|LETTER TO THE EDITOR
|Year : 2013 | Volume
| Issue : 3 | Page : 195-196
Community group centers for health education: Lessons from Northeastern Brazil
Maria Vieira de Lima Saintrain1, Janaína Oliveira Braga2, Paulo Leonardo Ponte Marques3, Anya Pimentel Gomes Fernandes Vieira4
1 DDS, MSc, PhD, Post doc in Public Health, Professor of the Public Health Masters Program, University of Fortaleza - Unifor, Brazil
2 DDS, Masters student in the Geriatric Masters Program, University of Coimbra, Portugal
3 DDS, Masters' student in Public Health- University of Fortaleza - Unifor, Brazil
4 DDS, MSc, PhD. Coordinator of the Family Health Masters Program, Oswaldo Cruz Foundation, Brazil
|Date of Web Publication||28-Jan-2014|
Maria Vieira de Lima Saintrain
100 Irmã Simas street, Apt 201/A, Varjota 60165 220, Fortaleza, Ceará Brazil
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Saintrain MV, Braga JO, Marques PP, Vieira AF. Community group centers for health education: Lessons from Northeastern Brazil. Educ Health 2013;26:195-6
The aging of populations is a global phenomenon. With aging, changes occur in various organs, tissues and cells. This is considered a natural phenomenon. When changes do not influence vulnerability to accidents and diseases, this is referred to as healthy aging or senescence.  Health promotion is important in maintaining quality of health, including understanding of the health-disease process and its determinants, as well as the allocation and availability of societal and institutional resources for a healthy senescence. Health promotion should occur where close relationships are formed  and through educational activities.
Those responsible for educational activities need to understand the "true reality" of their target groups, including socioeconomic, cultural, and epidemiological characteristics. This focused understanding facilitates systematization of the problems and enables actions that influence change processes in healthcare delivery. 
Starting with the premise that participatory and dialogic problem-based education are essential, our research team decided to find strategies to provide older adults or seniors with health education, with emphasis on their ability to interact and through their empowerment in health promotion. We used community group centers for seniors (CGCS) as facilitators for the development of the learning process for health promotion through activities planned and developed based on the seniors' problems and necessities, as well as the societal and institutional resources available. The CGCS are run by the municipal government and are designed to develop social and cultural activities.
A quantitative and educational intervention research project was conducted in six CGCS in Fortaleza, Brazil. The project consisted of two stages based on Bordenave's  problematization methodology: observation of reality (problems), identification of key points, formulation of theory, search for solutions, and application to reality. This methodology was selected because it enabled the seniors, and their issues, to be the focus of care.
The first stage, observing the reality and identifying problems, consisted of administration of a structured questionnaire on socioeconomic characteristics, self-reported diseases, use of medications, oral hygiene, and attitudes about habits in the seniors' daily lives.
The second project stage, based on the first, consisted of educational activities being planned and implemented related to seniors' needs, with the aim of promoting their empowerment in health promotion. A total of four educational activities lasting an average of 60 minutes were performed weekly. All research team members participated in the development and application of educational activities.
During the first meeting, the findings of the first stage were presented to the seniors who became aware of their problems as a group and identified, along with researchers, priority issues to be discussed. The second meeting focused on general health care, especially on oral health. The third and fourth meetings focused on issues common to people in this age group, such as hypertension, diabetes, osteoporosis, functional limitations, isolation, abuse, and depression.
The second meeting started with seniors' self-physical examination. Members of the research team used the mirror technique, where seniors are guided to perform self-examination utilizing a mirror. Photos, figures, and models were also presented. In the group process, seniors were able to establish a relationship among themselves in the context of the information and situations being presented. Then, participants exchanged experiences and asked questions about the care needed to improve their lives and health conditions.
The third and fourth activities had similar educational strategies. First, the team presented slideshows regarding issues selected by the seniors in the first activity, then "conversation circles" were introduced, with experiences and information exchanged between participants and researchers. The elders brought their empirical knowledge and life experience, while researchers contributed with the scientific knowledge, with the two groups relating to each other in a respectful manner to make changes in health awareness and behaviors. Types of comments and observations from seniors included: " if dirt brings diseases.our street should be better cared for.let's hold hands and do better", ".we are in the same age group. we could arrange to meet in our homes to play cards, chat, etc." . "if dirt brings diseases...our street should be better cared for…let's hold hands and do better", "…we are in the same age group...we could arrange to meet in our homes to play cards, chat, etc."".
After the meetings, the research team asked the seniors about lessons learned. They reported as essential: oral health; nutrition reeducation; group physical activities, prayer, dancing, singing, and handcrafts, as promoting activities to ease sadness, functional limitation, isolation, depression; control, and use of medications; social rights; a family approach; and issues on health risks related to smoking and domestic violence due to alcohol and other drugs. They also identified the "conversation circle" as an essential health promotion tool as it facilitated the exchange of experiences. Some mentioned that the circles eased loneliness and strengthened friendships.
The care of seniors requires use of a methodological approach that fosters the understanding of observed phenomena, interpreting these contextually from multiple angles, including organic, social and cultural nature.  Knowing the socioeconomic, cultural and health characteristics of seniors in community group centers enabled planning of health education actions according to seniors' needs. Seniors do not learn and get involved in health promotion activities in the same manner as other age groups. In order to be effective, seniors need to be involved, as a group, in pleasurable activities that enable them to identify their own body and surroundings, understanding the needs and possibilities for a healthy senescence, as seen in the mirror technique and conversation circles. We, as researchers, learned that when activities are performed in groups, the number of seniors covered is higher and the effectiveness of the activities is increased due to the "group effect", which occurs due to the links created among elders themselves. We conclude that, when in groups, seniors can identify with each other and get the necessary strength for change, facilitating empowerment and self-reflection on health promotion. This group effect is a reality in all cultures and, therefore, the experience described in this communication can be replicated in different settings.
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