Levels of engagement in primary health care professionals: a comparative study in two Brazilian municipalities

Lourenção, Luciano Garcia; Silva, Albertina Gomes da; Borges, Márcio Andrade

doi:10.1590/2177-9465-EAN-2019-0005

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Sumário

RESEARCH • Esc. Anna Nery 23 (3) • 2019 • https://doi.org/10.1590/2177-9465-EAN-2019-0005 copy

Levels of engagement in primary health care professionals: a comparative study in two Brazilian municipalities

Niveles de engagement en profesionales de la atención primaria a la salud: estudio comparativo en dos municipios brasileños

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To evaluate the levels of engagement of Primary Health Care professionals in two municipalities.

Methods:

A descriptive study was carried out with 238 health professionals who work in the Primary Care services of two municipalities in the state of São Paulo. The engagement dimensions of the professionals were investigated through the Utrecht Work Engagement Scale.

Results:

Female predominance (82.8%), age under 40 years (52.9%). Median working time in primary care of three (municipality A), four years (municipality B). Significant difference in levels of engagement in both municipalities. Community health agents presented mean scores in all dimensions. Significant difference in levels of engagement according to professional category in all dimensions.

Conclusion and implications for practice:

Municipal health professionals with 100.0% coverage by the Family Health Strategy tend to have higher levels of engagement. Nurses presented greater engagement; community health workers reached lower levels than other professionals did. Engagement is an indicator that contributes to the evaluation of the workforce in the Primary Health Care services and can be used to direct strategies that improve the levels of dedication, absorption and vigor of the professionals, benefiting the organization of the primary care services.

Keywords:
Engagement at Work; Primary Health Care; Health promotion; Family Health Strategy; Unified Health System

Variables	Municipality A	Municipality B
Variables	n (%)	n (%)
Total	173 (100.0)	65 (100.0)
Professional category
Doctor	22 (12.7)	9 (13.8)
Nurse	28 (16.2)	15 (23.1)
Nursing Assistant/Technician	38 (22.0)	12 (18.5)
Community health agent	85 (49.1)	29 (44.6)
Gender
Male	24 (13.9)	14 (21.6)
Female	147 (85.0)	50 (76.9)
Did not answer	2 (1.1)	1 (1.5)
Age Group
From 18 to 28 years old	34 (19.7)	7 (10.8)
From 29 to 39 years old	57 (32.9)	28 (43.1)
At 40 years of age or older	75 (43.4)	25 (38.5)
Did not answer	7 (4.0)	5 (7.7)
Time acting in PHC
Up to 2 years	80 (46.2)	18 (27.7)
From 3 to 10 years	70 (40.5)	33 (50.8)
Above 10 years	23 (13.3)	12 (18.4)
Did not answer	-	2 (3.1)

	Dedication Mean (±sd)	Absorption Mean (±sd)	Vigor Mean (±sd)	Overall score Mean (±sd)
Municipality A	3.8 (±1.5)^a a Medium level of engagement.	3.6 (±1.4)^a a Medium level of engagement.	3.9 (±1.4)^a a Medium level of engagement.	3.8 (±1.3)^a a Medium level of engagement.
Municipality B	4.6 (±1.2)^b b High level of engagement.	4.2 (±1,1)^b b High level of engagement.	4.4 (±1.0)^b b High level of engagement.	4.4 (±1.0)^b b High level of engagement.
Total	4.0 (±1.4)^b b High level of engagement.	3.8 (±1.3)^a a Medium level of engagement.	4.0 (±1.3)^b b High level of engagement.	3.9 (±1.3)^a a Medium level of engagement.
p-value	< 0.001	0.004	0.006	0.001

