Notre thèse s’inscrit dans le champ de la Promotion de la Santé définit par l’Organisation Mondiale de la Santé. L’activité de la recherche consiste principalement à évaluer l’efficacité de la Promotion de la Santé au travers de programmes d’interventions, pour ainsi démontrer ses effets sur la santé des populations et par la même son utilité sociale. Dans le cadre de cette thèse, nous nous demandons si le programme est la seule modalité d’intervention en Promotion de la Santé alors même qu’il répond à des attendus de la Santé Publique. Nous proposons une modalité alternative plus en phase avec la Promotion de la Santé, à savoir la notion de dispositif dont la figure centrale est le sujet. Mais parce que les interventions de professionnels au sein d’un dispositif peuvent différer en fonction de leur perception du terme de santé, cela nécessite un temps d’explicitation pour déterminer leurs intentions. Nous nous appuyons sur les théories de l’intervention interdisciplinaire et des conceptions en santé pour déterminer les fondements d’un dispositif en Promotion de la Santé. L’intervention interdisciplinaire est principalement conditionnée à l’engagement des professionnels qui auront, au préalablement, déterminé un problème commun. Les conceptions en santé participent, quant à elles, à structurer nos actions dans les situations quotidiennes relatives à notre santé, elles peuvent aussi éclairer les situations qui concernent les professionnels qui ont à décider et agir dans une perspective promotrice de santé des sujets qu’ils accompagnent. Ceci nous permet d’alimenter un objet de recherche en Promotion de la Santé autour de l’implantation d’un dispositif. En inscrivant les sujets comme point nodal d’un dispositif, nous nous interrogeons sur ce qui leur permettrait de décider d’y participer ce qui constitue notre question de recherche. Pour ce faire, nous avons étudié un dispositif en Promotion de la Santé, EST03, qui vise l’accompagnement d’acteurs territoriaux qui interviennent auprès d’enfants et d’adolescents. Nous nous sommes focalisés sur un moment clé que sont les prémices de ce dispositif où des professionnels sont en situation de déterminer leur engagement. Nous avons conçu deux protocoles permettant le recueil puis l’analyse de discours de 63 sujets, par la méthode de l’entretien semi-dirigé, concernant leur activité professionnelle et les liens avec le terme de santé. Nous avons utilisé le logiciel d’analyse de contenu qualitatif Nvivo 11© et avons élaboré deux étapes d’analyse. La première a permis la constitution de 812 références. La deuxième étape de l’analyse a permis de révéler 28 conceptions en santé mobilisées par les sujets. En utilisant une mesure de similarité nous avons observé l’existence d’une conception collective en santé dans une situation asynchrone puis avons confirmé la présence d’un méta-système de conceptions en santé. Nous discutons d’une limite méthodologique quant à la situation même de l’entretien entendue comme une situation perturbatrice. Cette dernière interroge l’engagement du chercheur dans sa posture avec l’objet de recherche mais qui permet d’être en phase avec la temporalité réelle des prémices d’un dispositif. Nous revenons sur l’hypothèse principale en indiquant que le processus d’explicitation des conceptions en santé constitue un indicateur de mobilisation des professionnels par son effet déclencheur. Le méta-système de conceptions en santé observé permet, quant à lui, d’établir une liaison avec la notion d’activité collective mais également avec le concept sociologique de la négociation. Cela nous permet d’établir quelques conditions préalables à un dispositif en Promotion de la Santé à savoir l’explicitation des conceptions en santé des sujets en amont du dispositif, l’activité collective comme modalité d’organisation du dispositif, la reconnaissance et la valorisation explicites des institutions quant à l’activité collective des professionnels et la coordination des tâches / Our thesis falls within the scope of Health Promotion defined by the World Health Organization. The research activity consists mainly of evaluating the effectiveness of Health Promotion through intervention programs, thus demonstrating its effects on the health of the populations and by the same its social utility. In the framework of this thesis, we wonder if the program is the only modality of intervention in Health Promotion even though it responds to expectations of Public Health. We propose an alternative modality more in line with the Promotion of Health, namely the concept of device whose central figure is the subject. But because the interventions of professionals within a device can differ according to their perception of the term of health, it requires a time of explanation to determine their intentions. We rely on theories of interdisciplinary intervention and health conceptions to lay the foundation for a Health Promotion device. Interdisciplinary intervention is mainly conditioned by the commitment of professionals who will have previously identified a common problem. The health conceptions participate, as for them, to structure our actions in the daily situations relating to our health, they can also enlighten the situations which concern the professionals who have to decide and act in a perspective promoter of health of the subjects which they accompany. This allows us to feed an object of research in Health Promotion around the implementation of a device. By listing topics as a nodal point of a device, we question what would allow them to decide to participate in what constitutes our research question. To do this, we studied a device in Health Promotion, EST03, which aims to support territorial actors who intervene with children and adolescents. We focused on a key moment that is the beginnings of this device where professionals are in a position to determine their commitment. We conceived two protocols allowing the collection and the analysis of speeches of 63 subjects, by the method of the semi-directed interview, concerning their professional