PPGSFN - Doutorado Profissional em Saúde da Família no Nordeste
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Doctoral Thesis Impactos da formação em saúde mediada por tecnologia direcionada aos profissionais do programa mais médicos na atenção primária à saúde(Universidade Federal do Rio Grande do Norte, 2025-08-11) Pereira, Laianny Krízia Maia; Rosendo, Tatyana Maria Silva de Souza; Silva, José Adailton da; https://orcid.org/0000-0002-6037-7649; http://lattes.cnpq.br/0353536075419724; https://orcid.org/0000-0001-6131-3201; http://lattes.cnpq.br/4946747115155324; https://orcid.org/0000-0002-2407-9943; http://lattes.cnpq.br/7055104622481205; Cortez, Lyane Ramalho; Valentim, Ricardo Alexsandro de Medeiros; Pessoa, Talitha Rodrigues Ribeiro Fernandes; Lima, Thaisa Gois Farias de Moura SantosPrimary Health Care (PHC) constitutes the center of the Health Care Network and the organizing basis of the Brazilian Unified Health System (SUS), requiring continuous strategies for workforce qualification. In this context, technology-mediated health education has emerged as a powerful alternative to expand the reach and effectiveness of Continuing Health Education (Educação Permanente em Saúde – EPS). This thesis aimed to analyze the impacts of technology-mediated training, directed at physicians participating in the Mais Médicos Program (PMM), on work processes and health outcomes in PHC. The investigation was structured into four axes, integrating distinct methodological approaches at each stage of the research. Initially, a scoping review was conducted following the Arksey and O’Malley framework and the PRISMA-ScR guidelines, with a systematic search in national and international databases and a narrative analysis of scientific evidence on the impacts of continuing education in Primary Health Care in Brazil. Subsequently, a descriptive study was carried out using N-gram analysis applied to intervention plans developed by physicians participating in the Permanent Education Program in Family Health (PEPSUS), aiming to identify priority themes and strategies adopted in the territories. The impact of the training on health indicators was assessed through a quasi-experimental study, based on statistical analysis of secondary data from official SUS databases. The comparison between municipalities with and without PEPSUS-trained physicians included both process and outcome indicators, with stratification by Municipal Human Development Index (MHDI) and the application of association and correlation tests to identify significant effects. Lastly, the qualitative stage involved semi-structured interviews with PMM physicians, analyzed using thematic content analysis to explore their perceptions regarding the strengths, weaknesses, and contributions of the training process. The results revealed, based on the scoping review, a predominance of studies evaluating changes in work processes, but also identified gaps in the measurement of clinical outcomes and in the direct impacts of continuing education in health on health indicators. Subsequently, the analysis of the interventions carried out by the physicians showed that the actions were concentrated in priority areas of Primary Health Care, such as Women’s Health, Child Health, Noncommunicable Diseases, and Mental Health, as well as cross-cutting themes such as reception and teamwork.The analysis of secondary data showed positive correlations between training and indicators such as prenatal care coverage, cancer screening, and childhood vaccination, with stronger effects observed in municipalities with higher Human Development Index (HDI), suggesting that socioeconomic context may moderate the impact of the training. Finally, the participants reported that the distance-learning course—grounded in active methodologies and contextualized content—was meaningful and applicable, despite existing challenges. It is concluded that technology-mediated training, such as that offered by PEPSUS, has the potential to improve healthcare practices, reorganize work processes, and contribute to better health outcomes in PHC. The findings reinforce the relevance of continuing education strategies that are integrated into the daily routine of health services, attentive to regional inequalities, and supported by institutional conditions that enable the effective application of knowledge. This thesis contributes to the field of Public Health by providing empirical evidence on the effects of professional training within the SUS, with implications for the advancement of public policies aimed at strengthening and retaining physicians in PHC.Doctoral Thesis O idadismo na estratégia saúde da família: um estudo hermenêutico sob a perspectiva da bioética de intervenção(Universidade Federal do Rio Grande do Norte, 2025-07-25) Melo, Ricardo Henrique Vieira de; Amorim, Karla Patricia Cardoso; http://lattes.cnpq.br/6339836465951509; https://orcid.org/0000-0003-0595-6020; http://lattes.cnpq.br/8774327852944516; Freitas, Cláudia Helena Soares de Morais; https://orcid.org/0000-0003-0265-5396; http://lattes.cnpq.br/8905654343063318; Forte, Franklin Delano Soares; https://orcid.org/0000-0003-4237-0184; http://lattes.cnpq.br/1213257434295598; Lima, Kenio Costa de; Santos, Paula Fernanda Brandão Batista dosIntroduction: Ageism is a global phenomenon expressed through stereotypes, prejudices, and discrimination based on age. It is a form of symbolic and structural violence that negatively affects aging and health care. In Primary Health Care (PHC) and particularly in the Family Health Strategy (FHS), this issue remains underreported, although its presence is frequent and impactful. Research questions: What are the conceptions of ageism in the FHS? How does it manifest in the daily health practices? What are its repercussions on care? And what coping strategies emerge from the involved subjects? Objectives: To analyze ageism against the elderly in the Family Health Strategy (FHS) from the perspective of Intervention Bioethics; to understand the conceptions of users, professionals, and managers of the FHS about ageism; to identify the forms of manifestation of ageism against the elderly in the FHS; to map the repercussions of ageism against the elderly in health care; and to propose strategies to combat ageism against the elderly in the context of the FHS. Methodology: Qualitative, cross-sectional study conducted with 89 participants - users, professionals, and managers of the FHS - through seven emancipatory workshops guided by Guba and