Margareth Santos Zanchetta

Effectiveness of community health agents' actions in situations of social vulnerability

Evaluation is purposeful activity examining multiple, diverse realities [1] that affect the implementation of social interventions and their management [2]. As political activity, evaluation involves partnerships among managers, stakeholders and internal and external evaluators. These partners review common interests and concerns to modify policies and modi operandi, and ultimately, to influence human life [3]. Evaluation is particularly sensitive to social problems and expectations; it documents their features, incidence and prevalence [2]. This article reports the quanti-qualitative results of an in-service effectiveness evaluation of interventions to reduce health risks for socially vulnerable people by community health agents (CHAs) (Agentes Comunitarios de Saude) in Brazil. CHAs are key personnel within the nationwide community health agent program (CHAP), created in 1991, that operates within Brazil’s Family Health Strategy (FHS). CHAP considers social inclusion through health education and promotion, a cornerstone of collective health. Most CHAs are from the communities they serve. This article documents some crucial features of CHAs’ work in dangerous neighborhoods previously inaccessible to health professionals (HPs). Knowledge about these residents’ health needs, challenges and difficulties due to their social vulnerability may not have reached health care providers.

Nursing students’ international placement experience: an arts-informed Narrative Inquiry

Research shows that high cultural competence is most often acquired through both the theoretical education and the practical experiences within the international contexts. The purpose of this project evaluation was to learn from four undergraduate nursing students, who spent three-months in a Brazilian community, how they experienced their international placement. Students’ emotive responses to their international placement were elicited using the creative Narrative Reflective Process, which is informed by the Narrative Inquiry qualitative framework. This process included stories, memory box, metaphor and drawing, and creative writing. The generated creative data were reflected upon by the participants and key narrative threads teased out. The overarching findings speak to the transcultural exchange that took place: students went to teach the local population of Brazil about the social determinants of health from the Canadian perspective, while in turn learning life lessons from their hosts that enriched their personal and professional ways of being.

Education and professional strengthening of the community health agent - an ethnography study

This inquiry explored the educative actions of Community health agents (CHAs) with socially disaffiliated populations in a Rio de Janeiro metropolitan area. Individual and group interviews, participant observation during visits to the shantytowns, and picture gathering apprehended the philosophical and empirical dimensions of such actions. The software ATLAS ti. 4.2 supported the coding procedures of the raw material. Abduction in communication framed findings’ analysis and interpretation. Analysis revealed their social professional identity, political awareness regarding their own organization as a professional group, plus criticisms regarding the negligence of occupational safety and the lack of governmental help. CHAs “voice” is a tool of social leadership and a main facilitator to empower the population, and to promote optimization of the health care system. Since their professional practice revealed conflicts, contradictions and paradoxes, it seems necessary a collective reflection on the needed support to sustain CHAs wishes for change and freedom to act.

Enhancing Critical Reflection of Brazilian Community Health Agents’ Awareness of Social Determinants of Health

This project aims to assess how Brazilian community health agents’ critical awareness of the social determinants of health was enhanced and led to a greater understanding of the major structural changes necessary to sustain health promotion initiatives. Educational workshops inspired by Paulo Freire’s ideas on critical pedagogy were delivered to 82 community health agents in three Brazilian cities. The workshops utilized evocative objects to link and develop participants’ conceptual and experiential knowledge. The participants exchanged connections and experiences and created hypothetical action plans to be implemented in collaboration with community members. The discussions were audio recorded, transcribed verbatim, and submitted to content analysis. The connections provoked by evocative objects were related to required assets for the development of a healthy community. As social advocates, they are already committed to a social movement for health equity to catalyze a more equitable distribution of social goods, promote social inclusion, and liberate communities.

Life Under Inequalities: The Long-Term Impacts of the Silent Social Child Abuse

This paper addresses the impacts of silent social abuse suffered by children who live in developing countries with socio-economic inequalities. Privation of basic social benefits leads them to school evasion, early pregnancy, and the consumption or dealing of drugs. A single case study introduces the life story of a Brazilian teenager who was supposedly psychosocially rehabilitated but returned to the practice of illegal acts, resulting in his imprisonment. The analysis explores the later consequences of childhood abuse over his teenager life and demonstrates how multiple types of abuse are interlinked to hinder a longer psychosocial rehabilitation.

