Analysis of an interprofessional education activity in the occupational health field*

Objective: to analyze the results of an Interprofessional Education activity in the Occupational Health field. Method: this is an Action Research, which encompassed the implementation and evaluation stages of the activity. It was developed in a Public Higher Education Institution through 15 meetings, totaling 60 hours. It had 16 participants, five undergraduate students, three graduate students, five teachers and three health professionals, representing the areas of Nursing, Physical Education, Physiotherapy, Gerontology and Psychology. Data regarding the implementation of the activity were collected in a field diary and analyzed through Thematic Analysis. An evaluation form constructed exclusively for this purpose was applied, whose data were submitted to descriptive statistical analysis. Results: three thematic categories were identified: (1) Comprehensive care; (2) Work as a social determinant of the health-disease process; and (3) Interprofessional teamwork. The activity of Interprofessional Education was positively evaluated by the participants, who pointed out the contributions of this strategy in the construction of knowledge directed to Occupational Health. Conclusion: the activity of Interprofessional Education proved to be possible and important in the context of the formation of health professions to strengthen occupational health care.


Introduction
The remodeling of the training processes of health professionals has been highlighted, from the perspective of providing comprehensive care, focused on the complex individual and collective health needs (1) .
Actions have been implemented to qualify professional training through the articulation of education and professional practice in different areas.
The main objective is to develop knowledge, skills, attitudes and values based on collaboration and aligned with the principles of the Brazilian Public Healthcare System (SUS) and the demands of users, families and communities (2) .
Interprofessional Health Education (IPE) is a powerful strategy for articulating actions and services for the promotion, prevention, treatment and recovery of the health of individuals and communities. Its conjectures are recognized and supported by the World Health Organization (WHO) and are strengthening of the SUS principles (3)(4)(5) .
IPE is defined as a proposal in which members of more than one profession learn together, in order to contribute to the health and well-being of users; this interactive learning requires participation and active exchanges between members of various professions (3) , with the explicit purpose of developing contribution (5) .
Considering the potential of IPE to structure interprofessional and collaborative work and the field of Occupational Health as an interdisciplinary, multiprofessional, interinstitutional and intersectoral practice that goes beyond the limits of the health sector (6) , we sought to structure an IPE activity that would foster discussions in this theme and, thus, strengthen the training focused on the comprehensiveness of care of the working population.
Occupational Health is a constitutional right attributed to the SUS, which should be contemplated in all services of the Health Care Network (RAS), especially in Primary Care, through various policies and strategies that guide comprehensive and qualified care to worker (6)(7)(8) . However, these have not been shown to be sufficient to meet workers' health needs due, among other factors, to their professional unpreparedness in dealing with specific Workers' Health Surveillance issues, which constitute a knot in training and professional qualification (9) .
Another issue that should be considered is the transversal outline of the Occupational Health field, which requires articulated and coordinated actions between professionals and services for the effectiveness of care. However, what has been observed in practice is the fragmentation of health care, shaped by the The interprofessional meetings were guided by active learning methodologies, considering the IPE precepts, such as the construction and collective problematization.
In all the meetings, besides the participants, an observer and a moderator with experience in the themes and in the facilitation of groups participated. The first was responsible for recording the observed data in a field diary and the second for triggering and moderating discussions and other activities. APS (Primary Health Care) and Occupational Health Surveillance; 12. Recognition of causal link (14) .
The face-to-face and virtual meetings were recorded in a field diary, written in a word processor on a portable computer by the observer, who had the ability to type at high speed, which allowed the reproduction of information and even speech of the participants.
Data from the field diary were analyzed through Thematic Analysis (12) and organized into three categories, which aligned with the three interprofessional competencies for occupational health care previously established in the planning stage (14) .
Thematic Analysis facilitates the understanding of the actors' language and aims to discover the meaning of the terms spontaneously used by them and which are related to the relevant themes of the investigated situation (12) . Thus, exhaustive reading of the records in the field diary and grouping was performed according to the repetition of terms, expressions and meanings, which originated the thematic categories.
At the end of the IPE activities, participants

Results
The implementation and evaluation of the Rev. Latino-Am. Enfermagem 2020;28:e3247. At the end of the meetings, the participants were invited to perform the evaluation of the IPE activity.
When asked about the knowledge acquired in each theme addressed, most participants agreed that the themes added knowledge and learning, as shown in Table 1.

