REVIEW PROTOCOL
Professional training in leprosy in Primary Health Care: a scoping review protocol
Natalia Marciano de Araujo Ferreira1, Franciely Midori Bueno de Freitas1, Natacha Bolorino1, Laís Cristina Gonçalves Ribeiro1, Carla Fernanda Tiroli1, Rafaela Marioto Montanha1, Vanessa Cristina Luquini1, Flavia Meneguetti Pieri1
1State University of Londrina, Londrina, PR, Brazil
ABSTRACT
Objective: To describe the systematization of a scoping review to map scientific evidence related to the professional training of the members of the leprosy primary health care team. Method: The recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) will be met, as well as the Joanna Briggs Institute's guidelines. It is expected that the evidence found in the national and international literature can guide professionals and managers in implementing actions to control and eliminate leprosy, a public health problem, through education.
Descriptors: Scoping Review; Health Human Resource Training; Leprosy.
INTRODUCTION
Leprosy is a chronic disease that predominantly affects the skin and peripheral nerves, with long-term consequences that include deformities and disabilities. Leprosy is one of the neglected diseases, defined as diseases that generate high human, social and economic consequences, afflicting vulnerable and marginalized populations(1-2).
In 2018, the global leprosy detection rate was 2.74 cases per 100,000 inhabitants, despite the global decrease compared to the previous year. Brazil, which is among the countries with high burdens of the disease and ranks second in the number of new cases and more than 90% of all cases in the Americas, was one of the countries with an increase in this number, with a heterogeneous distribution of cases due to the Social Determinants in Health (SDH), which are distinctive for each region (mainly underprivileged and vulnerable populations, with precarious housing and food conditions), and internal migration routes(3).
Public policies aimed at leprosy in the country began in 1923 with Decree No. 16,300 and, since then, have evolved along with the treatment and epidemiological fluctuations of the disease. In the most current national strategy, the Ministry of Health (MH) outlines objectives aligned with global ones, aiming to eliminate the disease as a public health problem, especially concerning late diagnosis and its consequences, such as physical disabilities. Strengths and strategies mentioned in this document relate to support in terms of training for health professionals, evaluation of the methodologies used, incorporation of technological innovations, encouragement of continuing education, and strengthening of permanent education to face leprosy in the teaching-service integrated network(3).
These actions align with epidemiological data released in recent years, which still point to cases diagnosed by passive detection, in which the individual seeks the health service or is referred to it when he presents any of the symptoms. This suggests fragility in disease control activities, so it is necessary to establish actions that favor the active search and engagement of professionals, increasing contact detection and surveillance activities, considered one of the more effective measures for the diagnosis and control of leprosy, contributing to the break of the chain of transmission of the disease(4).
The Research and Action Group in Infectious Diseases of the State University of Londrina (GAPI/UEL in Portuguese), active in southern Brazil, has been developing studies on leprosy and, over the last few years, has identified important aspects including those mentioned above. In prior studies, the difficulty of access to diagnosis and treatment was demonstrated, and the specific evaluation found weaknesses in the performance of the Community Health Agents (CHA) concerning the attributes of Primary Health Care (PHC)(5-6).
Other studies by the group showed a direct relationship between the disease and SDH, such as agglomeration of individuals in the same municipality, race/color, income, and education, in addition to a critical node regarding the time elapsed between the first symptoms and diagnosis, which can take from months up to decades, requiring, on average, 4.6 years and almost eight consultations, far from the recommended goals(7-8). Concerning the importance of professional training explained above for the control and possible elimination of leprosy, this protocol aims to describe the systematization of a scoping review to answer the following question: What is the scientific evidence about the professional training of the members of the leprosy PHC team?
METHOD
The PCC framework was used to establish the research question, as shown in Figure 1.
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Research question |
What is the scientific evidence about the professional training of the members of the leprosy PHC team? |
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Population |
The leprosy PHC team ̶ a doctor, a nurse, nursing technicians, Community Health Agents (CHA), and other health care workers. |
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Concept |
Training for health professionals on leprosy, a communicable and chronic disease caused by Mycobacterium leprae and characterized by loss of sensitivity and possible implications and disabilities(1). |
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Context |
Actions carried out within the scope of PHC, focusing on the Family Health Strategy and other PHC workers, including training, carried out in loco through workshops or remotely. |
Source: Prepared by the authors, 2022.
