Continuing education intervention for primary health care professionals improves knowledge of noncommunicable diseases in Brazil

Continuing education intervention for primary health care professionals improves knowledge of noncommunicable diseases in Brazil | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Continuing education intervention for primary health care professionals improves knowledge of noncommunicable diseases in Brazil Luiz Felipe de Paiva Lourenção, Vitória da Cunha Paiva Carneiro, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8970839/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective: This study aimed to to evaluate the effectiveness of a continuing health education intervention of professionals involved in the Family Health Strategy of a municipality in Minas Gerais, Brazil, based on the 2021-2030 DANT Plan. Methods: This is a University Extension action called “Continuing Education in Health for Community Health Agents and Community: Non-Communicable Diseases and Conditions (NCDs)”, carried out between September and November 2024. The evaluation of the Extension Action was carried out through a questionnaire, on a 7-point Likert scale. The effectiveness of the action was evaluated using the paired t-test, comparing the average knowledge scores before and after the Extension Course, with a significance level of p<0.05. Results: The sample consisted of 27 professionals, 88.9% of whom were female, with a median age of 36 years. The average knowledge on the DANT theme before the Course was 4.44 points and after the 4 meetings, the average knowledge on the theme addressed was 6.37 points, observing a difference (p<0.001) between the average scores before and after the theme taught. Conclusion: The evaluation of the themes addressed during the Training Course demonstrated that they were effective in the acquisition of knowledge among the participants. Health Education Noncommunicable Diseases Health Promotion Community Health Workers Primary Health Care Introduction The Unified Health System (SUS, in Portuguese), with its foundations structured in the health reform, has, as a constitutional competence, the responsibility of ordering the training of health professionals [ 1 ] (Brazil, 2018a). In view of this, the promotion of initiatives that stimulate and provide training for professionals is of paramount importance in the constant process of strengthening the SUS [ 2 ]. Continuing Education becomes an essential component of training and human resource development programs, aiming at updating knowledge. Since it emphasizes the promotion of training and courses offered by institutions [ 3 ]. Continuing Education needs to be considered a member of Permanent Health Education, which is an educational approach that continuously seeks to develop health professionals and emphasizes the importance of continuous learning and constant updating to ensure the provision of high-quality health services [ 4 ]. Among the target audience for participating in Continuing Health Education, Community Health Agents stand out, as they are health professionals who work in Primary Health Care. Community Health Agents effectively symbolize the connection between the Family Health Strategy (ESF, in Portuguese) and the community, playing an important role in consolidating the SUS (Brazilian Unified Health System) through care-based and supportive relationships [ 5 ]. The Community Health Agent is a professional with political, social, and health responsibilities and is a fundamental figure for the ESF, since they transmit important health-related information to the population. Therefore, this professional has the potential to intervene in the population's health situation, as their knowledge of daily life in the territories can contribute to the development of strategies aimed at improving the work carried out in the areas covered by the FHS [ 6 ]. A central point of discussion within continuing health education refers to Non-Communicable Diseases and Conditions (NCDs), which constitute the group of diseases with the highest prevalence in the country, especially affecting the most vulnerable populations, such as those with low income and low education. NCDs are responsible for more than half of all deaths in Brazil. In 2019, 54.7% of deaths registered in Brazil were caused by Non-Communicable Chronic Diseases (NCDs) and 11.5% by related conditions [ 7 , 8 ]. In order to address this problem, the Ministry of Health launched the Strategic Action Plan to Combat NCDs in Brazil, 2011–2022. With the approaching end of the validity of this plan, and in accordance with the Sustainable Development Goals (SDGs) of the United Nations (UN), a new strategic action plan for addressing Chronic Diseases and Non-Communicable Diseases (NCDs) in the country was developed for the period 2021–2030 (NCD Plan). In addition to NCDs, NCDs include accidents and violence. Thus, the new plan reaffirms and expands the proposals for addressing these issues, as well as presenting itself as a guideline for the prevention of risk factors for NCDs [ 9 ]. NCDs, mainly cardiovascular diseases, cancers, diabetes, and chronic respiratory diseases, are caused by various factors linked to the living conditions of individuals. These are determined by access to public goods and services, guarantee of rights, information, employment and income, and the possibility of making choices favorable to health. The main behavioral risk factors for developing NCDs are: smoking, alcohol consumption, unhealthy diet, and physical inactivity. These can be modified by behavioral change and by government actions that regulate and reduce, for example, the marketing, consumption, and exposure to products harmful to health [ 8 , 10 ]. The 2021–2030 NCD Plan addresses the four main groups of chronic diseases and their risk factors. In this plan, the Ministry of Health (2021) defined guidelines and actions in three areas: a) surveillance, information, evaluation, and monitoring; b) health promotion; and c) comprehensive care. To address NCDs, in addition to organizing the health sector to ensure access to care, promotion, prevention, and surveillance, an articulation of intersectoral actions is essential. Policies to address NCDs must be articulated, integrated, and cooperative [ 11 ]. Thus, the present work aimed to promote the training of professionals involved in the Family Health Strategy (ESF) in the municipality of Passa Quatro-MG, Brazil, based on the 2021–2030 National Plan for Disease Prevention and Control (DANT), with a view to improving the work of Community Health Agents within the scope of Primary Care and in the care process for users served in their homes, strengthening the functioning of the Brazilian Unified Health System (SUS). Methods Study design and setting This study was conducted as a program evaluation embedded within a university extension activity entitled “Continuing Health Education for Community Health Agents and the Community: Non-Communicable Diseases and Conditions (NCDs).” The initiative aimed to strengthen professional training within Primary Health Care services and was implemented between September and November 2024 in the municipality of Passa Quatro, Minas Gerais, Brazil. The extension activity was formally registered with the Pro-Rectorate for Extension of the Federal University of Alfenas (UNIFAL-MG) under protocol number PREAE 7420. The present evaluation employed a pre–post analytical approach to assess changes in participants’ knowledge following the educational intervention. The evaluation component was designed exclusively to assess educational outcomes and program effectiveness. Participants All professionals linked to the Family Health Strategy (FHS) units in the municipality were invited to participate in the extension course. A total of 27 health professionals enrolled in the activity and attended the four educational sessions. Participation in the evaluation component was voluntary. All attendees agreed to participate in the pre- and post-intervention assessments. Ethics approval and consent to participate This study was conducted as part of a university extension activity aimed at continuing professional education and professional training at the Universidade Federal de Alfenas - UNIFAL-MG. The extension project was formally approved by the Pró-Reitoria de Extensão e Cultura da Universidade Federal de Alfenas under registration number PREAE 7420. The activity consisted of an educational intervention followed by a program evaluation process designed to assess participants’ knowledge. According to the institutional guidelines of the Research Ethics Committee (Comitê de Ética em Pesquisa – CEP) of UNIFAL-MG and the ethical regulations established by the Brazilian National Health Council (Resolution No. 466/2012), activities characterized as educational program evaluation that involve minimal risk to participants and do not collect identifiable personal data may be exempt from formal review by a Research Ethics Committee. Based on these criteria, the present study was considered exempt from formal ethical review (waived approval) because it involved an educational intervention with program evaluation components, posed minimal risk to participants, and did not involve the collection of identifiable personal information. The evaluation focused exclusively on aggregated knowledge outcomes related to the educational activity and did not involve sensitive personal data, clinical information, or any procedures that could pose risk to participants. All participants were informed about the objectives of the activity and the voluntary nature of their participation. Verbal informed consent was obtained prior to data collection. No personal identifiers were collected, and confidentiality and anonymity were ensured throughout all stages of the study. The study was conducted in accordance with the ethical principles of the Declaration of Helsinki. Educational intervention The course consisted of four in-person meetings addressing major non-communicable diseases and conditions, including hypertension, diabetes mellitus, obesity, and other priority chronic conditions in Primary Health Care. Educational strategies included dialogical lectures, case discussions, and problem-based learning activities. The Extension Activity was developed through 4 (four) Thematic Meetings, taught by different Health Professionals, in order to carry out a theoretical-practical approach to the main points raised about the care, management and attention to NCDs. The meetings were held between September and November 2024, covering the following topics: Meeting 1: Strategic Action Plan for Addressing Chronic Diseases and Non-Communicable Conditions in Brazil, 2021-2030 (NCD Plan); Meeting 2: Healthy Eating in the fight against Non-Communicable Diseases and Conditions (NCDs); Meeting 