Evaluation studies on health promotion in primary care: A scoping review Estudos de avaliação em promoção da saúde na atenção primária: uma revisão de escopo

Adão, Izaltina; Rocha, Dais Goncalves; Rios, Luiza Rahmeier Fietz; Colussi, Claudia Flemming

doi:10.1590/2358-2898202514710344P

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REVIEW • Saúde debate 49 (147) • Nov 2025 • https://doi.org/10.1590/2358-2898202514710344I linkcopy

Evaluation studies on health promotion in primary care: A scoping review Estudos de avaliação em promoção da saúde na atenção primária: uma revisão de escopo

Authorship SCIMAGO INSTITUTIONS RANKINGS

This study investigated health promotion evaluations of Primary Health Care (PHC) in public systems. The search was conducted across eight databases and gray literature, following the PRISMAScR guidelines and the JBI Manual for Evidence Synthesis. The selection process was double-blind, with an independent analysis of titles and abstracts, followed by a full-text review. A total of 2,726 studies were identified, of which 517 were excluded due to duplication, 2,179 during the initial screening, and 22 after full-text review, resulting in the inclusion of eight articles published between 2013 and 2022, in Portuguese, English, and Spanish, from four countries. Five studies used qualitative methods, two applied mixed approaches, and one used quantitative method. The evaluations focused on specific programs, such as breastfeeding, diabetes prevention, physical activity, nutritional assistance, and oral health. The studies analyzed different dimensions: three assessed only the process, two focused on outcomes, while the others combined structure, process, and/or outcomes. The study revealed that although evaluations address structural, process, and outcome dimensions highlighting the need to strengthen individual and community capacity, the benefits of health promotion interventions vary. However, the scarcity of evaluative studies on health promotion in PHC highlights a significant knowledge gap.

KEYWORDS
Health promotion; Primary Health Care; Public health systems research; Evaluation study; Scoping review

Author	Type of study	Population	Identified outcomes
Barreto²⁵	Evaluation of the process and effects of implementing Brazil Breastfeeding and Feeding Strategy (Estratégia Amamenta e Alimenta Brasil).	48 mothers of children aged under 2 years and 85 professionals of health unities.	Improving the nutritional and feeding conditions of children under two years of age and the organization of services related to breastfeeding and complementary feeding practices in the health units participating in the study.
Guarda et al.²⁴	Evaluation of the implementation degree of the Health Academy Program.	Professionals and managers of the municipality's Family Health Strategy.	The low level of implementation of the Health Academy Program, especially related to multi-professional collaboration and the difficulty in coordinating with other sectors or social actors, demonstrates the need for a reorganization of actions.
Morera Llorca, Niclos Esteve e Egea Ronda²⁷	Qualitative evaluation study of the health center's walking group program.	12 participants of the health center's walking group program, aged between 61 and 78 years.	Perceived benefits: physical, emotional, and social. Advantages of the group: inclusion, adherence, and motivation. Dissemination: awareness of the activity, visibility. Attitudes observed: overall evaluation, discipline, motivation, adherence. Suggestions for improvement: extended hours, diversification. Participation: gender asymmetry. Monitors’ role: leadership skills, activity dynamization. Course conditions: route, alternatives, safety.
Neves, Zangirolani e Medeiros²³	Assessment of nutritional care provided to overweight adults.	28 participants comprised of managers and healthcare professionals.	Excess weight does not primarily result from approaches in Primary and Secondary Care, but rather from prescriptive practices that are often ineffective in promoting the autonomy of user.
Penn et al.²⁸	Evaluation of the implementation phase of the National Health Service (NHS) Diabetes Prevention Programme in England.	Groups of 15 to 20 adults in England, aged 18 and over, with non-diabetic hyperglycemia, identified through primary care and NHS Health Checks.	The NHS offers an evidence-based behavioral intervention for the prevention of type 2 diabetes in high-risk adults.
Silveira Filho et al.²¹	Evaluation of the potential effectiveness of oral health promotion strategies in primary health care.	1,819 dental surgeons working in teams of 26 state capitals and of the Federal District.	Statistically significant differences were found between the analyzed geopopulation units. The Southeast and South regions demonstrate superior performance in Oral Health Promotion strategies compared to other regions of Brazil.
Venâncio et al.²²	Evaluation of the implementation of the Brazil Breastfeeding Network in primary care.	Patients, leaders, and staff from the Health Centers. Three levels of analysis were considered (federal, state, and municipal). At the municipal level, the focus was on three municipalities, totaling 35 primary health care units.	The promotion of breastfeeding in primary care shows varying implementation rates, ranging from 18% to 100% in municipalities, influenced by the organizational context.
Zhong et al.²⁶	Evaluation of the implementation of the support program for the management and self-management of diabetes in the Province of Anhui, China.	264 participants over 15 years of age, with type 2 diabetes, residents in one of the subcomunities for more than 1 year and with no physical or mental disabilities, and professionals of CHSCs. In each of the 3 cities of the Province of Anhui, 2 subcomunities were randomly designated.	Qualitative evaluations indicated positive acceptance of the program among patients, leaders, and staff at the Health Centers. Implementation was successful in 2 of the 3 sub-communities, with the third failing due to a lack of staffing resources.

