Text in English / Health Communication Campaigns are one of the strategies used in facing the challenges of the spread and effects of the HIV/AIDS epidemic, which is not only a health issue but also has sociocultural implications and consequences. Although there are some models and research tools available to guide the planning, designing, implementing, monitoring and evaluation of health communication campaigns, the premise of the study was on two assumptions. First, most available models that guide the planning and execution of HIV/AIDS communication campaigns do not sufficiently highlight sociocultural variables; and second, since most available models do not sufficiently emphasise sociocultural variables, the design of the instruments for the assessment of the campaigns are not sufficiently geared towards identifying and assessing sociocultural variables of the campaigns. In light of these assumptions, the study was undertaken for three reasons. Firstly, to construct a sociocultural health communication campaign conceptual model that incorporates and highlights sociocultural variables to guide the planning and implementation of health communication campaigns; particularly HIV/AIDS communication campaigns. Secondly to develop an assessment instrument for assessing the presence or absence of sociocultural variables in the planning and implementation of health communication campaigns. Thirdly to test the theoretical sociocultural assessment instrument developed in the study in an HIV/AIDS communication campaign of the Ekurhuleni Metropolitan Municipality’s HIV/AIDS Unit. The results indicated that the instrument is a functional sociocultural assessment tool that can be used to determine three main aspects. Firstly, whether or not and at what level there is/or was active involvement and participation of the target audience in the communication campaigns process. Secondly, whether or not and at what level in the planning and execution of a campaign, the sociocultural context was taken into consideration and the relevant elements of such context incorporated in the campaign process. Thirdly, whether or not and at what level relevant theories/models underpinned the whole process of the health communication campaigns in the planning, designing, implementation, monitoring and evaluation stages. The sociocultural assessment instrument, therefore, is not meant for assessing the effectiveness of health communication campaigns per se. It is rather meant for use to ascertain the presence or absence of those three aspects on the assumption that if they are taking care of in the planning and implementation of such campaigns, the probability is that the campaigns would be more socioculturally appropriate. The implications of this study are that for health communication campaigns to be socioculturally appropriate, they display continuous community interactivity and participative (ensuring mutual relationship between campaign planners and target audience) in their planning, implementation and evaluation/assessment; making the whole campaign process strategic and integrative – their management should be strategic, implementation creative and monitoring and evaluation continuous. / Communication Science / D. Litt. et Phil. (Communication)

<p>All images in this document may not be produced without the expressed written consent of the author.</p> / <p>The innovative research method of “body mapping” was used in this study with geriatric inpatients receiving daily hæmodialysis therapy for end-stage renal disease at Toronto Rehabilitation Institute.</p> <p>Five people took part in this study; three participants completed all study phases. They created three body maps each and took part in one follow up, semi-structured interview to share their experiences of body mapping. Two themes were drawn from the data: (1) body mapping gives patients a voice to communicate their experiences in the dialysis unit; and (2) body mapping makes visible participants’ illness adjustment patterns, and levels of connection, or disconnection in the dialysis unit.</p> <p>Based on the ways body mapping benefitted participants in this study, it is reasonable to suggest that this visual communication tool could be useful in other research settings, and as a clinical tool to support patients’ attention to their bodies and their interactions with healthcare providers.</p> / Master of Arts (MA)

Health communication is a vital part of health care and treatment. For patients living with HIV, effective health communication is crucial. This study aimed at describing health communication from the perspective of HIV-positive patients by uncovering their experiences as they interacted with various medical staff members at Stanger Hospital. Guided by a review of various health communication models, data were collected via individual interviews and non-participant observation. The findings showed that interactive communication was favoured by all the respondents, especially communication that was patient-centred. Such communication encompassed education on how to live and cope with HIV. Obstacles to effective communication such as power differentials, lack of time and privacy at public health care clinics were identified. The study found that the different medical staff members at the clinic to various degrees addressed distinctive communication needs of HIV-positive patients. This study contributed to effectively understating the communication process as a whole. / Sociology / M.A. (Social Behaviour Studies in HIV/AIDS)

The main research of the study was: How is integrated communication applied in the UKZN AIDS Programme at Westville Campus? The following six subsidiary research questions were formulated to address this topic:  How is communication aligned with the strategic focus in the UKZN AIDS Programme?  How consistent are messages and media used in and outside the UKZN AIDS Programme?  What is the status of infrastructure for integration within the UKZN AIDS Programme?  What is the status of internal stakeholder orientation and differentiation in the UKZN AIDS Programme?  What are the mechanisms put in place to coordinate communication efforts and action within the UKZN AIDS Programme?  