Research Report
“The potential of focus groups
as a strategy for participatory technology development for promoting mental
health”[i]
Katyane
Heck Girardi[ii]
Universidade do Estado
de Santa Catarina (UDESC)
Florianópolis, SC - Brasil
lattes.cnpq.br/3045738475356608
Leila
Zanatta[iii]
Universidade do Estado
de Santa Catarina (UDESC)
Florianópolis, SC - Brasil
lattes.cnpq.br/8690234560867282
Denise
Antunes de Azambuja Zocche [iv]
Universidade do Estado
de Santa Catarina (UDESC)
Florianópolis,
SC - Brasil
lattes.cnpq.br/0777467805281716
Research Report “The potential
of focus groups as a strategy for participatory technology development for
promoting mental health”
Abstract
Due to the high demands in the
mental health field, this study aimed to present the use of FG as a tool for
the participatory technology development for promoting mental health in Primary
Health Care (PHC). This action research was performed in a city in the Midwest
of Santa Catarina, Brazil. Data were collected through a focus group that met
once. Two professors from the Professional Master’s Program in PHC Nursing and
15 PHC workers from the mental health field participated in the focus group.
The information was collected in October 2022, and the data treatment was
guided by content analysis. The health workers’ experiences in mental health include
a concern with adolescents and women, as they identify the need to implement
care practices to strengthen protective and preventive mental health factors.
Educational gymkhanas, online psychoeducational interventions, and a podcast
emerged as care strategies to be implemented in mental health within PHC. The
perceptions of the PHC workers regarding mental health needs and demands
enabled defining the public audience and the educational technology that needs
to be developed to promote and protect the mental health of PHC service users.
Keywords: primary health care;
focus groups; mental health; educational technology.
Relato de Pesquisa “O
potencial do grupo focal como estratégia para o desenvolvimento participativo
de uma tecnologia para promoção da saúde mental”
Resumo
Devido à
alta demanda de atendimentos no campo de saúde mental, este estudo teve por
objetivo apresentar o grupo focal como uma ferramenta para o desenvolvimento
participativo de tecnologia para a promoção da saúde mental na Atenção Primária
à Saúde. Trata-se de uma pesquisa-ação, desenvolvida em um município localizado
no Meio Oeste de Santa Catarina. A coleta de dados se deu através de um grupo
focal, realizado em um único encontro. Dois docentes do Programa de Mestrado
Profissional de Enfermagem na APS e quinze profissionais de saúde, atuantes na
APS, no campo de saúde mental participaram do grupo focal. As informações foram
produzidas no mês de outubro de 2022 e o tratamento dos dados foi guiado pela
análise de conteúdo. Dentre as vivências relatadas pelos profissionais de saúde
na assistência em saúde mental está a preocupação acerca dos adolescentes e das
mulheres, identificando a importância e a necessidade da realização de práticas
de cuidado pensando em fortalecer os fatores de proteção e prevenção em saúde
mental. A gincana educativa, as intervenções psicoeducativas on-line, e o
podcast, emergiram como estratégias de cuidado em saúde mental na APS. As
percepções dos profissionais de saúde da APS, acerca das necessidades e demandas
locais de cuidado em saúde mental, possibilitaram definir o público-alvo e a
tecnologia educacional a ser construída, voltada à promoção e proteção da saúde
mental dos usuários na APS.
Palavras-chave: atenção primária à saúde; grupo focal; saúde mental;
tecnologia educacional.
1
Introduction
Primary Health Care (PHC) professionals must
develop technologies and care strategies to promote the health of individuals
and families, as between a third and half of the population may experience
psychological distress throughout life if no specific interventions are
implemented (Melo; Pauferro, 2020).
Caring-Educational Technologies (CET) are
understood as a set of knowledge/scientific concepts derived from realized
processes that support the operationalization of the process of caring for and
educating others (Salbego et al., 2018).