Figure 1 - PCC framework applied to the scoping review. Londrina, PR, Brazil, 2022
Types of studies
Inclusion criteria will be original articles, case reports, final papers, monographs, theses, and dissertations not published in scientific journals and manuals, with access available free of charge or through an institutional subscription, in Portuguese, English, or Spanish, with no time restraint, and published until June 2021. The start date was not pre-fixed since leprosy is an old disease whose actions and publications can go back many decades. It is emphasized that the authors acknowledge search limitations, such as the recent emergence of some databases, indexing, and the popularization of scientific literature.
The exclusion criteria will be secondary studies, duplicates, selection notices, catalog sheets, reviews, letters, editorials, and studies written in a language different from those considered in the study.
Methodology
The protocol was developed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) and on the Joanna Briggs Institute's (JBI) guidelines(9), comprising five stages: (1) identification of the research question; (2) identification of relevant studies; (3) selection of studies; (4) extraction of data; and (5) collating and summarizing the results. The protocol was registered in the Open Science Framework (OSF) (https://osf.io/mt8fb/).
Search strategy and information
The search strategy described below will be used, using the descriptors (DeCS and MeSH) and alternative terms combined with the Boolean operators AND and OR, according to the research question.
The search will be carried out through the Federated Academic Community (CAFe) of the University of Londrina Central Library to identify relevant materials using a standardized data collection. The following databases will be explored: Virtual Health Library (VHL), MEDLINE via National Library of Medicine National Institutes of Health (PubMed), CINAHL (Cumulative Index to Nursing and Allied Health Literature), Web of Science (WOS), Scopus (Scopus Preview), Latin American and Caribbean Health Sciences Literature (LILACS), Cochrane, Coordination for the Improvement of Higher Education Personnel (CAPES) Portal of theses and dissertations, Latin American Portal of theses, and World Cat Dissertations and Theses. Terms in Portuguese, Spanish, and English will be used. Descriptors in Portuguese and Spanish can be found in the Descriptors in Health Sciences (DECs), while those in English will be retrieved from the Medical Subject Headings (MeSH). The gray literature search for unindexed materials will be conducted through Google Scholar and the Gray Literature Report, as shown in Figure 2.
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Databases used |
Search strategy |
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- Virtual Health Library - CINAHL - LILACS - Latin American Portal of theses - Google Scholar |
(“equipe de assistência ao paciente” OR “patient care team” OR “equipe multiprofissional” OR “equipe de saúde” OR “enfermeiras e enfermeiros” OR “nurses” OR “médicos” OR “physicians” OR “assistentes de enfermagem” OR “nursing assistants” OR “auxiliares de enfermagem” OR “fisioterapeutas” OR “physical therapists” OR “agentes comunitários de saúde” OR “community health workers”) AND (“capacitação profissional” OR “staff development” OR “formação profissional” OR “capacitação de recursos humanos em saúde” OR “formação profissional em saúde” OR “educação continuada” OR “education, continuing” OR “educação permanente” OR “educação” OR “education” OR “oficinas de trabalho” OR “programas de treinamento” OR “workshops” OR “prevenção de doenças” OR “preventive medicine” OR “preventive health services” OR “ações preventivas contra incapacidades” OR “hanseníase” OR “leprosy” OR “doença de Hansen” OR “lepra” OR “Mycobacterium leprae” OR “hanseníase paucibacilar” OR “leprosy, paucibacillary” OR “hanseníase indeterminada” OR “hanseníase multibacilar” OR “leprosy, multibacillary” OR “hanseníase dimorfa” OR “leprosy, borderline” OR “hanseníase tuberculoide” OR “leprosy, tuberculoid” OR “hanseníase virchowiana” OR “leprosy, lepromatous” OR “hanseníase cutânea” OR “hanseníase nodular”) AND (“atenção primária à saúde” OR “primary health care” OR “saúde pública” OR “public health” OR “saúde coletiva” OR “saúde da família” OR “Family health” OR “estratégia saúde da família”) |
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- MEDLINE via PubMed - Web of Science - Scopus - Cochrane - World Cat Dissertations and Theses - Gray Literature Report |
(“patient care team” OR “nurses” OR “physicians” OR “nursing assistants” OR “physical therapists” OR “community health workers”) AND (“staff development” OR “education, continuing” OR “education” OR “workshops” OR “preventive medicine” OR “preventive health services” OR “leprosy” OR “Mycobacterium leprae” OR “leprosy, paucibacillary” OR “leprosy, multibacillary” OR “leprosy, borderline” OR “leprosy, tuberculoid” OR “leprosy, lepromatous”) AND (“primary health care” OR “public health” OR “Family health”) |
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- CAPES Portal of theses and dissertations |
(“equipe de assistência ao paciente” OR “equipe multiprofissional” OR “equipe de saúde” OR “enfermeiras e enfermeiros” OR “médicos” OR “assistentes de enfermagem” OR “auxiliares de enfermagem” OR “fisioterapeutas” OR “agentes comunitários de saúde”) AND (“capacitação profissional” OR “formação profissional” OR “capacitação de recursos humanos em saúde” OR “formação profissional em saúde” OR “educação continuada” OR “educação permanente” OR “educação” OR “oficinas de trabalho” OR “programas de treinamento” OR “workshops” OR “prevenção de doenças” OR “ações preventivas contra incapacidades” OR “hanseníase” OR “doença de Hansen” OR “lepra” OR “Mycobacterium leprae” OR “hanseníase paucibacilar” OR “hanseníase indeterminada” OR “hanseníase multibacilar” OR “hanseníase dimorfa” OR “hanseníase tuberculoide” OR “hanseníase virchowiana” OR “hanseníase cutânea” OR “hanseníase nodular”) AND (“atenção primária à saúde” OR “saúde pública” OR “saúde coletiva” OR “equipe de saúde da família” OR “estratégia saúde da família”) |
Source: Prepared by the authors, 2022.
