Community and Home Care, Physical Therapy, Sports Therapy and Rehabilitation, Multidisciplinary
14
Scopus Publications
Scopus Publications
Effect of a Community Health Worker-Led Intervention on Physical Activity in Adults with Type 2 Diabetes in Primary Health Care in the Brazilian Amazon Elisa Brosina de Leon, Camila Fabiana Rossi Squarcini, Iasmin Machado Soares, Hércules Lázaro Morais Campos, Rafael Martins da Costa International Journal of Environmental Research and Public Health, 2026 Type 2 diabetes mellitus (T2DM) is a major global public-health problem, and physical inactivity contributes to poor disease control. In settings with limited access to health services, as in the Brazilian Amazon, interventions delivered by Community Health Workers (CHWs) within Primary Health Care (PHC) may offer a pragmatic strategy to increase physical activity (PA). We aimed to evaluate the effect of a CHW-led, theory-based intervention on PA among adults with T2DM in PHC in a cluster-randomized, community-based trial. A total of 274 participants were enrolled (intervention: n = 140, control: n = 134). CHWs in the intervention group completed a blended training (e.g., asynchronous modules, printed educational materials, and hands-on guidance). They conducted six home visits over six months to support behavior change, including increased PA. PA was measured using the International PA Questionnaire (IPAQ-LF), which assessed active commuting, walking, moderate-to-vigorous PA (MVPA), and total PA. Group-by-time effects were examined using mixed-effects zero-inflated Gamma models. No significant intervention effects were observed for the conditional mean of minutes or the probability of participation in active commuting, walking, or total PA. However, for MVPA, the zero-inflated Gamma model revealed a significant intervention effect on the probability of engaging in activity. The intervention group showed a marked reduction in the likelihood of remaining at zero minutes of MVPA (Odds Ratio = 0.08; 95% CI = 0.01–0.79; p = 0.001) compared to the control group, indicating effective behavioral activation among previously inactive participants. These findings suggest that empowering CHWs to deliver structured, theory-driven interventions within PHC can reduce inactivity among high-risk adults with T2DM in underserved communities.
Engagement of Community Health Workers in the Amazonas in the Development of an Educational Technology: A Co-Design Study Yandra Alves Prestes, Camila Fabiana Rossi Squarcini, Thais Favero Alves, Thalyta Mariany Rego Lopes Ueno, Amanda Laranjeira Alves, Hércules Lázaro Morais Campos, Elisa Brosina de Leon Community Science, 2026 Community Health Workers (CHWs) play a pivotal role in the management of Type 2 Diabetes Mellitus (T2DM) within Primary Health Care settings. Adequate training is essential to strengthen their capacity to deliver care, particularly by fostering dialogue between the health team and the community. This study aimed to describe the co‐design process underlying the development of an educational technology (ET) intended to train CHWs in T2DM management in the Brazilian Amazon. This mixed‐methods study involved the development of video lectures and printed support materials through the following stages: identification of CHWs' primary training needs; definition of the ET structure; development of thematic content, scripts, and instructional materials; creation of interactive resources; expert review; preliminary presentation to CHWs; and final evaluation and validation by experts. Usability was assessed by CHWs using the System Usability Scale (SUS), with scores ≥72.74 considered indicative of acceptable usability. The 17 participating CHWs rated the ET positively, with a mean SUS score of 84 ± 11.1, reflecting high usability. The educational technology demonstrated strong usability and, given its collaborative and problem‐oriented development process, represents a promising tool to enhance CHWs’ performance in T2DM management.
Understanding physical activity adherence in vulnerable adults with type 2 diabetes in the rural Brazilian Amazon Farias, Ueno, Monteiro, Squarcini, Autran, Morais Campos, De Leon Rural and Remote Health, 2026 INTRODUCTION: Adopting healthy behaviors is challenging in any context, especially related to physical activity in individuals with chronic conditions. In socially vulnerable settings, challenges are even greater. This study aimed to understand the barriers and facilitators to physical activity adherence in a vulnerable population with type 2 diabetes mellitus in the Brazilian Amazon setting. METHODS: We conducted an exploratory qualitative study using a phenomenological approach. We used semi-structured interviews with participants with type 2 diabetes and the World Café group technique with community health workers. The meetings were recorded. In the organization and processing of the data, the recordings of the semi-structured interviews, the content of the tablecloths, and the videos were transcribed using the Reshape website, coded, and organized using the ATLAS.ti24 software. We used thematic analysis to identify the main facilitators and barriers. The ecological model was employed to guide data collection, analysis, and message development. RESULTS: The main barriers identified were physical limitations, financial difficulties, lack of knowledge, lack of trained and qualified professionals, distance from physical activity locations, and lack of motivation. The major facilitators included an appropriate location within the coverage area of the primary healthcare units, professional guidance, trained and qualified professionals, personal motivation, family support, and adequate financial conditions. CONCLUSION: Environmental factors, personal motivation, and qualified professional guidance were crucial for adherence to physical activity. Our findings underscore the need for public policies and health interventions tailored to vulnerable populations.