Health education technologies emerge in the health
field to facilitate care delivery and health education processes. Implementing
such technologies in individuals daily lives effectively promotes reflective,
creative, and transforming knowledge, enabling people to become autonomous and
understand their life and health conditions (De Melo Lanzoni et al.,
2015). Hence, actions in mental health services are needed to prevent harm and
promote healthier behaviors among individuals (Fernandez et al., 2020).
The health field, especially graduate programs, has
contributed to the production of knowledge and technologies to transform and
change services through interventionist research, including action research,
which uses the collection of data and collaborative strategies to jointly build
new knowledge intending to solve problems or transform contexts (Zocche; Primo;
Leal, 2022). According to Vantil and collaborators, the participants in this
type of research share the experience of producing knowledge to develop
technologies and products necessary to solve the problems identified in a given
work context (Vantil et al., 2020).
Studies have adopted the focus group (GF) technique
in the Seminar stage, which, in addition to expanding the participation of
research subjects, also serves as an instrument to collect data, supporting the
development of technologies and educational products (Silva; Castilho, 2022).
Focus groups within PHC in the nursing field allow the participants to reflect
and act upon professional practice, providing helpful information to improve
the quality of health services and guide public policies (Zocche; Rosa;
Zanatta, 2021).
Thus, this study’s objective is to present the use
of FG as a tool for the participatory technology development for promoting
mental health in Primary Health Care.
2 Method
This action research was developed through five
phases adapted from the method described by Thiollent (2011). This paper
presents the second phase, the Seminar stage, where the FG technique was
implemented. This technique enables the participants and researcher to
interact, promoting the exchange of experiences, concepts, and opinions among
the participants and encouraging them to play an active role as they dialogue
and collectively construct the study’s results (Kinalski et al., 2017).
Inclusion criteria were: being a PHC physician,
nurse, nursing technician, physical therapist, psychologist, or social worker
involved with mental health care, or a community health agent (CHA) who is in
close contact with the community; and being working in a PHC service for at
least six months. The exclusion criterion was: being on sick leave. The
decision to include these PHC professionals was based on the fact that even
though each professional plays a specific role in care practice, the demand of
patients is the same; hence, all the team members must apply the construct and
commit collectively (BRASIL, 2006).
The health professionals were intentionally
selected and personally invited to participate. Two professors from the
Professional Master’s Program in Nursing in Primary Health Care (PHC) and 15
PHC professionals participated in the FG: one physician, four nurses, five
nursing technicians, one psychologist, one physical therapist, and three CHAs
working in the mental health service from a town located in the Midwest of
Santa Catarina, Brazil. The FG was held in October 2022 and lasted 75 minutes.
The participants sat around a table so that everyone could see each other and
watch the multimedia exhibition, ensuring face-to-face interaction. The
activity was coordinated by a moderator (the study’s author, a master’s
student), with the support of the research co-advisor and an observer (research
advisor).
The FG was divided into three parts: first, the
participants were welcomed, the researchers were introduced, and the study’s
objective was presented, after which the participants introduced themselves and
received clarification about the FG’s session and organization and the time the
session would end. Next, the data collected in the study’s first stage
(exploratory stage) were presented, including a) the characterization of the
patients with psychological distress attending the service, mostly women aged
between 50 and 54. The most prevalent health problem/condition was Anxiety; b)
the individual interviews held previously with the professionals, which aimed
to identify health promotion practices implemented in the work process; and c)
the results of an integrative literature review on Educational Technologies
(ET) that collaborated to promote the mental health of PHC users. Infographics
containing the study’s results were presented in the first part of the FG
session to promote reflection and debate. The debate followed a semi-structured
script to promote a participatory discussion around the topic and material
presented. In the third part, after the debate, the central ideas raised in the
discussion were summarized and validated, and the session ended. The focus
group session was audio recorded and transcribed for further analysis.
