Desenvolvimento de um programa para assistência de enfermagem na prevenção e controle de sobrepeso ou obesidade em adolescentes

Abstract

Obesity is a worldwide public health problem that has increased prevalence among adolescents. In Brazil, the Ministry of Health has designated that the prevention and control of the problem is a function of Primary Health Care. However, no guideline instruments or programs for nursing practice with this population are offered. The objective was to develop a nursing care program for prevention and control of overweight or obesity among adolescents in Primary Health Care. Methodology study conducted in four public schools and four Primary Care Health Units in the city of Natal/RN. The participants were: four nurses, representing the four geographic city zones (north, south, east and west); 114 adolescents; and 40 school teachers. A participative intervention for the prevention and control of overweight and obesity in adolescents was developed, using the six stages of Bartholomew´s Intervention Mapping framework (needs evaluation, construction of objectives for change matrices, definition of theory-based methods and strategies, program development, application planning, implementation, and evaluation). The needs were identified by an integrated review of literature, adolescent and teachers´ focal groups, and semi-structured interviews with the nurses. Data were synthesized using the collective subject discourse method. Forty-one (36%) adolescents were identified with overweight (25/71%) or obesity (16/39%); and the main needs that emerged for discussion were: bullying, nutritional re-education, opportunity for physical exercise, help to establish a school-health service link, and university support to establish nursing interventions. Matrices for performance objectives, determinants, and for change objectives were created, discussed and modified with the nurses; and then selected the theories and methods for the intervention activities. The interventions emerged from the integrative review of nursing interventions with overweight and obese adolescents, and from the NIC intervention “Care for weight reduction (1280)” from the Classification of Nursing Interventions. The result was the development of the “School Health Nursing Program” that was implemented by the planners for testing and evaluation of the practice strategies. This resulted in the reduction of physical exercise time, from 60 to 45 minutes per class hour. Each target group was encouraged to participate in the adoption and continuation of the Program and a bimonthly evaluation plan was constructed. The conclusion is that a participative theory-based intervention that is procedurally mapped, with community link, that maximizes the existing resources, has implications for nursing practice because of its potential to guide need-focused interventions and enhance the prevention and control of obesity in Primary Health Care. The intervention Program developed represents a scientific and technologic contribution to the advancement of nursing knowledge in health promotion theory.