Habilidades Culinárias Domésticas na Atenção Primária à Saúde do município de São Paulo: desafios e necessidades na ótica de profissionais de saúde

Camanho, Júlia Souza Pinto; Villar, Betzabeth Slater; Teixeira, Aline Rissatto

doi:10.1590/1678-9865202437e230024

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Original | Dietetics • Rev. Nutr. 37 • 2024 • https://doi.org/10.1590/1678-9865202437e230024 linkcopiar

Habilidades Culinárias Domésticas na Atenção Primária à Saúde do município de São Paulo: desafios e necessidades na ótica de profissionais de saúde

Autoria SCIMAGO INSTITUTIONS RANKINGS

Objetivo Buscou-se compreender as principais necessidades, dificuldades e oportunidades para implementação das Habilidades Culinárias Domésticas na Atenção Primária à Saúde, de acordo com o Guia Alimentar para a População Brasileira, na perspectiva de profissionais de saúde.

Métodos Trata-se de pesquisa qualitativa realizada entre junho de 2020 e novembro de 2021 por meio de dois grupos focais com profissionais do sexo feminino da Atenção Primária à Saúde com ensino superior completo (n=6) e com ensino médio e técnico (n=5) atuantes no Município de São Paulo. A média de idade foi de 42 (DP=8) anos, com 11 anos (DP=10) de atuação na Atenção Primária à Saúde. Desenvolvemos um roteiro semiestruturado de perguntas disparadoras e conduzimos as discussões por meio da técnica de funil. Gravamos e transcrevemos as entrevistas. Usamos a Análise Temática para análise de dados e compilamos nossas descobertas em um modelo conceitual.

Resultados Este estudo revelou que as dificuldades para a implantação das Habilidades Culinárias Domésticas na Atenção Primária à Saúde estão relacionadas à Transição Culinária, aliada a práticas reducionistas em saúde e identificou-se necessidade de qualificação profissional. Como oportunidade tem-se a centralização de atividades de Habilidades Culinárias Domésticas nos Agentes Comunitários de Saúde e priorização da agenda de ações de Habilidades Culinárias Domésticas em um cenário em que profissionais reportam que, para os gestores, a quantidade de atendimentos realizados parece ser mais importante do que a qualidade. Esses aspectos deram bases para a construção do modelo conceitual.

Conclusão Conclui-se que há necessidade de sensibilização e qualificação profissional sobre a temática das Habilidades Culinárias Domésticas, principalmente dos Agentes Comunitários de Saúde. Além disso, é importante que os gestores priorizem essa agenda em detrimento de metas e números que não refletem a qualidade e a integralidade da Atenção Primária à Saúde. Apresenta-se modelo conceitual que envolve todas as categorias profissionais, com foco no Agente Comunitário de Saúde compreendido enquanto profissional-chave para a implementação das ações de Habilidades Culinárias Domésticas na Atenção Primária à Saúde.

Palavras-chave:
Brasil; Culinária; Grupos focais; Profissionais de saúde; Atenção primária à Saúde; Pesquisa qualitativa

Questions order	Item
1	What is the relationship between Domestic Cooking Skills and health, in your opinion? Probes: What do you think are the purposes of promoting culinary practices in PHC?
2	The Dietary Guidelines for the Brazilian Population suggests that “if you are a worker whose job involves health promotion, try to include cooking in the topics of your meetings or conversations with the population”. Do you believe you possess the skills and knowledge necessary to guide you through culinary practices? How could this improve? Probes: What are your impressions of your own role in guiding and conducting education actions to promote DCS in PHC?
3	Do you think it is necessary for you and your co-workers to receive qualification on this topic? Are there any specific topics that you have greater difficulty and consider important in training?
4	In your opinion, what would be the ideal formats for health professional qualification courses about domestic cooking skills that fits your reality? For example, videos, booklets, courses, workshops, podcasts. Probes: What types of pedagogical tools do you consider relevant for health professional qualification courses about domestic cooking skills?
5	Let’s talk about practice: do you guide DCS actions? How? Which other co-workers guide the DCSs in your unit? What actions do they take?
6	In your perception, how important is for your co-workers to do education actions to promote DCS? Tell me a little more about it. How do you think this could improve? Probes: What do you believe is necessary for health professionals to start to value and carry out educational actions to promote DCS in Primary Health Care?
7	Since we are talking about professional resources, let’s now talk about the other resources: physical, financial, time, management... In your Primary Health Care Center, what do you have and what is missing to implement DCS actions? Probes: Which resources do you consider essential for promoting education actions regarding DCS? Does your PHC Center have these features?
8	Taking into account the resources available to you presently, what additional measures do you think you could implement to advocate for DCS? Probes: What other guidelines or education actions to promote DCS could be carried out? Where could these actions take place?
9	Now let’s talk about the people you attend... What are your perceptions about their DCS? What makes you think that?
10	And what do you do when you realize that their (people you attend) DCS are low? Probes: How do you handle situations that need culinary guidance?
11	Finally, based on your perception, we will list: The main existing actions regarding DCS; The main professionals involved in these actions; The main difficulties and/or obstacles to the implementation of counseling and education actions to promote DCS in your PHC Center; The main opportunities and/or possibilities for the implementation of these actions; The professional training formats that best adapt to your reality; Is there anything else you would like to add about what was discussed?

