Efeito de intervenção educativa em precauções na atenção primária à saúde: ensaio clínico randomizado

Abstract

Introduction: health professionals’ compliance to Standard and Specific Precautions is essential to prevent transmission of microorganisms, but it is known that this compliance is still very small. Strategies that favor interferences within one or more components of this system may increase professionals’ compliance to good precautionary practices. Objective: To evaluate the effect of an educational strategy on precautionary practices in the context of primary health care. Method: multiple design project: to elaborate and to validate the educational strategy (webquest) for nursing professionals in this scenario by using the methodological study of validation by consensus; a qualitative study in order to acknowledge the perception of local Primary Attention Managers’ regarding the educational strategy as well as to what work as facilitators and what work as barriers for the implementation; a randomized controlled trial of the pre-test / post-test kind, using a control group with no blinding, and following CONSORT standards to assess the effect of the educational strategy and its potential to interfere with adherence to precautionary practices in the studied context; and lastly a descriptive study to evaluate the practicability of the webquest. What was used for the analysis: a content validation index, frequency tables and descriptive statistics, a Pearson's chi-square test or Fisher's exact test, a Mann-Whitney test, and Repeated Measures (ANOVA). Results: The webquest was validated, with an index of content validation greater than 80; regarding the perception of Primary Attention Managers, knowing their opinion facilitated the initial stage of implementation and directed the future stages of the study; during the assessment of the webquest’s effect, there was a significant difference (p <0.05) for risk identification, hand hygiene, use of masks and cough etiquette, and referred compliance, with better results within the intervention group. After six months, there was a reduction in the average of correct answers for the instrument as a whole and in relation to the use of cough mask and etiquette; as for practicality, the average time taken to perform it was 32.48 minutes, and was pointed out as easy to perform and the resolution and the topics as easy to understand by 96% of the professionals. Conclusion: the educational strategy was validated for large-scale use in the Primary Health Care setting as it increased the knowledge of the nursing staff and referred their compliance, highlighting its importance for incorporating evidence into practice, thus contributing for the improvement of care quality.