Objectives* Strongly Agree Agree
To raise awareness about the role of different professionals in Occupational Health

75% 25%
To understand the social determination of the healthdisease process 87.5% 12.5% To develop teamwork skills 87.5% 12.5% To recognize the epidemiological and productive profile of the population assigned to the territory 75% 25% To understand the structure of the Health Care Network and the user's referral and counter-referral system 75% 25% To understand the actions and advances that can be incorporated into the work process in the field of Occupational Health 75% 25% *"Neither Agree nor Disagree", "Disagree" and "Strongly Disagree" options did not occur, so these columns were deleted from the table   Table 3 presents the participants' responses regarding the general aspects of the development of the IPE activity, pointed out as "very good" by most participants.
The answers to the open questions of the evaluation form, which included the most and least appreciated points in the IPE activity, as well as any suggestions, were summarized in Figure 1. • Opportunity and assistance for searching epidemiological databases on Occupational Health.
• As a point to be improved, I think of the late start of meetings.
• Having the case study as a closing of the Interprofessional Health Education activity and a way of construction (meeting by meeting).
• Opportunity for communication and discussion from different perspectives and points of view.
• Group activities and dynamics, which favored interprofessionality and teamwork, sharing different perspectives.
• The activity hours. Increasing workload.
• Quality of contents, themes and readings.
• The discussions, themes, sensitivity and empathy of the moderator and the observer.
• The length of some texts suggested for reading.
• Increasing the number of classes.
• Possibility to learn from each other.
• The teaching methodologies used.
• Conduct a field work.
• Learning about the themes.
• To understand the importance of work in the illness of the individual.
• Larger number of participants.
Offer the activity in all semesters focusing on the development of common professional skills for the health care of workers previously defined (14) .
Using Action Research as a methodological strategy proved to be effective for the study proposal and the field diary records allowed the monitoring of the activity, as well as the perceptions and experiences of the actors involved.
In the thematic analysis, three categories that aligned with the previously defined professional competences emerged, a reflection of the activity's own organization, planed for development in this sense.
Many times, during the activity, the participants pointed to the concern with the integration of health Health education is still based on the construction of specific and isolated professional identities, with little or no integration between different areas, in a process that is far from collaboration and teamwork (17) .
In an attempt to reverse this logic, the Ministry of In the field of occupational health, interprofessional collaboration reaches even greater relevance, given the specificity and transversality of this area and its relationship with the social, economic and work context. Studies have emphasized the importance of this perspective in the context of health promotion and disease prevention (9,(19)(20) and, in Brazil, policies and strategies have been launched aiming at strengthening Occupational Health Surveillance actions (9) .
However, for these strategies to impact on health care, it is necessary to overcome a second challenge, related to the training of health professionals (9) , which still needs to advance in understanding the influences of work on the health of individuals. The records in the field diary evidenced the participants' concern with the gap between training and practice, an aspect that reinforces Rev. Latino-Am. Enfermagem 2020;28:e3247.
the need to strengthen the teaching-service articulation already mentioned.
In this sense, it is necessary to reformulate health education to encompass work-related issues, enabling professionals to recognize the influence of risks and injuries in the work context and to act to ensure effective practices in health care and also in the Occupational Health field (20)(21) . This enables the complementarity of knowledge and professional practices in teamwork, in order to contribute to the qualification of user care. The activity format is replicable and also allows adjustments for other health-related themes and transversal issues, requiring the incorporation of new competency assessment processes.
It is hoped that this study will motivate researchers and health professionals to apply IPE in different areas of knowledge, integrating undergraduate students, professionals and teachers, in order to strengthen the collective construction of knowledge and inter professional collaboration.