3: Physical Activity/Body Practice and Prevention and Control of Smoking; Meeting 4: The School Community and the actions of the National School Feeding Program (PNAE) in combating Non-Communicable Diseases and Conditions (NCDs) in childhood. Each meeting was held in person in the municipality of Passa Quatro-MG, Brazil, with a workload of 3 (three) hours each, totaling 12 (twelve) hours of activities. In the first meeting, a questionnaire was applied in order to obtain general information about the participants of the Extension Activity, such as age, biological sex, education level, and length of time working with the Family Health Team. The evaluation of the Extension Activity was carried out using a questionnaire, on a 7-point Likert scale, a type of psychometric response scale, encompassing the context of pre-test and post-test. In the first meeting, the professional had to answer the question: "How do you consider your knowledge about the topic of Non-Communicable Diseases and Conditions (NCDs), today, before the Course?", considering the options of the Likert scale: 1 (very little), 4 (moderate), 7 (quite a lot) [12]. In the last meeting, the same professional answered the following question: "How do you consider your knowledge about the topic of Non-Communicable Diseases and Conditions (NCDs), now, after the Course?", considering the same response options from the Likert scale, that is, 1 (very little), 4 (moderate), 7 (quite a lot), for later verification of the difference in averages. To evaluate the effectiveness of the proposed Action, the paired t-test was used to compare the average knowledge scores of the participants after and before the Extension Course, where the differences (between the averages) were considered significant when p<0.05. For the analysis, the statistical software Statistical Package for the Social Sciences - SPSS, version 25.0, was used. Results The extension course included 27 health professionals affiliated with the Family Health Strategy (FHS) units in Passa Quatro, Minas Gerais, Brazil. All participants attended the four training sessions and completed both the pre- and post-intervention assessments. The majority were female (n = 24; 88.9%), with a median age of 36 years (interquartile range: 26–45 years). Most participants (59.2%) were aged 39 years or younger. Regarding education, 44.4% (n=12) have completed high school, and the same percentage have completed higher education. The sample's length of service in the Family Health Team is predominantly below 5 years (n=11; 40.7%), with 7 professionals (25.9%) working for more than 10 years with the teams. The general characteristics of the participants are presented in Table 1. Table 1 – General characteristics of the participants in the Extension Activity: Continuing Education in Health for Community Health Agents and Community: Non-Communicable Diseases and Conditions (NCDs), Passa Quatro-MG, Brazil, 2025. Characteristic n % Sex Female 24 88.9 Male 3 11.1 Age Range 50 years 4 14.8 Education Level High School 12 44.4 Higher Education 12 44.4 Postgraduate Studies 3 11.1 Time working in the Family Health Team 10 years 7 25.9 Source: prepared by the authors (2025). The evaluation of the Extension Activity, carried out through a questionnaire, on a 7-point Likert scale, demonstrated that the average knowledge about the DANT theme, before the Course was 4.44 points [4.03; 4.86]. After the 4 meetings, the average knowledge about the topic covered was 6.37 points [6.10; 6.64]. Through the paired t-test, a difference (p<0.001) was observed between the average scores after and before on the topic taught, proving the gain in knowledge among the participants through the approach of the distinct theme. The average score (gain) after the educational intervention can increase by up to 2.47 points among the participating professionals, considering a confidence level of 95% (Table 2). Table 2 – Results of the paired t-test to assess knowledge about the topic of Non-Communicable Diseases (NCDs) (after and before the intervention), Passa Quatro-MG, Brazil, 2025. Variable n Mean before Mean after p-value Mean of differences*, CI95% ( ) Knowledge about the topic of NCDs Participants in the Extension Activity 27 4.44 6.37 <0.001 1.92 [1.37; 2.47] * Estimate of the mean difference (After-Before) in knowledge about the topic of Non-Communicable Diseases (NCDs) and respective 95% confidence interval for the mean difference (gain in knowledge) in the population. Source: prepared by the authors (2025). Discussion University Extension activities are considered a link between the University and Society, providing scientific knowledge in conjunction with the needs presented by different sectors and social instances. Along with the educational process proposed by University Extension, some guidelines must be observed and substantiated, namely: dialogical interaction; interdisciplinarity and interprofessionality; the inseparable relationship between teaching, research and extension; impact on student training; and social impact and transformation [13]. Continuing Education in Health, associated with extension activities in partnership with Higher Education Institutions, should aim to keep professionals updated on advances and changes in their respective areas of expertise [14]. In Primary Health Care, the formation of a multidisciplinary team requires attention and care at this level of health care, given the coordinated action in the comprehensive care and treatment of an individual or group of individuals, requiring a comprehensive and holistic approach to health care [15]. The themes and topics addressed in the training process for health teams should be innovative, intersectoral, and focused on comprehensive health care. The National Policy on Permanent Education in Health, established by Ordinance GM/MS No. 198, of February 13, 2004, commits to creating innovative methodologies aimed at identifying the training and development needs of health workers and building strategies and processes that improve health care and management and strengthen social control in the sector with a view to producing a positive impact on individual and collective health [1, 16]. These actions should prioritize the teaching-learning process based on discussions, joint analyses, and implications with real problems, in a constant process of investigating their causes and seeking alternative solutions [17]. The Surveillance System for Risk Factors of Chronic Diseases by Telephone Survey (Vigitel), with the purpose of monitoring the frequency and distribution of the main determinants of NCDs in Brazil, estimated in 2023 that the frequency of medical diagnosis of hypertension was 27.9% in Brazilian capitals, being higher among women (29.3%) than among men (26.4%). The frequency of medical diagnosis of diabetes was 10.2%, being higher among women (11.1%) than among men (9.1%). The frequency of adult smokers was 9.3%, being higher in males (11.7%) than in females (7.2%) [18]. Vigitel, as well as other NCD Risk Factor Surveillance systems of the Ministry of Health, tend to subsidize the mechanisms of action and the formulation of Public Policies that promote the improvement of the quality of life of the Brazilian population. As a central axis, the Strategic Action Plan for Addressing Chronic Diseases and Non-Communicable Conditions in Brazil, 2021-2030 (NCD Plan), stands out, with the objective of pointing out actions aimed at the prevention and control of NCDs and their risk factors [19]. Given the multifactorial etiology of NCDs, their magnitude and the complex interaction of social determinants of health, different levels and stages of action are necessary in addressing them within the Health System and the formulation of joint and multi-professional interventions [20]. The NCD Plan establishes the strengthening and (re)organization of work processes for health promotion in constant dialogue with the main health policies. Its implementation is the responsibility of co-management, in order to offer conditions for the strengthening and integration of the team [21]. The document itself cites the following dimension for the reinforcement and scope of the NCD Plan: Continuing Education in Health focused on the themes and implementation strategies of the NCD Plan – This involves ensuring these themes are included in state and/or municipal Continuing Education in Health plans, providing training to build and strengthen the skills and abilities of health professionals to address and provide care for NCDs and related conditions… [1]. Thus, professionals who are part of the Family Health Team, especially Community Health Agents, must be trained to conduct active case finding and community awareness of this issue, and also, acting in an interdisciplinary manner in the early detection of NCDs, identifying risk factors in the home and territory and coordinating actions to promote the health of the population and health education strategies that promote people's participation and autonomy for health care [22-24]. Regarding NCDs, the National Health Promotion Policy (PNPS) document points to priority actions for addressing these conditions based on their main modifiable risk factors, namely Healthy Eating, Physical Activity/Exercise, and Tobacco Prevention and Control [25]. Adequate and healthy food is a basic human right and is related to improved health, a lower risk of non-communicable diseases, and longevity. The beneficial effect on disease prevention comes from the food itself and the combinations of nutrients and other chemical compounds that are part of the food matrix, rather than from isolated nutrientes [26, 27]. Healthy food should be accessible, tasty, varied, colorful, harmonious, and safe in terms of sanitary aspects; it should consider cultural food practices and value the consumption of healthy regional foods. In addition, it should be adequate to the biological and social needs of individuals and should be in accordance with the stages of the life course. The promotion of healthy eating is supported by the National Food and Nutrition Policies (PNAN) and the PNPS. Furthermore, it is recommended that such actions be based on the information present in the Dietary Guidelines for the Brazilian Population (updated in 2014). The Guide clearly and concisely guides the path to a healthy and sustainable diet and is easy to understand, serving as a basis for all actions developed on nutrition in the context of Primary Health Care. Thus, when the patient understands the NOVA classification [28], they become able to develop autonomy over their food choices and no longer depend solely on health professionals to manage their nutritional treatment [29]. Healthy food choices lead to significant improvements in the population's quality of life. Therefore, it is necessary to develop actions and programs to promote