Circle of Culture and permanent education for transformation of professional practice: an integrative review

Rozal, Juliana Ferreira; Monteiro, Estela Maria Leite Meirelles; Marinus, Maria Wanderleya de Lavor Coriolano; Santos, Tamyris Arcoverde

doi:10.1590/1413-812320232811.16782022EN

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REVIEW • Ciênc. saúde coletiva 28 (11) • Nov 2023 • https://doi.org/10.1590/1413-812320232811.16782022EN copy

Circle of Culture and permanent education for transformation of professional practice: an integrative review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This article aimed to know the scientific evidence that underlies Culture Circle application as a device of Permanent Education in Health for professional practice transformation. This is an integrative literature review carried out in the PubMed, CINAHL, LILACS and Scopus databases, in October 2021, with the descriptors “health professionals”, “professional practice”, “continuing education”, “health promotion” and the uncontrolled term “Culture Circle”. Data were analyzed in a descriptive way. The results identified 217 articles and five were included to compose the final sample. It was identified that the most discussed themes in Culture Circles were health education and health promotion. There was an average of 13 participants, lasting between one and a half to four hours, with the presence of an animator/researcher and carried out in the workplace. It is concluded that applying Culture Circles in Permanent Education in Health is a powerful inducer of change in professional practice. Recommendations are presented for its application in empowering subjects and in strengthening health promotion actions as well as the need for field research to broaden the understanding of the implication of the method and its consequences in professional practice.

Key words:
Permanent education; Health personnel; Professional practice; Health education; Health Promotion

Database	Search strategy
MEDLINE/PubMed	("Culture of Circle") OR ("Circle of Culture") AND ("Professional Practice") OR ("Health Personnel") OR ("Education, Continuing") OR ("Staff Development ") OR ("Health Promotion")
CINAHL	"Circle of culture"
LILACS	("Círculo de Cultura") AND ("Educação Continuada") OR ("Pessoal de Saúde") OR ("Desenvolvimento de Pessoal") OR ("Capacitação de Recursos Humanos em Saúde") OR ("Promoção da saúde")
Scopus	“Culture of Circle” OR "Circle of culture"

Inclusion	Exclusion
Original articles.	Studies such as dissertation, thesis, book/book chapter, editorial, journalistic articles, conjunctural analysis, integrative or systematic literature review, letter to the editor, protocol assessment, theoretical discussion of concepts, reflective study, experience report, expert opinion and abstract of congress, original article not available electronically and repeated publications in databases.
Articles published in English, Portuguese and Spanish.	Articles published in languages other than English, Portuguese and Spanish
Articles that deal with the application of crop circles as PEH.	Articles that relate Culture Circles with other functionalities.
Articles that had health professionals as study population (high school, technical and/or higher education).	Articles that do not describe the methodology used in culture circles as PEH

Code (COD)	Title/Journal/ Scientific database	Authors/Year of publication/ Language/Place/Country	Objectives	Design/ Level of evidence
A1	Educação em saúde a partir de círculos de cultura Revista Brasileira de Enfermagem/PubMed	Monteiro and Vieira, 2010¹⁷17 Monteiro EMLM, Vieira NFC. Educação em saúde a partir de círculos de cultura. Rev Bras Enferm 2010; 63(3):397-403. Portuguese/ Recife-PE/ Brazil	Systematize, through Culture Circles, a proposal for the (re)construction of health education actions that articulate the skills needed by nurses in the Family Health Program.	Action research/VI
A2	Educação em saúde: perspectivas da equipe da Estratégia Saúde da Família na visão de Paulo Freire Revista Brasileira de Enfermagem/Scopus	Fernandes and Backes, 2010¹⁸18 Fernandes MCP, Backes VMS. Educação em saúde: perspectivas de uma equipe da Estratégia Saúde da Família sob a óptica de Paulo Freire. Rev Bras Enferm 2010; 63(4):567-573. Portuguese/ Ouro Preto-MG/ Brazil	Know the educational practice developed by a family health team, unveiling their perspectives on health education and rethinking them within their own work processes.	Qualitative research/VI
A3	Situações-limite nas práticas de atenção à saúde da criança: desafios ao empoderamento do enfermeiro Revista da Escola de Enfermagem da USP/PubMed	Souza et al., 2020¹⁹19 Souza AA, Heidemann ITSB, Souza JM. Limit-situations in child health care practices: challenges to the empowerment of nurses. Rev Esc Enferm USP 2020; 54:e03652. Portuguese and English/ Manaus-AM/ Brazil	Analyze the extreme situations faced by nurses in child health care practices from the perspective of empowerment in health promotion.	Action research/VI
A4	Círculos de cultura sobre determinantes socioambientais: pesquisa-ação com agentes comunitários de saúde de Paraisópolis, SP Revista Gaúcha de Enfermagem/PubMed	Santos and Toledo, 2020²⁰20 Santos FNP, Toledo RF. Culture circles on social and environmental determinants: action research with community health agents of Paraisópolis, SP. Rev Gaucha Enferm 2020; 41:e20190353. Portuguese and English/ Paraisópolis-SP/ Brazil	Identify socio-environmental health determinants, from the perception of community health workers, and develop a health education process to contribute to health promotion improvement.	Action research/VI
A5	Percurso cuidativo-educativo dialógico sobre envelhecimento ativo com profissionais da estratégia saúde da família Texto & Contexto Enfermagem/LILACS	Labegalini et al., 2020²¹21 Labegalini CMG, Nogueira IS, Hammerschmidt KSA, Jaques AE, Carreira L, Baldissera VDA. Educational and care-related dialogical pathway on active aging with family health strategy professionals. Texto Contexto Enferm 2020; 29:e20180235. Portuguese and English/ Paraná/ Brazil	Unveil knowledge and practices about active aging based on the dialogical educational-care proposal with Family Health Strategy professionals.	Convergent Care Research/VI

