A thesis submitted in partial fulfilment of the requirements for the degree of MASTER OF ARTS (COUNSELLING PSYCHOLOGY) at the UNIVERSITY OF ZULULAND, 2007. / Zululand, the north eastern area of Kwa-Zulu Natal in South Africa is characterized by its diversity in development. This resulted from historical imbalances that were enforced by the Apartheid system and so, typifying South Africa with its unlevelled development. With large parts of the region being underdeveloped, the Zululand Mental Health Community Psychology Programme (ZMHCPP) was formally established in 1994 in response to the high demands for local community psychological services in the area. For the programme to stay updated and effective, constant evaluation is necessary. This will allow the programme to build upon its strengths as well as respond to short comings and new emerging needs. This qualitative study investigated the ZMHCPP from an appreciative perspective. It records valuable aspects of the ZMHCPP and identifies challenges and opportunities for improvement. Findings in this study were guided by relevant stakeholders 7 first hand experiences of the ZMHCPP. Participants' experiences of the ZMHCPP were generally positive. The programme was mainly appreciated for the essential services it provides to the community and the fact that it also indirectly contributes to the profession of Community Psychology by creating opportunities for intern training and research. While the ZMHCPP was appreciated for providing psychological services at affordable rates, the need for funding to secure adequate resources and to sustain itself was expressed. This dilemma highlighted the greatest challenge for the programme. It is hoped that this research project will encourage government and potential donors / sponsors to further realise the value of the programme and provide financial support. / National Research Foundation

Disproportionately high numbers of Black people use mental health services and experience involuntary treatment in the UK. There is no simple explanation, but research and policy suggest that groups run by and for Black people with mental health problems provide valued support. This study asks how community development (CD) practice can help these groups to develop and thrive. The research adopted an action research framework to develop four cycles of research, each informing the next, within a social constructivist paradigm. Methods were mainly qualitative: interviews, group discussions and observation, with a questionnaire survey in cycle one. This asked CD practitioners about their activities and helped to identify two groups for case studies in cycles two and three. During the case studies, groups received development support on their chosen topic while participating in qualitative research; activities were clearly demarcated. Reflective field notes added to the data. In the fourth cycle reflective conversations with eminent ‘critical friends’ refined and affirmed the learning. Thematic analysis was continuous and progressive. Findings suggest that CD practitioners can inspire and help Black people with mental health problems to come together in member-led, mutually supportive groups, justifying Black-only membership. Effective practitioners, especially Black role models, helped groups to generate self-belief and self-efficacy through collective action, enabling members to change their status, services and community. Those practitioners who demonstrated critical humility, commitment and competence broke the pattern of racial and psychiatric dominance. Others inadvertently reinforced societal oppression. A new concept is introduced to encapsulate the learning: the ‘liberation approach’ to CD which synthesises four perspectives: radical CD, mental health recovery, Black self-help and liberation theories. This approach helps groups to challenge oppressive processes, breaking the mould in which they feel constrained. The study contributes new theory, evidence and research methodology about CD and self-organising groups within this context.

