Sobrepeso e obesidade infantil na atenção primária à saúde: percepções dos médicos e enfermeiros da Estratégia de Saúde da Família em Botucatu-SP
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Data
2019-04-12
Autores
Silva, Marina Bollini e
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Universidade Estadual Paulista (Unesp)
Resumo
A Organização Mundial de Saúde (OMS) aponta a obesidade como um dos maiores problemas de saúde pública no mundo. Este fato é bastante preocupante, pois a associação da obesidade com alterações metabólicas, como a dislipidemia, a hipertensão e a intolerância à glicose, considerados fatores de risco para o diabetes melitus tipo 2 e as doenças cardiovasculares até alguns anos atrás eram mais evidentes em adultos; no entanto, hoje já podem ser observadas frequentemente na faixa etária mais jovem. Segundo dados da Organização Mundial de Saúde (OMS, 2017), estima-se que 7,3% das crianças menores de cinco anos estão acima do peso, sendo as meninas as mais afetadas, com 7,7%. Essa situação gera impactos importantes na saúde e deve ser um tema prioritário nas agendas dos profissionais da saúde e das autoridades. Esta pesquisa está voltada a reconhecer conhecimentos e práticas na percepção de médicos e enfermeiros da Estratégia de Saúde da Família (ESF) sobre o sobrepeso e a obesidade infantil. Entende-se que compreender a percepção da atenção à criança com sobrepeso e obesidade é relevante para que se possa delinear como estes se apresentam na atenção básica, contribuindo para a reflexão sobre as políticas públicas na área e para a melhoria da qualidade das práticas de saúde dirigidas às crianças e à comunidade. Trata-se de uma pesquisa descritiva que utiliza um questionário semiestruturado para identificação e caracterização dos sujeitos da pesquisa e uma entrevista com roteiro em abordagem qualitativa que busca identificar as percepções dos médicos e dos enfermeiros das unidades da ESF do município de Botucatu acerca da atenção à saúde e da importância da abordagem e manejo do sobrepeso e da obesidade infantil na Atenção Primária. Os dados qualitativos foram analisados a partir da construção de categorias temáticas. O presente estudo foi aprovado pelo CEP-FMB UNESP, sob o número 79790417.4.0000.5411/2017. Como resultados, destacamos que foram entrevistados 100% dos médicos e enfermeiros que atuam na ESF do município de Botucatu e como características encontrou-se que a maioria dos profissionais é jovem, do sexo feminino e cerca de 50% deles com alguma especialização ou residência em Saúde da Família ou em outra área. Embora a maioria tenha referido ênfase na atenção primária durante a graduação, poucos referiram ter tido ênfase no atendimento à criança com sobrepeso ou obesidade. A análise qualitativa das entrevistas permitiu identificar 8 categorias temáticas: Embora a obesidade infantil seja identificada como um problema, ela não é considerada como prioridade no trabalho dos médicos e enfermeiros da Estratégia de Saúde da Família; os pais como o centro do cuidado da criança com sobrepeso ou obesidade; caminhos desencontrados para o diagnóstico da criança com obesidade; percepção da dificuldade de mudança de hábito da família para o cuidado da criança; preconceito em relação às atitudes da criança obesa e sua família; existência de profissionais mais sensibilizados em relação ao tema; reconhecimento da existência do trabalho em equipe na ESF e falta de relação intersetorial. Destacamos a percepção da dificuldade do cuidado integral às crianças com sobrepeso ou obesidade e a falta de um protocolo de atendimento para o correto diagnóstico e abordagem deste tema. Também foi possível destacar que o NASF tem papel fundamental no cuidado a esse grupo populacional e que o trabalho com os pais é considerado primordial. Foi possível identificar falas muito preconceituosas e que de certa forma não têm uma compreensão mais ampla em relação à presença da obesidade na criança ou na família. Como considerações finais, espera-se, com esse trabalho, contribuir para a qualificação da atenção à criança com sobrepeso ou obesidade a partir da percepção das principais dificuldades identificadas nessa pesquisa e propor ações para o enfrentamento desse problema na Estratégia de Saúde da Família.