activity and the links with the term of health. We used the qualitative content analysis software Nvivo 11 © and developed two analysis steps. The first allowed the constitution of 812 references. The second stage of the analysis revealed 28 health conceptions mobilized by the subjects. Using a similarity measure, we observed the existence of a healthy collective design in an asynchronous situation and then confirmed the presence of a meta-system of healthy conceptions. We discuss a methodological limit on the very situation of the interview as a disruptive situation. The latter questions the commitment of the researcher in his posture with the research object but which allows to be in phase with the real temporality of the beginnings of a device. We return to the main hypothesis by indicating that the process of explaining conceptions in health is an indicator of mobilization of professionals by its triggering effect. The meta-system of conceptions in health observed makes it possible to establish a link with the notion of collective activity but also with the sociological concept of negotiation. This allows us to establish some prerequisites for a device in Health Promotion, namely the explanation of the health conceptions of the subjects upstream of the device, the collective activity as modality of organization of the device, recognition and valorization of the collective activity of professionals by the institutions and the coordination of tasks

Os temas relacionados à saúde humana são tradicionalmente desenvolvidos desde os anos iniciais da escolarização formal, sendo obrigatórios na Educação Básica no Brasil desde 1971. Por se tratar de um termo polissêmico, a saúde, assim como os fatores que a influenciam e determinam podem ser entendidos de diversas formas que acabam por conformar distintas abordagens para o ensino do tema em sala de aula. Dentre os materiais de apoio ao professor, o livro didático, pelo papel que desempenha no cotidiano escolar, pode ser considerado como importante, senão o principal, instrumento de organização curricular, inclusive no que tange à abordagem relacionada à saúde. Portanto, o modo como a saúde está presente nesse material influencia diretamente o entendimento que alunos e professores têm sobre o tema, assim como os objetivos educacionais a ele relacionados. O presente trabalho, embasado nos referenciais teóricos dos campos da Saúde Coletiva e da Epidemiologia Social, tem como objetivo investigar como e a partir de que concepções os conteúdos relacionados à saúde humana são abordados nos livros didáticos de Ciências para os anos iniciais do Ensino Fundamental no Brasil e qual a importância atribuída aos diversos fatores que influenciam e determinam o processo saúde-doença. Foram analisadas as onze coleções aprovadas pelo Programa Nacional do Livro Didático em 2010, a partir do mapeamento dos temas relacionados à saúde, das concepções de saúde presentes, do papel atribuído aos seus determinantes e dos objetivos educacionais relacionados ao tema. Apesar de importantes diferenças encontradas entre eles, os livros tendem a abordar o tema a partir de uma perspectiva que enfatiza e reduz a saúde a seus aspectos biológicos, atribui pouca relevância aos seus determinantes sociais e tem como foco o indivíduo e seu conjunto de comportamentos e hábitos, sendo a modificação ou adequação destes o principal objetivo a ser alcançado. Sugere-se que esse material incorpore os avanços conceituais da área da saúde, a fim de tratar o tema a partir de uma moldura mais ampla que leve em conta os aspectos de distintas naturezas que interferem na situação de saúde dos indivíduos, grupos e população, com vistas a tornar mais significativas e contextualizadas as discussões sobre a saúde em sala de aula. / The issues related to human health are traditionally developed since the early years of formal schooling, being mandatory in Basic Education in Brazil since 1971. Health, due to is a polysemic term, as well as the factors that influence and determine health situation can be understood in different ways, that ultimately conform distinct approaches to the teaching of this subject inside and outside the classroom. Among the various materials in support of the teacher, the textbook, because of the role it plays in everyday school life, can be considered as important, if not the main instrument of curriculum organization, including those related to health issues. Indeed, how health is present in this material directly influences the understanding that students and teachers have on the subject, as well as the educational objectives related to it. This study, based on the theoretical fields of Collective Health and Social Epidemiology, aims to investigate how and from what conceptions content related to human health are discussed in Science textbooks for the early years of Elementary School (Ensino Fundamental) in Brazil and what is the role attributed to several factors that influence and determine the health-disease process. We analyzed the eleven collections approved by the National Textbook Program in 2010 (PNLD 2010) from the mapping of health issues, the understandings and conceptions on health present in these materials, the role assigned to its determinants and the educational objectives related to the topic. In spite of significant differences between them, the textbooks examined tend to approach the issue from a perspective that emphasizes and reduces health discussions to its biological aspects; attaches little importance to the social determinants of health and focuses on the individual and whole behaviors and habits pointed the modification or adaptation of these as the main objective to be achieved. It is suggested that this material addresses the conceptual advances in the health area, in order to address the issue from a broader framework that takes into account the different aspects that affect the health status of individuals and population groups, in order to make more meaningful and contextualized the discussions on health in the classroom.