Variables	Dedication Mean (±sd)	Absorption Mean (±sd)	Vigor Mean (±sd)	Overall score Mean (±sd)
Professional category
Doctor	4.5 (±1.4)^b b High level of engagement.	3.9 (±1.4)^a a Medium level of engagement.	4.1 (±1.2)^b b High level of engagement.	4.2 (±1.2)^b b High level of engagement.
Nurse	4.6 (±1.2)^b b High level of engagement.	4.5 (±1.0)^b b High level of engagement.	4.5 (±1.1)^b b High level of engagement.	4.5 (±1.0)^b b High level of engagement.
Nursing Assistant/Technician	4.5 (±1.2)^b b High level of engagement.	3.9 (±1.2)^a a Medium level of engagement.	4.3 (±1.2)^b b High level of engagement.	4.2 (±1.1)^b b High level of engagement.
Community health agent	3.5 (±1.5)^a a Medium level of engagement.	3.4 (±1.3)^a a Medium level of engagement.	3.6 (±1.4)^a a Medium level of engagement.	3.5 (±1.3)^a a Medium level of engagement.
p-value	<0.001	<0.001	<0.001	<0.001
Gender
Male	4.3 (±1.5)^b b High level of engagement.	3.8 (±1.4)^a a Medium level of engagement.	4.1 (±1.3)^b b High level of engagement.	4.1 (±1.3)^b b High level of engagement.
Female	4.0 (±1.4)^b b High level of engagement.	3.8 (±1.3)^a a Medium level of engagement.	3.9 (±1.3)^a a Medium level of engagement.	3.9 (±1.3)^a a Medium level of engagement.
p-value	0.305	0.855	0.232	0.461
Age group
From 18 to 28 years old	3.9 (±1.5)^a a Medium level of engagement.	3.7 (±1.2)^a a Medium level of engagement.	3.8 (±1.2)^a a Medium level of engagement.	3.8 (±1.2)^a a Medium level of engagement.
From 29 to 39 years old	4.0 (±1.5)^b b High level of engagement.	3.7 (±1.5)^a a Medium level of engagement.	3,9 (±1.4)^a a Medium level of engagement.	3.9 (±1.4)^a a Medium level of engagement.
At 40 years of age or older	4.2 (±1.4)^b b High level of engagement.	4.0 (±1.2)^b b High level of engagement.	4.2 (±1.2)^b b High level of engagement.	4.1 (±1.2)^b b High level of engagement.
p-value	0.421	0.167	0.153	0.173
Time acting in PHC
Up to 2 years	4.1 (±1.5)^b b High level of engagement.	3.9 (±1.3)^a a Medium level of engagement.	4.2 (±1.3)^b b High level of engagement.	4.1 (±1.2)^b b High level of engagement.
From 3 to 10 years	3.9 (±1.4)^a a Medium level of engagement.	3.7 (±1.4)^a a Medium level of engagement.	3.8 (±1.4)^a a Medium level of engagement.	3.8 (±1.3)^a a Medium level of engagement.
Above 10 years	4.1 (±1.4)^b b High level of engagement.	3.9 (±1.3)^a a Medium level of engagement.	4.0 (±1.3)^b b High level of engagement.	4.0 (±1.3)^b b High level of engagement.
p-value	0.558	0.400	0.089	0.253