What is the status of free flow of information within the UKZN AIDS Programme? A qualitative research design was conducted using field and survey research. These two research methods may be used for descriptive, exploratory, and explanatory research (Mouton 1996:232). Descriptive and exploratory field and survey research were used to ascertain the integrated communication applied in the UKZN AIDS Programme. Data was collected from sixteen UKZN AIDS Programme employees and eight students using semi-structured focus group and in-depth interviews respectively. Data collected was analysed using thematic analysis a technique that involves identifying, analysing and reporting in detail patterns or themes within data.The study found that the UKZN AIDS Programme focuses mostly on the University as its main stakeholder. Therefore, there is little emphasis on employees and students. Besides, the study revealed that there is poor alignment of the programme’s communication strategy with the programme’s strategy. To achieve the UKZN AIDS Programmes’ strategic objectives and mission, there is need to reassess the efforts of the programme and re-strategise. Findings on the consistency of messages and media in the UKZN AIDS Programme reveal that all communications are managed by senior employees and consistent in terms of programme identity by using the university identity, and website messages. The status of the consistency of messages and media in the programme can be improved if a comprehensive approach can be used in communicating internal messages. Findings on the consistency of messages and media in external communication show that the programme tries to communicate different prevention messages using channels favoured by students. However, channels such as drama and peer educators have weaknesses that need to be addressed in addition to employing diverse communication channels. Findings show that some of the messages communicated are relevant in the sense that they address students’ sexual risk behaviour while others are not as they are off tangent such that they address issues students are not concerned about. In addition, findings show that peer educators were not exemplary in their work while drama programmes did not allow students to actively participate in the prevention activities. On infrastructure for integration, the study found that there is infrastructure and several prospects for information sharing in the programme created by information technology though not fully explored. With regards the free flow and sharing of information, the study established that the required systems for communication exist but not adequately utilised. Findings on the co-ordination of communication efforts and actions to promote integrated communication show flaws. Departments in the programme function in silos due to lack of cross-functional planning. The integrated communication conceptual framework used in the study was useful in making the study successfully ascertain integrated communication applied by the UKZN AIDS Programme. The conceptual framework can therefore be used to underpin any research topic on health integrated communication. / Communication Science / MA (Communication) / 1 online resource (v, 222 leaves)

Des études récentes ont démontré une augmentation de la prévalence de l’infertilité au Canada ainsi qu’une augmentation fulgurante de l’utilisation de la procréation assistée. Le Québec s’est doté en 2010 d’un programme de financement de la procréation assistée visant un accès universel ainsi que la protection de la santé des mères et des enfants. Les diverses parties prenantes attribuent un certain nombre de lacunes à ce programme, incluant l’absence de mesures de prévention et de promotion de la santé visant à réduire la prévalence de l’infertilité. En effet, une proportion significative de cas d’infertilité découle de facteurs modifiables et relatifs aux modes de vie tels que le tabagisme, les infections transmises sexuellement et par le sang, les problèmes de poids, les toxines environnementales et l’âge. De plus, l’âge maternel avancé ainsi que l’usage de la procréation assistée comportent des risques pour la santé des mères et des enfants au sujet desquels la population ne possède pas une connaissance suffisante. Des approches en amont ont été proposées par diverses organisations et dans divers pays, toutefois, peu ont été adoptées. Force est de constater que ces initiatives représentent de grands défis au point de vue de l’acceptabilité sociale, en raison de la nature sensible du sujet et d’une grande valorisation sociale de l’autonomie reproductive. L’éthique des communications en santé permet d’identifier ces défis qui touchent l’usage de tactiques persuasives, le risque de stigmatisation et l’attribution indue d’une responsabilité. Si leur élaboration tient compte de ces enjeux, les campagnes de communications en santé ont le potentiel d’informer adéquatement la population afin de favoriser l’autonomie et la santé reproductive des individus, sans causer de dommage iatrogénique. L’éthique de l’ « empowerment », qui requiert l’attribution d’une responsabilité individuelle de nature prospective, l’apport de ressources concrètes et l’implication des communautés, permet d’identifier les besoins en termes de solutions législatives favorisant des contextes socioéconomiques qui soutiennent la santé reproductive et l’autonomie reproductive. / Recent studies have demonstrated an increased prevalence of infertility in Canada and a tremendous growth in assisted reproductive technologies use. In 2010, the Quebec government launched a public funding program for assisted reproductive technologies, which aims to provide equitable access and to protect the health of mothers and children. Various stakeholders have identified a number of shortcomings to this program, including the absence of prevention and health promotion measures aimed towards reducing the prevalence of infertility. Indeed, a significant proportion of infertility cases is attributable to modifiable and lifestyle related factors such as smoking, sexually transmitted infections, weight problems, environmental toxins and age. In addition, both advanced maternal age and assisted reproductive technologies utilization pose risks to the health of mothers and children, about which the population is not adequately informed. Preventative approaches have been proposed by many organizations in various countries but few have been implemented. A reason for this might be that these initiatives represent major challenges in terms of social acceptability, due to the sensitive nature of the subject and the strong social respect for reproductive autonomy. Health communication ethics highlights these issues such as the use of persuasive tactics, the risk of stigmatization, and undue attribution of responsibility. If designed effectively with these challenges in mind, health communication campaigns for infertility prevention have the potential to adequately inform the public, thus fostering reproductive autonomy and health, without causing iatrogenic damage. The ‘ethics of empowerment’, with its requirements for assigning only prospective individual responsibility, providing concrete resources and involving communities in social change, helps in identifying the needs for policy solutions that address the social context in order to enhance reproductive health and reproductive autonomy.

