Development of an animated infographic on Permanent Health Education

Objective: to create an animated infographic on the concept of Permanent Health Education according to the National Policy and its main differences compared to continuing education and health education. Method: a methodological study that analyzed context and knowledge gaps with a literature review and brainstorming; synthesized knowledge into a concept map; built and validated a script; created a didactic design; and produced infographic media. 18 representatives from the Center for Permanent Education and Humanization participated in the stages of context analysis and synthesis of knowledge, and six specialists participated in the validation of the script. Results: through the combination of texts, images, audios, animations and transitions, the concepts, principles and legal journey of the Permanent Education policy were presented with examples from daily work and, at the end, the difference compared to continuing education and health education is presented. The specialist on the theme evaluated the infographic positively as it has clear information that meet the needs of the target audience; favors learning; and is able to circulate in the scientific environment. Conclusion: the infographic includes content on Permanent Health Education as it represents the daily work scenario and encourages reflection by the health care workers.


Introduction
Permanent Health Education (PHE) aims to burst the ethical, technical and scientific knowledge of the health care workers and managers, in order to respond to the demands and social health needs in the work process of the health unit to which they belong (1) ; these actions have collaboratively mobilized educational institutions and health services, with mutual benefits, which translate into advances in the qualification of the care practice and of the training of human resources in health (2) , by building new forms of interaction between them and the population (1,3) .
Legally, they were enhanced with the publication of the National Policy of Permanent Health Education (Política Nacional de Educação Permanente em Saúde, PNEPS) (4) , which presupposes the propositional critical thinking of workers, managers, users, and educational institutions, recognized as the PHE quadrilateral (5)(6) . The PNPES (7) has an ethical and social commitment to the integrity of health care for people and the community (8) by seeking changes that are in line with policies and programs of the Unified Health System (Sistema Único de Saúde, SUS).
Thus, PHE becomes the motion that qualifies assistance and management and should be incorporated into the daily activities of each health unit, as part of solving their problems, by providing collective reflection and offering instruments to change the work practices (4)(5)(6)(7)(8)(9) .
However, the dynamism of PHE depends on the political, historical, and social contexts to be materialized (10) . Its dissemination has been a historic challenge from the very understanding of its meaning, as its assumptions are unknown; it is often used as a synonym for qualification, training or even confused with Continuing Education (CE) and Health Education (HE), both by the health workers and by the managers (6) . Some health professionals still have an incipient view of PHE, reproducing it as specific activities for the transmission of knowledge with pre-defined themes based exclusively on management needs (11) . The lack of understanding on the theme (11)(12) and difficulties in the use and management of resources destined to PHE (13) have implications for it use, with limitations of resolving actions that could strengthen the care practices and the flow of care in the Health Care Network (Rede de Atenção à Saúde, RAS) (11)(12)(13) .
One of the main strategies used by the managers to implement PHE is dialog, maintaining an open space for collective reflection (1) . It is also believed that, by adding new ways of teaching and learning, such as teaching technologies, the workers will be compelled to learn, which can enhance discussions and possibly contribute to close the gaps in knowledge and facilitate the understanding of the meaning of PHE in and for the work context.
Among the technological resources in teaching that can be used, the animated infographics available online stand out for making different contents accessible to different profiles of people, as they use aesthetic components that seduce and capture attention, with the use of images, audios, texts, moving photos, videos, and animations, all at the same time (14) . They have a format for visualizing ideas that convey complex information so that they can be quickly explored (15) . Therefore, it is gaining popularity in the media, such as newspapers, magazines, Facebook, Twitter, and YouTube, and also as a teaching resource in the teaching-learning process.
Several studies recognize that the animated infographic is a stimulating resource, potentially useful for education with expressive results (15)(16) and that learning through an infographic is 6.5 times greater than compared to the reading of texts (17) . Advances in information and communication technologies have created a visual culture of the web, in which images, photos, and videos have become a form of social currency to be shared (18) . to the ICT and the role of the participants as its main strengths (19) .
Given the above, the objective of this study was to develop an animated infographic on the concept of Permanent Health Education, according to the National Policy, and its main differences compared to both continuing education and health education.