Author	Date	Country	Methods	Description of the intervention	Outcome
Barreto²⁵	2018, Brazil	Evaluative research employing both quantitative and qualitative approaches. Questionnaires developed by the researchers, based on the Implementation Analysis document of the Brazil Breastfeeding Network and the Breastfeeding and Municipalities Project, were used. The development and validation stages of the evaluation instrument are not mentioned. The participation of the actors involved in the intervention in the development of the evaluation model is not discussed.	Evaluation of the process and effects of implementing the Brazil Breastfeeding and Feeding Strategy in a health unit.	5 months (June to November 2017).	Increased number of e-SUS records; increased proportion of home visits, breastfeeding support, and guidance on Complementary Feeding after the implementation of the Strategy. Positive effects were identified four months after the strategy's implementation, namely: professional involvement in workshops, understanding of the importance of counseling on breastfeeding and healthy complementary feeding, and improved data entry in the agreed-upon and current information system.
Guarda et al.²⁴	2021, Brazil	Evaluative study, using a normative approach, developed a theoretical and logical model and a judgment analysis matrix. This evaluation model was validated in consensus workshops with experts. Data collection consisted of questionnaires developed based on the indicators from the validated matrix. The participation of the actors involved in the intervention in the development of the evaluation model is not discussed.	Evaluation of the structure and process dimensions related to the process of implementation work of the Health Academy Program.	2 months (November 2017 to January 2018).	The low level of implementation of the Health Academy Program, especially related to multi-professional coordination, and the difficulty in coordinating with other sectors or social actors, shows the need for a reorganization of actions. The program is partially implemented (intermediate). The highest score was in the structure dimension, the lowest in the process dimension.
Morera Llorca, Niclos Esteve e Egea Ronda²⁷	2022, Spain	Descriptive qualitative evaluative study with a predominantly phenomenological perspective, conducted through focus groups of participants in the Group Walking Program. The data collection instrument was a semi-structured questionnaire developed by the researchers based on the literature. The development and validation stages of the evaluative instrument are not mentioned. The participation of the actors involved in the intervention in the development of the evaluation model is not discussed.	Interviews were conducted with 90-minute duration, following a semi-structured script, with a moderator and two observers. The sessions aimed to create a dialogical environment to explore different perspectives on the program, and were recorded and transcribed in full.	Not informed.	Participants identified benefits in physical health: improved biological parameters, greater mobility, and less fear of falling; emotional benefits: release of tension, increased self-esteem, feelings of joy; and social benefits: establishing new relationships and strengthening existing ones.
Neves, Zangirolani e Medeiros²³	2017, Brazil	Qualitative and quantitative evaluation of nutritional care through a census conducted in 28 Primary Care services and 4 Secondary Health Care services. The data collection instrument was a semi-structured questionnaire based on an existing one. The development and validation stages of the evaluation instrument are not mentioned. The participation of the actors involved in the intervention in the development of the evaluation model is not discussed.	Assessment of nutritional care provided to overweight adults by Primary and Secondary Health Care services.	Conducted between 2013 and 2015.	Nutritional diagnosis and health promotion only occur in cases of excess weight associated with other diseases. The referral and counter-referral system and intersectoral collaborations were ineffective. In Secondary Care services, nutritional care focused on clinical treatment with traditional nutritional education approaches. Limiting factors for the promotion of comprehensive care included unproductive actions and a lack of effective dialogue between Primary and Secondary Care services.
