Título:	Elaboração de uma proposta de programa de educação terapêutica para pessoas com diabetes tipo 2 em uso de insulina na atenção primária à saúde
Autor(es):	Machado, Alexandre Vaz
Orientador(es):	Galato, Dayani Raposo, João Filipe Cancela dos Santos
Coorientador(es):	Lima, Rodrigo Fonseca Ó, Dulce Maria do Nascimento do
Assunto:	Diabetes mellitus Tipo 2 Atenção primária à saúde Equipe de assistência ao paciente Recursos humanos - saúde
Data de publicação:	26-Jun-2026
Data de defesa:	11-Dez-2025
Referência:	MACHADO, Alexandre Vaz. Elaboração de uma proposta de programa de educação terapêutica para pessoas com diabetes tipo 2 em uso de insulina na atenção primária à saúde. 2025. 255 f., il. Tese (Doutorado em Ciências e Tecnologias em Saúde) — Universidade de Brasília, Brasília, 2025.
Abstract:	Therapeutic Patient Education (TPE) aims to support the acquisition and maintenance of self management skills, facilitating adaptation to health conditions. Multidisciplinary action is essential, especially in the care of people with type 2 diabetes (T2D). The objective of this thesis was to develop a proposal for a TPE program for people with DM2 using insulin in Primary Health Care (PHC) in the Federal District (DF), using a sequential mixed methods design: (I) scope review, (II) situational diagnosis of the Brazilian scenario (analysis of prescriptions, application of DES-SF and DMSES, and perception of PHC team members regarding DM2 care), (III) participant observation at the Portuguese Association for the Protection of Diabetics (APDP) and application of DES-SF, and (IV) development of a program proposal, with support from focus groups and adoption of the ETP and Donabedian theory. In stage (I), the scope review included 42 studies on chronic conditions, with terminological and conceptual variations in relation to ETP. Some used the World Health Organization (1998) definition, while other approaches incorporated empowerment, health literacy, and person-centered care. In stage (II), the situational diagnosis in the Federal District evaluated insulin prescriptions; 99.2% were legible, but only 13.2% contained the expression “international units” in full. It was observed that 3.7% included adjustments based on blood glucose levels. At the same time, a cross sectional study with people with DM2 revealed low educational levels. The mean scores for empowerment (3.6 ± 1.2) and self-efficacy (3.6 ± 1.3) showed statistically significant differences in relation to gender, education level, and age. In addition, the perceptions of 44 PHC team members regarding the care of people with DM2 were analyzed. The mean perception of confidence varied between categories, with mean confidence ranging from physicians (82.9%) to community health workers (57.1%). The results highlight inequalities between categories and the need for training. Participant observation (III) was carried out at the APDP, where multidisciplinary activities were monitored. At this stage, the DES-SF was also applied to 100 people with DM2 treated at the service. The average was 3.9 points (±0.5), classified as a high score. Differences were observed according to BMI classification and glycated hemoglobin levels. In stage (IV), two focus groups were held: one with APDP professionals and another with APS professionals from the Federal District. The discussions allowed us to identify perceptions and practical contributions that supported the final development of the program. The proposal includes an initial individual meeting to present the program and collect baseline information, followed by six group sessions at two-week intervals and, subsequently, quarterly reinforcement sessions. The structure, processes, and outcomes to be evaluated in the proposed program were defined. The proposal for a TPE program, focused on the therapeutic education crystal, can fill gaps in care, and develop skills in people with DM2. The findings provide support for clinical practice and dialogue with public policies, and can guide TPE strategies in Brazilian PHC.
Unidade Acadêmica:	Faculdade de Ciências e Tecnologias em Saúde (FCTS) – Campus UnB Ceilândia
Informações adicionais:	Tese (doutorado) — Universidade de Brasília, Faculdade de Ceilândia, Programa de Pós-graduação em Ciências e Tecnologias em Saúde, 2025.
Programa de pós-graduação:	Programa de Pós-Graduação em Ciências e Tecnologias em Saúde
Agência financiadora:	Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
Aparece nas coleções:	Teses, dissertações e produtos pós-doutorado

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