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Health Education Research Advance Access first published online on May 13, 2008
This version published online on May 15, 2008
Health Education Research, doi:10.1093/her/cyn023
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© The Author 2008. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

Effectiveness of community health agents’ actions in situations of social vulnerability

Margareth S. Zanchetta1,*, Susan McCrae Vander Voet2, Wilson Galhego-Garcia2,3, Vera Maria N. Smolentzov3, Yves Talbot2, Monica Riutort2, Amine Maria M. F. Galhego4, Thiago J. de Souza3, Rodrigo S. Caldas3, Edwaldo Costa3, Márcia M. Kamikihara5 and Sérgio Smolentzov5

1 School of Nursing, Faculty of Community Services, Ryerson University, Toronto, Ontario M5B 2K3, Canada
2 Department of Family and Community Medicine, International Programs, Faculty of Medicine, University of Toronto, Toronto, Ontario M5T 1W7, Canada
3 Department of Basic Sciences, Faculty of Dentistry, São Paulo State University, Araçatuba, São Paulo 16018-805, Brazil
4 Institute of Social Sciences and Communication, Universidade Paulista, Araçatuba, São Paulo 16063-700, Brazil
5 Department of Family Health Care, Araçatuba Municipal Health Secretariat, Araçatuba, São Paulo 16015-150, Brazil

Correspondence to: * Correspondence to: M. S. Zanchetta. E-mail: mzanchet@ryerson.ca

The first 150 words of the full text of this article appear below.


   Introduction
 
Evaluation is purposeful activity examining multiple, diverse realities [1] that affect the implementation of social interventions and their management [2]. As political activity, evaluation involves partnerships among managers, stakeholders and internal and external evaluators. These partners review common interests and concerns to modify policies and modi operandi, and ultimately, to influence human life [3]. Evaluation is particularly sensitive to social problems and expectations; it documents their features, incidence and prevalence [2].

This article reports the quanti-qualitative results of an in-service effectiveness evaluation of interventions to reduce health risks for socially vulnerable people by community health agents (CHAs) (Agentes Comunitários de Saúde) in Brazil. CHAs are key personnel within the nationwide community health agent program (CHAP), created in 1991, that operates within Brazil's Family Health Strategy (FHS). CHAP considers social inclusion through health education and promotion, a cornerstone of collective health. Most CHAs . . . [Full Text of this Article]


   Social context of the evaluation
 

   Literature review: the community health agent program and CHAs’ roles
 

   Evaluation questions and objectives
 

   Method
 

   Ethical considerations
 

   Results
 
CHAs’ knowledge of risks in socially mobilizing clients
Interventions to facilitate clients’ social inclusion and personal safety
Interventions to protect clients’ human rights
Interventions to enhance clients’ quality of life
Integration with the practices of family physicians and registered nurses
Qualitative findings
Political knowledge about the municipal health council
General perceptions of the FHS teams
Justification of abilities and actions

   Analysis and discussion
 

   Implications for practice
 

   Conclusion
 

   Funding
 

   Conflict of interest statement
 

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