Des études récentes ont démontré une augmentation de la prévalence de l’infertilité au Canada ainsi qu’une augmentation fulgurante de l’utilisation de la procréation assistée. Le Québec s’est doté en 2010 d’un programme de financement de la procréation assistée visant un accès universel ainsi que la protection de la santé des mères et des enfants. Les diverses parties prenantes attribuent un certain nombre de lacunes à ce programme, incluant l’absence de mesures de prévention et de promotion de la santé visant à réduire la prévalence de l’infertilité. En effet, une proportion significative de cas d’infertilité découle de facteurs modifiables et relatifs aux modes de vie tels que le tabagisme, les infections transmises sexuellement et par le sang, les problèmes de poids, les toxines environnementales et l’âge. De plus, l’âge maternel avancé ainsi que l’usage de la procréation assistée comportent des risques pour la santé des mères et des enfants au sujet desquels la population ne possède pas une connaissance suffisante. Des approches en amont ont été proposées par diverses organisations et dans divers pays, toutefois, peu ont été adoptées. Force est de constater que ces initiatives représentent de grands défis au point de vue de l’acceptabilité sociale, en raison de la nature sensible du sujet et d’une grande valorisation sociale de l’autonomie reproductive. L’éthique des communications en santé permet d’identifier ces défis qui touchent l’usage de tactiques persuasives, le risque de stigmatisation et l’attribution indue d’une responsabilité. Si leur élaboration tient compte de ces enjeux, les campagnes de communications en santé ont le potentiel d’informer adéquatement la population afin de favoriser l’autonomie et la santé reproductive des individus, sans causer de dommage iatrogénique. L’éthique de l’ « empowerment », qui requiert l’attribution d’une responsabilité individuelle de nature prospective, l’apport de ressources concrètes et l’implication des communautés, permet d’identifier les besoins en termes de solutions législatives favorisant des contextes socioéconomiques qui soutiennent la santé reproductive et l’autonomie reproductive. / Recent studies have demonstrated an increased prevalence of infertility in Canada and a tremendous growth in assisted reproductive technologies use. In 2010, the Quebec government launched a public funding program for assisted reproductive technologies, which aims to provide equitable access and to protect the health of mothers and children. Various stakeholders have identified a number of shortcomings to this program, including the absence of prevention and health promotion measures aimed towards reducing the prevalence of infertility. Indeed, a significant proportion of infertility cases is attributable to modifiable and lifestyle related factors such as smoking, sexually transmitted infections, weight problems, environmental toxins and age. In addition, both advanced maternal age and assisted reproductive technologies utilization pose risks to the health of mothers and children, about which the population is not adequately informed. Preventative approaches have been proposed by many organizations in various countries but few have been implemented. A reason for this might be that these initiatives represent major challenges in terms of social acceptability, due to the sensitive nature of the subject and the strong social respect for reproductive autonomy. Health communication ethics highlights these issues such as the use of persuasive tactics, the risk of stigmatization, and undue attribution of responsibility. If designed effectively with these challenges in mind, health communication campaigns for infertility prevention have the potential to adequately inform the public, thus fostering reproductive autonomy and health, without causing iatrogenic damage. The ‘ethics of empowerment’, with its requirements for assigning only prospective individual responsibility, providing concrete resources and involving communities in social change, helps in identifying the needs for policy solutions that address the social context in order to enhance reproductive health and reproductive autonomy.