healthy eating habits through nutritional education and health promotion in all health services, concentrating them in Primary Care, understanding it as a privileged locus for this purpose [30]. The benefits of physical activity are well established and recognized for reducing the prevalence of cardiovascular diseases, diabetes, cancer, obesity, among others, and ultimately for reducing mortality from NCDs [8]. Physical inactivity is a major risk factor for NCDs and one of the leading causes of death worldwide [31, 32]. Regular physical activity helps prevent and control NCDs, helps manage weight, reduces anxiety and symptoms of depression, improves sleep quality, and benefits mental health, including preventing memory loss. Physical activity can be practiced in leisure time, during commutes, work or study activities, and household chores [33]. The Ministry of Health, in its Physical Activity Guide for the Brazilian Population [34], addresses physical activity in all life cycles – children, adolescents, adults and the elderly, including pregnant women and people with disabilities, in addition to highlighting School Physical Education. Another important risk factor for NCDs is smoking, which is related to the development of various types of malignant neoplasms, respiratory diseases, cardiovascular diseases, among other diseases. Smoking constitutes a major threat to public health, being responsible for more than 8 million deaths per year worldwide, of which about 1.2 million are due to passive smoking [35, 8]. Brazil has expertise in the area of tobacco control, and is also recognized worldwide for its success in anti-tobacco policy. Achieving the agreed-upon goal of reducing the prevalence of smoking in the country by 40% will allow Brazil to further advance its tobacco control policy, which is a significant risk factor for NCDs and global public health [36, 37]. The National Tobacco Control Program (PNCT) is an initiative of the Ministry of Health that aims to reduce the number of smokers and mortality caused by tobacco. Tobacco control groups are structured in sessions that take place with a multidisciplinary team and use techniques such as active listening, guidance and explanations about addiction and risk factors, following booklets provided by the Ministry of Health. The meetings help participants understand the meaning of smoking and strengthen their will to change and avoid relapses [38, 39]. Given the problem of nicotine addiction, the Community Health Agent plays an important role in welcoming and informing smokers about the programs that the government makes available to help them break free from addiction, as well as providing information about the risks that smoking causes, as well as the benefits that quitting smoking brings to their health [39]. The topic addressed, concerning the School Community and the actions of the National School Feeding Program (PNAE) in combating NCDs in childhood, highlighted the importance of offering Adequate and Healthy Food in the school environment and the development of healthy eating habits among students. School feeding is a right guaranteed by Law No. 11,947/2009, standing out as a type of Public Policy that provides healthy school food, associated with sustainable initiatives and the strengthening of family farming, aiming at Food and Nutritional Security (SAN) [40]. The School Community is present in the territories of operation of the Family Health Strategy (ESF), being considered an area of operation for the health teams that work in the assigned region. Due to its multidisciplinary and multiprofessional approach, the National Primary Care Policy (PNAB) stipulates that members of the teams working in Primary Care must provide comprehensive health care to the assigned population, primarily within the Basic Health Unit, and when necessary, at home and in other community spaces, such as schools, through intersectoral actions and strategies, such as the School Health Program (PSE) [41]. The National School Feeding Program (PNAE) can be characterized as a Healthy Public Policy (HPP), given its proposition directly linked to Health Promotion [40]. The legal framework of the Program, according to current legislation, provides for the offering of meals that meet the nutritional needs of students during the school year, in addition to the supply of fresh fruits, vegetables and greens, and the inclusion of foods that are sources of heme iron and foods that are sources of vitamin A in school menus. There is a limitation on the supply of certain products, such as meat products, dairy drinks, biscuits, cookies, bread or cakes, sweets, regional sweet preparations and others. And in an innovative way, based on the recommendations of the Dietary Guidelines for Brazilian Children Under 2 Years Old, it advocates the prohibition of supplying ultra-processed foods and the addition of sugar, honey and sweeteners in culinary preparations and beverages for children up to three years of age [42, 43]. Family Health teams, within their responsibilities, can carry out interventions in School Units aimed at promoting adequate and healthy eating, in addition to institutional and intersectoral partnerships aimed at Food and Nutrition Education (FNE) actions in the school environment, in order to contribute to the adoption of healthy eating practices and the development of skills for self-care and well-being in the school environment, acting in a coordinated manner in the prevention of all forms of malnutrition, obesity and other chronic diseases in childhood and adolescence [44, 45]. The importance of Community Health Agents in Primary Health Care and alongside Family Health Teams is widely recognized in the literature, going beyond individual care. Given their diverse responsibilities, it is essential to offer appropriate training and adequate and ongoing qualification to fulfill their competencies within the community, thus requiring a continuous training process and improvement of the work carried out in the areas assigned to the Family Health Strategy (ESF) teams [46, 6]. This study has some limitations that should be acknowledged. The pre–post design without a control group limits causal inference regarding the observed knowledge gains. In addition, the small convenience sample, restricted to a single municipality, may reduce the generalisability of the findings. Knowledge assessment relied on self-reported measures using a Likert scale, which may be subject to social desirability bias. Furthermore, the evaluation was conducted immediately after the intervention, preventing assessment of long-term knowledge retention or changes in professional practice. Finally, the absence of qualitative methods limited a deeper exploration of participants’ perceptions and the applicability of the training in real-world settings. Conclusion The evaluation of the topics covered during the Training Course proved effective in the acquisition of knowledge among the participants. Thus, it is concluded that the implementation of Continuing Health Education among Family Health Teams is important in order to qualify and improve the work process in relation to the topics included in public health services from a multi-professional and interdisciplinary perspective. Thus, by encouraging healthier habits, such as regular physical activity and the adoption of a balanced diet, it is possible to significantly reduce the risk of developing these diseases, promoting an improvement in the health of the population. Declarations Ethics approval and consent to participate This study was conducted as part of a university extension activity aimed at professional training at the Universidade Federal de Alfenas - UNIFAL-MG. According to the guidelines of the Institutional Research Ethics Committee (Comitê de Ética em Pesquisa – CEP) of UNIFAL-MG, the activity was characterized as an educational intervention with program evaluation components and therefore did not require formal review or approval by the Research Ethics Committee. In accordance with Brazilian regulations (Resolution No. 466/2012 of the National Health Council), activities classified as educational program evaluation without individual identification are exempt from Research Ethics Committee review. All participants were informed about the objectives and the voluntary nature of their participation in the evaluation process. Verbal informed consent was obtained prior to data collection. No personal identifiers were collected, and confidentiality and anonymity were ensured throughout all stages of the study. The study was conducted in accordance with the ethical principles of the Declaration of Helsinki. Consent for publication Not applicable. Clinical trial number Not applicable. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding The authors received no financial support for the research, authorship, and/or publication of this article. Authors’ contributions L.F.P.L. conceptualized and designed the study, coordinated the intervention, performed the statistical analysis, and drafted the initial manuscript. V. C. P. C and D. A. C. contributed to the implementation of the intervention, participated in data collection activities, and substantially contributed to manuscript writing and critical revision. All authors reviewed, revised, and approved the final version of the manuscript. Acknowledgements The authors thank the Municipal Health Department of Passa Quatro, Minas Gerais, and all participating health professionals for their collaboration. References Brasil. Ministério da Saúde (MS). Secretaria de Gestão do Trabalho e da Educação na Saúde. Departamento de Gestão da Educação na Saúde (2018) Política Nacional de Educação Permanente em Saúde : o que se tem produzido para o seu fortalecimento?. Brasília: MS. https://bvsms.saude.gov.br/bvs/publicacoes/politica_nacional_educacao_permanente_saude_fortalecimento.pdf Cruz PJSC, Silva MRF, Pulga VL. (2020) Educação Popular e Saúde nos processos formativos: desafios e perspectivas. 