Bardin content analysis was used in data analysis
(BARDIN, 2016). A field diary was also adopted for the researcher to record
observations and impressions. It was a recording and support instrument, as the
analyses were based on the participants’ reports. According to Minayo (2000, p.
295), “the collection of impressions and notes on the differences between
reports, behaviors, and relationships can make field research more real”.
The transcribed material was read to enable an
understanding of the meanings of the professionals’ reports, from which two
thematic categories emerged.
The study complied with Resolutions No. 466/12 and
No. 510/2016 of the Brazilian National Health Council, which guides research
with human beings subjects. Additionally it was submitted to and approved by
the Institutional Review Board at the State University of Santa Catarina
(Opinion report No. 5.538.518, July 21st, 2022), CAAE n. 58479622.7.0000.0118.
The participants’ identities remained confidential, so the initials “CHA”
(Community Health Agent), “SW” (Social Worker), “N” (Nurse), “PT” (Physical
therapist), “P” (Physician), “PSY” (Psychologist), and “NT” (Nursing
Technician) were followed by sequential numbers: SW1, P1, N2, NT2, CHA3,
respectively. All the participants signed free and informed consent Forms.
3 Results
Most of the participants in the FG were women
(n=14), in relation to age group, 2 (14,3%) were between 25-29 years old; 4
(28,6%) were 30-34 years old; 3 (21,4%) were 35-39 years old, 1 (7,1%) were
40-44 years old; 3 (21,4%) were 45-50 years old and 1 (7,1%) 51-54 years old,
and had a professional experience of 8.5 years on average. Next, the data
composing the thematic categories are presented: the concerns and difficulties
health professionals experienced in mental health care and mental health care
strategies in primary care.
3.1 The concerns and difficulties health professionals
experienced in mental health care
This category presents the participants’
perceptions of the difficulties experienced during assistance provided to
people with mental health conditions within PHC. Note that the reports mainly
focused on defining the public to whom the actions are intended.
The first weakness the PHC professionals mentioned
concerns the service users' difficulty acknowledging their mental health
problems. For example, denying that they have a mental disorder configured a
barrier that prevented the implementation of actions, as the following report
shows:
We note that patients resist acknowledging their mental problems. They
believe it is taboo, a prejudice on top of that, not even relating the
medication to their pathology (N2).
Sometimes the patient takes a medication, and when they are filing in
the registration, they’d say that they do not have a mental condition (N1).
Yeah, we live in a society that
still has “pre-conceptions”. You know, going to a psychologist or a
psychiatrist is for crazy people. But it is a change that takes time, and we
see this situation frequently in our population(N2).
Another concern the professionals markedly
mentioned was toward adolescents due to fear of the impacts of the Covid-19
pandemic and its implications for this population’s mental health.
You
could see that she needed help. It’s a phase; it will pass, but if you don’t
bring her here, don’t seek help; how will she be diagnosed? We can’t reach a
diagnosis. We can visit and see her condition, but the parents are the ones who
have to bring her, especially when it’s a minor. [...] I think that the
pandemic was when young people became more anxious and did not know how to deal
with what happened. I think that nowadays anxiety symptoms are the most
prevalent among youngsters”(CHA1).
The participants mentioned the importance and the
need to implement care practices among adolescents to strengthen protective and
preventive mental health factors. “Considering health promotion; if you prevent
it now during adolescence, you won’t need to treat them later” (P1).
Note that the participants discouraged the use of
digital technologies to provide education to adolescents. “Young people are
already in poor health because they are on their mobile phones, playing games”
(CHA3).
The discussion following the data presentation
showed that women were the population that most frequently sought assistance in
the last three years. Most participants considered women to be the technology’s
target audience.
Other issues the professionals discussed concerned
the family relationships of patients in mental distress. This population,
primarily women, often raised complaints from their family context.