Introdução: No Brasil, a maioria dos nascimentos é por cirurgia cesárea (CC), sendo amplamente utilizada no setor privado, mesmo com pesquisas indicando que quando as taxas de CC ultrapassam10-15%, os riscos adicionais superam os benefícios. A informação sobre benefícios e riscos das intervenções é fundamental para uma assistência segura e efetiva. É considerável o aumento de busca na web durante a gestação, no entanto, a qualidade das informações é questionável. Objetivo: avaliar a qualidade e abrangência das informações disponíveis sobre cesariana para leigos, em português, após um conjunto de políticas públicas para regular esta prática (2014/2015), na internet em geral e no site da Federação Brasileira de Associações de Ginecologia e Obstetrícia (FEBRASGO). Métodos: Trata-se de estudo documental observacional, transversal e analítico. A palavra \"cesárea\" e 25 sinônimos foram submetidos no campo de procura do site da FEBRASGO e em cinco motores de pesquisa para avaliar a preferência dos termos de busca. Os links catalogados foram analisados por dois pesquisadores independentes utilizando dois checklists: o DISCERN e um checklist específico para conteúdo. Adicionalmente, apresentou-se um debate sobre o sentido do nascimento, o ciberativismo e as políticas público no Brasil. Optou-se pela apresentação da tese no formato de três publicações, sendo duas já submetidas. Resultados: A palavra \"cesaria\" é a forma mais frequente, seguida de \"cesarea\". Na análise do conteúdo geral da internet, a produção de dado proveniente do Google.com.br representou apenas 45,5% (n = 235, 2018), sendo que este buscador tem a preferência de 94,5% dos brasileiros. Um terço do conteúdo esteve associado com informações relativas à recuperação da CC, resultado similar ao apontado pelo Google Trends com termos preferencias de busca na internet. As páginas Web foram melhor avaliadas em 2018 que em 2013, principalmente no critério de confiabilidade. O número páginas Web obtídos em 2018 foi 33% maior que em 2013, sendo que 93% eram inéditas. No site da FEBRASGO, foram observadas três fases distintas: 1) sem informação para leigos sobre CC, até 2014; 2) momento defensivo, onde os conteúdos estavam associados às medidas de redução de CC; 3) informativo, melhor redigido e autoral em 2018, porém, sem debater indicações, riscos e seu uso abusivo, no qual a CC é apenas citada dentro de outros temas. O debate sobre os ritos, mitos e as narrativas utilizadas no nascimento institucionalizado do Brasil traçou um paralelo teórico dos estudos entre o interacionismo simbólico de Mead e Blumer, com Davis Floyd e Diniz. Conclusões: Comparando os períodos de 2013 e 2018, nota-se melhora na confiabilidade da informação, porém, com uma queda do número de indicações e danos potenciais, e mais informação sobre recuperação. A cesárea é tratada frequentemente como fato consumado, tema que as gestantes estão mais interessadas. As associações médicas profissionais não tem promovido a devida informação sobre gravidez e parto, em linguagem apropriada para leigos, a Febrasgo poderia ocupar um lugar de referência na apomediação da relação médico-paciente, através de uma área dedicada a pacientes. O questionamento à epidemia de cesáreas se beneficiou da participação de iniciativas coletivas que representam narrativas independentes, como de grupos organizados de usuárias. Para a oferta de informações úteis à promoção de melhores resultados maternos e infantis, é necessária a mobilização em todas esferas sociais, públicas e privadas, e entre movimentos sociais, para a produção de conteúdo sobre CS com bases científicas, e uma orientação aos profissionais de saúde em recomendar páginas Web de qualidade às gestantes / Introduction: In Brazil, the majority of births are due to cesarean surgery (CC), being widely used in the private sector, even with research indicating that when CC rates exceed 10-15%, the additional risks outweigh the benefits. Information on benefits and risks of interventions is critical to safe and effective care. There is a growing trend for web research during pregnancy; however, the quality of information found is questionable. Objectives: This research aims to evaluate the quality and comprehensiveness of available information on CC for laypeople in Portuguese, following implementation of a set of public policies aimed at regulating this practice (2014/2015), on the internet in general and on the website of the Brazilian Federation of Associations of Gynecology and Obstetrics (FEBRASGO). Methods: An observational, transversal, analytical documentary research. The word \"cesarean\" and 25 synonyms were submitted in the search field of the FEBRASGO website and in five search engines to evaluate the preference of search terms.Two independent researchers using checklists to analyze the cataloged links: the DISCERN and a specific checklist for content.In addition, a debate was presented on the meaning of birth, cyberpolitics and public policies in Brazil.The thesis is presented in the article format, of the three publications, two already submitted.Results:The preliminary results on Internet search