COD	Theme	Culture circle characteristics	Professional practice transformation
A1	Health education actions	Number of participants: 10 Professional category: Nursing Average duration: Not mentioned Number of meetings: 8 Frequency: February to May 2006 Learning environment: Health Unit Materials used: Photocopied text Strategies and techniques: Production of posters and animation technique with relaxation exercises Facilitator: Nurse/researcher	It facilitated the exercise of socio-political awareness, which is essential to the process of empowering health professionals in health education practices. It evidenced the empowerment of nurses through the application of knowledge worked in Culture Circles that supported the development of educational proposals aimed at the demands of population groups in their territories. As well as, there was the consolidation of the necessary requirements for implementing effective health education actions in the primary care setting.
A2	Health education actions	Number of participants: 9 Professional categories: CHW, nursing and medicine Average duration: One and a half hours Number of meetings: 9 Frequency: Monthly Learning environment: Health Unit Material used: Texts with content from the group’s perspective Strategies and techniques: Dynamics and production of illustrative materials Facilitator: Researcher	There was a change of attitude and the adoption of new attitudes towards the educational process of the team itself and of the team in relation to users.
A3	Child health promotion	Number of participants: 16 Professional category: Nursing Average duration: One and a half to three hours Number of meetings: 13 Frequency: Fortnightly Learning environment: Health Unit Material used: Audio recorder, notebook, data show, brown paper, colored pens Strategies and techniques: Use of cards Facilitator: Researcher	Based on the identification of extreme situations, mediated by the reality of their practices in child health care, reflected in the work process, reflection on the concept of health promotion, the need to integrate nurses’ activities with the team, in order to share work demands in Basic Health Units and consider users as active subjects in the health and disease process, to provide better compliance with the monitoring of children. There was, therefore, the strengthening of nurses based on reflective dialogues regarding the reality experienced, enabling awareness and interventions to transform their practices in child health care.
A4	Socio-environmental determinants	Number of participants: 29 Professional category: CHW Average duration: 2 to 4 hours Number of meetings: 4 Frequency: Monthly - February and May 2019 Learning environment: Health Unit Material used: Printed maps of the areas where CHW work, sheets of paper Strategies and techniques: Community breakfast, reception and talking map technique Facilitator: Nurse Researcher from one of the FHS teams	It contributed to qualifying knowledge, values and skills on socio-environmental determinants and their applicability in FHS as well as revealing the importance of community strengthening for health promotion and coping with vulnerabilities and health inequalities.
A5	Active aging and elder care	Number of participants: 4 Professional category: FHS and NASF health professionals Average duration: Not mentioned Number of meetings: 1 Frequency: January 2018 Learning environment: Health Unit Material used: Not mentioned Strategies and techniques: Group discussion Facilitator: Researcher	The care-educational and dialogical path allowed the collective definition of active aging, thus making it possible to advance towards comprehensive elder care promotion.

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[1] Chief editors:

Romeu Gomes, Antônio Augusto Moura da Silva