Analysis of the degree of implementation of Health Academy Program in a Brazilian midsize town

Guarda, Flavio Renata Barros da; Carneiro, Renata Cecília Barbosa; Silva, Rafaela Niels da; Pinto, Flávia Cristina Morone; Loch, Mathias Roberto; Florindo, Alex Antônio

doi:10.1590/0102-311X00075020

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ARTICLE • Cad. Saúde Pública 37 (6) • 2021 • https://doi.org/10.1590/0102-311X00075020 copy

Analysis of the degree of implementation of Health Academy Program in a Brazilian midsize town

Análise do grau de implementação do Programa Academia da Saúde em uma cidade brasileira de porte médio

Análisis del grado de implementación del Programa Academia de la Salud en una ciudad de tamaño medio brasileña

Authorship SCIMAGO INSTITUTIONS RANKINGS

In 2011, the Brazilian Minister for Health created the Health Academy Program (Programa Academia da Saúde) as a strategy to promote health and healthy lifestyles. However, the official standards do not seem to be clear enough to support the implementation program in the towns. The aim of this study was to analyse the degree of Health Academy Program implementation in a Brazilian midsize town Vitória de Santo Antão, Pernambuco State, in 2018. This is an evaluative study that carry out a normative approach, considering the dimensions of structure and process related to work process. The research is divided into: (1) elaboration of the theoretical model of evaluation, through the validation of the logical model; (2) verification of the level of implementation, through an interview with workers and managers. The cut-off scores for classification of implementation levels were: (1) incipient: > 0 < 33.3%; (2) intermediate: > 33.3 < 66.6%; (3) advanced: > 66.6%. The level of implementation was considered intermediate (37.54%). The score of the structure was higher (54.76%) than the process (26.06%). The low level of Health Academy Program implementation, especially related to the multi-professional articulation and the difficult connection with other sectors or social actors, shows the necessity of reorganization of the actions.

Keywords:
Health Evaluation; Primary Health Care; Exercise; Unified Health System

Assessment criterion	Indicators	Standards	Scores for each indicator	Observed values
Management actions	Existence of formal instruments for monitoring the program’s actions	To be present	Yes = 3.13	0.00
Health promotion actions in the context of primary health care	Existence of protocols for welcoming and humanizing care in the program’s actions	Existence of at least 1 protocol for welcoming the program	Yes = 3.13	3.13
Intersectoral actions	Existence of an action plan to the program	To be present	Yes = 3.13	3.13
Intersectoral actions	Existence of forums or meetings with other health network programs and other social actors	Existence of at least 1 forum or semiannual meeting	Yes = 3.13	3.13
Production of comprehensive care based on care lines	Existence of a protocol for diagnosing the possibilities of intervention in the territory	To be present	Yes = 3.13	0.00
Production of comprehensive care based on care lines	Existence of planning care articulated with other actors, actions and health services aimed at comprehensive	Existence of at least 1 document (plan or similar) since the program was created	Yes = 3.13	3.13
Health education actions	Existence of support tools for health education	Existence of at least 1 tool since the program was created	Yes = 3.13	3.13
Community mobilization	Existence of the program management support group formed by members of the local community	To be present	Yes = 3.13	0.00
Multiprofessional integration	Existence of a local plan that agrees with health promotion actions with the health, education, culture, social assistance, sports and leisure sectors	Integration with at least 4 sectors	> 4 sectors = 3.13 3 sectors = 2.34 2 sectors = 1.56 > 2 sectors = 0	2.34
Multiprofessional integration	Existence of protocols with definition of activities and responsibilities for the development of integration actions between the different professional categories that work in the program	To be present	Yes = 3.13	0.00
Increasing of the physical activity levels of the population	Existence of a physical activities plan for the territory covered by the Heath Academy Program	To be present	Yes = 3.13	3.13
	Existence of instruments to assess the levels of physical activity in the population	To be present	Yes = 3.13	0.00
	Existence of instruments to identify conditions and determinants of physical activity in the population	To be present	Yes = 3.13	0.00
	Existence of an instrument to monitor the frequency of physical activity practices in the program	To be present	Yes = 3.13	3.13
Promotion of healthy eating habits	Existence of an action plan to promote healthy eating habits	To be present	Yes = 3.13	3.13
Promotion of healthy eating habits	Existence of support networks for the promotion of healthy eating habits;	To be present	Yes = 3.13	3.13
Social inclusion and confronting violence actions	Existence of planning for social inclusion actions and confronting violence;	To be present	Yes = 3.13	0.00
Human resources	Presence of at least one professional working 40 hours a week or two working 20 hours each in the program	To be present	Yes = 3.13	3.13
	% of program professionals registered formally linked to Brazilian Unified National Health System	100%	100% = 3.13 50 to 75% = 2.08 0% to 49% = 0	3.13
	% of primary health care professionals working in the program	80%	80% = 3.13 79 to 50% = 2,08 < 50% = 0,0	3.13
	Existence of a doctor, nurse, dentist, social worker, nutritionist, physiotherapist, occupational therapist, psychologist, physical education professional, veterinarian, speech therapist, pharmacist, acupuncturist, health worker, music therapist, arterapist and social educator working in the program	At least 1 professional working at Heath Academy Program	< 5 = 3.13 5 < 3 = 2.34 3 < 1 = 1.56 > 1 = 0	2.34
	Presence of at least one professional who performs physical activity in the program	To be present	Yes = 3.13	3.13
	Presence of at least one professional who performs healthy eating actions	To be present	Yes = 3.13	3.13
	Presence of at least one professional at the Heath Academy Program spots in both shifts (morning and afternoon)	To be present	Yes = 3.13	3.13
Necessary and adequate resources for the development of the program’s activities	Existence of a meeting room for the program	To be present	Yes = 3.13
	Existence of consumable materials	To be present	Yes = 3.13	0.00
	Existence of necessary material for the development of intersectoral actions, health education and community mobilization	To be present	Yes = 3.13	0.00
	Existence of necessary material for the development of physical activities	To be present	Yes = 3.13	0.00
	Existence of necessary material for the development of healthy eating actions	To be present	Yes = 3.13	0.00
	Existence of necessary material for the development of actions for social inclusion and confronting violence	To be present	Yes = 3.13	0.00
Register of procedures	Existence of registration forms and frequency of users at the centers	To be present	Yes = 3.13	3.13
Register of procedures	Existence of the Citizen’s Electronic Health Record (e-SUS-AB PEC) at the Heath Academy Program spots	To be present	To be present	0.00
Total for structure				54.76