shows that the word \"cesaria\" is the most frequent form of the internet, followed by \"cesarea\". In the analysis of the general content of the internet, the production of data from Google.com.br represented only 45.5% (n = 235, 2018), and this search engine has the preference of 94.5% of Brazilians.One-third of the content was associated with CC recovery, a similar result to the one pointed out by Google Trends as preferences for internet search terms.The webpage (WP) number collected in 2018 was 33% higher than in 2013, and 93% of the previous were unpublished before. In 2018, WP were better endorsed than 2013 ones, particularly concerning the reliability criterion. On the FEBRASGO\'s website, analysis went through three phases: 1) no information for lay people about CC in 2014; 2) defensive texts associated with the CC reduction measures, in 2016; 3) a more informative, better written and authorial content in 2018, but with no debate on indications and abusive use of CC, only mentioned in other topic CC. The debate about the rites, myths and narratives used in the institutionalized birth of Brazil drew a theoretical parallel between the symbolic interactionism by Mead and Blumer and those by Davis Floyd and Diniz. Conclusions: When comparing the two periods, there is an improvement in the quality of information on CS, but with a decrease in the number of texts on indications and potential damages, as well as a rise on information about recovery from the surgery - often treated as a fait accompli - which is also a theme of great interest to pregnant women. Medical corporations have not promoted adequate information on pregnancy and childbirth in language appropriate for laypeople and need to be a reference in apomediation the physician-patient relationship through an area dedicated to patients. The questioning of the CS epidemy has benefited from the participation of collective initiatives that represent independent narratives, such as organized groups of healthcare consumers. To provide useful information that will improve the lives of mothers and infants, it\'s necessary to act in all social spheres, such as the public and the private, and across different social movements, producing CS related content based on scientific evidence, and guide healthcare professionals to recommending quality PW to pregnant women.

A adesão do paciente ao tratamento é crucial para a efetividade dos programas de aids. O Programa Brasileiro recomenda monitorar a adesão e incorporar ao cuidado atividades de promoção, tais como atendimentos individuais com foco em adesão. Revisões sistemáticas apontam maior efetividade das intervenções complexas, que incluem sessões de conversas entre profissional-paciente: informativas, educativas e aconselhamentos motivacionais. Criticam: insuficiente explicitação das bases teóricometodológicas das intervenções; enfoque excessivo no nível individual com baixa incorporação do contexto sociocultural; insuficiência de informação acerca da fidelidade aos protocolos. Poucos estudos descrevem a \"intimidade\" das sessões. Planejada para o cuidado individual, uma modalidade de intervenção psicossocial de apoio à adesão teve seu protocolo implementado em ensaio clínico com pacientes adultos, com carga viral detectável, em serviço especializado do SUS, em São Paulo- Brasil. Suas bases teórico-metodológicas: Quadro da Vulnerabilidade e Direitos Humanos na dimensão psicossocial do Cuidado, filiados a uma perspectiva construcionista de psicologia social na saúde. Focada na noção de sucesso prático, a intervenção objetivou contribuir para que as pessoas construíssem formas de conviver melhor com o tratamento que lhes fossem mais convenientes. Baseada na interação profissional-paciente buscou intensificar a dialogia mediante a exploração dos sentidos intersubjetivos que as \"tomadas\" das medicações adquirem em diferentes cenas/cenários. Para avaliar qualitativamente a implementação selecionaram-se 12 casos (4 de cada uma das profissionais que conduziram a intervenção) entre os 44 pacientes do grupo experimental. A análise contemplou dois eixos interdependentes: a) fidelidade da implementação ao protocolo; b) qualidade dialógica das conversações. Apresentamse os resultados em três artigos. A variação nas modalidades e enfoques comunicacionais implementados permitiu a classificação em quatro níveis crescentes de fidelidade ao protocolo: nível 1 (3 casos), nível 2 (6), nível 3 (1), nível 4 (2). A inflexão na direção da dialogia não ocorreu plenamente. Princípios relacionais como solidariedade, não repreensão, foram bem desenvolvidos. As conversas valorizaram experiências singulares de dificuldades com o tratamento e produziram coentendimentos sobre o que acontecia cotidianamente. Entretanto, a decodificação de sentidos na compreensão \"dos problemas\" e criação de \"soluções\" priorizou o nível individual cognitivo-comportamental. Por exemplo, ao invés de dialogar sobre atrasos/perdas de doses em situações sociais relacionadas ao estigma/discriminação, o sentido \"problemas de memória\" prevaleceu na decodificação das falhas no tratamento. Foi incipiente a