Community Health Agents Research Articles

Implementation of the HepClink test-and-treat community strategy targeting Pakistani migrants with hepatitis C living in Catalonia (Spain) compared with the current practice of the Catalan health system: budget impact analysis

ObjectivesTo perform a budget impact analysis of the HepClink test-and-treat strategy in which community health agents offer hepatitis C virus (HCV) testing, diagnosis and treatment to the Pakistani population living...

Intervention project: follow-up of hypertensive and diabetic users using optimized cardiovascular risk stratification through VBA®

Introduction: Among the main chronic diseases are cardiovascular diseases, with systemic arterial hypertension and diabetes mellitus as important risk factors. The identification of patients with high cardiovascular risk is a priority action in Primary Health Care. The Framingham score is used for this classification. The motivation for this study was the finding of the loss of outpatient follow-up of patients with hypertension and diabetes, which leads to treatment abandonment and a high number of complications. General objective: To implement a monitoring worksheet for hypertensive and diabetic patients in the family health strategy (FHS) and their classification according to Framingham score in low, medium and high risk. Methodology: Hypertensive and diabetic patients were located in the electronic medical record and classified according to the Framingham score using a spreadsheet with VBA computer language in the Microsoft Excel program. Results: A total of 219 medical records were analyzed from September to November 2021. Of the total, 210 users with systemic arterial hypertension (SAH) and 65 with diabetes mellitus (DM). Regarding cardiovascular risk, 86 patients (39.3%) fit into low risk, 37 patients (16.9%) in moderate/intermediate risk and the rest, 96 patients (43.8%) in high cardiovascular risk. Conclusion: The expected results with the organization of users with optimized spreadsheets bring improvements such as better control of four-monthly, six-monthly or annual follow-up according to the classification of cardiovascular risk, active search for absentees through community health agents with guidance on the importance of follow-up in PHC, community health indicators in relation to hypertensive and diabetic patients and targeting intervention proposals aimed at the population at higher risk such as lectures, physical activity groups and conversation circles on the subject. In addition, it is essential to note that there is a high number of consultations for this study group, and monitoring with nursing through its protocols is essential to contribute to improving health care.

The instituted and the real in the training of community health agents: a scoping review

Objective: To map the formation processes and ongoing education actions experienced by Community Health Agents (CHAs) in the context of family health, anchored in the concept of culture. Methodology: Scope review following the Joanna Briggs Institute (JBI) methodology and guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). The search in databases such as BVS, EBSCO – Academic Search Premier, CINAHL, GreenFILE, SocINDEX, Embase, ERIC, Global Index Medicus, PUBMED, Scielo, Scopus, WOS, took place in November and December 2022. The search terms were: Community Health Workers, Professional Training, Continuing Education, Family Health Strategy, Primary Health Care. Studies analyzing training experiences and actions of Permanent Education in Health (PEH) for CHAs in the context of family health were included. Endnote and Rayyan software were used in managing the selection of findings. The review protocol was registered on the Open Science Framework (OSF). Results: The sample included 25 studies, generating two categories: The primacy of instrumental technical training culture; and The biomedical culture guiding PEH. CHA training involves disinvestment and invisibility, focusing on the biomedical model. On the other hand, even if sporadic, PEH actions are guided by emerging health themes. Final Considerations: The formative processes and PEH for CHAs involve paths of construction and deconstruction, progress, and setbacks, based on a culture that often restricts established rights.

Analysis of indicators of pleasure and suffering at work associated with anxiety and depression among community health agents