[...] We know that the mother, as always, is concerned with her
children and absorbs it all. So, there are many problems, especially anxiety,
the most frequent complaint, which is strongly related to family problems.
[...] They are the ones who hold down the fort, for their children,
husband, and even the neighbor (N3).
Women are the ones making the family stick (N1).
The FG also discussed that the environment and
family standards reflect on the behavior of family members, and is a reference
for children and/or adolescents, as the reports show:
Many children and adolescents don’t know how to deal with parents with
a disorder, anxiety, or depression. So, they end up developing it; the
condition is passed from the parents to the children. I think this is an
interesting subject to discuss (P1).
We often associate the mother,
who has been dealing with a depressive condition for years, and then her
daughter comes, and we identify them both, including suicidal attempts (N2).
Regarding the definition of the target audience,
the results from the focus group’s discussion show the importance and the need
to implement care practices for two populations: women, who comprise most
patients experiencing psychological distress attending the PHC service in the
Vargem, SC, Brazil; and adolescents, intending to strengthen protective and
preventive mental health factors.
A
crucial aspect is to keep the health of these women facing illnesses balanced
and implement preventive measures among the next generation, the adolescents
(N2).
3.2 Mental health care
strategies in PHC
This category includes the participants’
suggestions about health promotion and mental health care strategies to be
implemented among PHC patients, CET to be developed, and its content. In this
study, we addressed the suggestions related to mental health promotion and
interventions, considering that the work of PHC professionals should go beyond
the care provided to patients with mental disorders and include activities to
promote and prevent mental health problems in the population.
Suggestions included online psychoeducational
interventions conducted by a psychologist (tele-psychotherapy) as an
opportunity to provide therapeutic support to decrease symptoms and improve the
patients’ physical and mental quality of life of both audiences.
Most participants mentioned online psychological
support as a resource to promote mental health and comfort those in distress.
The participants stated that such a service is an alternative to facilitate the
population’s access, enabling care to be provided to those people who want to
keep their treatment confidential and to those who are shy and do not like
face-to-face sessions, as noted below:
Many people are shy and don’t even want to come to the health unit
(NT3).
Without having a family member accompanying the consultation, people
feel more at ease to talk about their complaints (M1).
Some participants suggested refraining from using
digital technologies in the educational environment directed to adolescents
because youngsters are already immersed in digital technologies and social
networks.
Adolescents already spend much time on mobile phones (CHA3).
This increased prevalence of mental health disorders in this age group,
among adolescents [...] I think it’s because of this (mobile phone). So, if we
chose this method, we may lose a lot; hence, the idea is to bring them for
something different, something face-to-face (P1).
Therefore, they proposed an educational and
recreational approach, such as a gymkhana, in which playful and educational
aspects can be integrated, in addition to developing didactic materials, such
as infographics.
A gymkhana involving all the groups. I think this is something that
involves teenagers, I see myself back in my time when I was very involved in
this sort of thing, and the whole school would get involved. I think that it
would get their attention (PT1).
Having fun, being competitive, and having a goal (N2).
Learning too. We can use some things, some aspects that they will have
to research, they will have to go after and build materials (P1).
The other strategy proposed was an educational
podcast, produced by the inter-professional team and radio transmitted,
providing relevant information related to the risk factors for mental problems,
the leading mental disorders, symptoms that affect PHC patients, strategies and
tools for promoting mental health care, encouraging the use of Integrative and
Complementary Practices offered within PHC. Such a podcast would be directed to
both audiences as a mental health care strategy. Presenting this topic in depth
to the population is essential to implement preventive actions and promote
mental health.
[...] a healthy habit that was recently adopted, especially because of
technology, is staying at home and enjoying family time, forgetting about the
mobile phone, having dinner together, watching a TV show or reading something
together (P1).
Health education addressing the risk factors and showing that it is OK
to experience anxiety, have tachycardia, stress, sorrow, or feel like crying
(N2).