Os temas relacionados à saúde humana são tradicionalmente desenvolvidos desde os anos iniciais da escolarização formal, sendo obrigatórios na Educação Básica no Brasil desde 1971. Por se tratar de um termo polissêmico, a saúde, assim como os fatores que a influenciam e determinam podem ser entendidos de diversas formas que acabam por conformar distintas abordagens para o ensino do tema em sala de aula. Dentre os materiais de apoio ao professor, o livro didático, pelo papel que desempenha no cotidiano escolar, pode ser considerado como importante, senão o principal, instrumento de organização curricular, inclusive no que tange à abordagem relacionada à saúde. Portanto, o modo como a saúde está presente nesse material influencia diretamente o entendimento que alunos e professores têm sobre o tema, assim como os objetivos educacionais a ele relacionados. O presente trabalho, embasado nos referenciais teóricos dos campos da Saúde Coletiva e da Epidemiologia Social, tem como objetivo investigar como e a partir de que concepções os conteúdos relacionados à saúde humana são abordados nos livros didáticos de Ciências para os anos iniciais do Ensino Fundamental no Brasil e qual a importância atribuída aos diversos fatores que influenciam e determinam o processo saúde-doença. Foram analisadas as onze coleções aprovadas pelo Programa Nacional do Livro Didático em 2010, a partir do mapeamento dos temas relacionados à saúde, das concepções de saúde presentes, do papel atribuído aos seus determinantes e dos objetivos educacionais relacionados ao tema. Apesar de importantes diferenças encontradas entre eles, os livros tendem a abordar o tema a partir de uma perspectiva que enfatiza e reduz a saúde a seus aspectos biológicos, atribui pouca relevância aos seus determinantes sociais e tem como foco o indivíduo e seu conjunto de comportamentos e hábitos, sendo a modificação ou adequação destes o principal objetivo a ser alcançado. Sugere-se que esse material incorpore os avanços conceituais da área da saúde, a fim de tratar o tema a partir de uma moldura mais ampla que leve em conta os aspectos de distintas naturezas que interferem na situação de saúde dos indivíduos, grupos e população, com vistas a tornar mais significativas e contextualizadas as discussões sobre a saúde em sala de aula. / The issues related to human health are traditionally developed since the early years of formal schooling, being mandatory in Basic Education in Brazil since 1971. Health, due to is a polysemic term, as well as the factors that influence and determine health situation can be understood in different ways, that ultimately conform distinct approaches to the teaching of this subject inside and outside the classroom. Among the various materials in support of the teacher, the textbook, because of the role it plays in everyday school life, can be considered as important, if not the main instrument of curriculum organization, including those related to health issues. Indeed, how health is present in this material directly influences the understanding that students and teachers have on the subject, as well as the educational objectives related to it. This study, based on the theoretical fields of Collective Health and Social Epidemiology, aims to investigate how and from what conceptions content related to human health are discussed in Science textbooks for the early years of Elementary School (Ensino Fundamental) in Brazil and what is the role attributed to several factors that influence and determine the health-disease process. We analyzed the eleven collections approved by the National Textbook Program in 2010 (PNLD 2010) from the mapping of health issues, the understandings and conceptions on health present in these materials, the role assigned to its determinants and the educational objectives related to the topic. In spite of significant differences between them, the textbooks examined tend to approach the issue from a perspective that emphasizes and reduces health discussions to its biological aspects; attaches little importance to the social determinants of health and focuses on the individual and whole behaviors and habits pointed the modification or adaptation of these as the main objective to be achieved. It is suggested that this material addresses the conceptual advances in the health area, in order to address the issue from a broader framework that takes into account the different aspects that affect the health status of individuals and population groups, in order to make more meaningful and contextualized the discussions on health in the classroom.