RESUMO Objetivo Analisar os indicadores de prazer e sofrimento no trabalho associados a depressão e ansiedade entre agentes comunitários de saúde (ACSs). Métodos Estudo transversal, no qual variáveis dependentes foram a presença de sintomas de ansiedade e depressão, avaliadas com o Patient Health Questionnaire (PHQ-9) e com o Inventário de Ansiedade de Traço-Estado (IDATE). As variáveis independentes foram avaliadas com um questionário sociodemográfico e a Escala de Indicadores de Prazer e Sofrimento no Trabalho (EIPST) do Inventário do Trabalho e Riscos de Adoecimento (ITRA). As associações entre as variáveis foram testadas com o uso de regressão logística multinominal. Resultados Participaram do estudo 675 ACSs, sendo a maioria mulheres (83,7%), com até 40 anos (51,3%). As chances de apresentar sintomas de ansiedade foram maiores entre ACSs efetivos (1,61 [1,10-2,36]), e avaliações críticas ou graves nos fatores realização (Crítica 1,87 [1,30-2,68]; Grave 4,16 [2,06-8,40]) e esgotamento profissional (Crítica 2,60 [1,78-3,80]; Grave 3,97 [2,53-6,21]). Sexo feminino (2,12 [1,03-4,40]), idade de até 40 anos (1,741 [1,05-2,89]), tempo de serviço superior a cinco anos (1,88 [1,18-2,99]), avaliações crítica ou grave nos fatores realização (Crítica 2,53 [1,55-4,10]; Grave 6,07 [2,76-13,38]), esgotamento profissional (Crítica 5,21 [2,30-11,80]; Grave 15,64 [6,53-37,44]) e falta de reconhecimento (Crítica 1,93 [1,13-3,28]) estiveram associados a maiores chances de sintomas depressivos. Conclusões Apesar de se tratar de estudo transversal, que não permite inferir causalidade, os achados sugerem importante associação entre aspectos laborais dos ACS e os sintomas de ansiedade e depressão. Sexo feminino e possuir 40 anos ou menos também mostraram relação com o aumento dos sintomas de depressão.

Female community health agents’ structure of social thinking about domestic violence against women

This study aimed at describing community health agents' representational structure on domestic violence against women. A quantitative-qualitative research study based on the Theory of Social Representations in its structural approach and carried out in a municipality from inland Bahia, Brazil. The community health agents participated through free evocation and centrality techniques: choix-par-bloc, constitution of word pairs and mise-en-cause, from May to August 2019. Data analysis was carried out by means of the EVOC software (Ensemble of Programs Permettant I'analyse des Evocations), similarity analysis and mise-en-cause analysis. These professionals' representational structure is organized from the central elements of disrespect and sadness, which attribute negative meanings to the representation regarding their positions and repercussions; the other elements integrate specific information to the structure of the representations, justifying them. It is concluded that the understanding regarding organization of the community agents' social thinking about the phenomenon allows its problematization, as well as the elaboration of prevention and coping strategies for women in situations of violence, the aggressors and the community.

Estrutura de pensamento social de agentes comunitárias de saúde sobre violência doméstica contra a mulher

Abstract This study aimed at describing community health agents’ representational structure on domestic violence against women. A quantitative-qualitative research study based on the Theory of Social Representations in its structural approach and carried out in a municipality from inland Bahia, Brazil. The community health agents participated through free evocation and centrality techniques: choix-par-bloc, constitution of word pairs and mise-en-cause, from May to August 2019. Data analysis was carried out by means of the EVOC software (Ensemble of Programs Permettant I’analyse des Evocations), similarity analysis and mise-en-cause analysis. These professionals’ representational structure is organized from the central elements of disrespect and sadness, which attribute negative meanings to the representation regarding their positions and repercussions; the other elements integrate specific information to the structure of the representations, justifying them. It is concluded that the understanding regarding organization of the community agents’ social thinking about the phenomenon allows its problematization, as well as the elaboration of prevention and coping strategies for women in situations of violence, the aggressors and the community.

Características do trabalho do agente comunitário de saúde na pandemia de COVID-19 em municípios do Nordeste brasileiro

Abstract The community health agents (CHAs) comprised the workforce at the forefront of health systems in the fight against COVID-19. The study identified the structural conditions for organizing and characterizing the work of CHAs in three municipalities of northeastern Brazil during the pandemic period. A qualitative study of multiple cases was carried out. Twenty-eight subjects were interviewed, including community agents and municipal managers. Data production assessed the interviews with document analysis. The operational categories that emerged from the data analysis were: structural conditions and characteristics of the activities. The results of this study disclosed the scarcity of the structural conditions in the health units, which during the pandemic made improvised adaptations of the internal spaces. As for the work characteristics, actions permeated by bureaucratic aspects of an administrative nature were evidenced in the health units, resulting in the elimination of their binding function of territorial articulation and community mobilization. Thus, changes in their work can be seen as signs of the fragility of the health system and, especially, of primary health care.

Characteristics of the community health agent's work in the COVID-19 pandemic in municipalities of Northeastern Brazil.