Some participants mentioned radio broadcasting
because it facilitates access to most of the population:
Our population has easy radio access, even in the interior. Some have
difficulties accessing the Internet, but we know everyone has radio (N2).
It’s in our culture to listen to the radio, especially during the day,
women, people in the interior, listen to radio (N1).
The previous discussion show that the FG was an
opportunity for reflecting on the work process, interacting and sharing
different practices and demands, where the participants expressed their
opinions, suggestions, and understanding about the development of educational
technology to promote the mental health of the users attending the city’s
health service.
4 Discussion
The literature highlights that people sometimes
refuse treatment, therapy, and care, often abandoning it, compromising their
health and aggravating mental disorders. In such a context, users may find it
challenging to access the service, and professionals cannot act and intervene
in times of crisis. Thus, patients’ denial is a challenge preventing the implementation
of resolving actions, as people have an internal struggle between their need
for treatment and their willingness to accept it (Rotoli et al., 2019).
As for concerns about adolescents’ mental health,
note that the literature points to the need to perform health education
activities focusing on the families to care for the adolescents’ mental health
(Almeida et al., 2020). Family members should be sensitized to perceive
changes in the adolescents’ behavior, seek help from health professionals, and
get guidance and treatment, preventing symptoms from becoming chronic and
causing more severe consequences (Prime; Wade; Browne, 2020). Santos (2021)
notes that anxiety was one of the factors leading adolescents to use the
Internet and social media more intensively during the Covid-19 pandemic.
Loiola et al. show that mental disorders are
more predominant among women than men, highlighting some aspects such as
potential external stressors, in which violence stands out, the demand from the
society that assigns roles and tasks to the female figure, and hormonal factors
and reproduction-related aspects, which can also lead to frustration and
distress (Loiola et al., 2020).
The diagnosed patient is usually the “tip of the
iceberg.” Most of the time, it is easier for people to blame a family member
for their misunderstood or unacceptable afflictions than express, acknowledge,
and work through their emotions, feelings, and thoughts that permeate their
families. Hence, this family member is the one to blame for the family’s
limitations, overloading one member but easing the tensions of others (Knewitz;
Boeckel, 2022).
Emotionally healthy relationships are protective
factors. The quality of interpersonal relationships and their affective
representations play an important role in determining vulnerabilities to
psychopathologies and promoting security and psychosocial adjustment. On the
other hand, insecure, disorganized, and indiscriminate bonds are related to
psychological distress among adolescents, exposing them to emotional and
affective vulnerability (Rodrigues; Mendes, 2019).
Among the therapeutic practices adopted in the
individuals’ routines to gradually reduce anxious and depressive symptoms,
online psychological care emerges as an alternative for providing mental health
care within PHC. It prevents the aggravation of mental disorders and promotes
mental health by providing active listening and comfort to patients in distress
(Araujo et al., 2020).
Studies suggest that online treatments are as
effective as the face-to-face model. Correia et al. highlight that
online psychological care is a feasible alternative to implementing
psychological interventions in times of crisis, confirming the possibility of
establishing bonds in the virtual model (Correia et al., 2023).
We know the intersectoral partnership between
health and education is vital to building strategies to promote adolescents’
health, favoring a broader understanding of their way of life, and encouraging
healthy behaviors (Tavares, 2020). The study developed by Costa et al.
considered gymkhanas an alternative to promote health education, as it enabled
uniting students as a team and aroused their interest through competitiveness,
providing a favorable environment for learning and expanding skills (Costa et
al., 2020). Such health education actions should enable dialogue, inquiry,
reflection, questioning, and professional cooperation (Melo; Pauferro, 2020).
A podcast is a compelling educational technology in
the teaching and learning process (Gomes et al., 2020). Bragé et al.
report the use of a podcast as an educational practice that allows listeners to
easily access scientific information to promote knowledge and learning (Bragé et
al., 2020).
