[Focus groups: preliminary experiences in educational health programs in Brazil]. / Grupos focais: experiências precursoras em programas educativos em saúde no Brasil.

Since 1989, the public health education section of the University of São Paulo (USP), Brazil, has been using the focus group technique to identify educational problems and evaluate programs being developed. The focus group is a research technique that allows qualitative data to be collected through group sessions involving 6 to 15 persons with some shared trait (for example, sex, age, occupation, role in the community). The group discusses various aspects of a specified subject. This paper describes five research projects in which this technique was used. The projects were carried out by professors in the School of Public Health/USP in the state of São Paulo between 1989 and 1992 with population groups and in health institutions. These experiences showed that the technique is efficient, permitting rapid identification and in-depth analysis of problems from the point of view of the population. Among the drawbacks to the technique is that it uses a small and nonrandom sample, which means that in certain cases focus groups should be considered a complement to quantitative studies. The data described here provide knowledge of perceptions, ideas, opinions, expectations, and social images-in short, the cultural and verbal universe of the population. With this information, educators and administrators can plan and evaluate education programs on the basis of the needs and views of the people they serve, putting into practice the plan to make education more democratic and responsive to the needs of its public.

Capacitacion de profesionales de salud en lactancia natural y reformas institucionales subsiguientes / Breast-feeding training for health professionals and resultant institutional changes

Se evalua un curso de capacitacion sobre la lactancia natural al que asistieron varios profesionales de la salud en el Centro de Lactancia de Santos (CLS), Estado de Sao Paulo, Brasil, y se examina su efecto en la ejecucion de programas para la promocion de la lactancia natural en hospitales de maternidad. Ocho hospitales de este tipo se incluyeron en el estudio. De ellos, cuatro fueron asignados aleatoriamente al grupo experimental y enviaron a tres profesionales de salud a un curso de 18 dias en el CLS; las cuatro instituciones restantes formaron el grupo testigo. Para determinar en que grado se adheria cada hospital a las "Diez medidas para el exito de la lactancia materna" establecidas por la OMS y el UNICEF se calculo un puntaje antes del curso y otro seis meses despues de concluirlo. Las instituciones del grupo experimental tuvieron un mejor puntaje que las del grupo testigo. El curso del CLS fue eficiente porque permitio a los participantes promovieran la practica de la lactancia natural. Sin embargo, para ejecutar con exito los programas correspondientes, los profesionales de salud tambien tienen que aprender a aplicar los conocimientos adquiridos en el curso y lograr que todo el equipo del servicio de maternidad participe en las actividades correspondientes (AU)

Capacitacion de profesionales de salud en lactancia natural y reformas institucionales subsiguientes / Breast-feeding training for health professionals and resultant institutional changes

Se evalua un curso de capacitacion sobre la lactancia natural al que asistieron varios profesionales de la salud en el Centro de Lactancia de Santos (CLS), Estado de Sao Paulo, Brasil, y se examina su efecto en la ejecucion de programas para la promocion de la lactancia natural en hospitales de maternidad. Ocho hospitales de este tipo se incluyeron en el estudio. De ellos, cuatro fueron asignados aleatoriamente al grupo experimental y enviaron a tres profesionales de salud a un curso de 18 dias en el CLS; las cuatro instituciones restantes formaron el grupo testigo. Para determinar en que grado se adheria cada hospital a las "Diez medidas para el exito de la lactancia materna" establecidas por la OMS y el UNICEF se calculo un puntaje antes del curso y otro seis meses despues de concluirlo. Las instituciones del grupo experimental tuvieron un mejor puntaje que las del grupo testigo. El curso del CLS fue eficiente porque permitio a los participantes promovieran la practica de la lactancia natural. Sin embargo, para ejecutar con exito los programas correspondientes, los profesionales de salud tambien tienen que aprender a aplicar los conocimientos adquiridos en el curso y lograr que todo el equipo del servicio de maternidad participe en las actividades correspondientes (AU)

Se publico en ingles en el Bull. WHO. Vol. 73(4), 1995

Breast-feeding training for health professionals and resultant institutional changes.

Assessed is a breast-feeding training course that was attended by health professionals at the Santos Lactation Center (SLC), Santos, São Paulo, Brazil, as well as its impact on the implementation of breast-feeding programmes in maternity hospitals. Eight maternity hospitals were studied--four were randomly allocated to the experimental group and sent three health professionals to attend an 18-day course at SLC; the remaining four institutions constituted the control group. The compliance of all eight hospitals with WHO/UNICEF's "Ten steps for successful breast-feeding" was determined using scores obtained before and 6 months after the training course. Institutions in the experimental group had an improved score, but those in the control group did not. The SLC training course was efficient since it enabled the participants to promote breast-feeding practices. However, in order to succeed in implementing breast-feeding programmes, health professionals require also to develop skills to apply the knowledge they acquire in the course, as well as to involve the whole maternity unit team in the activities.

PIP: A breast-feeding training course was assessed that was attended by health professionals at the Santos Lactation Center (SLC), Santos, Sao Paulo, Brazil, as well as its impact on the implementation of breast-feeding programs in maternity hospitals. Eight maternity hospitals were studied, 4 were randomly allocated to the experimental group with 3 health professionals to attend an 18-day course at SLC; the remaining 4 institutions constituted the control group. The course consisted of 45 units that covered theoretical and practical aspects of breast-feeding over a 133-hour period. The compliance of all 8 hospitals with the World Health Organization (WHO)/UNICEF's 10 steps for successful breast-feeding was determined using scores obtained before and 6 months after the training course. Individual interviews were held 6 months after the SLC course with directors in participating institutions, with administrative managers, and with professionals in charge of antenatal, nursery, and outpatient services. 16 focus group sessions were also held with 6-15 persons of the staff 6 months after the course. Pre- and postcourse test results showed that in general there was improvement in the students' knowledge on breast-feeding (the average number of correct answers were 20.27 precourse and 26.92 postcourse). Institutions in the experimental group had an improved score, but those in the control group did not. Changes were more particularly in relation to steps 2 (train all health care staff in skills necessary to implement this policy) and 10 (foster the establishment of breast-feeding support groups and refer mother to them upon discharge from hospital). Among graduate-level professionals interpersonal conflicts limited the possibilities for change. The SLC training course enabled the participants to promote breast-feeding practices. However, in order to succeed in implementing breast-feeding programs, health professionals also have to apply the knowledge they acquire in the course as well as involve the whole maternity unit team in the activities.