo visa analisar o processo de implementacao e avaliacao de projetos de melhoria da qualidade de vida, do ponto de vista dos gestores municipais brasileiros, que tem buscado alternativas para a pratica da gestao local. Optou-se por identificar a percepcao de gestores, representantes do poder executivo local, prefeitos, secretarios de governo e coordenadores, identificados como atores-chave importantes na implementacao de projetos de melhoria da qualidade de vida em quatro municipios do Estado de Sao Paulo/Brasil. Foram feitas entrevistas individuais e em profundidade, com roteiro semi-estruturado. A analise dos quatro projetos por melhoria de qualidade de vida na cidade mostra que o processo de municipalizacao e descentralizacao da gestao, que vem sendo impulsionado no Brasil, vem contribuindo para definir uma politica local mais autonoma, para criar novas instâncias de decisao, incorporando praticas de controle social e de democratizacao da gestao. Porem, ainda existem muitas limitacoes no que se refere a incorporacao da avaliacao, como elemento retro-alimentador, no planejamento das acoes e da pratica participativa.

Conhecendo egressos do curso técnico de Enfermagem do PROFAE

El PROFAE (Proyecto de Profesionalizacion de Trabajadores del Area de Enfermeria) fue una iniciativa importante en la educacion profesional. Se objetivo describir el perfil de egresados del curso de tecnico en enfermeria de centros de formacion de la Secretaria de Estado de Salud de San Pablo y conocer los resultados para desempeno profesional y movimiento del mercado laboral. La recoleccion de datos se realizo mediante cuestionario respondido por 216 egresados y cuatro grupos focales de egresados-enfermeros supervisores. Quienes respondieron fueron mayoritariamente mujeres con media etaria 42,2 anos. El curso fue bien evaluado, destacandose el apoyo institucional y las resoluciones del Consejo Regional de Enfermeria (COREN) como impulsores de su promocion. Los egresados perciben tener mayor iniciativa y preparacion teorica luego del curso. En el area, la funcion mas ejercida es la de auxiliar de enfermeria. Esto genera insatisfaccion, pues principalmente en servicios publicos, no existen cargos de tecnico.The PROFAE (Professionalization Project in Nursing) was a relevant initiative for professional education. The objectives were to describe the profile of the former students of the technical nursing course of the São Paulo Health Department training centers so as to evaluate the effects of the course for the mobility and professional performance in the working market. Data collection was performed using a questionnaire answered by 216 former students and four focal groups with former students and nurse supervisors. Most respondents were women, with an average age of 42.2. The course received a positive evaluation, and two aspects were pointed out as motivating for searching for it: institutional support and CORENs resolutions. The former students perceive they had more initiative and theoretical preparation after the course. Nursing aide remains as the most common position in the area, thus causing dissatisfaction, because, especially in public services, technician positions are not available.

School feeding programs' role in forming eating habits

OBJETIVO Identificar as percepcoes dos gestores pedagogicos a respeito da relacao da alimentacao na escola e a promocao dos habitos alimentares entre escolares. METODOS Estudo do tipo descritivo, com abordagem qualitativa, desenvolvido no municipio de Guarulhos por meio de entrevistas com informantes-chave de escolas publicas municipais. Selecionaram-se escolas publicas (n=13), classificadas quanto ao nivel de exclusao social, tamanho e atividade economica da regiao onde a escola se localiza. Entrevistaram-se coordenadores e diretores individualmente, a partir de um roteiro de perguntas semiestruturadas. RESULTADOS Observaram-se tres categorias tematicas relacionadas a percepcao dos diretores e coordenadores pedagogicos: Alimentacao no contexto escolar; Papel da alimentacao na escola e o Conceito de Seguranca Alimentar e Nutricional, evidenciando a alimentacao escolar como parte da rotina da escola para atender as necessidades fisiologicas de energia e nutrientes. Entretanto, a alimentacao na escola nao foi percebida pelos entrevistados como uma acao pedagogica sob sua responsabilidade. CONCLUSOES A relacao entre a alimentacao escolar e a formacao de habitos alimentares nao e um tema usualmente discutido entre os diferentes atores sociais envolvidos. A execucao de politicas promotoras de saude em sua plenitude somente sera possivel com amplo debate sobre como cada escola e sua equipe pedagogica realizam efetivamente as diretrizes do programa e como os atores envolvidos as decodificam no seu dia a dia.

Participação comunitária em um programa de intervenção em área de proteção ambiental

Este artigo discute os conceitos de participacao e empowerment em Promocao da Saude e Desenvolvimento Sustentavel, considerando as agendas de implementacao local, Municipios/Cidades Saudaveis e Agenda 21, e a importância dos processos de avaliacao nesse contexto, por meio da analise de uma intervencao em area de mananciais - o Programa Bairro Ecologico (PBE), desenvolvido em 51 bairros do municipio de Sao Bernardo do Campo, Estado de Sao Paulo, Brasil. O estudo teve por objetivo avaliar os processos de participacao e empowerment da comunidade, a partir das acoes desencadeadas pelo PBE. Foram aplicados questionarios e realizados grupos focais com moradores de bairros que sofreram a intervencao. Tambem foram realizadas entrevistas individuais com gestores do programa e do poder judiciario. Os resultados indicaram que a participacao na implementacao do PBE favoreceu o empowerment individual e grupal, presente nas duas comunidades estudadas. As comunidades tornaram-se mais organizadas. Ha indicios de que os processos de tomada de decisoes sao centralizados. Apesar disso, as comunidades entendem que sua participacao no programa lhes traz muitas coisas boas. Houve um processo participativo no desenvolvimento do programa, ainda que alguns relatos apontem para o carater obrigatorio da participacao. Deve-se destacar o impacto do envolvimento e fortalecimento das liderancas na implementacao e sustentabilidade do programa. No que diz respeito a esta ultima, verificou-se que a sensibilizacao ambiental tem sido fator determinante para a execucao e manutencao das acoes ao longo do tempo.

Casa Siloé: a história de uma ONG para crianças portadoras de HIV/AIDS

Casa Siloe (Siloam House) is a Catholic support house that shelters children with human immunodeficiency virus or acquired immunodeficiency syndrome. The article presents a history of the institution and discusses its work. A qualitative approach was used, relying on oral history techniques and documental analysis. Eight key informants were interviewed: the president of the institution, two coordinators who worked at the home, a member of the supporting foundation, a volunteer social worker, a member of the state NGO/AIDS forum, a physician, and a psychologist from the state public service. Topics addressed include the Catholic Church and AIDS, community mobilization, the Casa Siloe, the State and civil society, and project evaluation and outlook.