Brazilian community health agents and qualitative primary healthcare information.
OBJECTIVE
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.


RESULTS
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.
1Daphne Cockwell School of Nursing, Faculty of Community Services,Ryerson University,Toronto,Canada.
Margareth S
MS
Zanchetta
2School of Social Work,Columbia University,New York,USA.
Rogério Meireles
RM
Pinto
3Department of Basic Sciences, Faculty of Dentistry of Araçatuba,Estadual Paulista University,Araçatuba,São Paulo,Brazil.
Wilson
W
Galhego-Garcia
4Masters in Family Health Program,Estácio de Sá University,Rio de Janeiro,RJ,Brazil.
Zeilma
Z
da Cunha
5Masters in Family Health Program,Estácio de Sá University,Rio de Janeiro,RJ,Brazil.
Hésio A
HA
Cordeiro
6Independent Researcher,Toronto,Canada.
Francisco E
FE
Fagundes-Filho
7Souza Marques Tecno-Educational Foundation & Adolescentro Paulo Freire (Municipal Secretary of Healht and Civil Defense of Rio de Janeiro),Rio de Janeiro,Brazil.
Mônica A L
MA
Pinho
6Independent Researcher,Toronto,Canada.
Susan M V
SM
Voet
8Department of Family and Community Medicine, Faculty of Medicine & Dala Lana School of Public Health,Health Policy Management and Evaluation,University of Toronto,Toronto,Canada.
Yves
Y
Talbot
9Department of Basic Sciences, Faculty of Dentistry of Araçatuba,Estadual Paulista University,Araçatuba,São Paulo,Brazil.
Rodrigo S
RS
Caldas
9Department of Basic Sciences, Faculty of Dentistry of Araçatuba,Estadual Paulista University,Araçatuba,São Paulo,Brazil.
Thiago J
TJ
de Souza
9Department of Basic Sciences, Faculty of Dentistry of Araçatuba,Estadual Paulista University,Araçatuba,São Paulo,Brazil.
Edwaldo
E
Costa
D000328:Adult; D001291:Attitude of Health Personnel; D001938:Brazil; D003150:Community Health Workers / Q000458:organization & administration / Q000523:psychology* / Q000592:standards; D003219:Confidentiality / Q000592:standards; D003625:Data Collection / Q000379:methods / Q000592:standards; D004282:Documentation / Q000379:methods / Q000592:standards; D005260:Female; D017144:Focus Groups; D006266:Health Education / Q000379:methods* / Q000592:standards; D006792:House Calls; D006801:Humans; D033181:Information Dissemination; D007400:Interprofessional Relations; D008875:Middle Aged; D011204:Poverty Areas; D011320:Primary Health Care / Q000379:methods* / Q000458:organization & administration; D036301:Qualitative Research; D055815:Young Adult
Brazil; Rio de Janeiro; São Paulo; community health agents; deprived communities; information system; primary healthcare; qualitative health information