Integrative and complementary practices in Primary Care: unveiling health promotion*

Objective: to understand the use of integrative and complementary practices as a health promotion action. Method: qualitative study, action-participant type, with the application of Paulo Freire’s Research Itinerary, in which 30 Primary Health Care professionals participated. Thematic research was developed with two Primary Care Units, one that used integrative and complementary practices in daily life and another that focused more on allopathic concepts of assistance. To carry out the three stages of the method used, seven Culture Yarning Circles took place. The critical unveiling took place concurrently with the participation of those surveyed. Results: integrative and complementary practices constitute a form of health care, with the purpose of understanding the human being in the health-disease process, making it possible to work with the different aspects that involve them. In this way, they reduce damages resulting from the excessive use of medications, stimulate comprehensiveness and promote health. Conclusion: integrative and complementary practices are resources for health promotion, through comprehensive care and reducing the use of medications.


Introduction
The biomedical model is found in the current of positivist thought, supported by the technological apparatus, specialized knowledge and, consequently, the fragmentation of the human being (1) . The beliefs, values and individualities (5) .
The National PIC Policy in Brazil seeks to develop training and qualification strategies in these practices for health professionals working in SUS, especially in Primary Health Care (PHC), in order to expand the forms of care and cure (6) . Therefore, it is essential to stimulate changes in health services, based on reflections on the work process, polishing concepts and habits, in order to modify the look and culture immersed in health, adding to professional understanding, popular and familiar knowledge and practices. Health promotion needs to be understood as a guiding axis, opening space for PIC, which emerge as a form of care that seeks empowerment, autonomy, comprehensive care and, promotion of individual, family and social health (7) .
Health promotion, in the PIC approach, requires rethinking the meaning of human beings' autonomy in their ways of living, consolidating themselves in daily life, in schools, churches, businesses, leisure areas, health services, non-governmental organizations. Bearing in mind that the population, in general, uses different spaces and strategies in search of what traditional medicine does not provide: relaxation, support, moments of well-being and meeting with his self (8) .
An integrative literature review, which identified and analyzed the productions about PIC in PHC and its relationship with health promotion, revealed the lack of use/guidance of PIC with health promotion actions, both by professionals and by users, with an understanding of the PICs directed to the disease, treatment and cure (7) .
Thus, the present study aimed to understand the use of Integrative and Complementary Practices as a health promotion action.

Method
A qualitative study, of the action-participant type (9)(10) , was carried out using Paulo Freire's Research Itinerary, which is based on a liberating pedagogical perspective, conducted through dialogue and horizontal relations. This methodological framework is organized into three dialectical moments: thematic investigation (data collection); encoding and decoding (data collection/data analysis); and critical unveiling (data analysis), which are outlined in Figure 1 below (11)(12) .

Thematic Research
Discovery of the vocabulary universe, words or themes extracted from the participants' daily lives.

Encoding/Decoding
Expansion of knowledge about generating themes, search for meaning. Theme of silence. Consciousness-making.
Critical Unveiling Preliminary analysis of the contents extracted from the objective coding, including elements of interpretive subjectivity. It represents reality and possibilities.
Group of people united by an existential limit situation.  The steps defined above are carried out in spaces called the Culture Circle. This is characterized by a group of people with some common interest, who discuss their problems and life situations, building a deeper perception of reality (11)(12) . For exclusion, the following criteria were adopted: being a professional in another health service  The method used (11)(12)  Rev. Latino-Am. Enfermagem 2020;28:e3277.     (11)(12) performing the analysis in three significant themes (13) :

Results
The group of research participants was 30 health professionals, 18 from the Orient team and 12 from the Occident team. Regarding training, the following stand out: three doctors, three nurses, a dental surgeon, an oral health assistant, eight community health workers, a physical education professional and a psychologist. In addition, five residents (two doctors, a nurse, a physical education professional and a social worker) and seven academics (five in medicine and two in nursing).
In view of the codified generating themes, decoding and unveiling were promoted, in order to produce knowledge for the area under study.
In the first theme -"Unveiling concepts and expanding the understanding of PIC", the professionals highlighted that PIC are part of the expanded concept of health. In some situations, they are complementary to allopathic practices, in others they are integrative, promoting comprehensive care and being the only therapy, and yet, they can be integrative and complementary as they were called by the National Therefore, depending on the situation, the PIC in use will be the person's integral and unique treatment, the first choice of intervention, but in other cases, it will act to complement allopathy. It is noteworthy that regardless of whether it is an integrative practice,

