GITIRANA, José Valdeci Almeida. Et al. Health education for disease prevention: a review of the literature. Revista Científica Multidisciplinar Núcleo do Conhecimento. Year. 06, Ed. 11, Vol. 08, pp. 134-147. November 2021. ISSN: 2448-0959, Access link: https://www.nucleodoconhecimento.com.br/health/education-for-disease, DOI: 10.32749/nucleodoconhecimento.com.br/health/education-for-disease
Currently public policies, government actions and different programs involving Health Education (HE) are carried out in favor of population health. With regard to the theme of HE, this is a multifaceted theme, convergent to various personal conceptions, whether in the area of education or health, which may result in divergent understandings. Due to the complexity of the theme, the problem occurs due to the lack of understanding of what is really population-facing HE, dissolving the importance of HE for preventive measures against different diseases, which generates a high budgetary cost in public health. In view of this context, this article has as its main question: How can health education contribute to the prevention of diseases in the population? The study aimed to present the HE for Disease Prevention (DP), branching out in addressing its concepts, as well as highlighting the legal bases that ensure the HE to the population. To this end, the study was conducted through a literature review by the search sites “Google Scholar”, “Scielo” and “PubMed”. Through the descriptors: Health Education; Health education as disease prevention; Health Education for the population, where studies were chosen that presented the HE focused on DP. It is concluded that The HE is the education for self-knowledge and reflection on their own health, as well as the full awareness that something goes wrong, attributing the critical reflection of the subject regarding their habits and preventive measures. It is applied through the school curriculum from primary school as well as by government programs in health centers, in order to educate society to raise awareness about preventive measures and promote a better quality of life, thus preventing the spread of diseases.
Keywords: Health Education, Disease Prevention, Health Promotion, Population.
Health Education (HE) is a social practice whose learning process contributes to the formation of critical personal awareness regarding health problems themselves, making the citizen reflect on their reality, and from it, seek solutions and organization in favor of their health and collective health, result in a Health Promotion (HP) (BISCARDE; PEREIRA-SANTOS; SILVA, 2014).
The origins and conceptions of HP began with the advent of HE at the beginning of the 20th century, through the observation of the decrease in illness rates resulting from educational practices performed by “hygienists” of the period (ENRIA; STAFOLANI, 2010). At that time, the meaning of HP was attributed to the actions of ES, with the aim of a better quality of life. However, The HE currently has an amplified characteristic, since it is considered one of the main devices for the viability of HP, leading to the development of individual responsibility and disease prevention (DP) (LOPES; Hail; XIMENES, 2010; FALKENBERG et al., 2014; SPERANDIO; SPERANDIO, 2018).
Although the ES is understood as one of the measures for the DP (JANINI; BESSLER; VARGAS, 2015; SPERANDIO; SPERANDIO, 2018), it is a multifaceted theme, convergent to various personal conceptions, whether for people in the area of education, or in the area of health, which may result in divergent understandings. (SCHALL; STRUCHINER, 1999).
Due to the complexity of the theme, the problem occurs due to the lack of understanding of what is really population-facing HE, dissolving the importance of HE for preventive measures against different diseases. Because of this, many diseases that could be avoided are often evidenced to have a major impact on the public budget. Therefore, the present study was to answer the question: How can health education contribute to the prevention of diseases in the population? Through a literature review, the general objective sought to present how HE can promote PD, branching out in addressing its concepts, as well as highlighting the legal bases that ensure HE to the population.
To this end, the study was conducted through a literature review by the search site “Google Scholar”, “Scielo” and “PubMed”. Through the descriptors: Health Education; Health education as disease prevention; Health Education for the population. As a way of inclusion, articles and documents were chosen between 2018 and 2020, composing the necessary structure to achieve the desired objective. Subsequently, 20 articles were found, of which 8 were selected. The articles that answered the objective and the guide question and were within the proposed time frame were included. Studies aimed only at health professionals or undergraduate skilled in the health area were excluded.
The theme is relevant today, since HE can influence the population’s ability to reflect to combat different diseases, resulting in better life habits. It may be relevant for lay people or for students and professionals in the academic field, serving as a source for future studies because it is enlightening the concept of HE for the population as inseparable from the DP, providing a language that is easy to understand.
2. THE INDISSOCIABILITY OF HEALTH EDUCATION AND DISEASE PREVENTION
HE is planned and applied in different ways, such teaching modality can be aimed at undergraduate students in the health area; for health professionals; for school education and for the population in general. Indeed, it tends to be understood in different ways, meeting the cultural and social formation of each one. However, this study emphasizes ES for the population as inseparable from DP, since ES is “[…] linked to the general objectives of public health: disease prevention, protection and health promotion of the individual, family and of the community”. (PIMONT, 1997, p. 17).