Item number / Item	Guide questions/description	Answers for the research study
Domain 1: Research team and reflexivity
Personal Characteristics
1. Interviewer	Which author/s conducted the interview or focus group?	Collaborating researcher external to the research.
2. Credentials	What were the researcher’s credentials? e.g., PhD, MD.	PhD, MSc, BSc.
3. Occupation	What was their occupation at the time of the study?	Academic teacher and researcher.
4. Gender	Was the researcher male or female?	Female.
5. Experience and training	What experience or training did the researcher have?	Previous experience in conducting qualitative research and mediating focus groups.
Relationship with participants
6. Relationship established	Was a relationship established prior to study commencement?	Yes, the focus group participants participated in a previous survey for instrument validation, without direct contact with the researcher.
7. Participant knowledge of the interviewer	What did the participants know about the researcher? e.g., personal goals, reasons for doing the research.	The participants knew nothing about the researcher.
8. Interviewer characteristics	What characteristics were reported about the interviewer/facilitator? e.g., bias, assumptions, reasons and interests in the research topic.	No researcher characteristics were reported.
Domain 2: study design
Theoretical framework
9. Methodological orientation and Theory	What methodological orientation was stated to underpin the study? e.g., grounded theory, discourse analysis, ethnography, phenomenology, content analysis.	Thematic Analysis, according to Braun and Clarke (2006).
Participant selection
10. Sampling	How were participants selected? e.g., purposive, convenience, consecutive, snowball.	Convenience; participants with EHAPS scores ≥88 points were selected.
11. Method of approach	How were participants approached? e.g., face-to-face, telephone, mail, email	Email and contact via WhatsApp messages.
12. Sample size	How many participants were in the study?	11.
13. Non-participation	How many people refused to participate or dropped out? Reasons?	None.
Setting
14. Setting of data collection	Where was the data collected? e.g., home, clinic, workplace	Participants were in physical environments of their choice and data were collected by video calls using Google Meet® and Zoom®.
15. Presence of non-participants	Was anyone else present besides the participants and researchers?	No.
16. Description of sample	What are the important characteristics of the sample? e.g., demographic data, date	Participants of all ages, regions of the city of São Paulo and of different professions.
Data collection
17. Interview guide	Were questions, prompts, guides provided by the authors? Was it pilot tested?	The semi-structured script of questions was pre-tested at the beginning of the research and was not provided to the participants.
18. Repeat interviews	Were repeat interviews carried out? If yes, how many?	No, the answers were extracted until data saturation.
19. Audio/visual recording	Did the research use audio or visual recording to collect the data?	Digital video and audio recording.
20. Field notes	Were field notes made during and/or after the interview or focus group?	Notes were taken during and after the focus groups by reporting researchers.
21. Duration	What was the duration of the interviews or focus group?	The focus groups had an average duration of 2 hours.
22. Data saturation	Was data saturation discussed?	Yes.
23. Transcripts returned	Were transcripts returned to participants for comment and/or correction?	No.
Domain 3: analysis and findings
Data analysis
24. Number of data coders	How many data coders coded the data?	Two.
25. Description of the coding tree	Did authors provide a description of the coding tree?	Yes.
26. Derivation of themes	Were themes identified in advance or derived from the data?	Themes were derived from the data.
27. Software	What software, if applicable, was used to manage the data?	Yes, Canva®.
28. Participant checking	Did participants provide feedback on the findings?	No.
Reporting
29. Quotations presented	Were participant quotations presented to illustrate the themes / findings? Was each quotation identified? e.g., with participant number	Yes.
30. Data and findings consistent	Was there consistency between the data presented and the findings?	Yes.
31. Clarity of major themes	Were major themes clearly presented in the findings?	Yes.
32. Clarity of minor themes	Is there a description of diverse cases or discussion of minor themes?	Yes.

Theme	Initial Codes
Challenges and impacts of the Culinary Transition	Devaluation of domestic cooking skills Family traditions and Food culture Ultra-processed food consumption Non communicable diseases
Reductionism X Integrality of Health Care	Nutritionism Health Care fragmentation and hierarchy
Overcoming barriers and limitations through professional qualification	Domestic Cooking Skills limitations Permanent Health Education Training topics Training formats
Management: raising awareness for prioritization	Resources scarcity Managers’ engagement COVID-19 pandemic Community Health Workers’ empowerment

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