Relevance and Acceptability of a Technology-delivered Childhood Obesity Intervention for Hispanic/Latino Families in Rural Nebraska: A Qualitative Approach Thais F. Alves, Natalia Santos, Camila Squarcini, Felipe Marta, Christine Eisenhauer, Fabio Almeida, Fabiana Brito Journal of Primary Care and Community Health, 2025 Background: Hispanics/Latinos (H/L) are the largest minority group in rural areas in the United States. Although childhood obesity represents a growing burden for this population, there is a lack of culturally relevant interventions designed for Latino children and their families. Objective: This study evaluates the relevance and acceptability of Hispanic Family Connections, a technology-delivered and family-based childhood obesity prevention program for Hispanic/Latino families in rural Nebraska. The program’s materials include a workbook with activities for home completion and interactive voice response (IVR) calls. Methods: A qualitative exploratory study was developed through Focus Groups. Participants were adults who self-identified as H/L, caregivers to children aged 6 to 12, and Spanish literate. A bilingual mediator used a script with 12 questions, based on the project’s conceptual and methodological frameworks: i-PARIHS, Cultural Relevance Questionnaire, and FRAME. We used PowerPoint presentations to share samples of the materials that comprise the Hispanic Family Connection intervention. Sessions were recorded, and we applied thematic content analysis with the support of a codebook based on the constructs of Innovation, Facilitation, Beneficiaries, and Adaptations. Results: Twenty-six H/L who lived in rural Nebraska participated in 8 Focus Groups (FG). We conducted 7 FG in Spanish and 1 in English. Participants highlighted the program’s delivery mode using automated personalized technology, which could give them more freedom to engage. They considered the images and wording culturally relevant and easy to understand. Also, the involvement of all family members was a positive note, with parents working as role models. Factors such as workload and weather conditions could act as barriers to participation. Conclusion: Overall, the intervention was considered relevant among rural Hispanic/Latinos, and the program design and materials were accepted with few adaptations suggested.
Feasibility of a culturally adapted technology-delivered, family-based childhood obesity intervention for Latino/Hispanic families in rural Nebraska: the Hispanic Family Connections study protocol Fabiana Almeida Brito, Thais Favero Alves, Natalia Santos, Tzeyu L Michaud, Christine Eisenhauer, Elisa Brosina De Leon, Camila Fabiana Rossi Squarcini, Stephen Kachman, Fabio Almeida, Paul Estabrooks BMJ Open, 2024 IntroductionAddressing childhood obesity risk factors like home environment, parental roles, excess weight, physical activity and healthy eating among Latino/Hispanic (L/H) families living in rural communities is an important priority. However, evidence supporting these interventions among L/H families living in rural communities is missing. Our trial will use cultural adaptation and implementation science frameworks to evaluate the feasibility of delivering a culturally appropriate family-based childhood obesity (FBCO) programme via an automated telephone system (interactive voice response) to L/H families in rural Nebraska.Methods and analysisA mixed-methods feasibility trial for L/H families with overweight or obese children. Aim 1 will focus on collaboratively adapting and evaluating all intervention materials to fit the rural L/H community profile better, including translation of materials to Spanish, culturally relevant content and images, and use of health communication strategies to address different levels of health literacy. In aim 2, a 6-month feasibility trial with contextual evaluation will randomise 48 dyads (parent and child) to either Family Connections (FC; n=29) or a waitlist standard-care group (n=29) to determine overall study reach, preliminary effectiveness in reducing child body mass index (BMI) z-scores, potential for programme adoption, implementation and sustainability through local health departments (RE-AIM outcomes). We will also evaluate health department perceptions of the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) constructs (innovation, context, recipient characteristics) and FC participants’ view of the intervention (ie, relative advantage, observability, trialability, complexity, compatibility). The study will answer three critical questions: (1) is a telephone-delivered FBCO programme in rural Nebraska culturally relevant, usable and acceptable by L/H families?; (2) is a telephone-delivered FBCO programme effective at reducing BMI z-scores in L/H children living in rural Nebraska? and (3) what real-world institutional and contextual factors influence the impact of the intervention and might affect its potential ability to sustainably engage a meaningful population of L/H families who stand to benefit?Ethics and disseminationThis protocol was approved by the University of Nebraska Medical Center Institutional Review Board (IRB#:0745-20-EP). Dissemination of findings will occur through ClinicalTrials.gov, in scientific forums and to the local rural communities, pilot data to inform the design of a larger clinical trial.Trial registration numberNCT04731506.