incorporação de dimensões socioculturais e programáticas ao entendimento das situações e construção/imaginação de estratégias para lidar com \"impasses\" que implicavam prejuízos à adesão. Mesclados à comunicação de enfoque cognitivo-comportamental ocorreram momentos dialógicos que se mostraram mais promissores à construção pelos participantes de enunciados de satisfação, bem-estar, intenções e mudanças práticas benéficas à adesão. Situações psicossociais dos pacientes influíram sobre a comunicação. Quanto mais complexas, desafiam \"o como dialogar\" sobre aspectos graves, sinérgicos e multidimensionais que prejudicam a saúde. São necessárias, mas insuficientes, estratégias que aprimorem a qualidade comunicacional e o enfoque psicossocial das intervenções em adesão nos serviços. Devem complementálas: a coordenação do Cuidado em equipe e ações clínicas e sociais, imediatas e objetivas, para mitigar situações que implicam graves vulnerabilidades, prejudiciais tanto à adesão ao tratamento da aids como à saúde integral / Patient\'s adherence to treatment is essential to the effectiveness of AIDS programs. The Brazilian Program recommends monitoring adherence and incorporating activities to care that promote adherence, such as individual care focusing adherence. Systematic reviews point towards greater effectiveness of complex interventions, which include conversation sessions - educational, informative, motivational counseling - between the health professional and the patient. They criticize: incomplete explanation of the theoretical-methodological bases of interventions; excessive focus on the individual level, with low incorporation of the sociocultural context; insufficient information on the fidelity to protocols. Few studies describe the \"intimacy\" of the conversation sessions. Planned for the individual care, a modality of psychosocial intervention supporting adherence had its protocol implemented in a clinical trial with adult patients with detectable viral load in a specialized care service of the Brazilian Unified Health System (SUS), in São Paulo. The following theoretical-methodological bases were adopted: the Framework of Vulnerability and Human Rights in the psychosocial dimension of Care, affiliated to a social psychology constructionist perspective in health. Focused on the notion of practical success, the intervention aimed at contributing so that people would build ways of coping better with the treatment which was the most convenient for them. Based on the health professional-patient interaction, it sought to intensify dialogic in exploring intersubjective meanings that the medication intake acquires in different scenes/scenarios. In order to qualitatively evaluate implementation, 12 cases (4 cases of each one of the health professionals who conducted the intervention) were selected among 44 cases of the experimental group. The analysis comprised two interdependent axes: a) implementation fidelity to protocol; and b) dialogic quality of conversations. The findings are presented in three papers. Variation in the implemented modalities and communicational approaches allowed the classification in four levels of increasing fidelity to protocol: level 1 (3 cases), level 2 (6 cases), level 3 (1 case), and level 4 (2 cases). Inflection towards dialogic has not completely occurred. Relational principles, such as solidarity and no reprimand, were well developed. The conversations valued singular experiences of difficulties with the treatment. Furthermore, they produced co-understandings on what happened in the daily routine. Nevertheless, the decoding of meanings in understanding \"problems\" and creating \"solutions\" prioritized the cognitive-behavioral individual level. For example, rather than dialoguing on delays/abolishing doses of medication intake in social situations concerning stigma/discrimination, it prevailed the sense of \"memory problems\" in decoding treatment failures. Programmatic and sociocultural dimensions were incipiently incorporated to the understanding of contexts and construction/imagination of strategies to cope with \"impasses\" which implied adherence losses. Mingled with the communication of cognitive-behavioral approach, there were more dialogic moments which showed to be more promising to the construction by the participants of utterances regarding satisfaction, well-being, intentions, and beneficial and practical changes to adherence. The psychosocial situations of patients influenced communication. The more complex, the more they challenge \"how to have a conversation\" about multidimensional, synergistic, serious issues which harm health. It is necessary, but insufficient, to have strategies which enhance the communication quality and psychosocial approach of adherence interventions in care. The coordination of Care as a team and social and clinical actions, both immediate and objective, should complement them in order to mitigate situations which imply serious vulnerabilities that impair AIDS treatment adherence as well as the overall health