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Departamento de Análise Epidemiológica e Vigilância de Doenças Não Transmissíveis (2023) Vigitel Brasil 2023: vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico: estimativas sobre frequência e distribuição sociodemográfica de fatores de risco e proteção para doenças crônicas nas capitais dos 26 estados brasileiros e no Distrito Federal em 2023. Brasília: MS. https://bvsms.saude.gov.br/bvs/publicacoes/vigitel_brasil_2023.pdf Mássimo E AL, Freitas MI F (2014) Riscos para doenças crônicas não transmissíveis na ótica de participantes do Vigitel. Saude soc 23(2): 651–63. https://doi.org/10.1590/S0104-12902014000200024 Aguiar JS, Andrade, RLM (2021) Construção da Vigilância das Doenças e Agravos Não Transmissíveis e os passos para sua inclusão na agenda da saúde pública do Espírito Santo. Rev. Bras. Pesq. Saúde 23(4): 85-97. Doricci GC, Guanaes-Lorenzi C (2020) Aspectos contextuais na construção da cogestão em Unidades Básicas de Saúde. Saúde debate 44(127): 1053–65. https://doi.org/10.1590/0103-1104202012708 Brasil. Ministério da Saúde (MS). Secretaria de Gestão do Trabalho e da Educação na Saúde. Departamento de Gestão da Educação na Saúde (2016) Diretrizes para capacitação de agentes comunitários de saúde em linhas de cuidado . Brasília: MS. https://bvsms.saude.gov.br/bvs/publicacoes/diretrizes_capacitacao_agentes_comunitarios_cuidado.pdf Morosini MV, Fonseca AF (2018) Os agentes comunitários na Atenção Primária à Saúde no Brasil: inventário de conquistas e desafios. Saúde debate 42(spe1): 261–74. https://doi.org/10.1590/0103-11042018S117 Melo ENN, Oliveira PC, Lopes DB et al. (2024) Conhecimentos de agentes públicos em saúde nos territórios: avaliação de um curso de qualificação. Contribuciones a Las Ciencias Sociales 17(1): 328–343. https://doi.org/10.55905/revconv.17n.1-019 Brasil. Ministério da Saúde (MS). Secretaria de Vigilância em Saúde. Secretaria de Atenção à Saúde (2018) Política Nacional de Promoção da Saúde (PNPS): Anexo I da Portaria de Consolidação nº 2, de 28 de setembro de 2017, que consolida as normas sobre as políticas nacionais de saúde do SUS. Brasília: MS. Paiva JB, Magalhães LM, Santos SMC et al. (2019) A confluência entre o “adequado” e o “saudável”: análise da instituição da noção de alimentação adequada e saudável nas políticas públicas do Brasil. Cad Saúde Pública 35(8): e00250318. doi: 10.1590/0102-311X00250318 Guerra LDS, Cervato-Mancuso AM, Bezerra ACD (2019) Alimentação: um direito humano em disputa - focos temáticos para compreensão e atuação em segurança alimentar e nutricional. Ciênc saúde coletiva 24(9): 3369–3394. https://doi.org/10.1590/1413-81232018249.20302017 Brasil. Ministério da Saúde (MS). Departamento de Atenção Básica (2014) Guia alimentar para a população brasileira. 2. ed. Brasília: MS. https://bvsms.saude.gov.br/bvs/publicacoes/guia_alimentar_populacao_brasileira_2ed.pdf Menegassi B, Almeida JB, Olimpio MYM et al. (2018) A nova classificação de alimentos: teoria, prática e dificuldades. Ciênc saúde coletiva 23(12): 4165–4176. https://doi.org/10.1590/1413-812320182312.30872016 Stocco-Padilha AB, Germani ACCG(2023) Food and nutrition education actions in school environment: a scoping review. Research, Society and Development 12(6): e28312642153. https://doi.org/10.33448/rsd-v12i6.42153 Bernal RTI, Malta DC, Iser BPM, et al. (2016) Método de projeção de indicadores das metas do Plano de Ações Estratégicas para o Enfrentamento das Doenças Crônicas não Transmissíveis no Brasil segundo capitais dos estados e Distrito Federal. Epidemiol Serv Saúde 25(3): 455–66. https://doi.org/10.5123/S1679-49742016000300002 Andrade FMD, Machado IE, Barbosa, JAG (2022) Prevalência de doenças não transmissíveis e fatores de risco em industriários de Minas Gerais. Avances en Enfermería 40(2): 199-213. Benedetti TRB, Borges LJ, Streit IA, et al. (2021) Validade e clareza dos conceitos e terminologias do Guia de Atividade Física para a População Brasileira. Revista Brasileira de Atividade Física & Saúde 26:1–11. https://doi.org/10.12820/rbafs.26e0212 Brasil. Ministério da Saúde (MS). Secretaria de Atenção Primária à Saúde. Departamento de Promoção da Saúde (2021) Guia de Atividade Física para a População Brasileira. Brasília: MS. https://bvsms.saude.gov.br/bvs/publicacoes/guia_atividade_fisica_populacao_brasileira.pdf Silva ST, Martins MC, Faria FR et al. (2014) Combate ao Tabagismo no Brasil: a importância estratégica das ações governamentais. Ciênc saúde coletiva 19(2): 539–552. https://doi.org/10.1590/1413-81232014192.19802012 Portes LH, Machado CV, Turci SRB et al. (2018) Política de Controle do Tabaco no Brasil: um balanço de 30 anos. Ciênc saúde coletiva 23(6):1837–1848. https://doi.org/10.1590/1413-81232018236.05202018 Vosmirko NMS, Machado AT, Vianna CGF et al. (2025) Fim de Jogo para o Tabagismo no Brasil. Revista Brasileira de Cancerologia 71(1): e–034922. https://doi.org/10.32635/2176-9745.RBC.2025v71n1.4922 Brasil. Ministério da Saúde (MS) (2023) Portaria GM/MS nº 502, de 1º de junho de 2023. Institui o Programa Nacional de Controle do Tabagismo (PNCT) no âmbito do Sistema Único de Saúde (SUS). Diário Oficial da União , Brasília, DF, 2 jun. 2023. Seção 1, p. 42-44. Instituto Nacional De Câncer – INCA (2025) Agente comunitário de saúde e o controle do tabagismo no Brasil. 3. ed. Rio de Janeiro: INCA. Kroth DC, Geremia DS, Mussio BR (2020) Programa Nacional de Alimentação Escolar: uma política pública saudável. Ciênc saúde coletiva 25(10): 4065–4076. https://doi.org/10.1590/1413-812320202510.31762018 Brasil. Ministério da Saúde (MS) (2017) Portaria GM/MS nº 2.436, de 21 de setembro de 2017. Aprova a Política Nacional de Atenção Básica, estabelecendo a revisão de diretrizes para a organização da Atenção Básica, no âmbito do Sistema Único de Saúde (SUS). Diário Oficial da União , Brasília, DF, 22 set. 2017. Seção 1, p. 68. Brasil. Ministério da Saúde (MS). Secretaria de Atenção Primaria à Saúde. Departamento de Promoção da Saúde (2019) Guia alimentar para crianças brasileiras menores de 2 anos. Brasília: MS. Brasil (2020) Resolução nº 06, de 08 de maio de 2020. Dispõe sobre o atendimento da alimentação escolar aos alunos da educação básica no âmbito do Programa Nacional de Alimentação Escolar – PNAE. Diário Oficial da União , Brasília, DF, 12 maio 2020. Seção 1, p. 38. Marques RJR, Rezende-Alves K, Soares CS et al. (2020) Análise do Trabalho em Equipe Multiprofissional para Ações de Alimentação e Nutrição na Atenção Básica. Trabalho, Educação e Saúde 18(1): e0024172. https://doi.org/10.1590/1981-7746-sol00241 Pedraza DF (2022) Atuação de enfermeiros da Estratégia Saúde da Família no cuidado nutricional de crianças. Cad saúde colet 30(1): 94–107. https://doi.org/10.1590/1414-462X202230010405 Samudio JLP, Brant LC, Martins ACFDC et al. (2017) Agentes Comunitários de Saúde na Atenção Primária no Brasil: Multiplicidade de Atividades e Fragilização da Formação. Trabalho, Educação e Saúde 15(3): 745–769. https://doi.org/10.1590/1981-7746-sol00075 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8970839","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":623053328,"identity":"60f70b02-933d-4d98-bd47-28ce286dcefe","order_by":0,"name":"Luiz Felipe de Paiva Lourenção","email":"data:image/png;base64,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","orcid":"","institution":"Federal University of Alfenas - UNIFAL-MG","correspondingAuthor":true,"prefix":"","firstName":"Luiz","middleName":"Felipe de Paiva","lastName":"Lourenção","suffix":""},{"id":623053329,"identity":"431000b6-6f71-4cfe-8731-af51b52b5a43","order_by":1,"name":"Vitória da Cunha Paiva Carneiro","email":"","orcid":"","institution":"Municipal Health Department of Passa Quatro-MG","correspondingAuthor":false,"prefix":"","firstName":"Vitória","middleName":"da Cunha Paiva","lastName":"Carneiro","suffix":""},{"id":623053330,"identity":"3ff31a46-5ef3-49d9-9879-41f604388984","order_by":2,"name":"Dandara Antunes Coimbra","email":"","orcid":"","institution":"Municipal Health Department of Passa Quatro-MG","correspondingAuthor":false,"prefix":"","firstName":"Dandara","middleName":"Antunes","lastName":"Coimbra","suffix":""}],"badges":[],"createdAt":"2026-02-25 19:38:06","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8970839/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8970839/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107018133,"identity":"7575fdbd-8d1b-4396-9bf0-9655b20f4089","added_by":"auto","created_at":"2026-04-15 20:24:48","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":639437,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8970839/v1/412a3123-6dae-4aff-98c6-8cf1fe277b61.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Continuing education intervention for primary health care professionals improves knowledge of noncommunicable diseases in Brazil","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe Unified Health System (SUS, in Portuguese), with its foundations structured in the health reform, has, as a constitutional competence, the responsibility of ordering the training of health professionals [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] (Brazil, 2018a). In view of this, the promotion of initiatives that stimulate and provide training for professionals is of paramount importance in the constant process of strengthening the SUS [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eContinuing Education becomes an essential component of training and human resource development programs, aiming at updating knowledge. Since it emphasizes the promotion of training and courses offered by institutions [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Continuing Education needs to be considered a member of Permanent Health Education, which is an educational approach that continuously seeks to develop health professionals and emphasizes the importance of continuous learning and constant updating to ensure the provision of high-quality health services [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAmong the target audience for participating in Continuing Health Education, Community Health Agents stand out, as they are health professionals who work in Primary Health Care. Community Health Agents effectively symbolize the connection between the Family Health Strategy (ESF, in Portuguese) and the community, playing an important role in consolidating the SUS (Brazilian Unified Health System) through care-based and supportive relationships [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The Community Health Agent is a professional with political, social, and health responsibilities and is a fundamental figure for the ESF, since they transmit important health-related information to the population. Therefore, this professional has the potential to intervene in the population's health situation, as their knowledge of daily life in the territories can contribute to the development of strategies aimed at improving the work carried out in the areas covered by the FHS [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA central point of discussion within continuing health education refers to Non-Communicable Diseases and Conditions (NCDs), which constitute the group of diseases with the highest prevalence in the country, especially affecting the most vulnerable populations, such as those with low income and low education. NCDs are responsible for more than half of all deaths in Brazil. In 2019, 54.7% of deaths registered in Brazil were caused by Non-Communicable Chronic Diseases (NCDs) and 11.5% by related conditions [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn order to address this problem, the Ministry of Health launched the Strategic Action Plan to Combat NCDs in Brazil, 2011\u0026ndash;2022. With the approaching end of the validity of this plan, and in accordance with the Sustainable Development Goals (SDGs) of the United Nations (UN), a new strategic action plan for addressing Chronic Diseases and Non-Communicable Diseases (NCDs) in the country was developed for the period 2021\u0026ndash;2030 (NCD Plan). In addition to NCDs, NCDs include accidents and violence. Thus, the new plan reaffirms and expands the proposals for addressing these issues, as well as presenting itself as a guideline for the prevention of risk factors for NCDs [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNCDs, mainly cardiovascular diseases, cancers, diabetes, and chronic respiratory diseases, are caused by various factors linked to the living conditions of individuals. These are determined by access to public goods and services, guarantee of rights, information, employment and income, and the possibility of making choices favorable to health. The main behavioral risk factors for developing NCDs are: smoking, alcohol consumption, unhealthy diet, and physical inactivity. These can be modified by behavioral change and by government actions that regulate and reduce, for example, the marketing, consumption, and exposure to products harmful to health [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe 2021\u0026ndash;2030 NCD Plan addresses the four main groups of chronic diseases and their risk factors. In this plan, the Ministry of Health (2021) defined guidelines and actions in three areas: a) surveillance, information, evaluation, and monitoring; b) health promotion; and c) comprehensive care.