Esta pesquisa compreende um estudo de caso do tipo descritivo, que pretende fazer uma abordagem quanti-qualitativa das ações de Promoção da Saúde do Agente Comunitário de Saúde (ACS). Teve como objetivos: descrever e analisar as ações do ACS, buscando identificar as concepções de promoção da saúde que dão suporte as mesmas. A pesquisa foi realizada na cidade de São Paulo, em uma Unidade Básica de Saúde localizada na região central deste município. Foram sujeitos do estudo 16 ACS que atuam na região. Os dados quantitativos foram coletados através de um Formulário, baseado na proposta do Ministério da Saúde para os eixos de Competências do ACS quais sejam aqui citados como: A integração da equipe com a população, Planejamento e avaliação, Promoção da Saúde, Prevenção e monitoramento de risco ambiental e sanitário e a grupos específicos e morbidades. Estes dados foram organizados segundo o programa EXCEL. Os dados qualitativos foram coletados por meio da técnica de Grupo Focal (GF) e visavam aprofundar os dados obtidos com o inquérito. As discussões das ações de promoção da saúde no GF foram analisadas pelo método do Discurso do Sujeito Coletivo (DSC). Foi possível a constatação de que o ACS investigado tinha mais habilidade com as ações de promoção da saúde que se dispunham informar a família sobre o comportamento adequado à saúde e, pouquíssimo domínio, em desenvolver a autonomia da população para tomada de decisão em relação as suas necessidades de saúde, e revelaram três Discursos Centrais: O trabalho do ACS, O desenvolvimento de atividades inter-setoriais na comunidade para o ACS e A valorização das ações do ACS para a comunidade. A análise destes discursos mostrou que as práticas de promoção da saúde do ACS, estão centradas numa visão higienista e não de empowerment. Os resultados mostram que a capacitação contínua, não considerou o embasamento teórico do novo modelo da Promoção da Saúde. Com isso, o ACS não compreendeu ainda qual é seu real papel e tão pouco desempenhou ações que auxiliassem no desenvolvimento da autonomia da população. A proposta deste trabalho é que sejam garantidos momentos de discussão entre as equipes de PSF, baseados teoricamente nos eixos de competências dos ACS e com isso, este profissional (ACS) terá a possibilidade de compreender seu real papel e poderá desenvolver ações cotidianas que capacitem e estimulem a população a participar no levantamento de suas necessidades e na organização de propostas para solucionar seus problemas de saúde / This research comprises a descriptive case study which intends to make a quantitative and qualitative approach of health promotion actions of community health Work (CHW). It aims to describe and analyze their actions, trying to identify the conceptions of health promotion which support them. The research took place in a Basic Health located downtown in Sao Paulo city and sixteen (16) community health work have been subject of study. Quantitative data were collected through a special form based on the proposal by Health Ministry to the axes of competences of CHW, such as the integration of the team with population, planning and evaluation, health promotion, prevention and monitoring of environmental and sanitary risk and to specific groups and illnesses. These data were organized by using the EXCEL program. Qualitative data were collected by using a focal group technique and aimed to deepen the results obtained with the investigation. The discussions on health promotion actions in the focal group were analyzed through the colective subject discourse method. According to the results, it was possible to verify that the analyzed workers had more ability to deal with health promotion actions which aimed to inform the family about a proper behavior related to health and very little competence in developing population autonomy regarding their health necessities. The discussion revealed three central discourses: the work of health\'s community work, the development of inter-sectoral activities in the community for the CHW, and the valuation of their actions for the community. The analysis of these discourses showed that the practices of health promotion of health\'s community work are focused on an hygienist view and not empowerment. The results have shown that the training of health\'s community work did not consider the theoretical basis of the new model of health promotion. Thus, the community health work have not understood what their real role is, and either have performed actions which promote the autonomy of the population. The purpose of this work is guarantee moments of discussion among the Family Health Program teams, theoretically based on the axes of competence of health\'s community work, in order to give to these professionals an opportunity to understand they real role, as well as to develop daily actions which allow population a greater participation in knowing their needs and organize proposals to solve their health problems

O Agente Comunitário de Saúde (ACS) tem sua inserção recente nas práticas de saúde, com a profissão sendo reconhecida legalmente em 2002. Sua atuação se dá no contexto do Sistema Único de Saúde, constituindo-se em novas oportunidades no mercado de trabalho. Como pré-requisitos para o exercício da profissão, a lei estabelece: I- residir na área da comunidade que atuar; II- haver concluído com aproveitamento o curso de qualificação básica para formação de ACS; III- haver concluído o ensino fundamental. O ACS deve trabalhar com a adscrição de famílias, tendo sob sua responsabilidade no máximo 150 famílias ou 750 pessoas, em base geográfica definida. O ACS, deve ainda desenvolver atividades de prevenção das doenças e promoção da saúde, por meio de visitas domiciliares e de ações educativas individuais e coletivas, nos domicílios e na comunidade, sob supervisão e acompanhamento do enfermeiro instrutor-supervisor. A complexidade da atuação do ACS sugere que, como profissional da saúde, esteja exposto a situações que o colocam sob estresse. Este estudo propôs identificar através das percepções que os ACS têm sobre seu trabalho, eventos que provocam sobrecarga e como lidam com eles. Utilizou-se o modelo de Lazarus e Folkman de estresse e enfrentamento. Para operacionalizá-los recorreu-se à produção de conhecimento na área quanto aos dois aspectos abordados. Este é um estudo descritivo, qualitativo. Participaram do estudo 16 ACS de equipes de Saúde da Família de São José Rio Preto- SP, e os dados foram coletados por meio de entrevistas gravadas e posteriormente transcritas. A análise centrou-se na identificação das situações consideradas pelos ACS como estressoras e dos mecanismos que utilizam para lidar com eles. As situações estressoras foram agrupadas em categorias: condições de trabalho; questões salariais; gênero; interface família-trabalho e carga emocional. Os mecanismos de enfrentamento foram agrupados em categorias focalizados na emoção e no problema. Considerando as diversas atividades desenvolvidas pelos ACS e a dinâmica da realidade sanitária, acredita-se que os relatos dos sujeitos participantes desta pesquisa, discutidos à luz de outros estudos, contribuam para o planejamento de suas atividades, preparo e capacitação dos futuros profissionais de forma a fortalecê-los para o exercício de seu trabalho. / The community health agent (ACS) is a health worker recently included in health workers staff. This profession was legally created in 2002 and it is part of the Brazilian Unique Health System. This health professional is expected to live in the same community he will work; have completed a training course and the elementary school. Their activities include the register of families and having under responsibility 150 families or about 750 persons, in a limited geographic area. They also achieve activities that aim disease prevention and health promotion by means of home visits and educative actions directed to individuals and community, under supervision of a nurse. The complexity of the agents activities suggests that they are exposed to stressing situations. So the aim of this work is to indentify by ACS s perceptions of stressors at work and coping mechanisms. The theoretical model was that of Lazarus and Folkman that focuses stress and coping. To operationalize the model other works relating to this one were accessed. This is a descriptive and qualitative research. Sixteen community health agents from ESF teams in a inner city of São Paulo state were interviewed. The interviews were recorded and transcribed. The analysis focused the work events the agents perceived as stressors and also the coping mechanisms they used to face them.The stressful events were grouped into categories: work conditions; salary; gender; relationship family and work e emotional burden. The coping mechanisms were grouped into emotional oriented and problem oriented. Considering the wide range of activities the health community workers achieve, the dynamic of sanitary situation and how they understand them, it is possible that these results in comparison to others may contribute to health agents educative programs including some emotional support as well.

