Thesis (M.P.H.M. (Primary Health Care Management))--Mahidol University, 2004.

Thailand has faced under-nutrition and yet, paradoxically, the prevalence of diseases of over-nutrition, such as obesity and diabetes, has escalated. Since access to diabetes prevention programs is limited in Thailand, especially in rural areas, it becomes critical to develop a health information delivery system that is relevant, cost-effective and sustainable. Therefore, the main objective of this program is to build capacity for chronic disease prevention in Thailand through application of learning technologies in the education, support and accreditation of community health care workers (CHCWs). This program stems from established partnerships among: The University of Waterloo (UW), Department of Health Studies and Gerontology; Institute of Nutrition, Mahidol University (INMU); The Office of Disease Prevention and Control 10 Chiang Mai province; Ministry of Public Health (MOPH), Thailand and UW, Centre for Teaching Excellence (CTE) . The development of the community-based diabetes prevention education program in Chiang Mai, Thailand was informed by in-depth interviews with health care professionals (n=12) and interviews (n=8) and focus groups (n = 4 groups, 23 participants) with community volunteers, screened as at-risk for diabetes. Coded transcripts from audio-taped interviews or focus groups underwent qualitative analysis by hand and using NVivo software. Health care professionals identified opportunities to integrate health promotion/ disease prevention into CHCWs’ duties. However, they also identified potential barriers to program success as motivation for regular participation, and lack of health policy support for program sustainability. Health care professionals supported an education program for CHCWs and recommended small-group workshops, hands-on learning activities, case studies and video presentations that bring knowledge to practice within their cultural context; CHCWs should receive a credit for continuing study. Community volunteers lacked knowledge of nutrition, diabetes risk factors and resources to access health information. They desired two-way communication with CHCWs. A tailored diabetes prevention education program was designed based on this formative research. Learning modules were delivered over eight group classes (n=5/class) and eight self-directed E-learning sessions (www.FitThai.org). The program incorporated problem-based learning, discussion, reflection, community-based application, self-evaluation and on-line support. The frequency that students accessed on-line materials, including video-taped lectures, readings, monthly newsletters, and community resources, was documented. Participant satisfaction was assessed through three questionnaires. Knowledge was assessed through pre-post testing based on an exam that was pilot tested with 32 CHCWs from a district outside of the 5 districts in semi-urban Chiang Mai province from which the 69 participating CHCWs (35 intervention, 34 control) were randomly selected. The program was implemented over four months. Three quarters of participants attended all eight classes and no participant attended fewer than six. Online support and materials were accessed 3 – 38 times (median 13). Participants reported that program information and activities were fun, useful, culturally relevant, and applicable to diabetes prevention in their specific communities. Participants also appreciated the innovative technology support for their work. Comfort with E-learning varied among participants. Scores on pre-post knowledge test increased from a mean (SD) of 56.5% (6.26) to 75.5% (6.01) (P < .001). The effect of the program on knowledge of CHCWs was compared between intervention and control communities at baseline and the end of the program. Overall, the knowledge at baseline of both groups was not significantly different (56.5% (6.26) intervention versus 54.9% (6.98) control) and all CHCWs scored lower than 70%. The lowest scores were found in the “understanding of nutritional recommendations” section (mean score = 28% in intervention and 30% in control CHCWs). After 4 months, CHCWs in the intervention group demonstrated improvement relative to the control group (75.5% (6.01) versus 57.4% (5.59), respectively, p <.001, n=69). The percent of CHCWs achieving a total score of 70% was 77% (27/35) in intervention and 0% in control groups. The diabetes prevention education program was effective in improving CHCWs’ health knowledge relevant diabetes prevention. The innovative learning model has potential to expand chronic disease prevention training of CHCWs to other parts of Thailand. Ultimately, prevention of chronic diseases and associated risk factors should be enhanced.