\u003c/p\u003e \u003cp\u003eTo address NCDs, in addition to organizing the health sector to ensure access to care, promotion, prevention, and surveillance, an articulation of intersectoral actions is essential. Policies to address NCDs must be articulated, integrated, and cooperative [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e Thus, the present work aimed to promote the training of professionals involved in the Family Health Strategy (ESF) in the municipality of Passa Quatro-MG, Brazil, based on the 2021\u0026ndash;2030 National Plan for Disease Prevention and Control (DANT), with a view to improving the work of Community Health Agents within the scope of Primary Care and in the care process for users served in their homes, strengthening the functioning of the Brazilian Unified Health System (SUS).\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy design and setting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted as a program evaluation embedded within a university extension activity entitled “Continuing Health Education for Community Health Agents and the Community: Non-Communicable Diseases and Conditions (NCDs).” The initiative aimed to strengthen professional training within Primary Health Care services and was implemented between September and November 2024 in the municipality of Passa Quatro, Minas Gerais, Brazil.\u003c/p\u003e\n\u003cp\u003eThe extension activity was formally registered with the Pro-Rectorate for Extension of the Federal University of Alfenas (UNIFAL-MG) under protocol number PREAE 7420.\u003c/p\u003e\n\u003cp\u003eThe present evaluation employed a pre–post analytical approach to assess changes in participants’ knowledge following the educational intervention. The evaluation component was designed exclusively to assess educational outcomes and program effectiveness.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll professionals linked to the Family Health Strategy (FHS) units in the municipality were invited to participate in the extension course. A total of 27 health professionals enrolled in the activity and attended the four educational sessions.\u003c/p\u003e\n\u003cp\u003eParticipation in the evaluation component was voluntary. All attendees agreed to participate in the pre- and post-intervention assessments.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted as part of a university extension activity aimed at continuing professional education and professional training at the Universidade Federal de Alfenas - UNIFAL-MG. The extension project was formally approved by the Pró-Reitoria de Extensão e Cultura da Universidade Federal de Alfenas under registration number PREAE 7420.\u003c/p\u003e\n\u003cp\u003eThe activity consisted of an educational intervention followed by a program evaluation process designed to assess participants’ knowledge.\u003c/p\u003e\n\u003cp\u003eAccording to the institutional guidelines of the Research Ethics Committee (Comitê de Ética em Pesquisa – CEP) of UNIFAL-MG and the ethical regulations established by the Brazilian National Health Council (Resolution No. 466/2012), activities characterized as educational program evaluation that involve minimal risk to participants and do not collect identifiable personal data may be exempt from formal review by a Research Ethics Committee.\u003c/p\u003e\n\u003cp\u003eBased on these criteria, the present study was considered exempt from formal ethical review (waived approval) because it involved an educational intervention with program evaluation components, posed minimal risk to participants, and did not involve the collection of identifiable personal information.\u003c/p\u003e\n\u003cp\u003eThe evaluation focused exclusively on aggregated knowledge outcomes related to the educational activity and did not involve sensitive personal data, clinical information, or any procedures that could pose risk to participants.\u003c/p\u003e\n\u003cp\u003eAll participants were informed about the objectives of the activity and the voluntary nature of their participation. Verbal informed consent was obtained prior to data collection. No personal identifiers were collected, and confidentiality and anonymity were ensured throughout all stages of the study.\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the ethical principles of the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEducational intervention\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe course consisted of four in-person meetings addressing major non-communicable diseases and conditions, including hypertension, diabetes mellitus, obesity, and other priority chronic conditions in Primary Health Care. Educational strategies included dialogical lectures, case discussions, and problem-based learning activities.\u003c/p\u003e\n\u003cp\u003eThe Extension Activity was developed through 4 (four) Thematic Meetings, taught by different Health Professionals, in order to carry out a theoretical-practical approach to the main points raised about the care, management and attention to NCDs.\u003c/p\u003e\n\u003cp\u003eThe meetings were held between September and November 2024, covering the following topics:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMeeting 1:\u003c/strong\u003e Strategic Action Plan for Addressing Chronic Diseases and Non-Communicable Conditions in Brazil, 2021-2030 (NCD Plan);\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMeeting 2:\u003c/strong\u003e Healthy Eating in the fight against Non-Communicable Diseases and Conditions (NCDs);\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMeeting 3:\u003c/strong\u003e Physical Activity/Body Practice and Prevention and Control of Smoking;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMeeting 4:\u003c/strong\u003e The School Community and the actions of the National School Feeding Program (PNAE) in combating Non-Communicable Diseases and Conditions (NCDs) in childhood.\u003c/p\u003e\n\u003cp\u003eEach meeting was held in person in the municipality of Passa Quatro-MG, Brazil, with a workload of 3 (three) hours each, totaling 12 (twelve) hours of activities. In the first meeting, a questionnaire was applied in order to obtain general information about the participants of the Extension Activity, such as age, biological sex, education level, and length of time working with the Family Health Team.\u003c/p\u003e\n\u003cp\u003eThe evaluation of the Extension Activity was carried out using a questionnaire, on a 7-point Likert scale, a type of psychometric response scale, encompassing the context of pre-test and post-test. In the first meeting, the professional had to answer the question: \"How do you consider your knowledge about the topic of Non-Communicable Diseases and Conditions (NCDs), today, before the Course?\", considering the options of the Likert scale: 1 (very little), 4 (moderate), 7 (quite a lot) [12]. In the last meeting, the same professional answered the following question: \"How do you consider your knowledge about the topic of Non-Communicable Diseases and Conditions (NCDs), now, after the Course?\", considering the same response options from the Likert scale, that is, 1 (very little), 4 (moderate), 7 (quite a lot), for later verification of the difference in averages.\u003c/p\u003e\n\u003cp\u003eTo evaluate the effectiveness of the proposed Action, the paired t-test was used to compare the average knowledge scores of the participants after and before the Extension Course, where the differences (between the averages) were considered significant when p\u0026lt;0.05. For the analysis, the statistical software Statistical Package for the Social Sciences - SPSS, version 25.0, was used.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe extension course included 27 health professionals affiliated with the Family Health Strategy (FHS) units in Passa Quatro, Minas Gerais, Brazil. All participants attended the four training sessions and completed both the pre- and post-intervention assessments. The majority were female (n = 24; 88.9%), with a median age of 36 years (interquartile range: 26\u0026ndash;45 years). Most participants (59.2%) were aged 39 years or younger.\u003c/p\u003e\n\u003cp\u003eRegarding education, 44.4% (n=12) have completed high school, and the same percentage have completed higher education. The sample\u0026apos;s length of service in the Family Health Team is predominantly below 5 years (n=11; 40.7%), with 7 professionals (25.9%) working for more than 10 years with the teams. The general characteristics of the participants are presented in Table 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1 \u0026ndash;\u0026nbsp;\u003c/strong\u003eGeneral characteristics of the participants in the Extension Activity: Continuing Education in Health for Community Health Agents and Community: Non-Communicable Diseases and Conditions (NCDs), Passa Quatro-MG, Brazil, 2025.\u003c/p\u003e\n\u003cdiv align=\"Left\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 190px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 188px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 440px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 190px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 188px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e88.