5 Final considerations
Note that a FG is a valuable strategy to support
the construction and collective definition of an ET. The group made
observations that enabled recognizing local needs and demands, proposing
solutions to collective problems, and bringing research closer to clinical
practice.
The conclusion is that the perceptions and
experiences of PHC health professionals regarding mental health care needs
enabled defining the target audience and collectively building CET to promote
and protect patients’ mental health within PHC.
Future research is suggested, utilizing the FG
technique for the collective construction of CET that promote mental health in
PHC.
References
ALMEIDA, S.; BRITO, R.; ALVES, M.;
ABRANCHES, D.; WANDERLEY, D.; ROSSANO, C.; BARROS, R. COVID-19 pandemic:
practical guide for promoting the mental health of children and
adolescents. Resid Pediatr, [Rio de Janeiro], v. 10, n. 2, p.
1-4, 2020. Disponível em: https://doi.org/10.25060/residpediatr-2020.v10n2-318.
Acesso em: 17 maio 2023.
ARAUJO, M. P. B.; PACCIULIO, A. L. M.; MONTANHA, L. T.;
EMERICH, B. F.; PELLATI, G.; CAMPOS, R. O. Pandemia de COVID-19 e a
implementação de teleatendimentos em saúde mental: um relato de experiência na
Atenção Básica. Saúde em Redes, [s. l.], v. 6, n. 2, p. 23-29, 2020. Suplemento. Disponível em: https://doi.org/10.18310/2446-4813.2020v6n2Supp23-29. Acesso em: 15 maio 2023.
BARDIN, L. Análise de conteúdo. São Paulo:
edições, v. 70, 2016.
BRAGÉ, É. G.; DA SILVA RIBEIRO, L.; RAMOS, D. B.; FIALHO, I.
R.; DA ROCHA, D. G.; BUSATTO, C.; LACCHINI, A. J. B. Desenvolvimento de um
podcast sobre saúde mental na pandemia de COVID-19: um relato de
experiência. Brazilian Journal of Health Review, [s. l.], v.
3, n. 4, p. 11368-11376, 2020.
Disponível em: https://doi.org/10.34119/bjhrv3n4-382. Acesso em: 16 maio 2023.
BRASIL.
Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção
Básica. Política Nacional de Atenção Básica. Brasília, DF: Ministério da
Saúde, 2006. Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/politica_nacional_atencao_basica_2006.pdf. Acesso em: 13 out. 2021.
CORREIA, K. C. R.; ARAÚJO, J. L. D.; BARRETO, S. R. V.; BLOC,
L.; MELO, A. K.; MOREIRA, V. Saúde mental na universidade: atendimento
psicológico online na Pandemia da Covid-19. Psicologia: Ciência e
Profissão, [s. l.], v. 43,
e245664, 2023. Disponível em: https://doi.org/10.1590/1982-3703003245664. Acesso em: 16 maio 2023.
COSTA, A. D. J.; FURTADO, M. E. R.; MIRANDA, A. L.; CAMPOS,
A. C. V.; DA SILVA CASTRO, P. Gincana da saúde como estratégia de educação em
saúde para escolares na cidade Marabá, Pará. Brazilian Journal of Health
Review, [s. l.], v. 3, n. 4, p. 10014-10026, 2020. Disponível em: https://doi.org/10.34119/bjhrv3n4-229. Acesso em: 16 maio
2023.
DE MELO LANZONI, G. M.; MAGALHÃES, A. L. P.; COSTA, V. T.;
ERDMANN, A. L.; DE ANDRADE, S. R.; MEIRELLES, B. H. S. Tornando-se gerente de
enfermagem na imbricada e complexa fronteira das dimensões assistencial e
gerencial. Revista Eletrônica de Enfermagem, [Goiânia], v. 17, n. 2,
p. 322-32, 2015. Disponível em: http://dx.doi.org/10.5216/ree.v17i2.29570. Acesso em: 09 jun.