Variables	Dedication		Absorption		Vigor		Overall score
	Municipality A	Municipality B	Municipality A	Municipality B	Municipality A	Municipality B	Municipality A	Municipality B
	Mean (±sd)	Mean (±sd)	Mean (±sd)	Mean (±sd)	Mean (±sd)	Mean (±sd)	Mean (±sd)	Mean (±sd)
Professional category
Doctor	4.1 (±1.5)^b b High level of engagement.	5.4 (±0.5)^c c Very High level of engagement.	3.7 (±1.5)^a a Medium level of engagement.	4.5 (±0.7)^b b High level of engagement.	4.0 (±1.2)^b b High level of engagement.	4.5 (±1.0)^b b High level of engagement.	3.9 (±1.3)^a a Medium level of engagement.	4.6 (±0.6)^b b High level of engagement.
Nurse	4.4 (±1.2)^b b High level of engagement.	5.1 (±0.9)^c c Very High level of engagement.	4.4 (±1.0)^b b High level of engagement.	4.8 (±1.1)^b b High level of engagement.	4.4 (±1.0)^b b High level of engagement.	4.7 (±1.2)^b b High level of engagement.	4.4 (±1.0)^b b High level of engagement.	4.8 (±1.0)^b b High level of engagement.
Nursing Assistant/Technician	4.4 (±1.3)^a a Medium level of engagement.	4.7 (±1.2)^b b High level of engagement.	3.8 (±1.1)^a a Medium level of engagement.	4.2 (±1.4)^b b High level of engagement.	4.2 (±1.2)^a a Medium level of engagement.	4.6 (±1.2)^b b High level of engagement.	4.1 (±1.1)^b b High level of engagement.	4.5 (±1.2)^b b High level of engagement.
Community health agent	3.4 (±1.5)^a a Medium level of engagement.	4.1 (±1.2)^b b High level of engagement.	3.3 (±1.4)^a a Medium level of engagement.	3.8 (±1.0)^a a Medium level of engagement.	3.5 (±1.5)^a a Medium level of engagement.	4.1 (±0.9)^b b High level of engagement.	3.4 (±1.2)^a a Medium level of engagement.	4.0 (±0.9)^b b High level of engagement.
p-value	<0.001	0.007	0.001	0.042	0.005	0.215	0.001	0.028
Gender
Male	4.1 (±1.6)^b b High level of engagement.	4.5 (±1.5)^b b High level of engagement.	3.6 (±1.6)^a a Medium level of engagement.	4.0 (±1.2)^b b High level of engagement.	4.2 (±1.3)^b b High level of engagement.	4.2 (±1.1)^b b High level of engagement.	4.0 (±1.4)^b b High level of engagement.	4.2 (±1.2)^b b High level of engagement.
Female	3.8 (±1.4)^a a Medium level of engagement.	4.7 (±1.1)^a a Medium level of engagement.	3.6 (±1.3)^a a Medium level of engagement.	4.3 (±1.1)^b b High level of engagement.	3.8 (±1.4)^a a Medium level of engagement.	4.4 (±1.0)^b b High level of engagement.	3.7 (±1.3)^a a Medium level of engagement.	4.4 (±1.0)^b b High level of engagement.
p-value	0.331	0.761	0.973	0.385	0.161	0.601	0.388	0.533
Age group
From 18 to 28 years old	3.9 (±1.5)^a a Medium level of engagement.	3.9 (±1.4)^a a Medium level of engagement.	3.7 (±1.2)^a a Medium level of engagement.	3.5 (±1.0)^a a Medium level of engagement.	3.8 (±1.3)^a a Medium level of engagement.	3.8 (±1.1)^a a Medium level of engagement.	3.8 (±1.2)^a a Medium level of engagement.	3.8 (±1.1)^a a Medium level of engagement.
From 29 to 39 years old	3.7 (±1.5)^a a Medium level of engagement.	4.7 (±1.3)^b b High level of engagement.	3.4 (±1.5)^a a Medium level of engagement.	4.2 (±1.3)^b b High level of engagement.	3.6 (±1.5)^a a Medium level of engagement.	4.4 (±1.0)^b b High level of engagement.	3.6 (±1.4)^a a Medium level of engagement.	4.4 (±1.1)^b b High level of engagement.
At 40 years of age or older	4.0 (±1.4)^b b High level of engagement.	4.7 (±1.0)^b b High level of engagement.	3.9 (±1.3)^a a Medium level of engagement.	4.3 (±0.9)^b b High level of engagement.	4.1 (±1.2)^b b High level of engagement.	4.3 (±1.1)^b a Medium level of engagement.	4.0 (±1.2)^b b High level of engagement.	4.4 (±0.9)^b b High level of engagement.
p-value	0.424	0.290	0.142	0.266	0.106	0.420	0.147	0.285
Time acting in PHC
Up to 2 years	4.1 (±1.4)^b b High level of engagement.	4.5 (±1.5)^b b High level of engagement.	3.9 (±1.3)^a a Medium level of engagement.	3.9 (±1.2)^a a Medium level of engagement.	4.1 (±1.3)^b b High level of engagement.	4.4 (±1.0)^b b High level of engagement.	4.0 (±1.3)^b b High level of engagement.	4.3 (±1,2)^b b High level of engagement.
From 3 to 10 years	3.6 (±1.5)^a a Medium level of engagement.	4.6 (±1.1)^b b High level of engagement.	3.4 (±1.5)^a a Medium level of engagement.	4.2 (±1.1)^b b High level of engagement.	3.6 (±1.4)^a a Medium level of engagement.	4.3 (±1.0)^b b High level of engagement.	3.5 (±1.4)^a a Medium level of engagement.	4.3 (±1.0)^b b High level of engagement.
Above 10 years	3.8 (±1.5)^a a Medium level of engagement.	4.9 (±0.9)^b b High level of engagement.	3.6 (±1.4)^a a Medium level of engagement.	4.5 (±1.2)^b b High level of engagement.	3.9 (±1.4)^a a Medium level of engagement.	4.6 (±1.2)^b b High level of engagement.	3.8 (±1.3)^a a Medium level of engagement.	4.7 (±1.0)^b b High level of engagement.
p-value	0.136	0.620	0.094	0.411	0.039	0.540	0.056	0.559

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[1] Corresponding author: Luciano Garcia Lourenção. E-mail: lucianolourencao.enf@gmail.com