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 190px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 188px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e11.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 440px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge Range\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 190px;\"\u003e\n \u003cp\u003e\u0026lt;29 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 188px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e29.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 190px;\"\u003e\n \u003cp\u003e29 a 39 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 188px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e29.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 190px;\"\u003e\n \u003cp\u003e40 a 49 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 188px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e25.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 190px;\"\u003e\n \u003cp\u003e\u0026gt; 50 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 188px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e14.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 440px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation Level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 190px;\"\u003e\n \u003cp\u003eHigh School\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 188px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e44.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 190px;\"\u003e\n \u003cp\u003eHigher Education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 188px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e44.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 190px;\"\u003e\n \u003cp\u003ePostgraduate Studies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 188px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e11.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 440px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTime working in the Family Health Team\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 190px;\"\u003e\n \u003cp\u003e\u0026lt; 5 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 188px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e40.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 190px;\"\u003e\n \u003cp\u003e5 a 10 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 188px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e33.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 190px;\"\u003e\n \u003cp\u003e\u0026gt; 10 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 188px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e25.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eSource: prepared by the authors (2025).\u003c/p\u003e\n\u003cp\u003eThe evaluation of the Extension Activity, carried out through a questionnaire, on a 7-point Likert scale, demonstrated that the average knowledge about the DANT theme, before the Course was 4.44 points [4.03; 4.86]. After the 4 meetings, the average knowledge about the topic covered was 6.37 points [6.10; 6.64].\u003c/p\u003e\n\u003cp\u003eThrough the paired t-test, a difference (p\u0026lt;0.001) was observed between the average scores after and before on the topic taught, proving the gain in knowledge among the participants through the approach of the distinct theme. The average score (gain) after the educational intervention can increase by up to 2.47 points among the participating professionals, considering a confidence level of 95% (Table 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2 \u0026ndash;\u0026nbsp;\u003c/strong\u003eResults of the paired t-test to assess knowledge about the topic of Non-Communicable Diseases (NCDs) (after and before the intervention), Passa Quatro-MG, Brazil, 2025.\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"651\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean before\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean after\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean of differences*,\u0026nbsp;\u003c/strong\u003e\u003cimg width=\"19\" height=\"20\" src=\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAABwAAAAeCAMAAAAIG46tAAAAAXNSR0IArs4c6QAAAHJQTFRFAAAAAAAAAAA6AABmADo6ADpmADqQAGaQAGa2OgAAOgBmOmaQOma2OpDbZgAAZjoAZjo6ZpC2ZrbbZrb/kDoAkDo6kGY6kNv/tmYAtpA6ttu2ttv/tv/btv//25A627Zm2////7Zm/9uQ/9u2//+2///b98LTjgAAAAF0Uk5TAEDm2GYAAAAJcEhZcwAAFiUAABYlAUlSJPAAAAAZdEVYdFNvZnR3YXJlAE1pY3Jvc29mdCBPZmZpY2V/7TVxAAAAw0lEQVQ4T9VSyRKCMAxNwA0EVETFhSrF/v8v+tJWBgROXjQHZmjeWiD6q+He/Eb0e8TzE5GOOB8EUpJ38cAuAKQ/5pDjPLxkiY6rkSqmAHc11bFkDsdYFg/bSSLVksjJwh8z2/lXomfWkS2Ba4oWbIrlpq2BcHAAfy8y8a0MKyRKm63UdMfQkhCwQ3c8vW1tNfxS2aszR+bEZlC2FPjpsLezFCXx/BjogQLIu1p3ryOxHCdaS3PmYPjxQHH3s75++ae9AD2KC0U3fHr7AAAAAElFTkSuQmCC\" v:shapes=\"_x0000_i1025\" alt=\"image\"\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCI95% (\u003c/strong\u003e\u003cimg width=\"19\" height=\"20\" src=\"data:image/png;base64,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\" v:shapes=\"_x0000_i1025\" alt=\"image\"\u003e\u003cstrong\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKnowledge about the topic of NCDs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\" style=\"width: 473px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 178px;\"\u003e\n \u003cp\u003eParticipants in the Extension Activity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e4.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e6.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e1.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e[1.37; 2.47]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e* Estimate of the mean difference (After-Before) in knowledge about the topic of Non-Communicable Diseases (NCDs) and respective 95% confidence interval for the mean difference (gain in knowledge) in the population.\u003c/p\u003e\n\u003cp\u003eSource: prepared by the authors (2025).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eUniversity Extension activities are considered a link between the University and Society, providing scientific knowledge in conjunction with the needs presented by different sectors and social instances. Along with the educational process proposed by University Extension, some guidelines must be observed and substantiated, namely: dialogical interaction; interdisciplinarity and interprofessionality; the inseparable relationship between teaching, research and extension; impact on student training; and social impact and transformation [13].\u003c/p\u003e\n\u003cp\u003eContinuing Education in Health, associated with extension activities in partnership with Higher Education Institutions, should aim to keep professionals updated on advances and changes in their respective areas of expertise [14]. In Primary Health Care, the formation of a multidisciplinary team requires attention and care at this level of health care, given the coordinated action in the comprehensive care and treatment of an individual or group of individuals, requiring a comprehensive and holistic approach to health care [15].\u003c/p\u003e\n\u003cp\u003eThe themes and topics addressed in the training process for health teams should be innovative, intersectoral, and focused on comprehensive health care. The National Policy on Permanent Education in Health, established by Ordinance GM/MS No. 198, of February 13, 2004, commits to creating innovative methodologies aimed at identifying the training and development needs of health workers and building strategies and processes that improve health care and management and strengthen social control in the sector with a view to producing a positive impact on individual and collective health [1, 16].\u003c/p\u003e\n\u003cp\u003eThese actions should prioritize the teaching-learning process based on discussions, joint analyses, and implications with real problems, in a constant process of investigating their causes and seeking alternative solutions [17].\u003c/p\u003e\n\u003cp\u003eThe Surveillance System for Risk Factors of Chronic Diseases by Telephone Survey (Vigitel), with the purpose of monitoring the frequency and distribution of the main determinants of NCDs in Brazil, estimated in 2023 that the frequency of medical diagnosis of hypertension was 27.9% in Brazilian capitals, being higher among women (29.3%) than among men (26.4%). The frequency of medical diagnosis of diabetes was 10.2%, being higher among women (11.1%) than among men (9.1%). The frequency of adult smokers was 9.3%, being higher in males (11.7%) than in females (7.2%) [18].\u003c/p\u003e\n\u003cp\u003eVigitel, as well as other NCD Risk Factor Surveillance systems of the Ministry of Health, tend to subsidize the mechanisms of action and the formulation of Public Policies that promote the improvement of the quality of life of the Brazilian population. As a central axis, the Strategic Action Plan for Addressing Chronic Diseases and Non-Communicable Conditions in Brazil, 2021-2030 (NCD Plan), stands out, with the objective of pointing out actions aimed at the prevention and control of NCDs and their risk factors [19].\u003c/p\u003e\n\u003cp\u003eGiven the multifactorial etiology of NCDs, their magnitude and the complex interaction of social determinants of health, different levels and stages of action are necessary in addressing them within the Health System and the formulation of joint and multi-professional interventions [20]. The NCD Plan establishes the strengthening and (re)organization of work processes for health promotion in constant dialogue with the main health policies. Its implementation is the responsibility of co-management, in order to offer conditions for the strengthening and integration of the team [21]. The document itself cites the following dimension for the reinforcement and scope of the NCD Plan:\u003c/p\u003e\n\u003cp\u003eContinuing Education in Health focused on the themes and implementation strategies of the NCD Plan – This involves ensuring these themes are included in state and/or municipal Continuing Education in Health plans, providing training to build and strengthen the skills and abilities of health professionals to address and provide care for NCDs and related conditions… [1].\u003c/p\u003e\n\u003cp\u003eThus, professionals who are part of the Family Health Team, especially Community Health Agents, must be trained to conduct active case finding and community awareness of this issue, and also, acting in an interdisciplinary manner in the early detection of NCDs, identifying risk factors in the home and territory and coordinating actions to promote the health of the population and health education strategies that promote people's participation and autonomy for health care [22-24].