Submitted by Jean Medeiros (jeanletras@uepb.edu.br) on 2016-03-16T13:35:44Z No. of bitstreams: 1 PDF - Juliana de Oliveira Musse.pdf: 965170 bytes, checksum: 211d3f9dc90f64dcbc7cca2caf8275f2 (MD5) / Approved for entry into archive by Secta BC (secta.csu.bc@uepb.edu.br) on 2016-07-21T21:12:24Z (GMT) No. of bitstreams: 1 PDF - Juliana de Oliveira Musse.pdf: 965170 bytes, checksum: 211d3f9dc90f64dcbc7cca2caf8275f2 (MD5) / Made available in DSpace on 2016-07-21T21:12:35Z (GMT). No. of bitstreams: 1 PDF - Juliana de Oliveira Musse.pdf: 965170 bytes, checksum: 211d3f9dc90f64dcbc7cca2caf8275f2 (MD5) Previous issue date: 2013-05-03 / “An Epidemiological Picture of Disability in Paraiba” (Redpb) is a software created by the Genetics and Education Research Centre (UEPB) for registration and management of information about people with disabilities. Data will be collected by the Health Community Agents (ACSs) after a continued distance education course. This work aimed to assess the skills and abilities of ACSs for the purpose of collecting and managing information about people with disabilities. Initially, we conducted a narrative review of the literature on the involvement of ACS in scientific research and subsequently collected socioeconomic data and applied an assessment multiple choice, involving 348 ACS- 54% of those serving in Campina Grande (PB). The results show that most of these professionals are 30-49 year-old women, married, with two children and high school formation. Over 98% are public employees and 55% have more than eight years in this career. 32.2% started or finished a graduation - mostly in UEPB (66.6%), predominantly in the social sciences area (78%). The overall performance score for the assessment varied from 33 to 60 points - on a scale from 0 to 60, with the mean score of 53.44 points. This means that the ACSs were able to properly resolve 65% of issues with better performance to resolve problems related to daily life. There was a positive correlation of performance with education and a negative one related to age, number of offspring and the time since formal education completion. It was evident, therefore, the yet unexplored potential of the ACS participation as a collector / informant of data in scientific research. This insertion may contribute to significantly expand the scope of the sampled populations and generalizations width of these studies. / Retrato Epidemiológico da Deficiência na Paraíba (Redpb) é um software criado pelo Núcleo de Estudos em Genética e Educação da UEPB para cadastramento e gerenciamento de informações sobre pessoas com deficiência. Os dados serão colhidos pelos Agentes Comunitários de Saúde (ACSs) após curso de formação continuada à distância. Nesta dissertação, objetivou-se avaliar as competências e habilidades dos ACSs para fins de coleta e gerenciamento de informação sobre pessoas com deficiência. Inicialmente, foi realizada uma revisão narrativa da literatura sobre a participação do ACS em pesquisa científicas e, posteriormente, colhidos dados socioeconômicos e aplicada uma avaliação de múltipla escolha, envolvendo 348 ACSs – 54% daqueles em serviço em Campina Grande (PB). Os resultados mostraram que a maioria desses profissionais são mulheres, 30 a 49 anos, casadas, com dois filhos e ensino médio completo. Mais de 98% são concursados; 55% atuam há mais de oito anos nesta profissão e 32,2% iniciaram ou concluíram um curso superior, na grande área das ciências sociais (78%) pela UEPB (66,6%). A pontuação referente ao desempenho global na avaliação variou de 33 até 60 pontos – em escala de 0 a 60, sendo obtida a média de 53,44 pontos. Isto significa que os ACSs foram capazes de resolver adequadamente 65% das questões, com melhor desempenho para resolução de problemas vinculados ao cotidiano. Houve correlação positiva do desempenho com a escolaridade e negativa com a idade, prole e o tempo de conclusão do ensino formal. Evidenciou-se, portanto, o potencial ainda inexplorado da participação do ACS como coletor/informante de dados em pesquisas científicas. Esta inserção pode contribuir para ampliar significativamente as populações amostradas e a abrangência das generalizações desses estudos.

Thesis equivalent (M.P.H.)--University of Michigan, 1947.

Thesis (M.P.H.)--University of Michigan, 1946.

Thesis (M.S.)--University of Michigan, 1981.

Thesis (M.S.)--University of Michigan, 1981. / eContent provider-neutral record in process. Description based on print version record.

Thesis (M.S.)--University of Michigan, 1981.