The community health agents (CHAs) comprised the workforce at the forefront of health systems in the fight against COVID-19. The study identified the structural conditions for organizing and characterizing the work of CHAs in three municipalities of northeastern Brazil during the pandemic period. A qualitative study of multiple cases was carried out. Twenty-eight subjects were interviewed, including community agents and municipal managers. Data production assessed the interviews with document analysis. The operational categories that emerged from the data analysis were: structural conditions and characteristics of the activities. The results of this study disclosed the scarcity of the structural conditions in the health units, which during the pandemic made improvised adaptations of the internal spaces. As for the work characteristics, actions permeated by bureaucratic aspects of an administrative nature were evidenced in the health units, resulting in the elimination of their binding function of territorial articulation and community mobilization. Thus, changes in their work can be seen as signs of the fragility of the health system and, especially, of primary health care.

A geospatial analysis of inequality indicators related to COVID-19 in Brazil

Background: This study aims at analyzing through the usage of computer models the relationship of variables such as the supply infrastructure, and socioeconomic and demographic contexts with the contagion and mortality rate by COVID-19 in Brazilian microregions. Methods: It’s an analytical ecological study that covers the 5570 municipalities aggregated in the 558 microregions of the IBGE, Brazilian Institute of Geography and Statistics, in the year 2020, based on the mean and standard deviation. Geospatial computer models were applied for data visualization. Results: Demonstrate that inequality and concentration of supply in some Brazilian regions, mainly in relation to the average household income per capita, Gross Domestic Product per capita, rate of Community Health Agents, Intensive Care Unit beds, Toilets, X-ray equipment and coverage by the Family Health Strategy, contributed to the fragility with which the country received COVID-19. Conclusion: It was possible to identify how housing conditions, and income and service provision infrastructure are related to indicators of infection and mortality by COVID-19 in Brazil, as well as the spatial behavior of health and inequality indicators. It is important to consider that the pandemic was still ongoing by the time this study was conducted and that other values ​​can be found.

Registration of the activity of community health agents during the pandemic

Registration of the activity of community health agents during the pandemic

Saúde mental infanto-juvenil: o cuidado em municípios de pequeno porte

This research presents the care strategies in Child and Adolescent Mental Health (SMIJ) in the municipality of Guamiranga, located in the south-central region of the state of Paraná. We seek to understand which strategies are used, based on the experiences of Community Health Agents (CHA), to identify and monitor children who have demands for mental health care. This research was divided into three stages: accompanying home visits, a focal group with CHAs and an analysis and data systematization utilizing Institucional Analysis. We understand that in order to produce this complex care network for CAMHC, it´s necessary to overcome the logic of personification, especialization and medicalization in the hopes that this care model for the CAMHC becomes a part of the political agenda of the city. The care needs to be based on the logic of co-responsibility and intersectoriality so that it´s not set on education as the place responsible for these issues.

Permanent education in maternal and child health for community health agents: an experience report

Objetivo: Relatar a experiência de acadêmicos de enfermagem na realização de uma atividade de educação permanente para Agentes Comunitários de Saúde sobre os cuidados à puérpera e ao recém-nascido. Métodos: Estudo descritivo, tipo relato de experiência, desenvolvido em uma Unidade de Saúde da Família de Belém-PA, nos meses de fevereiro e março de 2022, envolvendo os acadêmicos de enfermagem, a enfermeira da unidade e 10 Agentes Comunitários de Saúde (ACS). Para a construção e aplicação da atividade utilizou-se a metodologia da problematização através do Arco de Maguerez, representado em cinco etapas: observação da realidade, pontos-chave, teorização, hipóteses de solução e aplicação à realidade. Resultados: Os acadêmicos perceberam que os ACS demonstraram interesse nos assuntos abordados, e relacionaram os temas com as vivências na comunidade, bem como entenderam o papel fundamental que desempenham. Os assuntos observados maiores dúvidas e discussões foram: saúde mental da puérpera, cuidados com a higiene do recém-nascido e o calendário vacinal infantil. Conclusão: Através da experiência dos acadêmicos foi possível evidenciar que a educação permanente aos ACS sobre os cuidados da saúde da puérpera e do recém-nascidos é essencial para a qualidade do atendimento ofertado por eles à comunidade, contribuindo para uma assistência humanizada e individualizada.

