Práticas de promoção da saúde no contexto da atenção primária no Brasil e no mundo : o descompasso teoria e prática

Abstract

Integrative Review Study, with a qualitative approach, based on a critical analytical perspective, aiming to understand the meanings of Health Promotion in the context of PHC in Brazil and in other countries of the world; to analyze the practices of Health Promotion in the context of PHC in Brazil and in other countries of the world and to discuss the concreteness between the areas of action established in the International Conferences on Health Promotion on Health Promotion practices in the context of Primary Care in Brazil and in the world. For the production of the empirical data, we cover the six (6) steps performed in the Integrative Review, delimiting the corpus of the study to 18 articles with peer review conditions published between January 2016 and July 2017 in different countries of Asia, Europe and America. As a method of analysis, we adopt Hermeneutics-dialectics. The results are organized in four empirical categories: Characterization of the corpus of the study: a reality to be achieved; Meanings of Health Promotion in the context of PHC: confluences and dissonances between theory and practice; Health Promotion in the context of PHC: contradictions, fragilities and challenges in the health work process; confrontations between the areas of action of the International Conferences on Health Promotion on practices in the context of PHC. We understand that Health promotion implies a 'new' and 'polysemic' practice that still generates theoretical and philosophical tensions, which has been associated with concepts such as lifestyles-healthy habits-health behaviors, empowerment, social participation, autonomy, intersectoriality, however there is a conflict, even reinforced by several authors, related to the conceptual misconception about health education, and more worrying about its differential character as approaches and practices to primary prevention. In the work process of Health Promotion, the purpose was to 'improve people's quality of life' as well as 'generate empowerment in users'; as the instruments were considered the theoretical models as fundamentals of practice, as well as the combination of strategies, practical guides and various educational materials; activities were related to health education, the use of online technologies, health advisory services and counseling; the agents were identified under the figure of collective agents, such as nurses and doctors with different training areas, health visitors, psychologists, social workers, as well as other professionals from the health service and the community itself; as for the interpersonal relationship, it was possible to see the strengthening of the links between users and health teams with a certain potentiality in the practice of Health Promotion. The evaluation emerged as a topic that presents weaknesses in the practice of Health Promotion and which represents a challenge to be conquered. In the confrontation of the areas of action of Health Promotion with its practice evidenced in the corpus of the study. In relation to the development of healthy policies was reinforced the importance of support for decision makers and joint responsibility of the State, health services with their professionals and community. The creation of favorable environments was invisible, even when it is considered relevant, since it could be of ‘little importance’ given to them in the practice and actions of Health Promotion. Community empowerment had a direct relation with the processes of empowerment and social participation, emphasizing the intersectoriality as key in this process. The development of personal skills was the area most studied in the articles analyzed, focusing on health education activities and once again the emergence of prevention as a conflicting concept in the understanding and practice of Health Promotion; finally, the reorientation of health services was visible when considering the paradigm shift and the strengthening of professional training in Health Promotion. We consider that Health Promotion contributes from its innovative, differentiated approach and with a positive approach to health services and specifically PHC. The protagonism of the professional with a profile in Health Promotion is significant in the development of strategies and corresponding actions with the areas of action, as well as to dispel conflicts by the conceptual misconceptions of Health Promotion in relation to the concepts of health education and prevention.