Las representaciones sociales y las prácticas en intervención comunitaria en salud de los profesionales sanitarios de atención primaria

Abstract

The community intervention is defined as "The set of actions with community participation, aimed at the detection and prioritization of their health needs and problems, identifying the available community resources, prioritizing interventions and developing programs aimed at improving the health of The community, in coordination with other social and educational devices "(RD 1030/2006, page 32658) Knowing the meanings that the professionals attribute to the Community intervention is essential in the attempt to understand the why of the situation of this aspect of Health Care. Aware that there are diverse theoretical perspectives to approach the understanding of beliefs, knowledge, conceptions, symbols ..., in this thesis has chosen to resort to the central concept of Social Representation as an analytical tooi to decipher the construction of meanings from the perspective of Moscovici . The Social Representations that primary health care professionals have about Community Intervention has been our first unit of analysis. Community practice forms the second unit of analysis. The General Objective of this investigation has been: To observe, to understand and to interpret the social representations and the practice on Community Intervention in Health in the field of primary attention of Huelva. Methodologically, it has been the qualitative and procedural approach that has been imposed to approach the meanings, opinions, practice, attitude and symbols that primary health care professionals give to the Community Health Intervention as one of the dimensions of work , From the perspective of the Grounded Theory and the Phenomenological perspective. The Participant Observation, the Interview and the Free Association of Ideas, are the techniques used to gather the information of professionals of Medicine, of Nursing, with managerial positions and without positions, of Technicians of the Sanitary Districts Huelva-Coast and County- Countryside and teachers related to Community Health. The analysis of these evidences from the perspective used, has allowed us to elaborate a Theory on the Social Representation of the Community Intervention of the primary health care professionals. According to this theory we move in a pyramid in which we observe five different, unequal and progressive degrees of representation of our object of study. From a lower to a higher degree of elaboration of the representation, the Distant Representation in which a demographic vision, supported in the space and in the recipients that the discourse receives, prevails to work in the community, not with the community. The elements on which the next degree of representation is based are the purpose and specific recipients. Prevention and risk groups measure the degree of Biomedical Representation. But community activities are, mainly, Health Education Activities, so it has been called Instrumental Representation. Under the prism of the Social Participation Representation, in addition to confirming the purposes and recipients of the previous level, basic elements of the definition of Community Intervention are included: Health Education, health diagnosis, group activities, pondering another one of its main Tools: Community Participation. The most difficult to reach Representation is the most elaborate representation, formed in those informants who have extensive experience in Primary Care and Community Intervention. In their practice there have been or there are continuous examples of community activities and intersectoral work, even if they do not call it that, but in their speech they point out the importance of working with community leaders, with living forces as the main element of progress. As for the elements that outline the community practice in Primary Care in Huelva, we can conclude that the examination of reality has provided us with few elements about its community profile. The orientation of the work in the Health Centers suffers from the desired community dimension. Of the seven indicators used for the evaluation of community practice in primary care centers {work organization, community health diagnosis, basic primary care team, existence of someone responsible, community participation, intersectoral work, characteristics of Community activities) only one reaches an acceptable assessment.