Thailand has faced under-nutrition and yet, paradoxically, the prevalence of diseases of over-nutrition, such as obesity and diabetes, has escalated. Since access to diabetes prevention programs is limited in Thailand, especially in rural areas, it becomes critical to develop a health information delivery system that is relevant, cost-effective and sustainable. Therefore, the main objective of this program is to build capacity for chronic disease prevention in Thailand through application of learning technologies in the education, support and accreditation of community health care workers (CHCWs). This program stems from established partnerships among: The University of Waterloo (UW), Department of Health Studies and Gerontology; Institute of Nutrition, Mahidol University (INMU); The Office of Disease Prevention and Control 10 Chiang Mai province; Ministry of Public Health (MOPH), Thailand and UW, Centre for Teaching Excellence (CTE) . The development of the community-based diabetes prevention education program in Chiang Mai, Thailand was informed by in-depth interviews with health care professionals (n=12) and interviews (n=8) and focus groups (n = 4 groups, 23 participants) with community volunteers, screened as at-risk for diabetes. Coded transcripts from audio-taped interviews or focus groups underwent qualitative analysis by hand and using NVivo software. Health care professionals identified opportunities to integrate health promotion/ disease prevention into CHCWs’ duties. However, they also identified potential barriers to program success as motivation for regular participation, and lack of health policy support for program sustainability. Health care professionals supported an education program for CHCWs and recommended small-group workshops, hands-on learning activities, case studies and video presentations that bring knowledge to practice within their cultural context; CHCWs should receive a credit for continuing study. Community volunteers lacked knowledge of nutrition, diabetes risk factors and resources to access health information. They desired two-way communication with CHCWs. A tailored diabetes prevention education program was designed based on this formative research. Learning modules were delivered over eight group classes (n=5/class) and eight self-directed E-learning sessions (www.FitThai.org). The program incorporated problem-based learning, discussion, reflection, community-based application, self-evaluation and on-line support. The frequency that students accessed on-line materials, including video-taped lectures, readings, monthly newsletters, and community resources, was documented. Participant satisfaction was assessed through three questionnaires. Knowledge was assessed through pre-post testing based on an exam that was pilot tested with 32 CHCWs from a district outside of the 5 districts in semi-urban Chiang Mai province from which the 69 participating CHCWs (35 intervention, 34 control) were randomly selected. The program was implemented over four months. Three quarters of participants attended all eight classes and no participant attended fewer than six. Online support and materials were accessed 3 – 38 times (median 13). Participants reported that program information and activities were fun, useful, culturally relevant, and applicable to diabetes prevention in their specific communities. Participants also appreciated the innovative technology support for their work. Comfort with E-learning varied among participants. Scores on pre-post knowledge test increased from a mean (SD) of 56.5% (6.26) to 75.5% (6.01) (P < .001). The effect of the program on knowledge of CHCWs was compared between intervention and control communities at baseline and the end of the program. Overall, the knowledge at baseline of both groups was not significantly different (56.5% (6.26) intervention versus 54.9% (6.98) control) and all CHCWs scored lower than 70%. The lowest scores were found in the “understanding of nutritional recommendations” section (mean score = 28% in intervention and 30% in control CHCWs). After 4 months, CHCWs in the intervention group demonstrated improvement relative to the control group (75.5% (6.01) versus 57.4% (5.59), respectively, p <.001, n=69). The percent of CHCWs achieving a total score of 70% was 77% (27/35) in intervention and 0% in control groups. The diabetes prevention education program was effective in improving CHCWs’ health knowledge relevant diabetes prevention. The innovative learning model has potential to expand chronic disease prevention training of CHCWs to other parts of Thailand. Ultimately, prevention of chronic diseases and associated risk factors should be enhanced.

