Evidências de validade de curso para profissionais da atenção primária à saúde sobre o manejo em saúde mental de gestantes e puérperas

Abstract

Introduction: During pregnancy and the postpartum period, women experience physical, biological, psychological, and emotional changes. However, health care does little to track and treat psychological and emotional aspects. This implies recurrent referrals to mental health services, which may be associated with the lack of training of these professionals to meet these demands. Therefore, it is necessary to develop strategies to improve the quality of mental health care for pregnant and postpartum women in primary health care. Objectives: To identify validity evidence for a training course aimed at qualifying primary health care professionals in maternal mental health care, considering psychological distress and/or psychosocial vulnerability experienced by pregnant and postpartum women. Method: A cross-sectional study with a quantitative and qualitative approach for situational analysis was conducted, followed by a methodological study of content and semantic validation using Pasquali's theoretical framework. The cross-sectional study included a sample of 78 health professionals from Family Health Strategy teams working in seven Basic Health Units in the Central Health Region of the Federal District. Data collection involved a characterization questionnaire for the professionals and another for situational analysis, processed using Statistical Package for the Social Sciences (SPSS) version 26.0 and IRaMuTeQ. Content validation of the course involved eight judges selected based on their expertise as indicated in their Lattes Platform profiles. For semantic validation by the target audience, 32 health professionals from three Basic Health Units in the Federal District participated. Data collection for content validation used an instrument for evaluating health educational materials, while semantic validation employed an instrument developed by the authors. Quantitative validity was assessed using the Content Validity Index, with data tabulated and analyzed using Microsoft Excel. Results: The situational analysis showed that approximately half of the health professionals provide daily care to pregnant and/or postpartum women (55.1%). For 66.7% of these professionals, in a few consultations with this population, they identify signs and/or symptoms of emotional/psychological/mental distress. Regarding the training of professionals to act and help pregnant and/or postpartum women in relation to their mental health, 76.9% have doubts and 89.7% have not participated in training 10 on the subject, and all agreed on its relevance. The textual analysis of the discursive responses resulted in two categories: "Qualified listening as a welcoming instrument" and "Shared care and referral to a specialized professional". The content analysis obtained an overall content validity index of 0.96 and the semantic validation index of 0.87. Adjustments were made to the course structure in response to the judges' suggestions. The health professionals highlighted the relevance of the topic and suggested extending the course duration. Developed Products: Product 1: original article “Maternal mental health from the perspective of primary care professionals”. Product 2: original article “Evidence of validity of a course on perinatal mental health for primary care professionals”. Product 3: Pedagogical project for the “Training course on perinatal mental health for primary care professionals”. The course was divided into 3 parts: 1st part - Introduction to the topic of perinatal mental health through an expository-dialogue class; 2nd part - Presentation and discussion of clinical cases, through the audiovisual presentation of four clinical cases involving emotional and psychosocial issues; 3rd part - Evaluation of the course by professionals. Course participants also received a supporting document in digital format containing the locations of mental health services and the rights of pregnant and postpartum women. These products are aligned with the research line of Quality in Healthcare for Women, Children and Adolescents. Conclusions: It was found that professionals claim to provide care to pregnant or postpartum women in situations of risk or psychosocial vulnerability. Many reported having doubts during care related to perinatal mental health and not having received any type of training on this topic. The conduct is based on welcoming with qualified listening and referrals seem to be frequent, reinforcing the importance of training on this topic. The course presented satisfactory evidence of content and semantic validity, and can be used in continuing education programs on perinatal mental health for primary health care professionals, with the capacity to be offered in an online format. The pedagogical project structured with innovative methodologies adds relevance to the developed product and qualifies it to generate a real impact to influence training in the health area and, consequently, promote improvements in professional practice, with feedback of the results to the population. The course was tested in loco to ensure its local applicability, and can be easily replicated for primary health care services throughout the country.