To better contextualize the understanding of this inseparability, it is important to highlight that the HE is one:
Processo educativo de construção de conhecimentos em saúde que visa à apropriação temática pela população […]. Conjunto de práticas do setor que contribui para aumentar a autonomia das pessoas no seu cuidado e no debate com os profissionais […] a fim de alcançar uma atenção de saúde de acordo com suas necessidades. (BRASIL, 2012, p. 19).
As presented in the “Thematic Glossary: work management and health education” the HE causes the desirable autonomy so that people can express themselves effectively in order to evidence their specific needs in their clinical care, contributing to the care of the health professional to promptly treat the diseases, as well as prevent other secondary diseases. Complementing this definition, it is presented in the document of the National Health Foundation (FUNASA) Brasil (2007), that HE is a social practice, reaffirming that its intention weaves into a transformation for any type of person “[…] breaking with the paradigm of static conception of education as transfer of knowledge, skills and skills”. (BRASIL, 2007, p. 20).
Pimont (1997, p. 15) summarizes and analyzes different concepts adopted, emphasizing that ES aims to provide:
1) A consciência do direito à saúde, dentro do grau de desenvolvimento do grupo social no qual vive o indivíduo; 2) O conhecimento sobre saúde; 3) O conhecimento dos serviços para a saúde que a comunidade possua e sua consequente utilização; 4) O conhecimento e a utilização das práticas de saúde.
However, the author assimilates that for this teaching to be transformed into knowledge in order to promote the HP and DP, it is necessary that a planning is structured, attenuating an adequate educational methodology, composed of auxiliary instruments, which can then result in a constant educational process.
According to Altuve (1996), in order for HE to become knowledge, the organization of the community already becomes a method that produces social change, because in the midst of efforts and techniques, its application results in the induction and promotion of significant social change, encompassing all social sectors, such as the relationship of economic, political and educational levels.
Therefore, according to the cited authors, HE can be inseparable from DP to the population, when transmitted methodologically. However, the present study does not intend to deepen these methodologies, but also to conceptualize HE as DP for the population.
2.1 LEGAL BASES FOR HEALTH EDUCATION FOR THE POPULATION
With a focus on HE in Brazil, in August 1971 Law 5692 was created, reformulating the school curriculum in primary and secondary education implementing health-oriented education as presented in Article 7:
Art. 7º Será obrigatória a inclusão de Educação Moral e Cívica, Educação Física, Educação Artística e Programas de Saúde nos currículos plenos dos estabelecimentos de lº e 2º graus, observado quanto à primeira o disposto no Decreto-Lei n. 369, de 12 de setembro de 1969. (Vide Decreto nº 69.450, de 1971)
Later programs such as “Health at school”, were used as an intersectoral strategy developed in the school space and its surroundings, articulating actions aimed at THE and quality of life, together with the reflection on DP and knowledge of the Unified Health System (SUS) (BRASIL, 2012). This context can be punctuated by the fact that the actions for the HE are implemented throughout life, from the first phase of school education, so that people develop a critical, reflective and conscious sense gradually.
By positively erupting the scope of programs aimed at HE and DP, different laws were created, according to the legal bases presented in Table 1 below:
Table 1 – Legal bases of Health Education.
Fonte: Adaptado de Brasil (2012); Sousa, Guimarães e Amantes (2019).
The framework presents the laws, where some educational bases for the applicability of HE in school are highlighted, even if such guidelines are focused on the school environment, the curricular purposes guide the formation of people who understand the importance of HE and who through this knowledge can promote care for personal and population health, also composing the benefactor of the PD.
Today the United Nations presents the third objective in the “Agenda 2030”, and with global support, it is intended through the action, “To ensure a healthy life and promote well-being for all and all, at all ages” (ODS, 2021) regardless of social class, race or color.
The place on the 2030 agenda is in line with the perspective of SHALL (1999), when it attenuates that the definition for HE needs to be broader than simply an action resulting from the HP, since it focused on the population goes through a comprehensive process of the active participation of the entire population in the context of their daily life and not only of people who are at risk of falling ill, being then a way to prevent diseases for healthy people, establishing a better quality of life and greater well-being for all.
2.2 STUDIES RELATED TO DISEASE PREVENTION THROUGH HEALTH EDUCATION
Next, the main findings about DP will be presented as a result of the application of HE, available in the scientific literature, between the years 2018 and 2020. Next, table 2 shows a synthesis of the 8 previously selected articles presented in chronological order, where the methodologies used in each study will be explained later.