No verão 2007-2008, o Brasil registrou uma epidemia midiática de febre amarela, produzida a partir da cobertura jornalística da forma silvestre da doença, que, de acordo com a autoridade sanitária e a maioria dos especialistas, estava dentro da normalidade epidemiológica. Assentado fortemente em repertórios de risco em saúde, o noticiário deslocou discursivamente o evento de sua forma silvestre, espacialmente restrita e de gravidade limitada, para a urbana, de caráter epidêmico e potencialmente mais grave. Os sentidos produzidos pela mídia impactaram todo o sistema nacional de imunização e expôs a riscos desnecessários pessoas que se vacinaram contra a febre amarela incentivadas pelo discurso jornalístico e contrariando as recomendações do Ministério da Saúde, o que levou a quatro óbitos por vírus vacinal. Ancorada nos referenciais teórico-metodológicos dos estudos de comunicação e saúde, com ênfase na teoria social da mídia, especificamente em sua vertente jornalística, e das práticas discursivas e produção de sentidos no cotidiano, esta tese buscou compreender o processo de produção dessa epidemia midiática e alguns de seus desdobramentos no cotidiano dos atores envolvidos no fenômeno (gestores e profissionais de saúde; profissionais de imprensa e usuários dos serviços de imunização). Para tanto, foram realizadas análises de documentos de domínio público (textos jornalísticos e comunicações ministeriais) e 14 entrevistas com atores envolvidos diretamente no/pelo noticiário (gestores; profissionais de saúde; assessores imprensa; jornalistas da imprensa generalista; e usuários vacinados). A análise foi feita sob quatro grandes eixos temáticos: o processo de produção da narrativa, o uso de repertórios de risco, a fabulação da vacina e a tradução do conhecimento técnico-científico. Concluiu-se que a epidemia midiática foi sobretudo resultado do modo de produção da notícia (newsmaking), tendo sido, ao longo de toda a cobertura, atravessada fortemente por duas forças ideológicas (a da objetividade e a do profissionalismo), em um esforço jornalístico para configurar a narrativa como espelho de uma realidade epidêmica inexistente. O modelo oligopolista de comunicação do país e as falhas nas estratégias de resposta do governo também contribuíram para a produção da epidemia midiática de febre amarela. Entendido como uma crise sem precedentes, o fenômeno é avaliado como uma oportunidade de abrir o debate sobre as relações entre a imprensa generalista e a saúde coletiva brasileira, sobretudo na perspectiva da construção de uma política pública de comunicação específica e contra-hegemônica para o Sistema Único de Saúde. / In the summer of 2007-2008, Brazil registered a \"media epidemic\" of yellow fever, produced from the media coverage of the wild form of the disease, which, according to health authorities and experts, was within the expected epidemiological patterns. Strongly seated in repertoires of health risk, the news shifted the event from its wild form, spatially restricted and limited risk to the urban form, with its epidemic character and potentially more serious. The meanings produced by the media impact throughout the national immunization system and exposed to unnecessary risk people who have been vaccinated against yellow fever, encouraged by the journalistic discourse and against the recommendations of the Ministry of Health, which led to four deaths from vaccine virus. Anchored in the theoretical and methodological frameworks of communication and health studies, with an emphasis on media social theory, specifically in its journalistic aspect, and discursive practices and production of meanings in everyday life, this thesis sought to understand the production process of this media epidemic and some of its developments in the daily lives of the actors involved in the phenomenon (managers and health professionals, media professionals and users of immunization services). To this end, public domain document analyzes were performed (newspaper articles and ministerial communications) and 14 interviews with actors directly involved in / with the news (managers, health professionals, press officers, journalists from the general press, and vaccinated users). The analysis was carried out under four major themes: the narrative production process, the use of risk repertoires, the fable of the vaccine and the translation of technical and scientific knowledge. It is concluded that media epidemic was primarily a result of news production mode (newsmaking), having been throughout the coverage, strongly crossed by two ideological forces (objectivity and professionalism), in an effort to set the journalistic narrative as a mirror of a nonexistent epidemic reality. The oligopolistic model of the country\'s communication and failures in government response strategies also contributed to the production of the media epidemic of yellow fever. Understood as an unprecedented crisis, the phenomenon is evaluated as an opportunity to open the debate on the relationship between the general press and the Brazilian public health, especially in a view of the construction of a public specific and counter-hegemonic communication policy to the Unified Health System (SUS).