Lincoln's Hermeneutic-Dialectical Circle, in the municipality of Natal/RN. The analysis was conducted from the perspective of Gadamer's philosophical hermeneutics, articulated with the ethical-political foundations of Intervention Bioethics. Results: The identified conceptions were generic and marked by naturalizations of aging, including forms of interpersonal and self-directed ageism. The phenomenon manifested in the work process, in reception, in the biomedical care model, in the use of technologies, and in the logic of productivity. The repercussions involved psychological suffering for both users and professionals, barriers to accessing health services, professional dissatisfaction, violations of rights, and devaluation of care as a reflection of the precarization of work. Coping strategies emerged at the microsocial level, such as educational actions, strengthening autonomy, intergenerational activities, and health surveillance, with limited transformative reach at the institutional level. Conclusions: The Bioethics of Intervention, in dialogue with critical hermeneutics, proved to be suitable for revealing ageism as a complex and structural phenomenon. Its application allowed for the identification of discriminatory practices and the promotion of ethical strategies based on justice, equity, and shared responsibility among health teams, health unit managers, and users. Old age, from this perspective, is recognized as a territory of power, agency, and the right to dignity. Applicability in the Family Health Strategy: The results present direct applicability in the organization of workshops, discussion circles, and educational actions in the territories, aimed at ethical training, awareness, and literacy of health teams, managers, and users. At the meso level, they can support regional planning, work management, and the formulation of monitoring indicators for ageism in services. At the macro level, they sustain the need for specific public policies to confront ageism as a health inequity, with the production of clinical guidelines, public campaigns valuing old age, and institutionalizing the active participation of elderly individuals in the formulation of health policies. The research thus contributes to qualifying the Unified Health System and the Family Health Strategy towards comprehensive, equitable attention that is politically committed to the dignity of aging.Doctoral Thesis Avaliação da qualidade do cuidado na saúde digital na atenção primária à saúde: construção, validação e aplicação de instrumento(Universidade Federal do Rio Grande do Norte, 2025-07-10) Figueirêdo, Renan Cabral de; Uchoa, Severina Alice da Costa; https://orcid.org/0000-0002-2531-9937; http://lattes.cnpq.br/8414233332373275; https://orcid.org/0000-0001-5172-3733; http://lattes.cnpq.br/1160370539871807; Silva, José Adailton da; https://orcid.org/0000-0002-6037-7649; http://lattes.cnpq.br/0353536075419724; Amorim, Karla Patricia Cardoso; https://orcid.org/0000-0003-4047-6073; http://lattes.cnpq.br/6339836465951509; Oliveira, Ricardo Antunes Dantas de; https://orcid.org/0000-0003-0144-7288; http://lattes.cnpq.br/7112638703954011; Lapão, Luís Velez; https://orcid.org/0000-0003-0506-1294; http://lattes.cnpq.br/8392880481473258The use of Information and Communication Technologies in the healthcare sector has been steadily increasing worldwide, defining the emerging field of digital health. Particularly in Primary Health Care (PHC), these technologies have become essential for improving the quality of care. This study aims to develop and validate an indicator matrix for assessing the quality of digital healthcare in Brazilian PHC, as well as to evaluate the integration of digital technologies within PHC by identifying barriers and facilitators in a Brazilian capital city. The validation study was divided into three phases: instrument development, validity analysis, and a pilot study. The instrument was designed based on the PHC evaluation model, grounded in a comprehensive literature review. The validity analysis employed the Delphi technique, combined with the nominal group method and supported by evidence from existing literature. In the pilot study, audio-recorded interviews were conducted with key stakeholders in primary care. A survey was also administered, using a questionnaire developed through the validation study, involving physicians and nurses from Basic Health Units. The data analysis included descriptive statistics and association tests, supported by SPSS software, with a 5% significance level. The study resulted in the “QualiAPS Digital – Brazil” indicator matrix, composed of 37 indicators organized into three distinct components and their respective dimensions. The "Structure" component includes the "Resources" dimension; the "Processes" component encompasses the "Technical," "Organizational," and "Relational" dimensions; and the "Outcomes" component includes the "Short-Term Outcomes" and "Mid-Term Outcomes" dimensions. The overall values obtained for Content Validity Index (CVI) and Agreement Index (AI) during validation were 0.89 and 1.00, respectively. As a result, it was possible to design evaluation guidelines and suggest qualitative data collection techniques for assessing digital health in Brazilian PHC. Survey findings showed the presence of computers and the use of e-SUS/Electronic Citizen Health Record (PEC) in all units, with WhatsApp®, phone calls, and other digital media standing out as the main tools employed. Limited digital infrastructure, lack of adequate professional training, and absence of specific protocols for organizing digital actions were observed, with statistical associations found between these variables and the performance of digital health initiatives. Therefore, this study presents a validated instrument in terms of its relevance, content, and theoretical support for evaluating the quality of digital healthcare delivery. The findings also support recommendations for strengthening professional qualification policies and investments in infrastructure, aiming at the continuity and enhancement of Information and Communication Technology use in PHC. These results provide comparable insights for similar urban PHC contexts in Brazil and in countries with equivalent socioeconomic conditions and analogous public health systems. Further applications of the proposed tool may support decision-making by health managers and professionals in the pursuit of improving remote primary care services provided to the population.