Table 2 – Studies related to Health Education as disease prevention.
|Dias et al. (2018)||Report the experience of a health education action with elementary school students from a public school in rural areas.||Children are exposed to the risk of contamination by parasites, given the sanitary conditions they inhabit, evidencing the need to expand health education actions about the importance of preventing parasites.|
|Salci, Meirelles e Silva (2018)||Understand how the members of the Family Health Strategy organize themselves for health education, in the management and prevention of chronic complications of diabetes mellitus in Primary Health Care||It is considered that the practice of health education for people with diabetes
mellitus in Primary Health Care composes a multifaceted context, with multiple barriers to its execution.
|Gomes et al. (2019)||Report educational action in a group of men in order to seek a better understanding of penile cancer and prevention and early detection measures.||Knowledge about penile cancer still needs to be better worked out among men.|
|Figueiredo; Antunes e De Miranda (2019)||Lead to the creation of public health education policies, with specific school care and due referral of students with obesity to health units||Public Policies are essential for communication and strengthening all measures and guidelines in the areas of education and health. Interdisciplinarity will promote the desired transformations, through prevention actions, with the aim of reducing the involvement of obesity and its consequences, in the younger age groups, as well as the reduction of cardiovascular diseases in the early phase of life and in adulthood.|
|Ricci et al. (2019)||Report the experience of academics from the Federal University of Mato Grosso do Sul (UFMS) during an action developed with the group of pregnant women of a Basic Health Unit in Campo Grande – MS (UBS).||Realization of health education on Sexually Transmitted Infections (STIs) during pregnancy proved effective in providing dialogue, interaction, the exchange of experiences, knowledge and experiences, and the joint construction of knowledge, being then evidenced as important for health promotion and disease prevention, and for the development of a critical and reflective awareness of pregnant women about their health-disease process, by making them active in the learning process.|
|De Sousa Gonçalves et al. (2020)||To know the work of health education of a basic health unit in the municipality of Imperatriz – MA.||It is perceived that it is essential to constantly improve the knowledge and practice of professionals to develop health education actions. It is necessary to expand educational actions within the area of responsibility of each team, as well as a more active participation of all members of the family strategy team, as well as the professionals of the family health support center (NASF).|
|Lima et al. (2020)||Describe the experience as nursing students in health education activities for the prevention of cardiovascular diseases in the elderly.||Health education practices are transformative and bring important contributions to gerontological nursing, as it enables the exercise of critical-reflective thinking and contributes to the training of professionals committed to work in a care model, based on scientific evidence and capable of meeting the needs of the elderly population, which has been growing over the years.|
|Costa et al. (2020)||To report an action of health education occurred in the scope of primary health care, whose proposal was to prevent breast cancer from the prior recognition of its manifestations, as well as the maintenance of healthy habits, aiming at promoting the health of these women.||The action developed served as a consolidating mechanism of the aspects that constitute health education, reiterating the fundamental role of nursing in the care process.|
Fonte: O autor.
Dias et al. (2018), through an experience report with the extra-class activity method of the curricular component “Scientific Project Integrating Nursing Undergraduate Program” at Faculdade Verde Norte, carried out in October 2016 at the Odilon Antunes Municipal School, in Poções village in the city de Monte Azul, a health education action with the involvement of 30 students, 03 teachers and 09 parents. The action took place in the steps of dialogic display of the content and in the display of the video that triggers the discussion, being debated in a round of conversations with the public. Thus, the study provided preventive measures for contamination by parasitic diseases.
Salci; Meirelles e Silva (2018) conducted a qualitative study, composing Complex Thinking as a theoretical reference and evaluative research as a methodological reference. For data collection, 38 health professionals interviewed patients with Diabetes Mellitus. The health agents observed and analyzed the patients’ medical records, through the triangulation of the data with the support of the ATLAS.ti software. The authors observed that according to the complexity of the multifaceted theme, HE can promote primary and secondary DP.
Corroborating this complexity, Figueiredo; Antunes and De Miranda (2019) conducted a bibliographic review research, applying the exploratory research method. The authors related the prevention of comorbidities and cardiovascular diseases to the public policies of HE in the school environment. Therefore, they highlighted that the interdisciplinarity that involves HE can promote the desired transformations in students, through prevention actions, preventing cardiovascular diseases in childhood and adulthood.
Lima et al. (2020) in a similar study, but aimed at the elderly public, they observed through an experience report, through the descriptive method, with a qualitative approach, experienced in the “Health Care Program for the Elderly – PROASI”, that the activities of HE serve as a tool in the prevention of cardiovascular diseases, causing a critical-reflexive thinking to their own health and quality of life.
Gomes et al. (2019) through the exploratory descriptive study of the type of experience report, they applied an activity carried out in March 2018 in a church located on the outskirts of Belém/Pará. The participating public was composed of twenty-three men aged 18 to 50 years who were submitted to lectures with the presentation of banners; explanation of penile cancer; care for DP and demonstration of penile prostheses. The authors observed through the conversation wheel with the participants, who few knew about the theme of penile cancer. Therefore, the authors warned about the importance of implementing HE programs focused on DP such as penile cancer, because with programs focused on HE this and other diseases can be considerably decreased in the population.
