Práticas educativas nas unidades básicas de saúde de Belo Horizonte e sua relação com a promoção da saúde

Abstract

Introduction: In 2006, the publication of the National Policy of Health Promotionestablished that the majority of Brazilian counties should promote healthier lifestyles(HL), and it was touted as one of the most important changes in Health Education. Itis now evident that there is a profusion of new information that calls for a new andimproved paradigm. The volume of new information is evidence of the need for areview and change in the health field predominantly current studies and practices.This study used the "technical assistance hegemonic model" to prove the importanceof promoting healthy educational practices on a daily basis. Objetive: To understandhow efficient the HL educational practices are at the Basic Health Units (BHU) ofBelo Horizonte (BH) and to analyze how effective they are in promoting the principlesof a healthy lifestyle. Methods: Decriptive study. It was structured into two phases:(1) Mapping of all group educational actions within the BHU that were studied. Thestudy was performed through a quantitative approach and used semi-structuredinterviews as a way of collecting data. Twenty BHUs were randomly selected, andthen proportionally distributed among the nine regions responsible for attending toBH. The BHU managers have been interviewed, and they answered questionsconcerning the educational practices: (a) topic; (b) frequency; (c) duration; (d)objective; (e) professionals in charge of coordination. The results have beendiscussed quantitatively as to the frequency of distribution. (2) Analysis of the HLpractices that were developed by the BHU researchers, referring to the followingcategories: multiple causes of the disease-health process, intersectorability, socialsustainability, participation and utilization of teaching methods. The technique usedin the study was structural observation of the practices, which was analysed basedon the referencing of health, education and philosophy fields. Results: During thestudy 113 practices were studied, 33% have been recognized as health promoting.60% of the health professionals at the BHUs had never received any training on howto develop group activities. Out of the professionals who developed educationalpractices, 32.7% were male nurses, and 18.4% were doctors. The most studiedsubjects within the HL practices were those that dealt with womens health, followedby health promotion, hypertension, diabetes and oral health. The majority of the HLpractices have occurred weekly or monthly, and have had between 11 to 30participants per meeting. The multiple causes of the health-disease process as wellas the social participation were the principles guiding the actions developed duringthe practices of HL. In contrast, intersectorability and sustainability were the leastdeveloped principles. A significant portion (88%) of the practices encouraged theparticipants to take care of themselves while in contrast only 21% of the practicesapproached autonomy. A low number (32%) of the practices of HL were based onmodels of dialogic education. The practice of physical activities (walking, Lian Gongand Unibiotic) as well as those that used different teaching strategies (theater,handicrafts, music) comprised a representation of the practices surveyed.Conclusion: A large number of HL practices were assistive and/or preventative tothe detriment of being promotive. A major part of the educational practices are nottruly committed to new health promotion, both in regards to the scope of its conceptand the frequency in which it occurs. There seems to be no movement of ruptureand continuity in relation to the hegemonic models of education in primary care.There are practices based on the biomedical model and others that announcechanges in terms of promoting autonomy and the use of different teaching strategies.We believe that an education focused on HL cannot ignore the dialogic methods aswell as formative and emancipating concepts of health education in order to drive theimplementation of projects promoting the participants happiness.