Method
A methodological descriptive study (20) conducted in the following stages: analysis of the context and of the knowledge gaps; synthesis of the knowledge on the theme; creation, review, and validation of the script; didactic design; and media production (21)(22) .
To analyze the context and the knowledge In the synthesis of the knowledge on the theme (stage 2), the Concept Map (CM) was used to organize information and was created using the CmapTools ® program, version 5.05.01 Lite (24) .
From the CM, the script was built, reviewed and The specialists evaluated the objectives, structure, presentation, and relevance of the infographic, using an instrument (25) adapted for this purpose. The suggestions from the validation were analyzed and accepted.
Finally, the text went through a Portuguese-language proofreader for proper spelling corrections.
With the script in hand, the creation of the didactic design began (stage 4). It is an outline that allows for

Results
The  In the script validation stage, the content of the infographic was evaluated by six specialists in the field using a validation instrument (25) . All the items evaluated were classified as adequate or totally adequate, except the item on "Clarity and Objectivity", which was considered partially adequate in some phrases. The observations made by the specialists were analyzed by the researchers, and the script was modified to meet the  TVs (27) . In Figure 4, it is possible to see some screens of the finished infographic.  it using the PHE principles. As everyone is a regional NEPH representative and is close to the theme and the dilemmas they experience in their cities (28)  health" (8) .
It is aimed at the health team at the various organizational levels of the care network and seeks to qualify the practices for humanizing health care for the population and improving the management of the SUS (29) .
Pedagogically, educational actions must start Breaking this historical paradigm means adopting the principles of a pedagogy that uses problematization (33) , based on the dialogical-dialectic relationship. A conception in which managers,

