A adesão ao tratamento de portadores de hipertensão arterial sistêmica na atenção primária à saúde: (re)pensando estratégias de educação em nutrição e saúde

• Ano de defesa: 2010
• Autor(a) principal: Ribeiro, Amanda Gomes
• Orientador(a): Cotta, Rosângela Minardi Mitre
• Banca de defesa: Araújo, Raquel Maria Amaral , Ribeiro, Rita de Cássia Lanes , Siqueira-batista, Rodrigo
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de Viçosa
• Programa de Pós-Graduação: Mestrado em Ciência da Nutrição
• Departamento: Valor nutricional de alimentos e de dietas; Nutrição nas enfermidades agudas e crônicas não transmis
• País: BR
• Palavras-chave em Português: Atenção primária à saúde; Saúde da família; Educação em saúde; Hipertensão
• Palavras-chave em Inglês: Primary health care, Family Health, Health Education; Hypertension
• Área do conhecimento CNPq: CNPQ::CIENCIAS DA SAUDE::NUTRICAO
• Link de acesso: http://locus.ufv.br/handle/123456789/2752

Hypertension represents a serious public health problem not only in Brazil, but worldwide. Besides the risk it represents, the application of antihypertensive therapy and the consecutive control of the disease are still challenging the health service, especially at the primary health care. In this way, the objective of this study is to evaluate and compare two types of intervention aiming to guide changes on the diets that are indicated in the treatment of HA in women that show such a disease. The first type is based on educational group activities performed at the primary health care center (Unidade de Atenção Primária à Saúde-UAPS), while the second one is a combination of educational group activities and home visits following a systematic program of nutritional education and family monitoring. The research was carried out at the primary health care center at the urban area of Porto Firme State of Minas Gerais, Brazil, which houses two Family Health staffs. It is an explorative, longitudinal interventional, comparative, randomized, unblinded study with a quanti-qualitative approach. For the adherence study, 28 hypertensive women from the primary health care center in the urban area of Porto Firme, at age between 45 and 50, with tensional levels &#8805; 140/90 mm Hg and/or drug treatment for hypertension, without nutritional monitoring, without serious medical conditions, not pregnant, not abusively using alcohol and drugs, and that accepted to take part in the study, were selected. The study was carried out throughout April to August 2009. It was made up of the following strategies: 5 workshops monthly performed, aiming to educate and prevent worsening of the disease, emphasizing the nutritional recommendations for hypertensive people, and home advices, following a nutrition education program and systematic family monitoring. Besides the adherence study, the clinical-epidemiological profile of the group showing hypertension that took part in the educational workshops, as the workshops were opened to all community, was also performed. For that group, the body mass index (IMC), the blood pressure (PA), and the previous medical record, were all evaluated. For the adherence study sample, IMC, PA, waist circumference (CC), biochemical parameters (glycemia and lipid profile), food consumption, besides the knowledge and understanding about hypertension were evaluated both before and after the intervention. The softwares Excel for Windows 2007 and SPSS for Windows were used for the analyses of the quantitative data. For all tests performed, p < 0.05 was the significance level adopted. For the qualitative analyses of the social representation of the women regarding the hypertension and their perception on the educational activities, individual interviews and focal groups, which after being recorded and transcript were analyzed by the content analysis method according to Bardin (2004) and Minayo (2006), were performed. As to the medical epidemiological profile of the public present at the workshops, 238 hypertensive people were evaluated, being females (66.8%) and elderly (66.4%) the predominant groups. The mean IMC for the group was 27.4 kg/m², being the prevalence of overweighing statistically higher among the middleaged people (p<0.001) and women (p=0.004). PA control was observed for 55.5% of the sample. Different between sex and age was not found. The average of antihypertensive therapy was 2.3 types of medicines/person, and the main intercurrence found was hypertensive crisis (5.9%). In the adherence study, the group that had home advices the most showed a better performance on the evaluation of the diet, with a reduction on the consumption of foods which are considered to be of risk (p=0.01), oil (p=0.002) and sugar (p=0.02). The medical evaluation was also better, with a reduction in the IMC (-0.7 kg/m²; p=0.01); CC (-4.2 cm; p=0.001), systolic PA (-13 mmHG; p=0.004) and glycemia (-18.9 mg/dl; p=0.01), while the group that did not receive home advices showed reduction only in the CC (-2 cm; p=0.01). Regarding the social representation of the hypertensive participants, the following characters were raised during the analyses: psychological effects/feeling connected to hypertension diagnosis; the routine of the person with hypertension and the changes in her daily life; and the living of the family with the HA; based on that, different dimensions and spaces connected to the adherence in both individual and collective ambits were identified, being the access to information associated to social support a factor favorable to adherence to the treatment. Regarding the perception of the women on the educational activities, it was observed that the dialogical educational strategies used were an important tool that worked as a facilitator to both the people and relatives to the knowledge on the health-disease-sickening process, increasing their capacity of control over the determiners of the process. Thus, family visits stand out as an important inducer of the sanitary conscience and involvement of the relatives in the therapeutic process, once it allows the overcoming of the fragmentation of the relation/bond between health professionals and users of the system in a simpler way. One may point out that even both educational health strategies are positively effective on the adherence to the nutritional orientation on hypertension, the home guidance showed better and more significant results. That emphasizes the potential of this strategy as a facilitator/inducer for the adherence of people who have hypertension to the treatment.