Agentes comunitários de saúde: processos de trabalho e associação com sintomas depressivos

Abstract

Community Health Workers (CHW) play an important role in the Family Health Strategy because they bring the community and the health service closer together and because they are essential for making Primary Health Care viable in Brazil. Despite their relevance to the service and the population, those professionals face problems in carrying out their duties, which can have consequences for their mental health. This study aimed to analyze the work processes of CHW and their association with depressive symptoms. To achieve this objective, two studies were carried out. The first aimed to develop and conduct content and appearance validation of an instrument to identify the activities performed by CHW. This phase of the study, of a methodological nature, was composed of three stages: i) elaboration of the instrument based on the literature review; ii) content validation by 10 expert judges; and iii) apparent validation by the target population. Based on the analysis carried out by the judges, the Content Validity Index was calculated, which reached a value ≥ 0.90 for all items, presenting satisfactory validity. From this first stage, an instrument composed of 60 items was obtained, which reflected the reality of the work of CHW. The items were composed of the wide range of activities carried out by those professionals, covering activities recommended by ministerial regulations and duties that fall outside the scope of action, but which are present in the practice of those workers. Furthermore, the instrument also assesses the CHW agreement or disagreement with the performance of the activities. Secondly, using the validated instrument, a study was carried out to analyze the association of sociodemographic and work characteristics and disagreement with the activities carried out by CHW on the presence of depressive symptoms. It was a cross-sectional, quantitative and census study, using a questionnaire to identify the activities performed by CHW, a questionnaire on sociodemographic and work characteristics and the Patient Health Questionnare-9 (PHQ9), to assess symptoms of depression. Descriptive analyses, bivariate analysis and multiple analysis were performed, using binary logistic regression to estimate the magnitude of associations. 673 CHW participated in the study. As a result, an association of depression was obtained in female CHW, with experience > 5 years, who disagreed with carrying out actions to combat dengue through the identification of foci of the disease vector in homes, the creation of the material map and carrying out home visits in uncovered areas. The results highlighted that disagreement with carrying out activities can cause depressive symptoms in these workers, making it necessary to develop measures to improve the organization of their work. The information generated can enable institutions, managers and workers themselves to develop an attentive look at the issue, stimulating reflection on improvements in work, which, consequently, will reflect on the improvement of the mental health of CHW and the provision of services to the community.