\u003c/p\u003e\n\u003cp\u003eRegarding NCDs, the National Health Promotion Policy (PNPS) document points to priority actions for addressing these conditions based on their main modifiable risk factors, namely Healthy Eating, Physical Activity/Exercise, and Tobacco Prevention and Control [25].\u003c/p\u003e\n\u003cp\u003eAdequate and healthy food is a basic human right and is related to improved health, a lower risk of non-communicable diseases, and longevity. The beneficial effect on disease prevention comes from the food itself and the combinations of nutrients and other chemical compounds that are part of the food matrix, rather than from isolated nutrientes [26, 27].\u003c/p\u003e\n\u003cp\u003eHealthy food should be accessible, tasty, varied, colorful, harmonious, and safe in terms of sanitary aspects; it should consider cultural food practices and value the consumption of healthy regional foods. In addition, it should be adequate to the biological and social needs of individuals and should be in accordance with the stages of the life course. The promotion of healthy eating is supported by the National Food and Nutrition Policies (PNAN) and the PNPS. Furthermore, it is recommended that such actions be based on the information present in the Dietary Guidelines for the Brazilian Population (updated in 2014). The Guide clearly and concisely guides the path to a healthy and sustainable diet and is easy to understand, serving as a basis for all actions developed on nutrition in the context of Primary Health Care. Thus, when the patient understands the NOVA classification [28], they become able to develop autonomy over their food choices and no longer depend solely on health professionals to manage their nutritional treatment [29].\u003c/p\u003e\n\u003cp\u003eHealthy food choices lead to significant improvements in the population's quality of life. Therefore, it is necessary to develop actions and programs to promote healthy eating habits through nutritional education and health promotion in all health services, concentrating them in Primary Care, understanding it as a privileged locus for this purpose [30]. The benefits of physical activity are well established and recognized for reducing the prevalence of cardiovascular diseases, diabetes, cancer, obesity, among others, and ultimately for reducing mortality from NCDs [8]. Physical inactivity is a major risk factor for NCDs and one of the leading causes of death worldwide [31, 32].\u003c/p\u003e\n\u003cp\u003eRegular physical activity helps prevent and control NCDs, helps manage weight, reduces anxiety and symptoms of depression, improves sleep quality, and benefits mental health, including preventing memory loss. Physical activity can be practiced in leisure time, during commutes, work or study activities, and household chores [33]. The Ministry of Health, in its Physical Activity Guide for the Brazilian Population [34], addresses physical activity in all life cycles – children, adolescents, adults and the elderly, including pregnant women and people with disabilities, in addition to highlighting School Physical Education.\u003c/p\u003e\n\u003cp\u003eAnother important risk factor for NCDs is smoking, which is related to the development of various types of malignant neoplasms, respiratory diseases, cardiovascular diseases, among other diseases. Smoking constitutes a major threat to public health, being responsible for more than 8 million deaths per year worldwide, of which about 1.2 million are due to passive smoking [35, 8].\u003c/p\u003e\n\u003cp\u003eBrazil has expertise in the area of tobacco control, and is also recognized worldwide for its success in anti-tobacco policy. Achieving the agreed-upon goal of reducing the prevalence of smoking in the country by 40% will allow Brazil to further advance its tobacco control policy, which is a significant risk factor for NCDs and global public health [36, 37].\u003c/p\u003e\n\u003cp\u003eThe National Tobacco Control Program (PNCT) is an initiative of the Ministry of Health that aims to reduce the number of smokers and mortality caused by tobacco. Tobacco control groups are structured in sessions that take place with a multidisciplinary team and use techniques such as active listening, guidance and explanations about addiction and risk factors, following booklets provided by the Ministry of Health. The meetings help participants understand the meaning of smoking and strengthen their will to change and avoid relapses [38, 39].\u003c/p\u003e\n\u003cp\u003eGiven the problem of nicotine addiction, the Community Health Agent plays an important role in welcoming and informing smokers about the programs that the government makes available to help them break free from addiction, as well as providing information about the risks that smoking causes, as well as the benefits that quitting smoking brings to their health [39]. The topic addressed, concerning the School Community and the actions of the National School Feeding Program (PNAE) in combating NCDs in childhood, highlighted the importance of offering Adequate and Healthy Food in the school environment and the development of healthy eating habits among students. School feeding is a right guaranteed by Law No. 11,947/2009, standing out as a type of Public Policy that provides healthy school food, associated with sustainable initiatives and the strengthening of family farming, aiming at Food and Nutritional Security (SAN) [40].\u003c/p\u003e\n\u003cp\u003eThe School Community is present in the territories of operation of the Family Health Strategy (ESF), being considered an area of operation for the health teams that work in the assigned region. Due to its multidisciplinary and multiprofessional approach, the National Primary Care Policy (PNAB) stipulates that members of the teams working in Primary Care must provide comprehensive health care to the assigned population, primarily within the Basic Health Unit, and when necessary, at home and in other community spaces, such as schools, through intersectoral actions and strategies, such as the School Health Program (PSE) [41].\u003c/p\u003e\n\u003cp\u003eThe National School Feeding Program (PNAE) can be characterized as a Healthy Public Policy (HPP), given its proposition directly linked to Health Promotion [40]. The legal framework of the Program, according to current legislation, provides for the offering of meals that meet the nutritional needs of students during the school year, in addition to the supply of fresh fruits, vegetables and greens, and the inclusion of foods that are sources of heme iron and foods that are sources of vitamin A in school menus. There is a limitation on the supply of certain products, such as meat products, dairy drinks, biscuits, cookies, bread or cakes, sweets, regional sweet preparations and others. And in an innovative way, based on the recommendations of the Dietary Guidelines for Brazilian Children Under 2 Years Old, it advocates the prohibition of supplying ultra-processed foods and the addition of sugar, honey and sweeteners in culinary preparations and beverages for children up to three years of age [42, 43].\u003c/p\u003e\n\u003cp\u003eFamily Health teams, within their responsibilities, can carry out interventions in School Units aimed at promoting adequate and healthy eating, in addition to institutional and intersectoral partnerships aimed at Food and Nutrition Education (FNE) actions in the school environment, in order to contribute to the adoption of healthy eating practices and the development of skills for self-care and well-being in the school environment, acting in a coordinated manner in the prevention of all forms of malnutrition, obesity and other chronic diseases in childhood and adolescence [44, 45].\u003c/p\u003e\n\u003cp\u003eThe importance of Community Health Agents in Primary Health Care and alongside Family Health Teams is widely recognized in the literature, going beyond individual care. Given their diverse responsibilities, it is essential to offer appropriate training and adequate and ongoing qualification to fulfill their competencies within the community, thus requiring a continuous training process and improvement of the work carried out in the areas assigned to the Family Health Strategy (ESF) teams [46, 6].\u003c/p\u003e\n\u003cp\u003eThis study has some limitations that should be acknowledged. The pre–post design without a control group limits causal inference regarding the observed knowledge gains. In addition, the small convenience sample, restricted to a single municipality, may reduce the generalisability of the findings. Knowledge assessment relied on self-reported measures using a Likert scale, which may be subject to social desirability bias. Furthermore, the evaluation was conducted immediately after the intervention, preventing assessment of long-term knowledge retention or changes in professional practice. Finally, the absence of qualitative methods limited a deeper exploration of participants’ perceptions and the applicability of the training in real-world settings.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe evaluation of the topics covered during the Training Course proved effective in the acquisition of knowledge among the participants. Thus, it is concluded that the implementation of Continuing Health Education among Family Health Teams is important in order to qualify and improve the work process in relation to the topics included in public health services from a multi-professional and interdisciplinary perspective.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThus, by encouraging healthier habits, such as regular physical activity and the adoption of a balanced diet, it is possible to significantly reduce the risk of developing these diseases, promoting an improvement in the health of the population.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted as part of a university extension activity aimed at professional training at the Universidade Federal de Alfenas - UNIFAL-MG. According to the guidelines of the Institutional Research Ethics Committee (Comit\u0026ecirc; de \u0026Eacute;tica em Pesquisa \u0026ndash; CEP) of UNIFAL-MG, the activity was characterized as an educational intervention with program evaluation components and therefore did not require formal review or approval by the Research Ethics Committee.\u003c/p\u003e\n\u003cp\u003eIn accordance with Brazilian regulations (Resolution No. 466/2012 of the National Health Council), activities classified as educational program evaluation without individual identification are exempt from Research Ethics Committee review.