Made available in DSpace on 2015-05-08T14:47:22Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 1705837 bytes, checksum: 9b8b9d602653d22c528eee46e0d4e94e (MD5) Previous issue date: 2012-02-28 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / It is a qualitative research, made possible by the use of thematic oral story as a methodology. This allowed the knowledge of changes in personal and professional aspects of the nurses who use/used Integrative Therapy Community-ITC as a strategy for care groups in the SFH in João Pessoa, as well as understand the reasons for seeking training in ITC, and the challenges/difficulties in implementing this form of therapy. The study was performed at the FHU Health District III - scenario deployment of ICT in the capital of Paraiba - which contains the largest number of community therapist nurses. The material was produced from interviews with eight participants, and the final text was submitted to an interpretive thematic analysis, which allowed the identification of three themes: motivation of nurses to seek training in Integrative Therapy Community; contribution of ICT training for the personal and professional lives of nurses, and difficulties and challenges for the implementation of ICT in SFH, from the perspective of nurses. These themes guided the dialogue between research findings and literature. All research strictly followed the ethical standards, according to Resolution 196/96 of the National Health Council and the documment archiving will be under the custody of UFPB/PPGEnf. The stories of the collaborators revealed that the main reason that drove the nurses to seek the ICT course was the difficulty in developing collective and group activities, emphatically, due to poor technical knowledge base, which could not follow the new requirements of qualified professionals on developing strategies in care that address the aspects of the new paradigm of community health model. The statements show that training in ICT can influence the ways of acting and thinking of the nurses of the SFH, because the theoretical and methodological background recover fragments of their lives, work self-knowledge and awake the resilient being that empowers and allows for better use of their potential, promoting behavioral changes in social relationships and at work. With regard to the difficulties and challenges found in the implementation of ICT, the limitations are structural, historical and functional, among which are: lack of physical structure, the use of traditional methodologies for the development of group activities, motivation of professionals, users' lack of interest, poor participation of the team, work overload and lack of management support. Even with these obstacles, training in ICT has proved an effective instrument of positive change - in the scenario of the SFH, and how care technology - that assists in meeting both individual and in the systematization of any activity/action of collective health education. / Trata-se de uma pesquisa de natureza qualitativa, viabilizada pelo uso da História Oral Temática como caminho metodológico. Este teve o objetivo de conhecer as mudanças nos aspectos pessoais e profissionais das enfermeiras que utilizam/utilizaram a Terapia Comunitária Integrativa - TCI como estratégia de cuidado com grupos na ESF em João Pessoa-PB; bem como compreender os motivos para buscarem capacitação em TCI; e os desafios/dificuldades para a implementação desse recurso terapêutico. O estudo foi realizado nas USF do Distrito Sanitário III - cenário de implantação da TCI na capital paraibana - onde contém o maior número de enfermeiras terapeutas comunitárias. O material foi produzido a partir das entrevistas com oito colaboradoras, e o texto final foi submetido a uma análise temática interpretativa, que permitiu a identificação dos três eixos temáticos: motivação das enfermeiras para buscar a formação em Terapia Comunitária Integrativa; contribuição da formação em TCI para a vida pessoal e profissional das enfermeiras; e dificuldades e desafios enfrentados para a implementação da TCI na ESF, sob a ótica das enfermeiras. Estes eixos guiaram o diálogo entre os achados da investigação e a literatura pertinente. A pesquisa seguiu rigorosamente os preceitos éticos, conforme Resolução 196/96 do Conselho Nacional de Saúde, e o arquivamento do documento ficará sob a guarda da UFPB/ PPGEnf. As histórias das colaboradoras revelaram que o principal motivo que impulsionou as enfermeiras a procurarem o curso de TCI foi a dificuldade em desenvolver atividades coletivas, enfaticamente, devido à pouca base de conhecimento teórico-prático, que não atendeu as novas exigências de levar para o SUS profissionais qualificados para desenvolver estratégias de cuidados que contemplem os aspectos do novo paradigma do modelo comunitário de saúde. Os discursos apontam que a capacitação em TCI influenciou nos modos de agir e pensar das enfermeiras da ESF, pois os fundamentos teóricos e metodológicos da TCI resgataram fragmentos de suas vidas, trabalharam o autoconhecimento e despertaram o ser resiliente; e permitiu o melhor aproveitamento de suas potencialidades, promovendo mudanças de comportamento nas relações sociais e no trabalho. No que diz respeito às dificuldades e os desafios, foram citadas as limitações de ordem estrutural, histórica e funcional, dentre as quais estão: a falta de estrutura física; o uso de metodologias tradicionais para o desenvolvimento das atividades grupais; a desmotivação dos profissionais; o desinteresse dos usuários; a pouca participação da equipe; a sobrecarga de trabalho; e a falta de apoio da gestão. Mesmo com esses obstáculos, a TCI se mostrou um instrumento eficaz de mudanças positivas - no cenário da ESF; e também uma tecnologia de cuidado - que auxilia tanto no atendimento individual como na sistematização de qualquer atividade/ação de educação sanitária de caráter coletivo.