SISTEMA ACGEST PARA ASSISTÊNCIA À SAÚDE DE GESTANTES E PUÉRPERAS NA ATENÇÃO PRIMÁRIA

Ensuring quality prenatal and puerperal care is one of the public health policies in Brazil aimed at women and developed by nurses and community health agents (CHA) in primary care. Technology can improve the work process of these teams by making scheduling, tracking, and reporting easier. The objective was to create an integrated system between the routines of the CHA, the pregnant/postpartum women and the management carried out in the health services for this public. Then, through experimental research, field observations and knowledge of the great need to implement information technology (IT) in the public health environment, AcGest was modeled and developed. For this, IT needs were considered for use by the CHA, pregnant/postpartum women and health units. The system was divided into three modules: two applications for Android smartphones (pregnant and CHA modules) and one for the Web as a management module, which will be used on computers in health units. The system was tested in a simulated environment by the researchers and a health team in the city of Parnamirim-RN. The first version is ready, but it needs to be tested with pregnant/postpartum women, which will only be possible after submission to the ethics committee, for functionality improvements and usability evaluation. The application has great potential to improve routine care for this public, maternal and child health indicators, and serves as a model for further research in the area, as will be seen throughout this article.

Importance of vaccination against human papillomavirus in a rural settlement in Terenos, Mato Grosso do Sul.

To understand health professionals' perceptions about vaccination against human papillomavirus (HPV) in the Santa Mônica rural settlement in Terenos, Mato Grosso do Sul. Quantitative and qualitative methodologies, consultations on vaccination cards, records of community health agents and the focus group technique were used. The main factors of hesitation and vaccine refusal were analyzed, as well as the health team's strategies for the process of immunization against HPV, from June to August 2018. Of 121 children and adolescents, 81 (66.94%) received the complete vaccination schedule. Complete vaccination coverage for women was 73.17% (60/82) and for men, 53.8% (21/39). It was observed that, although strategies are adopted for vaccine promotion, such as mobile actions, the public is resistant due to superficial knowledge about the vaccine and its use in an early age group, showing itself to be susceptible to the negative influence of the media and to society's taboos. In addition, difficulties regarding the use of the Unified Health System card and the shortage of professionals were also observed. The results explain the immunization coverage below the target and reinforce the need to strengthen the family health strategy, as well as the permanent and continuing education of professionals, in order to increase parental confidence and adherence to vaccination.

Cruzain Inhibitors: State-of-Art of Novel Synthetic Strategies

Abstract: Concerned about a million people are infected worldwide, and other millions are living at risk zones of infection. Chagas disease causes 10 000 deaths annually, and the discovery of safe and effective drugs on a nanomolar scale has been headlined as a crucial goal by the worldwide research community and international health agencies. Nifurtimox and Benznidazole are the only marketed drugs for Chagas disease therapy, with the mode of action depending on the formation of free radicals. Thus, diverse studies have revealed cysteine proteases from T. cruzi as well-established targets for drug discovery. Validation of cruzain as a promising target has been based on several findings on the molecular biology of T. cruzi. Hence, several inhibitor classes have been elucidated, consisting of peptidic and nonpeptidic, and covalent and noncovalent. Thus, we present a perspective for the synthesis of novel cruzain inhibitors from scaffolds both recently approached and well established with an IC50 range of micromolar to nanomolar and supported by computational techniques.

Learn, Earn, Return

Recently, I attended the 25th anniversary celebration for the Power of Nursing Leadership event hosted by the University of Illinois at Chicago’s College of Nursing (CON). Twenty-five years ago, Dr. Joan Shaver, dean of the CON, observed that across the greater metro Chicago-land area, there were many integrated health care delivery systems, community and public health agencies, and large academic teaching hospitals with affiliated colleges of nursing (in addition to other nursing colleges and schools); however, there was little formal acknowledgment in the area about the contributions nurse scientists, leaders, faculty, and staff were making.

Self-Efficacy of the Community Health Agent, Importance of Motivation and Empowerment.