Melhorar a saúde das gestantes é uma prioridade para as agências de saúde global e para os governos dos países de baixa e média renda. O desafio da erradicação e/ou redução das morbimortalidades materna e perinatal evitáveis vem colocando em destaque a necessidade de expandir as ações para prevenção de agravos para além da abordagem clínica das complicações obstétricas, a partir do fortalecimento dos sistemas de saúde e da valorização da autonomia das mulheres dentro das sociedades, implementando a abordagem de direitos humanos como um dos componentes da qualidade do cuidado à saúde reprodutiva. O objetivo desta pesquisa é determinar se um programa de educação em saúde e apoio às gestantes, adaptado à realidade do Sistema Único de Saúde brasileiro e às especificidades da telefonia celular, é um complemento útil ao acompanhamento pré-natal padrão. A pesquisa foi realizada em duas etapas, tendo início com a condução de uma pesquisa formativa, exploratória, para identificar barreiras e facilitadores da atenção ao pré-natal e parto, avaliar aceitação do uso de mensagens de texto como item complementar ao cuidado pré-natal padrão, e desenvolver e refinar a intervenção do programa PRENACEL. Esta compreende um programa de 148 mensagens de texto no celular com informações essenciais para o acompanhamento do ciclo gravídico-puerperal de mulheres saudáveis, em atendimento na rede pública de saúde. Foi desenvolvida com propósitode melhorar resultados maternos e perinatais. Sua efetividade foi avaliada por meio de um ensaio aleatorizado por conglomerados, realizado em 20 unidades de saúde que provêm assistência pré-natal em uma cidade da região sudeste do Brasil. Gestantes em acompanhamento pré-natal nas unidades de saúde sorteadas para o grupo intervenção foram convidadas a participar do PRENACEL. Em unidades de saúde alocadas ao grupo controle, as gestantes receberam a atenção pré-natal padrão. Os dados analisados foram coletados durante a internação para o parto em quatro maternidades públicas da mesma localidade. Para cada variável de interesse, foram realizadas análise por intenção de tratar e análise por protocolo, pelo cálculo dos riscos relativos, com 95% de intervalo de confiança. Ao final do seguimento da gestação, 1210 mulheres elegíveis à participação no estudo tiveram seus desfechos avaliados nas maternidades selecionadas para a pesquisa, por meio de revisão de prontuários, cartões de pré-natal e entrevista individual estruturada. Das mulheres incluídas nas análises, 770 eram provenientes das unidades de saúde do grupo intervenção e 440 das unidades controle. Receber informações do programa PRENACEL durante a gestação foi associado a um aumento na percepção das mulheres de sentirem-se melhor preparadas para o parto, e na percepção de que o pré-natal colabora para que se sintam mais preparadas. Também foram observados impactos no estabelecimento do contato pele-a-pele e aleitamento materno e no conhecimento sobre intervenções obstétricas. Não foram observadas diferenças nos demais desfechos maternos e perinatais avaliados, incluindo a satisfação das mulheres com o atendimento. Nossa conclusão é de que o PRENACEL pode contribuir para a ampliação do acesso das mulheres a informações que lhes sejam estratégicas para que se sintam melhor preparadas para a experiência do parto. / Improving maternal health is a priority for global health agencies and for governments in low- and middle-income countries. The challenge of reducing preventable maternal and perinatal morbidity and mortality has highlighted the need to expand actions to prevent injuries beyond the clinical approach to obstetric complications, through strengthening health systems and enhancing autonomy of women within societies, by implementing a human rights approach as one of the components of the quality of reproductive health care. The objective of this research is to determine if a program of health education and support to pregnant women, adapted to be used by Brazilian National Health System and delivered by short messages service (SMS) on the cell phone is a useful complement to standard prenatal follow-up. The research was carried out in two stages, starting with the conduction of a formative and exploratory research to identify barriers and facilitators of antenatal and delivery care, to evaluate the acceptance of the use of SMS as a complementary item to antenatal care and to develop and refine the PRENACEL program intervention. It comprises a program of 148 SMS with essential information from pregnancy to puerperium, for healthy pregnant women attending antenatal care. It was developed with the purpose of improving maternal and perinatal outcomes. Its effectiveness was evaluated through a cluster-randomized trial conducted in 20 health units that provide antenatal care in a city in the southeastern region of Brazil. Pregnant women from the health units drawn for the intervention group were invited to participate in PRENACEL. In health unitsallocated to the control group, pregnant women received standard antenatal care. Analyzed data were collected during admission to labor in four public maternity hospitals in the same locality. For each variable of interest, intention-to-treat analysis and analysis by protocol were carried out, as well as the relative risk, with 95% of confidence interval. At the end of the gestation follow-up, 1210 women eligible to participate in the study had their outcomes evaluated in the maternity wards, through their medical records review, antenatal cards review and individual structured interviews. Of the women included in the analyzes, 770 came from the health units of the intervention group and 440 from the control units. Receiving information from the PRENACEL program during pregnancy was associated with an increase in women\'s perception of better preparedness for delivery, and the perception that antenatal care helps them feel more prepared. Enhancement of the timing for early skin-to-skin contact and breastfeeding, and knowledge on obstetric interventions were also observed. No differences were observed in other maternal and perinatal outcomes evaluated, including women\'s satisfaction with care. We concluded that PRENACEL can contribute to increase women\'s access to information that are strategic to the improve their perception of feeling confident and better prepared for the childbirth experience.