2022.
FERNANDEZ, M. V.; DE CASTRO, D. M.; FERNANDES, L. D. M. M.;
ALVES, I. C. Reorganizar para avançar: a experiência da Atenção Primária à
Saúde de Nova Lima/MG no enfrentamento da pandemia da Covid-19. APS
em Revista, [s. l.], v.
2, n.2, p. 114-121, 2020. Disponível
em: https://doi.org/10.14295/aps.v2i2.84. Acesso em: 07 out. 2021.
GOMES, R. M. C. M.; ALENCAR, M. P.; SANTOS, M. J. M. N.; DA
SILVA, R. S.; MESSIAS, J. B.; FLORÊNCIO, M. S. Café com Saúde: podcast como
ferramenta de ensino nos cursos de saúde. Brazilian Journal of
Technology, [s. l.], v. 3, n. 1, p. 48-58, 2020. Disponível em: https://doi.org/10.38152/bjtv3n1-002. Acesso em: 15 maio 2023.
KINALSKI, D. D. F.; PAULA, C. C. D.; PADOIN, S. M. D. M.;
NEVES, E. T.; KLEINUBING, R. E.; CORTES, L. F. Grupo focal na pesquisa
qualitativa: relato de experiência. Revista brasileira de Enfermagem, [s. l.], v.
70, p. 424-429, 2017.
Disponível em: https://doi.org/10.1590/0034-7167-2016-0091. Acesso em: 15 jan.
2022.
KNEWITZ, A. P.; BOECKEL, M. G. Disfuncionalidades das
famílias contemporâneas: queixas que levam à psicoterapia familiar. Contextos Clínicos, [s. l.], v. 15, n. 1, 2022.
Disponível em: https://doi.org/10.4013/ctc.2022.151.01. Acesso em: 17 mai.
2023.
LOIOLA, E. F.; COSTA, B. C.; OLIVEIRA, K. L. X.; BORGES, L.
D. A. R. Transtornos mentais evidentes no sexo feminino. Revista
Científica da Faculdade de Medicina de Campos, [s. l.], v.
15, n. 3, p. 72-76, 2020.
Disponível em: https://doi.org/10.29184/1980-7813.rcfmc.369.vol.15.n3.2020. Acesso em: 18 maio 2023.
MELO, R. C.; PAUFERRO, M. R. V. Educação em saúde para a
promoção do uso racional de medicamentos e as contribuições do farmacêutico
neste contexto. Brazilian Journal of Development,
[s. l.], v. 6, n. 5,
p. 32162-32173, 2020. Disponível em: https://doi.org/10.34117/bjdv6n5-603. Acesso em: 17 maio 2023.
MELO, B. D., et al.
Saúde mental e atenção psicossocial na pandemia COVID-19: recomendações para
gestores. Rio de Janeiro: Fiocruz. 2020. Disponível em:
https://www.arca.fiocruz.br/handle/icict/41030. Acesso em: 17 maio 2023.
MINAYO, M. C. D. S. O
desafio do conhecimento: pesquisa qualitativa em saúde. In O desafio do conhecimento: pesquisa
qualitativa em saúde. Rio de Janeiro: Hucitec, 2000. v. 7. Disponível
em: https://pesquisa.bvsalud.org/portal/resource/pt/crt-1255. Acesso em: 10 nov. 2022.
PRIME, H., WADE, M.; BROWNE, D. T. Risk and resilience in
family well-being during the COVID-19 pandemic. American Psychologist,
[s. l.], v. 75, n. 5,
p. 631, 2020. Disponível em: https://doi.org/10.1037/amp0000660. Acesso em: 17 maio 2023.
RODRIGUES, F. D. A.; MENDES, D. L. Estilos parentais e as
implicações no desenvolvimento afetivo entre pais e filhos adolescentes. Revista
Perspectiva: Ciência e Saúde, [s. l.], v.