The community health agent plays an essential role as a link between the community and health institutions; the effectiveness of their work is crucial in promoting health, prevention, and detection of diseases. Motivation and empowerment could affect the performance of the community agent in carrying out his work. To determine if work motivation and empowerment are factors associated with the self-efficacy of the community health agent. Observational and cross-sectional study. The study included community health agents in the Non-Governmental Organization ADRA in Imbabura and Pichincha, Ecuador. The sample selected by the census method corresponds to 300 agents. The instruments were the Motivation at Work Scale (R-MAWS), the Psychological Empowerment Scale, and the Professional Self-efficacy Questionnaire (AU10). Descriptive statistical analyses were performed using dispersion and summary measures-a comparative analysis with chi-square. The inferential analysis was done through logistic regression where the B coefficient and the odds ratio (OR) with 95% confidence intervals (CI) were evaluated, P < .05. The theoretical and adjusted model of the structural model allowed us to corroborate the association of the variables. Motivation had a positive effect on self-efficacy (OR = 10.091, CI [5.509-18.485], P < .05), empowerment had a minimal effect (OR = 0.664, CI [0.363-1.214], P > .05), which is not significant to predict the perception of self-efficacy. This study suggests that to improve the self-efficacy of the work of community health agents, it is necessary to intervene through strategies that keep them motivated in the exercise of their mediation work between the community and health institutions. Likewise, empowering them would contribute to self-efficacy and thus help in the fulfillment of the functions of health agents.

Usability evaluation of the Agente Escuta application: translational research.

To evaluate the usability and satisfaction of users with the interface of the 'Agente Escuta' application, in addition to identifying problems and possibilities for improvement. Descriptive exploratory translational study, characterized by a usability test with a quantitative and qualitative approach, subdivided into three stages: (I) prior evaluation of usability by 10 judges, including students, primary care professionals, professors and researchers in Information Technology and Speech Therapy; (II) evaluation of the application by the target audience, that is, community health agents from six municipalities in Rio Grande do Norte; (III) evaluation of the satisfaction of the agents who used the application in their work routine. The System Usability Scale and the Net Promoter Score were used, in addition to a qualitative evaluation of the opinions. Usability was rated as excellent by judges, regardless of category. In the evaluation by community health agents, usability was considered good and there was no effect of the city of origin. It was found that the perception of the judges and the target audience were different, with a lower score for the participants in the second stage. However, most would give positive publicity to the product. The heuristic with the highest score was ease of memorization and participants in the third stage were interested in continuing to use the tool in practice, even after the end of the study. The Agente Escuta prototype showed good usability and satisfaction and aspects that could be improved in future solutions were identified.

Community Health agents’ practices and conceptions regarding alcohol and other drugs in the potiguar Borborema

Resumo É possível perceber que na história múltiplas substâncias psicoativas foram usadas por indivíduos devido a diversos motivos, sentidos e contextos. Ao abordar essa temática, torna-se imprescindível compreender de que modo essa demanda chega aos serviços do Sistema Único de Saúde, especialmente na Atenção Primária à Saúde, e como estabelece ligação com a Redução de Danos. Diante disso, esta pesquisa tem como objetivo analisar como essa demanda impacta na Atenção Primária à Saúde diante da perspectiva dos Agentes Comunitários de Saúde. A pesquisa ocorreu em uma Unidade Básica de Saúde em uma cidade do interior do Rio Grande do Norte. Para abordar e interpretar os dados, optou-se por uma abordagem qualitativa, na perspectiva teórico metodológica da Análise Institucional, com ênfase na pesquisa-intervenção. Os instrumentos utilizados foram roda de conversa, entrevistas individuais e diário de pesquisa. Conforme os resultados, constatou-se o cuidado direcionado pelo saber biomédico, hospitalocêntrico, restritivo e segregador do cuidado, os quais envolvem processos fragmentados de trabalho num contexto imerso por desigualdades sociais e muita violência. Ademais, foi exposto como esses profissionais percebem a procura dos usuários no serviço em que atuam, com limites de diversas ordens, repletos de medos, tensões e silenciamentos em torno da complexidade da atuação no território.

O papel dos agentes comunitários de saúde no enfrentamento à pandemia de COVID-19: o caso de Peruíbe, São Paulo, Brasil

Abstract This study examined the role of community health workers in implementation of primary care actions during the COVID-19 pandemic in the municipality of Peruíbe, São Paulo, Brazil. This is a qualitative case study, guided by the theoretical perspective proposed by Lipsky, according to which street-level bureaucrats play a central role in policy implementation. The research tool was semi-structured interviews of two community health agents, a doctor, a nurse and four local health managers. Analysis of the transcripts identified municipal action in three dimensions to address the health crisis: health system organisation; community health workers’ activities; and restoration of primary health care routines. Community health workers were found to play active roles in the various local measures to combat COVID-19.