Aim: The aim of this study was to explore female community health agents' views about the value of recording qualitative information on contextual health issues they observe during home visits, data that are not officially required to be documented for the Brazilian System of Primary Healthcare Information. Background: The study was conducted in community primary healthcare centres located in the cities of Araçatuba and Coroados (state of São Paulo) and Rio de Janeiro (state of Rio de Janeiro), Brazil. Methods: The design was a qualitative, exploratory study. The purposeful sampling criteria were being female, with a minimum of three years of continuous service in the same location. Data collection with 62 participants was conducted via 11 focus groups (in 2007 and 2008). Audio files were transcribed and submitted to the method of thematic analysis. Four themes guided the analysis: working with qualitative information and undocumented observation; reflecting on qualitative information; integrating/analysing quantitative and qualitative information; and information-sharing with agents and family health teams. In 2010, 25 community health agents verified the final interpretation of the findings. Findings: Participants valued the recording of qualitative, contextual information to expand understanding of primary healthcare issues and as an indicator of clients' improved health behaviour and health literacy. While participants initiated the recording of additional health information, they generally did not inform the family health team about these findings. They perceived that team members devalued this type of information by considering it a reflection of the clientele's social conditions or problems beyond the scope of medical concerns. Documentation of qualitative evidence can account for the effectiveness of health education in two ways: by improving preventative care, and by amplifying the voices of underprivileged clients who live in poverty to ensure the most appropriate and best quality primary healthcare for them.
Background Narrative medicine (NM) encourages health care providers to draw on their personal experiences to establish therapeutic alliances with patients of prevention and care services. NM medicine practiced by nurses and physicians has been well documented, yet there is little understanding of how community health workers (CHWs) apply NM concepts in their day-to-day practices from patient perspectives. Objective To document how CHWs apply specific NM concepts in Brazil’s Family Health Strategy (FHS), the key component of Brazil’s Unified Health System. Design We used a semi-structured interview, grounded in Charon’s (2001) framework, including four types of NM relationships: provider–patient, provider–colleague, provider–society, and provider–self. A hybrid approach of thematic analysis was used to analyze data from 27 patients. Key Results Sample: 18 females; 13 White, 12 “Pardo” (mixed races), 12 Black. We found: (1) provider–patient relationship—CHWs offered health education through compassion, empathy, trustworthiness, patience, attentiveness, jargon-free communication, and altruism; (2) provider–colleague relationship—CHWs lacked credibility as perceived by physicians, impacting their effectiveness negatively; (3) provider–society relationship—CHWs mobilized patients civically and politically to advocate for and address emerging health care and prevention needs; (4) provider–self relationship—patients identified possible low self-esteem among CHWs and a need to engage in self-care practices to abate exhaustion from intense labor and lack of resources. Conclusion This study adds to patient perspectives on how CHWs apply NM concepts to build and sustain four types of relationships. Findings suggest the need to improve provider–colleague relationships by ongoing training to foster cooperation among FHS team members. More generous organizational supports (wellness initiatives and supervision) may facilitate the provider–self relationship. Public education on CHWs’ roles is needed to enhance the professional and societal credibility of their roles and responsibilities. Future research should investigate how CHWs’ personality traits may influence their ability to apply NM.
Introdução: Indicadores gerais de saúde tendem a alterarem-se devido à participação de indivíduos em redes sociais. Objetivo: Conhecer as ideias dos membros de comunidades lusófonas em Toronto, Canadá, sobre a possibilidade da criação de uma rede de apoio social a mulheres com câncer de mama. Método: Estudo etnográfico critico com 19 participantes que opinaram sobre a construção de uma rede de apoio social, pontos positivos e negativos, bem como pessoas a serem convidadas a ajudar. As discussões foram transcritas, analisadas e codificadas com o auxílio do programa de análise qualitativa Atlas ti 6.0. Resultados: Os componentes fundamentais para a construção da rede de apoio social foram a desmistificação do câncer de mama e de sua prevenção, ênfase na educação em saúde, divulgação da necessidade de voluntários e apoio social direto às mulheres com câncer. Os pontos positivos seriam a participação de mulheres mais idosas como líderes, uso do ambiente escolar e das instituições religiosas para a divulgação. Os empecilhos encontrados foram o câncer de mama ser uma doença vivida pelas mulheres, o desconhecimento relativo à cura e à falta de sensibilização. Em relação à participação de lideranças comunitárias, houve sugestão de diplomatas, padres e pastores, diretores de escolas e empresários da área da comunicação. Conclusão: A criação da rede de apoio social deve considerar a sensibilidade cultural e a diversidade interna das comunidades lusófonas. A recomendação é de que líderes sociais e profissionais angolanos sejam convidados para delinear a estrutura da rede de apoio conforme seus traços culturais específicos.
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