Individual and contextual factors and professional qualification completion for obesity management: a cross-sectional study, Brazil, 2021–2022

Silva, Angélica Ribeiro e; Ferreira, Nathália Luíza; Freitas, Patrícia Pinheiro de; Lopes, Mariana Souza; Lopes, Aline Cristine Souza

doi:10.1590/S2237-96222026v35e20251154.en

Objective: To identify the individual and contextual factors associated with completion of distance professional qualification for the collective management of obesity in the Brazilian Unified Health System (Sistema Único de Saúde, SUS).

Methods: A cross-sectional study with health professionals and students. The 40-hour course included tutoring and was based on material developed by the Ministry of Health. The individual factors analyzed included sociodemographic and professional data collected at the beginning of the course, and the contextual factors comprised economic and demographic data from the States and the Federal District where participants worked, obtained from institutional websites. Participants who completed all activities were considered to have completed the course. Due to convergence failure of the contextual variables in the multilevel logistic regression, a multivariate logistic regression was performed, including adjusted odds ratios (OR) and 95% confidence intervals (95%CI), adjusted for sex, age, and macro-region of the country.

Results: A total of 3,975 individuals enrolled in the course; 1,620 (40.8%) accessed the virtual platform. Most were women (91.0%) and dietitian (56.7%) and worked in the Southeast macro-region (54.8%) and metropolitan areas (51.0%). After model adjustment, being a dietitian (OR 1.55; 95%CI 1.09; 2.19) and having prior access to printed/digital materials on the topic (OR 1.27; 95%CI 1.04; 1.56) were found to increase the odds of completing the professional qualification.

Conclusion: Completion of the professional qualification was associated with being a dietitian and with prior access to printed/digital materials on the topic, highlighting the importance of professional category and prior exposure to the topic in promoting engagement and course completion.

Keywords:
Obesity; Education, Continuing; Education, Public Health Professional; Unified Health System; Cross-Sectional Studies

[TFN1] ^a 678 missing data; ^b 26 missing data.

Variable	Total	Participants who completed the course	Participants who did not complete the course (n=714)	p-value
	(n=1,620)	(n=906)
	% (95%CI)	% (95%CI)	% (95%CI)
Female sex	91.0 (89.6; 92.3)	91.4 (89.4; 93.0)	90.6 (88.2; 92.5)	0.588
Profession				0.026
Dietitians	56.7 (54.2; 59.1)	59.8 (56.6; 63.0)	52.7 (49.0; 56.3)
Nurse	9.8 (8.5; 11.4)	8.6 (6.9; 10.6)	11.3 (9.2; 13.9)
Undergraduate student	15.9 (14.2; 17.8)	15.3 (13.1; 17.8)	16.7 (14.1; 19.6)
Other professions	17.6 (15.8; 19.5)	16.2 (14.0; 18.8)	19.3 (16.6; 22.4)
Educational level				0.096
Complete high school	19.7 (17.9; 21.8)	18.8 (16.3; 21.4)	21.0 (18.2; 24.2)
Complete higher education	26.0 (23.9; 28.2)	24.3 (21.6; 27.2)	28.1 (25.0; 31.6)
Specialization/residency	40.9 (38.5; 43.3)	43.3 (40.1; 46.5)	37.8 (34.3; 41.4)
Master’s/doctoral degree	13.4 (11.8; 15.1)	13.7 (11.6; 16.1)	13.0 (10.7; 15.7)
Employment relationship				0.013
Temporary contract	17.0 (15.3; 18.9)	17.7 (15.3; 20.3)	16.2 (13.7; 19.1)
Formal employment contract	11.7 (10.2; 13.4)	10.9 (9.0; 13.1)	12.7 (10.5; 15.4)
Civil service position	30.7 (28.5; 33.0)	33.5 (30.5; 36.7)	27.0 (23.9; 30.4)
Other	40.6 (38.2; 43.0)	37.9 (34.7; 41.1)	44.0 (40.4; 47.6)
Level of care in which they work^a				0.212
Primary	72.4 (69.4; 75.2)	70.2 (66.2; 73.9)	75.4 (70.9; 79.3)
Specialized	15.6 (13.4; 18.1)	16.8 (13.9; 20.3)	13.9 (10.9; 17.7)
Both	12.0 (10.1; 14.2)	13.0 (10.4; 16.1)	10.7 (8.0; 14.1)
Previous participation in professional qualification on the topic	24.8 (22.8; 27.0)	28.0 (25.2; 31.0)	20.7 (17.9; 23.9)	0.001
Access to printed/digital materials on the topic^b	53.3 (50.9; 55.8)	56.5 (53.2; 59.7)	49.3 (45.6; 53.0)	0.004
Use of materials to support actions on the topic	58.3 (55.9; 60.7)	61.0 (57.8; 64.2)	54.9 (51.2; 58.5)	0.013