Evaluation of physical activity program for students: development and validation of an instrument Jaqueline Aragoni Silva, Valter Cordeiro Barbosa Filho, Danielle Biazzi Leal, Camila Fabiana Rossi Squarcini, Kelly Samara da Silva Revista Brasileira De Atividade Fisica E Saude, 2022 Este estudo objetiva desenvolver e validar um instrumento para avaliar dimensões do planejamento e processo de implementação de um programa de intervenção voltado à promoção de atividade física em escolares. Foi conduzido um estudo metodológico realizado durante os meses de julho a dezembro de 2016, vinculado ao programa de intervenção intitulado de “Movimente”. O estudo envolveu as fases teórica (construção do instrumento), empírica e analítica (validação de conteúdo por especialistas, com atribuição de pontuação para os itens e de semântica, por membros da comunidade escolar e alunos do 7º ao 9º ano). O instrumento é dividido em duas dimensões: planejamento e processo. Resultados mostram que a dimensão de planejamento foi composta por indicadores acerca da importância da discussão sobre temas de saúde no contexto escolar, interesse em participar do programa e de suas respectivas ações. A dimensão de processo englobou indicadores sobre conhecimento e avaliação do programa e de suas respectivas ações, bem como sobre o interesse em manter o mesmo. Todas as questões foram consideradas válidas (índices de validade acima de 0,90) e compreensíveis (escores acima de 0,82). Conclui-se que o instrumento apresentou qualidade satisfatória no que diz respeito a validade de conteúdo e semântica, sendo considerado apropriado para avaliação do Programa Movimente e programas e ou projetos similares.
Health promotion of people with diabetes mellitus regarding diabetic foot care Luzia Wilma Santana da Silva, Jarede Souza Silva, Camila Fabiana Rossi Squarcini, Fabiana Galvão Souza, Valéria dos Santos Ribeiro, Deborah Ferreira Gonçalves Ciencia Y Enfermeria, 2016 Objetivo: Conhecer os resultados das ações intervencionistas de educação em saúde à prevenção do pé-diabéti-co. Método: Estudo de método misto, avaliativo-interpretativo na abordagem pesquisa-ação na primeira etapa, oriundo de um projeto guarda-chuva, desenvolvido na Universidade Estadual do Sudoeste da Bahia, Jequié, BA, aprovado pelo Comitê de Ética da citada universidade. A amostra foi composta por 13 idosas. Os instrumentos: um questionário estruturado; um roteiro sistematizado para observação de campo e os registros do conteúdo programático da abordagem educativo-problematizadora do projeto guarda-chuva. Os dados foram analisados na perspectiva interpretativo-compreensica sugerida por Miles e Huberman. Na etapa quantitativa para análise dos dados, fez-se uso da estatística descritiva. Resultados: A estratégia pesquisa-ação foi potencializadora da abordagem educação em saúde ao cuidado de si das participantes, na adoção de medidas protetivas no cuidado com os pés. Conclusão: Mostra-se como fundamental a estratégia de metodologia proximal em práticas que aliem educação em saúde, treinamento e sistematização do autocuidado, de modo à reorientação do modelo assistencial, potencializador dos cuidados em Enfermagem.
Occupational characteristics and lifestyle of teachers in a city of northeast Brazil Saulo Vasconcelos Rocha, Camila Fabiana Squarcini, Jefferson Paixão Cardoso, Gelcemar Oliveira Farias Revista De Salud Publica, 2016 Objective To analyze the characteristics of work, lifestyle profile and its association with professional development cycles teachers of the state system of Jequié (BA). Materials and Methods Cross-sectional study with a random sample of 304 teachers who answered a questionnaire on sociodemographic information, occupational and lifestyle. The phases of professional development cycles adopted were: entry, consolidation, diversification and stabilization. For analysis, we used descriptive statistics and measures of association using the chi-square test (0.05) and multinomial logistic regression. Results It was observed that most teachers maintained a regular behavior for the general life style, with the increase statistically significant levels only to feed positive behavior. Conclusions We conclude that there is need to carry out programs to encourage the adoption of an active lifestyle among the teachers, especially after the entry phase in his career where negative behavior became more pronounced.
Ficha antropométrica nos Núcleos de Apoio à Saúde da Família: Potencialidades e obstáculos Camila Fabiana Rossi Squarcini, Gilmar Mercês de Jesus, Edio Luiz Petroski Revista Brasileira De Cineantropometria E Desempenho Humano, 2015 A model of an anthropometric record to be used in the Núcleos de Apoio à Saúde da Família (Centers for Family Health Support) in Brazil has been proposed in the literature, showing the logistics of use. The aim of this study was to discuss the anthropometric record, showing the potential and obstacles of its use. It was observed that, for adults, the screening measures (body mass index and waist circumference) for the determination of the risk of cardiovascular and metabolic diseases can be considered promising, although the Basic Health Care network already uses these measures. Nevertheless, the supplementary assessment (skinfold thickness and body circumferences) could be another potential possibility, except for the time spent to perform this assessment and the lack of studies of the cost-benefit of these anthropometric techniques. It was concluded that the anthropometric record proposed is an important instrument for improving the quality of the service provided to users of the Basic Health Care System; however, some adjustments, such as the removal of skinfold measurements as part of primary care, should be taken into consideration.
Chronobiology and educational inclusion of persons with blindness: From the biological to the social Revista Brasileira De Educacao Especial, 2013