Still in the context of cancer prevention, Costa et al. (2020), conducted a descriptive study with a qualitative approach, of the type of experience report. The study was carried out in the hospital scope, found in the peripheral region of the city of Belém- PA, in a health unit with professionals who promote a modality of health treatment focused on the primary level of diseases. The treatments aimed at the female public are consolidated in the implementation of the “Programa Saúde da Mulher”, in which patients are treated with prenatal care; childbirth; postpartum; care for families; programs for the prevention of breast and uterine cancer; IST. This program is composed of professionals from diverse health areas, together with the various types of clinical analyses for the adoption of preventive measures, promoting the previous diagnosis of pathologies such as cancer. With the implementation of an educational action in the program, health professionals followed the patients in their consultations, and similarly to the study by Gomes et al. (2019) exposed folders; anatomical presentations of the breast; among other educational and interactive activities. Therefore, the authors elucidated that the 16 participants had a greater reflection on the importance of self-care and understood the importance of HE for the prevention of breast cancer.
With regard to this reflection cited by Gomes et al. (2019), Ricci et al. (2019) corroborate that such a process of reflexive awareness occurs through dialogue; interaction; exchange of experiences; knowledge and experiences and the joint construction of knowledge, being then, such elements evidenced as important for the HP and the DP. This observation was evidenced through the study that occurred on March 15, 2017, in the first night in the meeting room of a Basic Health Unit of Campo Grande – MS. A methodology was used in a strategic way composed of practices of ludicity with the aim of interactivity of the participants so that through pedagogical practice they could acquire the understanding of the theme in question. Initially, pregnant participants were invited through convocations by community agents in the region of the health unit. Later The action began with the icebreaker technique “Passing the baby”, in which the participants were presented identifying with their name, gestational age and choice of the child’s name. Through the dynamics, the pregnant women became aware about the diseases that could be prevented during pregnancy as well as the DP in the baby itself.
For this reflexive awareness to involve the family, De Sousa Gonçalves et al. (2020), carried out a quantitative work with analytical approach, based on a retrospective collection of the actions of HE carried out from February to September 2019. The research was carried out in a Basic Health Unit (UBS) of the municipality of Imperatriz in the state of Maranhão, in which it was composed of 3 family health strategy teams. Data was collected from the document collection with records of the actions of HE performed in the UBS and in the schools of the area, covered by each team in the aforementioned period, made available by the direction of the health unit. The authors analyzed that through HE not only chronic, sexual or infectious diseases can be prevented, but also prophylactic measures can result from programs that help these families.
3. FINAL CONSIDERATIONS
HE can promote DP through public policy programs aimed at implementing HE educational programs in schools, UBS, hospital networks as well as health posts. For this, its concepts can be widely presented, since HE is a complex and multifaceted theme.
Through the findings, it is considered that the HE can stimulate DP together with the HP for the population, when there is engagement of this target audience through methodologically planned activities and applied with the contribution of specific instruments for the development of learning. Regarding DP , there are several prophylaxis found in the studies: cardiovascular, diabetes, chronic non-communicable diseases, sexually transmitted infectious diseases, parasitic diseases, cancers, among others.
In the context of laws and legal bases for HE, it is aimed at a great expectation in students of the early stages and high school, since the educational process is not imposed in adulthood but can be built during the course of life, becoming knowledge.
Therefore, in response to the right-thinking question, it is concluded that the HE is the education for self-knowledge and reflection on their own health, as well as the full awareness that something goes wrong, attributing the critical reflection of the subject regarding their habits and preventive measures, thus preventing diseases. It is applied through the school curriculum from primary school as well as by government programs in health centers, in order to educate society to raise awareness about preventive measures and promote a better quality of life.
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APPENDIX – REFERENCE FOOTNOTE
7. People who were part of the doctrine of hygienism, a doctrine born in the mid-nineteenth century, when the rulers gave greater attention to health, along with the morale of the population. At that time the disease was considered a social phenomenon involving all aspects of human life, it is through this context that the treatment of water, sewage, street lighting arises, in order to control or eliminate the pandemies (ABREU JUNIOR; OAK, 2012).
 Graduated in Pharmacy, post-graduated in Clinical Analysis, Currently medical academic.
 Medical scholar.
 Graduated in business administration. Graduated in foreign trade, currently a medical student.
 Graduated in food engineering, post-graduated in industrial process engineering, CBA in business management, and currently medical student.
 Medical scholar.
 Medical scholar.
Submitted: September, 2021.
Approved: November, 2021.