Penn et al.²⁸	2018, England	Qualitative evaluation of the implementation phase of the National Health Service (NHS) Diabetes Prevention Program in England. Document analysis, interviews, and focus groups were used. The data collection instrument was a semi-structured questionnaire developed by the researchers, based on scientific literature and refined from stakeholder feedback. Patients participated in the review of intervention materials intended for service users, as well as questionnaires developed by the researchers.	Intensive behavioral intervention with goals of weight loss, diet, and physical activity.	9 months.	The NHS offers an effective, evidence-based behavioral intervention for the prevention of type 2 diabetes in high-risk adults. Furthermore, the implementation of the program has shown positive results.
Silveira Filho et al.²¹	2016, Brazil	Quantitative evaluation of the potential effectiveness of Oral Health Promotion (OHP) strategies in Primary Health Care. The evaluation instrument was the OHP Strategy Effectiveness Assessment tool, as it is the instrument validated in the E.N.PRO. SA. The framework for the construction of the tool (evaluation indicator matrix) was based on a theoretical model that emphasizes the state of the art regarding the pillars and values of Health Promotion. The participation of the actors involved in the intervention in the development of the evaluation model is not mentioned.	Evaluation of the effectiveness of oral health promotion strategies, composed of 23 indicators, grouped into three dimensions: oral health, healthy public policies, and human and social development.	Not informed.	The OHP strategies identified in the study were heterogeneous, with better results favoring the South-Southeast regions and disadvantages for people living in the capitals of the Central-North-Northeast regions of Brazil. The results do not allow us to determine which dimensions, sub-dimensions, and indicators were well-evaluated or fell short of expectations.
Venâncio et al.²²	2013, Brazil	Evaluative research, implementation analysis type, using a qualitative approach to study the Brazil Breastfeeding Network in primary care. A theoretical and logical model and an analysis and judgment matrix were developed, based on official documents and ordinances. Document analysis, interviews, and focus groups were conducted. The data collection instrument used was not stated. Although the evaluation model was constructed based on the regulations, the development/validation stages of the data collection instrument used are not mentioned. The participation of the actors involved in the intervention in the development of the evaluation model is not mentioned.	Development of a theoretical and logical model, and definition of indicators and categories related to the organizational context and degree of implementation. Data collection techniques: document analysis, focus groups, and interviews. Definition of criteria for evaluation.	19 months (March 2009 to December 2010).	The promotion of breastfeeding is not fully implemented in primary care. Different organizational contexts were identified, with implementation levels ranging from 18% to 100% in municipalities. The influence of context on the implementation of the strategy was observed, highlighting the relationship between more favorable contexts and more advanced levels of implementation.
Zhong et al.²⁶	2015, China	Qualitative evaluation of the implementation of the support program for diabetes management and self-management in Community Health Service Centers (CHSCs) in Anhui Province, China. Implementation was analyzed using CHSC records and forms. Advantages, disadvantages, and barriers to implementation were assessed through focus groups and interviews with community and health unit leaders, peer supporters, and patients at the end of the Peer Support Program. The development and validation stages of the evaluation instrument are not mentioned. The participation of the actors involved in the intervention in the development of the evaluation model is not mentioned.	Leaders and staff from the CHSCs co-led educational meetings and bi-weekly discussions, promoted regular care, organized informal health promotion activities (such as walking and tai chi groups), and offered individual support to participants through casual contacts.	18 months, (June 2009 to December 2010).	The program was positively received by patients, leaders, and staff at the CHSCs. Implementation was successful in two of the three communities, with a third facing difficulties due to a shortage of staffing resources. Reported benefits included peer support as a bridge between the CHSCs and their patients. Analyses showed significant benefits in knowledge, self-efficacy, BMI, systolic and diastolic blood pressure, and blood glucose. Following evaluation, the program was extended to other communities.

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[1] Source: Prepared by the authors, adapted from PRISMA-ScR¹⁶.

[2] Note: For the studies included in this scoping review, the control group does not apply. Therefore, it has been removed, and the population involved in the studies is presented in table 1.