The World Health Organization (WHO) points to obesity as one of the biggest public health problems in the world. This fact is very worrying, since the association of obesity with metabolic alterations, such as dyslipidemia, hypertension and glucose intolerance, considered risk factors for type 2 diabetes mellitus and cardiovascular diseases until a few years ago were more evident in adults; however, they can now be seen frequently in the younger age group. According to data from the World Health Organization (WHO, 2017), it is estimated that 7.3% of children under five years of age are overweight, with girls being the most affected, with 7.7%. This situation generates important impacts on health and should be a priority issue in the agendas of health professionals and authorities. This research is aimed at recognizing knowledge and practices in the perception of physicians and nurses of the Family Health Strategy (FHS) on overweight and childhood obesity. It is understood that understanding the perception of attention to overweight and obese children is relevant so that it can be delineated as they appear in primary care, contributing to the reflection on public policies in the area and to improving the quality of health practices aimed at children and the community. This is a descriptive research that uses a semi-structured questionnaire for the identification and characterization of research subjects and a questionnaire interview with a qualitative approach that seeks to identify the perceptions of the physicians and nurses of the FHS units of the city of Botucatu about health care and the importance of approach and management of overweight and childhood obesity in Primary Care. The qualitative data were analyzed with the construction of thematic categories. The present study was approved by CEP-FMB UNESP, under the number 79790417.4.0000.5411 / 2017. As a result, we emphasize that 100% of the physicians and nurses who work in the ESF of the city of Botucatu were interviewed, and that as characteristics it was found that the majority of the professionals are young, female and about 50% of them with some specialization or residence in Family Health or in another area. Although most emphasized primary care during graduation, few reported having had an emphasis on care for overweight or obese children. The qualitative analysis of the interviews allowed us to identify 8 thematic categories: Although childhood obesity is identified as a problem, it is not considered as a priority in the work of the physicians and nurses of the Family Health Strategy; parents as the center of child care that is overweight or obese; inconsistent paths for the diagnosis of children with obesity; perception of the difficulty of changing the family habit for the care of the child; prejudice regarding the attitudes of the obese child and his / her family; existence of professionals more aware of the theme; recognition of the existence of teamwork in the ESF and lack of intersectoral relationship. We highlight the perception of the difficulty of comprehensive care for overweight or obese children and the lack of a care protocol for the correct diagnosis and approach of this topic. It was also possible to highlight that the NASF plays a fundamental role in caring for this population group and that working with parents is considered paramount. It was possible to identify very prejudiced speeches and that in some ways do not have a broader understanding regarding the presence of obesity in the child or in the family. As final considerations, this work is expected to contribute to the qualification of care for overweight or obese children based on the perception of the main difficulties identified in this research and propose actions to address this problem in the Family Health Strategy.
The World Health Organization (WHO) points to obesity as one of the biggest public health problems in the world. This fact is very worrying, since the association of obesity with metabolic alterations, such as dyslipidemia, hypertension and glucose intolerance, considered risk factors for type 2 diabetes mellitus and cardiovascular diseases until a few years ago were more evident in adults; however, they can now be seen frequently in the younger age group. According to data from the World Health Organization (WHO, 2017), it is estimated that 7.3% of children under five years of age are overweight, with girls being the most affected, with 7.7%. This situation generates important impacts on health and should be a priority issue in the agendas of health professionals and authorities. This research is aimed at recognizing knowledge and practices in the perception of physicians and nurses of the Family Health Strategy (FHS) on overweight and childhood obesity. It is understood that understanding the perception of attention to overweight and obese children is relevant so that it can be delineated as they appear in primary care, contributing to the reflection on public policies in the area and to improving the quality of health practices aimed at children and the community. This is a descriptive research that uses a semi-structured questionnaire for the identification and characterization of research subjects and a questionnaire interview with a qualitative approach that seeks to identify the perceptions of the physicians and nurses of the FHS units of the city of Botucatu about health care and the importance of approach and management of overweight and childhood obesity in Primary Care. The qualitative data were analyzed with the construction of thematic categories. The present study was approved by CEP-FMB UNESP, under the number 79790417.4.0000.5411 / 2017. As a result, we emphasize that 100% of the physicians and nurses who work in the ESF of the city of Botucatu were interviewed, and that as characteristics it was found that the majority of the professionals are young, female and about 50% of them with some specialization or residence in Family Health or in another area. Although most emphasized primary care during graduation, few reported having had an emphasis on care for overweight or obese children. The qualitative analysis of the interviews allowed us to identify 8 thematic categories: Although childhood obesity is identified as a problem, it is not considered as a priority in the work of the physicians and nurses of the Family Health Strategy; parents as the center of child care that is overweight or obese; inconsistent paths for the diagnosis of children with obesity; perception of the difficulty of changing the family habit for the care of the child; prejudice regarding the attitudes of the obese child and his / her family; existence of professionals more aware of the theme; recognition of the existence of teamwork in the ESF and lack of intersectoral relationship. We highlight the perception of the difficulty of comprehensive care for overweight or obese children and the lack of a care protocol for the correct diagnosis and approach of this topic. It was also possible to highlight that the NASF plays a fundamental role in caring for this population group and that working with parents is considered paramount. It was possible to identify very prejudiced speeches and that in some ways do not have a broader understanding regarding the presence of obesity in the child or in the family. As final considerations, this work is expected to contribute to the qualification of care for overweight or obese children based on the perception of the main difficulties identified in this research and propose actions to address this problem in the Family Health Strategy.
Descrição
Palavras-chave
Sobrepeso, Obesidade infantil, Atenção Primária à Saúde, Profissional da Saúde, Estratégia Saúde da Família, Overweight, Pediatric obesity, Primary health care, Health personnel, Family health strategy