\u003c/p\u003e\n\u003cp\u003eAll participants were informed about the objectives and the voluntary nature of their participation in the evaluation process. Verbal informed consent was obtained prior to data collection. No personal identifiers were collected, and confidentiality and anonymity were ensured throughout all stages of the study. The study was conducted in accordance with the ethical principles of the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors received no financial support for the research, authorship, and/or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eL.F.P.L. conceptualized and designed the study, coordinated the intervention, performed the statistical analysis, and drafted the initial manuscript. V. C. P. C and D. A. C. contributed to the implementation of the intervention, participated in data collection activities, and substantially contributed to manuscript writing and critical revision. All authors reviewed, revised, and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank the Municipal Health Department of Passa Quatro, Minas Gerais, and all participating health professionals for their collaboration.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBrasil. Minist\u0026eacute;rio da Sa\u0026uacute;de (MS). Secretaria de Gest\u0026atilde;o do Trabalho e da Educa\u0026ccedil;\u0026atilde;o na Sa\u0026uacute;de. 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Departamento de Aten\u0026ccedil;\u0026atilde;o B\u0026aacute;sica (2014) \u003cem\u003eGuia alimentar para a popula\u0026ccedil;\u0026atilde;o brasileira.\u003c/em\u003e 2. ed. Bras\u0026iacute;lia: MS. https://bvsms.saude.gov.br/bvs/publicacoes/guia_alimentar_populacao_brasileira_2ed.pdf \u003c/li\u003e\n\u003cli\u003eMenegassi B, Almeida JB, Olimpio MYM et al. (2018) A nova classifica\u0026ccedil;\u0026atilde;o de alimentos: teoria, pr\u0026aacute;tica e dificuldades. \u003cem\u003eCi\u0026ecirc;nc sa\u0026uacute;de coletiva\u003c/em\u003e 23(12): 4165\u0026ndash;4176. https://doi.org/10.1590/1413-812320182312.30872016 \u003c/li\u003e\n\u003cli\u003eStocco-Padilha AB, Germani ACCG(2023) Food and nutrition education actions in school environment: a scoping review. \u003cem\u003eResearch, Society and Development \u003c/em\u003e12(6): e28312642153. https://doi.org/10.33448/rsd-v12i6.42153\u003c/li\u003e\n\u003cli\u003eBernal RTI, Malta DC, Iser BPM, et al. (2016) M\u0026eacute;todo de proje\u0026ccedil;\u0026atilde;o de indicadores das metas do Plano de A\u0026ccedil;\u0026otilde;es Estrat\u0026eacute;gicas para o Enfrentamento das Doen\u0026ccedil;as Cr\u0026ocirc;nicas n\u0026atilde;o Transmiss\u0026iacute;veis no Brasil segundo capitais dos estados e Distrito Federal.\u003cem\u003e Epidemiol Serv Sa\u0026uacute;de\u003c/em\u003e 25(3): 455\u0026ndash;66. https://doi.org/10.5123/S1679-49742016000300002 \u003c/li\u003e\n\u003cli\u003eAndrade FMD, Machado IE, Barbosa, JAG (2022) Preval\u0026ecirc;ncia de doen\u0026ccedil;as n\u0026atilde;o transmiss\u0026iacute;veis e fatores de risco em industri\u0026aacute;rios de Minas Gerais. \u003cem\u003eAvances en Enfermer\u0026iacute;a\u003c/em\u003e 40(2): 199-213.\u003c/li\u003e\n\u003cli\u003eBenedetti TRB, Borges LJ, Streit IA, et al. (2021) Validade e clareza dos conceitos e terminologias do Guia de Atividade F\u0026iacute;sica para a Popula\u0026ccedil;\u0026atilde;o Brasileira.\u003cem\u003e Revista Brasileira de Atividade F\u0026iacute;sica \u0026amp; Sa\u0026uacute;de\u003c/em\u003e 26:1\u0026ndash;11. https://doi.org/10.12820/rbafs.26e0212\u003c/li\u003e\n\u003cli\u003eBrasil. Minist\u0026eacute;rio da Sa\u0026uacute;de (MS). Secretaria de Aten\u0026ccedil;\u0026atilde;o Prim\u0026aacute;ria \u0026agrave; Sa\u0026uacute;de. Departamento de Promo\u0026ccedil;\u0026atilde;o da Sa\u0026uacute;de (2021) \u003cem\u003eGuia de Atividade F\u0026iacute;sica para a Popula\u0026ccedil;\u0026atilde;o Brasileira.\u003c/em\u003e Bras\u0026iacute;lia: MS. https://bvsms.saude.gov.br/bvs/publicacoes/guia_atividade_fisica_populacao_brasileira.pdf \u003c/li\u003e\n\u003cli\u003eSilva ST, Martins MC, Faria FR et al. (2014) Combate ao Tabagismo no Brasil: a import\u0026acirc;ncia estrat\u0026eacute;gica das a\u0026ccedil;\u0026otilde;es governamentais. \u003cem\u003eCi\u0026ecirc;nc sa\u0026uacute;de coletiva\u003c/em\u003e 19(2): 539\u0026ndash;552. https://doi.org/10.1590/1413-81232014192.19802012 \u003c/li\u003e\n\u003cli\u003ePortes LH, Machado CV, Turci SRB et al. (2018) Pol\u0026iacute;tica de Controle do Tabaco no Brasil: um balan\u0026ccedil;o de 30 anos. \u003cem\u003eCi\u0026ecirc;nc sa\u0026uacute;de coletiva\u003c/em\u003e 23(6):1837\u0026ndash;1848. https://doi.org/10.1590/1413-81232018236.05202018 \u003c/li\u003e\n\u003cli\u003eVosmirko NMS, Machado AT, Vianna CGF et al. (2025) Fim de Jogo para o Tabagismo no Brasil. \u003cem\u003eRevista Brasileira de Cancerologia\u003c/em\u003e 71(1): e\u0026ndash;034922. https://doi.org/10.32635/2176-9745.RBC.2025v71n1.4922\u003c/li\u003e\n\u003cli\u003eBrasil. Minist\u0026eacute;rio da Sa\u0026uacute;de (MS) (2023) Portaria GM/MS n\u0026ordm; 502, de 1\u0026ordm; de junho de 2023. Institui o Programa Nacional de Controle do Tabagismo (PNCT) no \u0026acirc;mbito do Sistema \u0026Uacute;nico de Sa\u0026uacute;de (SUS). \u003cem\u003eDi\u0026aacute;rio Oficial da Uni\u0026atilde;o\u003c/em\u003e, Bras\u0026iacute;lia, DF, 2 jun. 2023. Se\u0026ccedil;\u0026atilde;o 1, p. 42-44. \u003c/li\u003e\n\u003cli\u003eInstituto Nacional De C\u0026acirc;ncer \u0026ndash; INCA (2025) \u003cem\u003eAgente comunit\u0026aacute;rio de sa\u0026uacute;de e o controle do tabagismo no Brasil. \u003c/em\u003e3. ed. Rio de Janeiro: INCA. \u003c/li\u003e\n\u003cli\u003eKroth DC, Geremia DS, Mussio BR (2020) Programa Nacional de Alimenta\u0026ccedil;\u0026atilde;o Escolar: uma pol\u0026iacute;tica p\u0026uacute;blica saud\u0026aacute;vel. \u003cem\u003eCi\u0026ecirc;nc sa\u0026uacute;de coletiva \u003c/em\u003e25(10): 4065\u0026ndash;4076. https://doi.org/10.1590/1413-812320202510.31762018 \u003c/li\u003e\n\u003cli\u003eBrasil. Minist\u0026eacute;rio da Sa\u0026uacute;de (MS) (2017) Portaria GM/MS n\u0026ordm; 2.436, de 21 de setembro de 2017. Aprova a Pol\u0026iacute;tica Nacional de Aten\u0026ccedil;\u0026atilde;o B\u0026aacute;sica, estabelecendo a revis\u0026atilde;o de diretrizes para a organiza\u0026ccedil;\u0026atilde;o da Aten\u0026ccedil;\u0026atilde;o B\u0026aacute;sica, no \u0026acirc;mbito do Sistema \u0026Uacute;nico de Sa\u0026uacute;de (SUS). \u003cem\u003eDi\u0026aacute;rio Oficial da Uni\u0026atilde;o\u003c/em\u003e, Bras\u0026iacute;lia, DF, 22 set. 2017. Se\u0026ccedil;\u0026atilde;o 1, p. 68. \u003c/li\u003e\n\u003cli\u003eBrasil. Minist\u0026eacute;rio da Sa\u0026uacute;de (MS). Secretaria de Aten\u0026ccedil;\u0026atilde;o Primaria \u0026agrave; Sa\u0026uacute;de. Departamento de Promo\u0026ccedil;\u0026atilde;o da Sa\u0026uacute;de (2019) \u003cem\u003eGuia alimentar para crian\u0026ccedil;as brasileiras menores de 2 anos.\u003c/em\u003e Bras\u0026iacute;lia: MS.\u003c/li\u003e\n\u003cli\u003eBrasil (2020) Resolu\u0026ccedil;\u0026atilde;o n\u0026ordm; 06, de 08 de maio de 2020. Disp\u0026otilde;e sobre o atendimento da alimenta\u0026ccedil;\u0026atilde;o escolar aos alunos da educa\u0026ccedil;\u0026atilde;o b\u0026aacute;sica no \u0026acirc;mbito do Programa Nacional de Alimenta\u0026ccedil;\u0026atilde;o Escolar \u0026ndash; PNAE. \u003cem\u003eDi\u0026aacute;rio Oficial da Uni\u0026atilde;o\u003c/em\u003e, Bras\u0026iacute;lia, DF, 12 maio 2020. Se\u0026ccedil;\u0026atilde;o 1, p. 38. \u003c/li\u003e\n\u003cli\u003eMarques RJR, Rezende-Alves K, Soares CS et al. (2020) An\u0026aacute;lise do Trabalho em Equipe Multiprofissional para A\u0026ccedil;\u0026otilde;es de Alimenta\u0026ccedil;\u0026atilde;o e Nutri\u0026ccedil;\u0026atilde;o na Aten\u0026ccedil;\u0026atilde;o B\u0026aacute;sica. \u003cem\u003eTrabalho, Educa\u0026ccedil;\u0026atilde;o e Sa\u0026uacute;de\u003c/em\u003e 18(1): e0024172. https://doi.org/10.1590/1981-7746-sol00241 \u003c/li\u003e\n\u003cli\u003ePedraza DF (2022) Atua\u0026ccedil;\u0026atilde;o de enfermeiros da Estrat\u0026eacute;gia Sa\u0026uacute;de da Fam\u0026iacute;lia no cuidado nutricional de crian\u0026ccedil;as. \u003cem\u003eCad sa\u0026uacute;de colet\u003c/em\u003e 30(1): 94\u0026ndash;107. https://doi.org/10.1590/1414-462X202230010405 \u003c/li\u003e\n\u003cli\u003eSamudio JLP, Brant LC, Martins ACFDC et al. (2017) Agentes Comunit\u0026aacute;rios de Sa\u0026uacute;de na Aten\u0026ccedil;\u0026atilde;o Prim\u0026aacute;ria no Brasil: Multiplicidade de Atividades e Fragiliza\u0026ccedil;\u0026atilde;o da Forma\u0026ccedil;\u0026atilde;o. \u003cem\u003eTrabalho, Educa\u0026ccedil;\u0026atilde;o e Sa\u0026uacute;de\u003c/em\u003e 15(3): 745\u0026ndash;769. https://doi.org/10.1590/1981-7746-sol00075 \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Health Education, Noncommunicable Diseases, Health Promotion, Community Health Workers, Primary Health Care","lastPublishedDoi":"10.21203/rs.3.rs-8970839/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8970839/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eThis study aimed to to evaluate the effectiveness of a continuing health education intervention of professionals involved in the Family Health Strategy of a municipality in Minas Gerais, Brazil, based on the 2021-2030 DANT Plan.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThis is a University Extension action called “Continuing Education in Health for Community Health Agents and Community: Non-Communicable Diseases and Conditions (NCDs)”, carried out between September and November 2024. The evaluation of the Extension Action was carried out through a questionnaire, on a 7-point Likert scale. The effectiveness of the action was evaluated using the paired t-test, comparing the average knowledge scores before and after the Extension Course, with a significance level of p\u0026lt;0.05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe sample consisted of 27 professionals, 88.9% of whom were female, with a median age of 36 years. The average knowledge on the DANT theme before the Course was 4.44 points and after the 4 meetings, the average knowledge on the theme addressed was 6.37 points, observing a difference (p\u0026lt;0.001) between the average scores before and after the theme taught.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThe evaluation of the themes addressed during the Training Course demonstrated that they were effective in the acquisition of knowledge among the participants.\u003c/p\u003e","manuscriptTitle":"Continuing education intervention for primary health care professionals improves knowledge of noncommunicable diseases in Brazil","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-15 09:36:14","doi":"10.21203/rs.3.rs-8970839/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"694b8632-2418-4beb-b67a-39eb1001a42a","owner":[],"postedDate":"April 15th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-15T20:24:31+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-15 09:36:14","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8970839","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8970839","identity":"rs-8970839","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}