Segurança Alimentar e Nutricional no Programa Saúde na Escola de Municípios do Oeste do Paraná

Abstract

In Brazil, overweight, associated with inadequate feeding practices, is part of the picture of food and nutritional insecurity present in all ages. Legal initiatives have been proposed to implement actions aimed at changing the nutritional picture in which overweight and obesity are seen as emerging public health problems. The School Health Program (PSE), created to promote comprehensive health care in the public school network, includes Food Safety and Healthy Eating Promotion as one of the actions to be undertaken by health and education professionals, in addition to involving primary health care and basic education teams and the school community. This study aims to identify and analyze the Food and Nutritional Security (SAN) actions implemented in Paraná municipalities to face possible food and nutritional problems among schoolchildren from the perspective of the professionals involved in the PSE and the current legislation. It is a Mixed Method (MM) multiphase study carried out in three phases. The first phase was of qualitative approach: a documentary study of the 56 regulations in force in March 2021 that guide the SAN, whose content analysis was performed with the support of Iramuteq, which, after lexicographic analysis, resulted in 3 thematic categories; and a narrative review with 29 articles about the PSE, analyzed by the SWOT matrix to identify the strengths (Strengths and Opportunities) and weaknesses (Weaknesses and Threats) of the program. The second phase was a quantitative, descriptive survey, using a structured, selfadministered, online questionnaire, to 340 health and education workers involved with the PSE in the 25 municipalities of the Western region of Paraná belonging to the 10th Health Region, which are in the program, whose statistical analysis included absolute and relative frequencies, and Chi-square tests. Through a qualitative approach and random sampling, nested with the participants of phase 2, the third phase had 26 participants for unstructured interviews online, having the content analysis performed with the help of Iramuteq. The analysis of the MM was carried out, after the three phases, with the integration of the data from phases 2 and 3 by connection, analyzed in the light of the three thematic categories identified in phase 1. It can be inferred that, in the practice of the services, the initiatives are isolated, with individualized actions, centered on the disease. The intersectoral disarticulation and the lack of training for professionals were the main weaknesses of the program, better known by health workers, whose planning of actions is centralized, and the PSE does not direct actions aimed at the SAN of schoolchildren. It suggests the need to strengthen the intersectoriality and the integrality of care to establish, in the PSE, possibilities of health promotion through good and healthy eating