Aconselhamento em doenças sexualmente transmissíveis por médicos e enfermeiros da Atenção Primária à Saúde: percepção, prática auto-referida e efeitos de uma intervenção educativa

Abstract

This study aimed to investigate the self-reported practice and the effects of an educational intervention about counseling on sexually transmitted diseases (STD) and HIV/AIDS in knowledge of physicians and nurses from primary health care (FHS). In this investigation we adopted the mixed method research, by combining quantitative and qualitative approaches in research, using the following designs sequentially: qualitative, cross-sectional and community trial approach. The subjects of study were physicians and nurses of Family Health Strategy (FHS) and who were not on vacation or other leave during the study period. The qualitative research was based on Social Phenomenology of Alfred Schütz and data collection took place in the focus group format with 12 professionals in order to investigate their perception about practice of counseling in primary care. The statements were recorded and later transcribed. The cross-sectional study was conducted by applying a questionnaire that evaluates selfreported practice based on manuals of the Ministry of Health, classifying it into proper/improper. It was investigated four areas of practice: counseling, preventive measures, risk behavior and vulnerability assessment and serological testing. In community trial, professionals were randomized into the control or intervention group. The intervention group received a 16-hour training with the use of active methodologies of counseling on STD and HIV/Aids in primary care. The intervention group (n=72) was compared to the control group (n=78). The control group received no guidelines in the period of the research. The evaluation of the educational intervention was carried out by means of pre-test and post-test of knowledge that addressed questions about counseling and communication, risk and vulnerability assessment, preventive measures and serological testing. Qualitative data were submitted to the steps of Social Phenomenology analysis and organized in three categories. Quantitative data were submitted to descriptive and bivariate analysis. The ethical principles were respected. The perception of professionals about the practice of counseling on STD and HIV/Aids was grouped into three categories: "Conceptions and practices of counseling on STD and HIV/Aids in PHC"; "Barriers to practice of counseling on STD and HIV/Aids in PHC"; "Expectations for improvement of professional counseling on STD and HIV/AIDS in PHC". The results of the qualitative study showed that professionals perform the counseling’ reduced form based on the orientation for disease prevention. This practice is part of the family planning and school activities. User access to service is marked by minimum demand. They found up difficulties for counseling on home visits, maintenance of confidentiality and privacy of user information. In the cross-sectional study participated 146 professionals (41.1% physicians and nurses 58.9%). Only 25.7% of the professionals reported adequate practices. The domain with the highest proportion of improper practice was assessment of risk behavior/vulnerability assessment. Physicians showed more chance of proper practice (OR: 3.48), especially in serological testing domain In the study of educational intervention with 150 professionals (40.0% physicians and 60.0% nurses), the results showed significant increase of correct answers in the questions asked after the intervention (p <0.001). This increase was significant in all domains of the questionnaire. In conclusion the practices of counseling on STD and HIV/Aids in FHS did not reached yet the parameters recommended by the Ministry of Health, revealing the need to intensify the sensitization/training of professionals. The educational intervention carried out was effective, because it made possible the rise of knowledge about counseling on STD and HIV/AIDS among primary health care professionals.