workers, users, and actors of educational institutions
reflect on the practice experienced and seek collective solutions for the work process. In this perspective, the focus is on meaningful learning and reflection (34) , built from previous knowledge and that makes sense in the daily work. This implies the active participation of the workers in the learning process (35) . In this sense, PHE is necessary for the consolidation of a work process that enhances the resolution of the health problems of local populations. The expected result is the democratization of work spaces and progress in improving the quality of health care and humanizing care (8) .
Some authors also indicate that, although this policy was created more than 15 years ago, in addition to the difficulty in understanding the meaning of PHE, there is also confusion or ignorance of its definition by professionals and managers, as they often cannot distinguish it from continuing education and/or health education. It is well known that the terms are often used interchangeably in the educational processes.
Although some actions have the purpose of permanent education, it is seen that, in practice, they conformed as continuing education or health education, with the confusion persisting regarding the terms, which makes it difficult to organize and implement effective actions aimed at PHE (36)(37) .
In the daily operations of the health services, the terms "permanent health education", "continuing education", and "health education" coexist in the same space. It is important not to consider them conceptually antagonistic in the System, but as educational processes that have different specificities in the teaching-learning process, in which it is www.eerp.usp.br/rlae 8 Rev. Latino-Am. Enfermagem 2020;28:e3311.
necessary to establish their contextualization so that the terms can make sense (38) .
Unlike PHE, CE includes activities that have a defined period for execution and uses, more often, the assumptions of traditional teaching methodology. It relates to activities aimed at promoting the sequential and cumulative acquisition of technical and scientific information by the person, in formal educational spaces (39) .
On its turn, HE is an educational process aimed at the population, which contributes to increasing the autonomy of people in their care and in the debate with professionals and managers to achieve health care according to their needs (40) .
Although the focus of the animated infographic is PHE, the script intended to build a narrative that elucidates, in a clear and accessible language, the main differences between PHE and both CE and HE, and to establish a dialog with practical examples from the reality of work. Therefore, at the beginning of the infographic, the invitation already implies reflection, with questions that follow with explanations supported by the reviewed concepts.
A study in which students of a nursing course created attractive and colorful static infographics using words and visual aids to communicate public health information showed that the task incorporated the use of data and evidence from the literature. In addition, the products were disseminated, serving as vehicles to influence public health and well-being (41) .
The common line of design between those productions and the study in question is the optimization of the way of viewing the information that was selected based on evidence in the literature, and which implies planning the presentation of the content of a message, the environment in which it presents itself, and the type of user it is intended for (42) .
However, it differs from them by structuring the reviewed information in a CM and by using ideas from the brainstorming session, with the active participation of the representatives in the construction of the design.
This study did not find any research that used CM in the creation of infographics. However, international qualitative studies use this tool to create conceptual or theoretical models based on data (43)(44) . In Brazil, a literature review with meta-synthesis used this strategy for data extraction and analysis, configuring itself as a multi-modal (semiotics and language) and aesthetics (art and graphic representation) communication (45) .
The CM structure was a way for researchers to understand and interpret the PHE phenomenon, by detailing the parts and recognizing the whole. It was an emotional and intellectual investment that created, from a dialectic process, visual data with which the researchers were able to interact in the creation of the script and design.
The brainstorming session contributed ideas to the design; this is a technique that promotes the creativity of different groups, through which thoughts are shared, in order to achieve solutions to practical problems (46) . It appeared in the 1950s, and its application was expanded to several areas, including other members of the group (47) . Finally, in electronic brainstorming, the participants use online tools, such as e-mail, chat, and discussion forums to support the discussion process in generating ideas, simultaneously (48) .
A literature review (49)  In this study, the content preceded the design of the infographic or its visual narrative. The infographic is characterized as an expressive type of contemporary view, as it implies the creation of moving images and a density of information (42) . Furthermore, the dynamics of this process was supported by the Cognitive Load Theory (CLT), whose principles guided the pedagogical aspects that supported the creation of this educational technology (50)(51) .
The Several studies show that the use of the technology enables access to countless learning possibilities, facilitates the understanding of technical and scientific information (19) , and increases interest and motivation in the search of knowledge, user satisfaction, and autonomy in learning, with reduced stress to learn (42,(53)(54)(55) . It also favors the combination of theoretical content and practice by promoting different spaces for learning that privilege the (re)construction of knowledge, with more engaging meanings (43) .
In PHE, more specifically, in recent years there has been an increase in technological resources to favor educational actions, but still less than the production of traditional didactic teaching resources. It can be said that in Brazil, in general, there is a shortage of computational educational materials as an auxiliary resource to the teaching-learning process, but the panorama has been expanding in recent years (42) .
Therefore, it is considered that the animated infographic will allow anyone to access it on the  It is expected that it will be a teaching technology that not only answers a question, but also motivates the learner to participate in discussions on the theme and raises further questions. And that also offers to the viewer potential for the effectiveness of PHE actions.
It is noteworthy that, although the animated infographic produced for educational purposes has little insertion in the media universe of health, it is Rev. Latino-Am. Enfermagem 2020;28:e3311.
quick and cheap access, and motivate the search for knowledge by health care workers.
As for the limitations of this study, there is the expensive cost for the creation of an animated infographic. It is understood that this hinders initiatives to create educational technological resources, since funding for the creation of these technologies is often scarce.

Conclusion
In As it is an innovative technology, a continuous cycle of reflection in action took place, providing significant learning with regard to the research process, linked to the reality of those who will possibly benefit from the produced resource.
It was proven that, according to the specialists' evaluations, the text of the animated infographic has clear, concise information that meets the needs of the target audience, favors learning in different situations, and is able to circulate in the scientific area. It is understood that these positive evaluations are due to the fact that the creation of the infographic was based on listening to the contributions offered by the representatives, which made it possible for the doubts and concerns on the theme to be addressed in the infographic.
More than just understanding about PHE and its particularities, it is expected to spark new ideas, instill curiosity, and provide reflection on the professional practice, so that the viewer can improve their actions in favor of excellent care to the health needs of the population. Although it was created and thought mainly for health care workers, for offering free access, it is expected that the scientific community, SUS' patients, students, and the population in general will also benefit from this technological resource.