Canadian Men’s Self-Management of Chronic Diseases A Literature Analysis of Strategies for Dealing With Risks and Promoting Wellness

This article reviews the qualitative research on men’s self-management of mental and physical chronic diseases, with emphasis on strategies for dealing with risks and promoting wellness. Using Bardin’s method of document analysis, it was focused on the findings of Canadian qualitative studies published in French or English from 2005 to 2011. Boltanski’s theory on social uses of the body inspired the analysis. Living with a chronic disease threatens men’s sense of masculinity and self-image, as well as their perceived ability to fulfill expected social roles. Social images of men’s bodies influence how men express their emotions, attributes, and attitudes, or acknowledge the need for and seek social affirmation. Self-management has been documented in Canadian qualitative literature as a complex phenomenon influenced by the social environment, personal capacities, feelings, perceptions, and potentials. The extent of how all these features interact within the scope of men’s mental and physical health and illness experiences was partially revealed in this study. The findings underscore the social invisibility of men’s bodies, especially those of men facing social inequities. Attending to principles of social justice can ensure that future research on men’s health will amplify the range of men’s voices and allow them to be heard. Recommendations address also the international scientific community interested in advancing men’s health research, especially in those countries that lack a national men’s health policy.

Insights for public education provided by French media on ideas about prostate cancer – A media analysis study

Background: This study explored the French media’s presentation of ideas and medical information about prostate cancer (PC) that may influence men’s understanding, attitudes and behavior. Methods: A qualitative media content analysis centered on PC information delivered by French professional media. The selected data were produced in the aftermath of the High Health Authoritys decision in 2008 not to recommend systematic screening by prostate specific antigen(PSA) for men over 50. Source was the Media Archives of the French National Library. Content was analyzed from 15 television programs, 14 radio programs, and 55 articles from 35 popular French newspapers (online and printed, weekly and monthly) and 20 magazines. Audio content was narrated into textual form and submitted to manual coding along with the print content. Results: Television and radio content focused on the nature of PC, screening and treatment,and conveyed a gender-centric position linked to male sexuality and virility. Newspapers and magazines targeted the testing controversy, the lack of consensus among professionals, and scientific advances in screening and treatment. Conclusion: Media participation in the European testing debate is valuable for allowing patients to hear all opinions on PC risk factors. Debate on testing policy contributes to confusion and uncertainty regarding appropriate action.

Immigrant grandmothers’ and mothers-in-law’s cancer literacy within their family context

ABSTRACT Data from focus groups held in Montréal (Canada) with 13 women born in Cameroon, Colombia, and Democratic Republic of Congo were used to explore cancer knowledge among immigrant grandmothers and mothers-in-law and their influence over family cancer-preventative practices. Thematic analysis identified the following leading themes: cancer literacy and influence over family cancer preventative and early detection practices, cancer literacy in relation to family health behaviors, and barriers to accessing health services. Perceived external causes of cancer and its prevention are countered by healthy eating and exercises. Cancer literacy was contextualized by the development of women’s ways of being and doing.

Community health workers and accountability: reflections from an international “think-in”

Community health workers (CHWs) are frequently put forward as a remedy for lack of health system capacity, including challenges associated with health service coverage and with low community engagement in the health system, and expected to enhance or embody health system accountability. During a ‘think in’, held in June of 2017, a diverse group of practitioners and researchers discussed the topic of CHWs and their possible roles in a larger “accountability ecosystem.” This jointly authored commentary resulted from our deliberations. While CHWs are often conceptualized as cogs in a mechanistic health delivery system, at the end of the day, CHWs are people embedded in families, communities, and the health system. CHWs’ social position and professional role influence how they are treated and trusted by the health sector and by community members, as well as when, where, and how they can exercise agency and promote accountability. To that end, we put forward several propositions for further conceptual development and research related to the question of CHWs and accountability.

Reports on boys’, youth’s and men’s health in Canadian newspapers: Now what?

Background: This media content analysis explored the Canadian newspapers reporting on mens health, and their contribution to public understanding of the social determinants of men’s health and lifestyles. Methods: A media content analysis of 44 news articles on boys’, youth’s and men’s health,published from 2010 to 2014 by three national newspapers (The Globe and Mail, National Post,and Metro News). Results: Data indicated that the predominant discourse consists of informative and awareness messages, mostly about men’s prostate and sexual health. Very little health news content referred to working conditions, education and income, all of which are significant social determinants of health (SDH). This may reflect the current state of health research, which does not adequately incorporate the effects of these determinants. It may also indicate a reproduction of dominant health knowledge and understanding of masculinity. Little content was found on policy solutions to other publicized health issues, such as limited access to health services or inter-sectoral collaborations; this reflects a lack of government action and a lack of citizen engagement toward the creation of a concerted men’s health policy. Conclusion: Despite the acknowledged importance of the media in promoting access to health information and indirectly contributing to improve the general public’s level of health literacy, it is also necessary to remember that there must be a greater attention to the structural constraints imposed by socioeconomic inequalities. Future studies should explore media discourses about men’s unequal access to health care services and citizens’ awareness of ways to overcome those inequalities shortcomings.