Variable	Total	Participants who completed the course (n=906)	Participants who did not complete the course (n=714)	p-value
	(n=1,620)
	% (95%CI)	% (95%CI)	% (95%CI)
Macro-region of work				0.097
North	6.6 (5.5; 7.9)	6.2 (4.8; 7.9)	7.1 (5.5; 9.3)
Northeast	23.5 (21.5; 25.6)	24.3 (21.6; 27.2)	22.5 (19.6; 25.8)
Central-West	3.6 (2.8; 4.6)	2.6 (1.8; 3.9)	4.8 (3.4; 6.6)
Southeast	54.8 (52.4; 57.2)	54.4 (51.1; 57.6)	55.3 (51.6; 58.9)
South	11.5 (10.0; 13.1)	12.5 (10.5; 14.8)	10.2 (8.2; 12.7)
Lives in the capitals of the states and the Federal District^a	39.8 (37.4; 42.3)	38.2 (35.0; 41.5)	41.9 (38.2; 45.7)	0.137
Lives in a metropolitan area^a	51.0 (48.5; 53.5)	49.8 (46.4; 53.1)	52.5 (48.7; 56.2)	0.287
Population density (inhabitants / km²)				0.045
2,53-35,02	56.9 (54.5; 59.4)	54.3 (51.0; 57.5)	60.4 (56.7; 63.9)
35,03-59,05	10.2 (8.9; 11.8)	10.6 (8.7; 12.8)	9.8 (7.8; 12.2)
59,06-489,01	32.8 (30.5; 35.1)	35.1 (32.0; 38.3)	29.8 (26.6; 33.3)
Prevalence of obesity in 2023	23.2 (23.1; 23.3)	23.1 (23.0; 23.3)	23.3 (23.1; 23.5)	0.423
Family Health Strategy coverage	70.4 (69.7; 71.2)	70.3 (69.3; 71.4)	70.5 (69.4; 71.7)	0.810
Total annual health expenditure (BRL/inhabitant)				0.018
501,72-584,61	59.7 (57.3; 62.1)	56.8 (53.5; 60.0)	63.5 (59.9; 67.0)
584,62-598,64	16.6 (14.9; 18.5)	17.3 (15.0; 20.0)	15.7 (13.2; 18.5)
598,65-2059,13	23.7 (21.6; 25.8)	25.9 (23.1; 28.9)	20.8 (17.9; 24.0)

Variable	Total	Participants who completed the course (n=906)	Participants who did not complete the course (n=714)	p-value
	(n=1,620)
	Mean (95%CI)	Mean (95%CI)	Mean (95%CI)
Total population (million inhabitants)	17,1	17	17,2	0.748
	(16,500; 17,700)	(16,200; 17,800)	(16,400; 18,000)
Monthly per capita household income (BRL)	1,559.81	1,558.54	1,561.43	0.890
	(1,539.43; 1,580.20)	(1,531.49; 1,585.59)	(1,530.35; 1,592.50)
Municipal Human Development Index	0.754 (0.752; 0.756)	0.755 (0.752; 0.757)	0.753 (0.751; 0.756)	0.596
Gini coefficient	0.512 (0.511; 0.514)	0.512 (0.510; 0.515)	0.513 (0.510; 0.515)	0.790
Health workers rate (per 1,000 inhabitants)	1.27 (1.23; 1.32)	1.28 (1.22; 1.34)	1.27 (1.20; 1.33)	0.807
Higher education institution offering health-related courses	180.2 (177.3; 183.1)	180.6 (177.0; 184.2)	179.3 (174.3; 184.3)	0.679

Variable	Initial model	Final model
	OR (95%CI)	OR (95%CI)
Profession
Nurse	1.00	1.00
Dietitian	1.63 (1.13; 2.34)	1.55 (1.09; 2.19)
Undergraduate student	1.18 (0.78; 1.77)	1.09 (0.74; 1.64)
Other	1.46 (0.81; 2.64)	1.36 (0.89; 2.10)
Educational level
Complete high school	1.00	-
Complete higher education	0.83 (0.57; 1.21)	-
Specialization/residency	1.09 (0.78; 1.52)	-
Postgraduate degree	0.83 (0.61; 1.14)	-
Employment relationship
Temporary contract	1.00	-
Formal employment contract	0.83 (0.56; 1.21)	-
Civil service position	1.09 (0.78; 1.52)	-
Other	0.83 (0.61; 1.14)	-
Length of practice in the Brazilian Unified Health System (Sistema Único de Saúde, SUS)	1.01 (0.99; 1.03)	-
Previous participation in professional qualification activities on the topic	1.18 (0.91; 1.54)	-
Access to printed/digital materials on the topic	1.16 (0.90; 1.49)	1.27 (1.04; 1.56)
Use of materials to support actions on the topic	1.0 (0.77; 1.29)	-

Individual and contextual factors and professional qualification completion for obesity management: a cross-sectional study, Brazil, 2021–2022

Factores individuales y contextuales y finalización de la capacitación profesional para el manejo de la obesidad: estudio transversal, Brasil, 2021-2022