4, n. 2, p. 69-100, 2019. Disponível em: http://dx.doi.org/10.29327/211045.4.2-4. Acesso em: 20 maio 2023.
ROTOLI, A.; SILVA, M. R. S. D.; SANTOS, A. M. D.; OLIVEIRA,
A. M. N. D.; GOMES, G. C. Saúde mental na atenção primária: desafios para a
resolutividade das ações. Escola Anna Nery, [s .l.], v.
23, n. 2, 2019. Disponível em: https://doi.org/10.1590/2177-9465-EAN-2018-0303. Acesso em: 16 mai. 2023.
SALBEGO, C.; NIETSCHE, E. A.; TEIXEIRA, E.; GIRARDON-PERLINI,
N. M. O.; WILD, C. F.; ILHA, S. Tecnologias cuidativo-educacionais: um conceito
emergente da práxis de enfermeiros em contexto hospitalar. Revista
Brasileira de Enfermagem, [s. l.], v. 71, p. 2666-2674, 2018.
Disponívem em: http://dx.doi.org/10.1590/0034-7167-2017-0753. Acesso em: 05 jun. 2023.
SANTOS, C. COVID-19 e saúde mental dos adolescentes:
vulnerabilidades associadas ao uso de Internet e mídias sociais. Holos, Natal,
v. 3, p. 1-14,
2021. Disponível em: https://doi.org/10.15628/holos.2021.11651. Acesso em: 17 maio 2023.
SILVA, C. F.; DE ALMEIDA CASTILHO, F. F. A Pesquisa-ação e o
design de jogos: uma proposta metodológica para o desenvolvimento de produtos
educacionais. Educitec-Revista de Estudos e Pesquisas
sobre Ensino Tecnológico, Manaus,
v. 8,
e180622, 2022. Disponível em: https://doi.org/10.31417/educitec.v8.1806. Acesso em: 28 maio 2023.
TAVARES, A. A. Escola
como espaço intersetorial para a promoção da saúde do adolescente: a
experiência das oficinas de futsal. 2020. Trabalho de Conclusão de Curso
(Especialização em Saúde Pública) – Escola de Saúde Pública de Minas Gerais,
Belo Horizonte, 2020. Disponível em: http://localhost:8080/xmlui/handle/123456789/351. Acesso em: 15 maio 2023.
THIOLLENT, M. Metodologia
da pesquisa-ação. São Paulo: Cortez editora, 2011. v. 18.
VANTIL, F. C. S.; LIMA, E. D. F. A.; FIGUEIREDO, K. C.;
MASSARONI, L.; SOUSA, A. I.; PRIMO, C. C. Safety of patients with mental disorders:
a collective construction of strategies. Revista Brasileira de
Enfermagem, [s. l.], v. 73, 2020. Disponível em: http://dx.doi.org/10.1590/0034-7167-2017-0905. Acesso em: 15 jun. 2023.
ZOCCHE, D. A. A.; DA ROSA, A. P.; ZANATTA, E. A.
Pesquisa-Ação no desenvolvimento de um instrumento para consulta de enfermagem
na saúde da mulher. New Trends in Qualitative Research, Oliveira
de Azeméis, Portugal, v. 8, p. 804-810, 2021. Disponível em: https://doi.org/10.36367/ntqr.8.2021.804-810. Acesso em: 15 jun. 2023.
ZOCCHE, D. A. de A.; PRIMO, C. C.;
LEAL, S. M. C. Pesquisa-ação na enfermagem: proposições e experiências
nos mestrados profissionais do brasil. In:
Denise Antunes de Azambuja ZOCCHE, D. A. de A.; PRIMO, C. C.; LEAL, S. M.
C. (org). Livro pesquisa-ação e
enfermagem: proposições e experiências nos programas de pós-graduação de
enfermagem do Brasil. Florianópolis: UDESC, 2022. p. 10-20.