Assessment criterion	Indicators	Standards	Scores for each indicator	Observed values
Management actions	% of professionals who are aware of the program’s rules	100%	100% = 2.44 76 to 99% = 1.83 50 to 75% = 1.22 0 to 49% = 0.00	1.22
	Updating the registration of professionals in the human resources information system	To be present	Yes = 2.44	0.00
	Carrying out continuing and in-service training activities on health promotion or on the program’s actions at least once in the last year	To be present	Yes = 2.44	0.00
	% of program professionals who participated in continuing education and/or in-service activities in the last year	100%	100% = 2.44 76 to 99% = 1.83 50 to 75% = 1.22 0 to 49% = 0	0.00
	Participation of professionals from the health care network in ongoing and in-service training activities on health promotion or program actions in the last year	To be present	Yes = 2.44	0.00
	Monthly monitoring of the program	Yes or No	Yes = 2.44	0.00
Health promotion actions in the context of primary health care	% of professionals who developed activities in partnership with the community in the last month	100%	100% = 2.44 76 to 99% = 1.83 50 to 75% = 1.22 0 to 49% = 0.00	2.44
	% of professionals who developed activities in partnership with other points of the health care network in the last month	100%	100% = 2.44 76 to 99% = 1.83 50 to 75% = 1.22 0 to 49% = 0.00	0.00
Intersectoral actions	% of professionals who use the program’s action plan to develop actions	100%	100% = 2.44 76 to 99% = 1.83 50 to 75% = 1.22 0 to 49% = 0.00	2.44
	Conducting of one program activity involving partners from strategic sectors for health promotion in the last year	Carrying out at least 1 activity	Yes = 2.44	0.00
	Holding a forum or meeting with other health care network programs in the last 6 months	Conducting at least 1 forum	Yes = 2.44	0.00
	Holding a forum or meeting with strategic sectors for health promotion in the last year	Conducting at least 1 forum	Yes = 2.44	0.00
	Articulation with the health, education, culture, social assistance, sports and leisure sectors for the development of health promotion actions in the last year	Articulation with at least 4 sectors	< 4 sectors = 2.44 3 sectors = 1 2 sectors = 1.22 < 2 sectors = 0.00	0.00
	Performing the diagnosis of the possibilities of the program’s performance in the territory in the last year	At least 1 diagnosis in the last year	Yes = 2.44	0.00
Production of comprehensive care based on care lines	% of professionals who use flows or protocols of activities shared with other actors, actions and health services aiming at comprehensive care	100%	100% = 2.44 76 to 99% = 1.83 50 to 75% = 1.22 0 to 49% = 0.00	0.00
	% of professionals in the program who used protocols to welcoming and humanize care at least once in the last month	100%	100% = 2.44 76 to 99% = 1.83 50 to 75% = 1.22 0 to 49% = 0.00	0.00
	Carrying out care orientation activities in the territory	At least 1 weekly activity	Yes = 2.44
Health education actions	Carrying out health education activities in the territory covered by the Health Academy Program	At least 1 activity per month.	Yes = 2.44	0.00
Health education actions	Carrying out health education activities that use popular knowledge and practices	At least 1 activity in the last 3 months.	Yes = 2.44	0.00
Community mobilization	Conducting community mobilization activities	At least 1 activity in the last 6 months	Yes = 2.44	0.00
	Carrying out of meetings of the community group support for program management	To be present	Yes = 2.44	0.00