Discussion
In the last decades, PICs have undergone an expansion process in Occident society, being inserted in the health systems of some countries, acting in the www.eerp.usp.br/rlae 7 Dalmolin IS, Heidemann ITSB. different dimensions of care, from health promotion and disease prevention to treatment, rehabilitation and cure (14) . PICs are understood as alternative, complementary and/or integrative practices to the therapies present in the current biomedical model (15) , which have a history and have the ability to be modified by social actors, presenting theoretical and practical continuity between past and present (16) , this makes them holistic in their action/intervention process.
On the other hand, few interventions use PICs to reduce health or illness problems or situations. A study carried out with pregnant women, in the United States, pointed out that pregnant women do not seek these complementary approaches because they do not know much about the subject and the professionals do not indicate them, even though these activities could provide benefits and care for maternal mental health during pregnancy (17) .
PICs as a health promotion action contribute to comprehensive care, especially with the worldwide increase in Chronic Noncommunicable Diseases.
Although PICs emphasize health promotion and health care, research in this area is dominated by clinical aspects. The professionals who use them can use them as a health resource to increase the population's access to certain preventive services integrated into the health system, but it becomes relevant to involve an interprofessional collaboration in order to seek to break the prejudices and overcome the differences in the perception of health and disease (18) . and users, working in the logic of comprehensive and universalassistance (19) . Comprehensiveness suggests the extension and development of care by different health professionals, in an expanded perspective, considering the human being in its multidimensionality, endowed with feelings, desires, afflictions and rationalities (20) .
There is evidence that the abusive use of medications harms individuals' physical and mental health. There are a significant number of Brazilians who self-medicate, and, in addition to the inappropriate use of medications, many increase the dosages to accelerate the effect, putting health and quality of life at risk (21) . Poisoning and adverse drug reactions are currently a significant cause of hospitalization and mortality, standing out as a public health problem that puts people's safety at risk. Analyzing the causes by gender, men died, mainly due to acute intoxication due to the use of multiple drugs and other psychoactive substances; and women, due to self-poisoning due to intentional exposure to anticonvulsants, sedatives, hypnotics, antiparkinsonian and psychotropic drugs.
With regard to hospitalization, both genders had as their main cause acute poisoning by the use of multiple drugs and other psychoactive substances (22) .
In this perspective, the use of promotion, as there are differences in worldview between the biomedical model and the entire health system (17) .
Despite the expansion of PICs in PHC in recent decades, obstacles to sustaining this form of health care are faced between users and SUS professionals.
Therefore, it is necessary to see knowledge and popular culture as a priority, enhancing discussions that foster the construction of strategies to strengthen PIC in PHC, for example, the investment in training for health professionals stands out (7) . The investment in the qualification of professionals, studies and promotion in the area is low, however, regardless of inducing resource, Brazilian municipalities offer PIC for health care, most of them with their own resources (23) .
In other countries it is no different, as in Spain, the education focused on PIC is insufficient, as there is no mandatory discipline in the curricula of nursing schools, consequently generating repercussions on the quality of care for future professionals (8) . For better health training, professionals and managers need more training, because they do not feel able to work within the scope of humanizing care practices, as there is a deficit of theoretical content during graduation and continuing education in work processes (19) . A care model that includes PIC promotes humanization, decreases costs with medicines and highly complex services. Therefore, it is necessary to promote the inclusion and development of academic spaces for training in this area (24) .
Worldwide, interest in the use of ICP has been gaining popularity, especially among children with cancer. In many countries, particularly in Africa, PICs have long been used within and outside the dominant www.eerp.usp.br/rlae 8 Rev. Latino-Am. Enfermagem 2020;28:e3277.
health system, being used as the first and last resource for many diseases, in which cultural beliefs and practices lead to self-care, even when modern medicine is available. In high-income countries, the growing use of PICs has been linked to concerns about the adverse effects of chemical drugs and questions about traditional approaches (25) .
On the other hand, it is essential to overcome the health and care fragmentation model, highlighting the perspective of multidisciplinary and interdisciplinary work (19) . In this dimension, it is reaffirmed that health professionals who work with PICs encourage individuals to find their well-being and balance, as

Conclusion
PICs are resources that promote health, which rescue the essence of being, causing a more conscious thinking about life and the experiences of becoming ill, caring and curing, expanding the view of professionals towards integrality, considering human multidimensionality. In addition, PICs can be used to reduce damage resulting from the abuse of medicines and the consequent medicalization of life.