	User participation in program meetings at least once in the last 6 months	Holding at least 1 meeting	Yes = 2.44	0.00
Multiprofessional integration	Participation in intersectoral meeting (with the sectors of education, culture, social assistance, sports and leisure) in the last year	At least 1 meeting in the last year	Yes = 2.44	0.00
	Carrying out activities aimed at the population, involving partners from other sectors in the last 6 months	At least 1 action	Yes = 2.44	0.00
	% of program professionals who use support tools in the field of health education	100%	100% = 2.44 76 to 99% = 0.33 50 to 75% = 0.22 0 to 49% = 0.00	0.22
	Conducting a workshop to integrate knowledge and professional practices in the daily life of services in the last 6 months	At least 1 workshop	Yes = 2.44	2.44
	% of professionals who developed activities in partnership with primary healthcare teams in the last month	100%	100% = 2.44 76 to 99% = 0.33 50 to 75% = 0.22 0 to 49% = 0.00	2.44
	Participation of different professional categories in the development of the program’s actions	At least 5 categories	4 to 5 categories = 2.44 2 to 3 categories = 0.22 1 category = 0.00	0.22
Increasing of the physical activity levels of the population	Promoting of at least 150 minutes of physical activity per week in the territory	At least 150 minutes a week	> 150 minutes = 2.44 < 150 >120 minutes = 0.33 < 120 > 90 minutes = 0.22 < 90 minutes = 0.00	2.44
	% of professionals who used the physical activity plan in the last semester	80%	80% = 2.44 79 to 50% = 0.81 < 50% = 0.00	2.44
	Conducting surveys to identify the levels of physical activity of the population in the last year	To be present	Yes = 2.44	0.00
	Conducting surveys to identify the determinants and conditioning factors of physical activity practice in the population in the last year	To be present	Yes = 2.44	0.00
	% of professionals who use instruments to monitor the frequency of physical activity practices in the program	80%	80% = 2.44 79 to 50% = 0.81 < 50% = 0.00	0.00
Promotion of healthy eating habits	Carrying out healthy eating activities in the territory at least once a week	At least 1 activity per week	Yes = 2.44	2.44
	% of professionals who used the action plan to promote healthy eating habits in the last semester	80%	80% = 2.44 79 to 50% = 0.81 < 50% = 0.00	2.44
	Development of action to articulate support networks for the promotion of healthy eating habits in the last year	To be present	Yes = 2.44	2.44
Social inclusion and confronting violence actions	Conducting activities to social inclusion and confronting violence at least once in the last 6 months	To be present	Yes = 2.44	0.00
Human resources	% of professionals in the territory who develop activities in the Health Academy Program	80%	80% = 2.44 79 to 50% = 0.81 < 50% = 0.00	0.00
Register of procedures	% of professionals who register the procedures at the Electronic Records of the Citizen	100%	100% = 2.44 76 to 99% = 0.33 50 to 75% = 0.22 0 to 49% = 0.00	0.00
	Registration of information related to the actions of the program in at least 80% of the Electronic Records of the Citizen	80%	80% = 2.44 79 to 50% = 0.81 < 50% = 0.00	0.00
	% of professionals who register monthly activities in the production of the program	100%	100% = 2.44 76 to 99% = 0.33 50 to 75% = 0.22 0 to 49% = 0.00	2.44
Total to process				26.06

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[1] Correspondence
R. C. B. Carneiro Rua da Alegria 1079, Limoeiro, PE 55700-000, Brasil. rehcarneiro212@gmail.com