Figure 2 - Search strategy. Londrina, PR, Brazil, 2022
A preliminary search was conducted using the strategy above in the MEDLINE database, via PubMed, on May 19, 2022, to identify the number of materials meeting the study's inclusion criteria. At the time, 25,750 studies were found, which would be evaluated in terms of inclusion and exclusion criteria.
Study selection, data extraction, and analysis
After searching for the materials in the selected databases through title and abstract screening, the selected studies will be exported from each database to Endnote version 9 for analysis. Subsequently, still at this stage, the StArt (State of the Art through Systematic Review) tool will be used, a literature review tool developed by the Software Engineering Research Lab of the Federal University of São Carlos(10).
In this phase, using the StArt software, duplicates will be removed, and the remaining studies will undergo a title and abstract screening in the first phase and a full-text screening in the second phase. These procedures aim to identify the materials that meet the study's inclusion criteria. The StArt software uses a flow that includes the inclusion and exclusion criteria for sorting the articles and other materials. Peers will read the titles, abstracts, and full texts to guarantee the legitimacy of the review and avoid biases. In the event of disagreement between the two reviewers, a third researcher will be consulted.
After choosing the materials, a form built based on the research question and inclusion and exclusion criteria will be used to detail the information found (Figure 3). These steps will be indicated in the item referring to the research method.
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Study identification |
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Authorship |
Year |
Country |
Language |
Objective |
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Study characteristics |
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Method |
Sample |
Strategy used |
Main results |
Conclusion (effectiveness of actions) |
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Figure 3 - Instrument for data collection. Londrina, PR, Brazil, 2022
Source: Prepared by the authors, 2022.
Data presentation
A flowchart will be built with information related to extracted, duplicated, and excluded materials by title, abstract, and full-text screening, as well as the number of materials listed as relevant for the review and the final sample of the study.
Upon consensus of the researchers involved in the extraction and analysis of data, the results (materials that will be included in the review after reading the full text) will be presented through tables, graphs, flowcharts, or charts containing information on the authors, year of publication, location, objective, population, method, characteristics/modality of training, and main findings. The results will support a discussion that explores studies related to the professional training of the members of the leprosy PHC team and compares the most used methods for training by identifying possible strategies used, their strengths, and weaknesses.
CONFLICT OF INTEREST
The authors have declared that there is no conflict of interest.
REFERENCES
1. World Health Organization (WHO). Guidelines for the Diagnosis, Treatment and Prevention of Leprosy [Internet]. [place unknown]: WHO; 2019 [cited 2022 Sept 09]. Available from: https://apps.who.int/iris/bitstream/handle/10665/274127/9789290227076-por.pdf
2. World Health Organization (WHO). Ending the neglect to attain the Sustainable Development Goals: a road map for neglected tropical diseases 2021–2030 [Internet]. 2020 [cited 2022 Sept 09]. Available from: https://www.who.int/neglected_diseases/Revised-Draft-NTD-Roadmap-23Apr2020.pdf?ua=1
3. Ministério da Saúde (BR), Secretaria de Vigilância em Saúde, Departamento de Doenças de Condições Crônicas e Infecções Sexualmente Transmissíveis. Estratégia Nacional para Enfrentamento da Hanseníase 2019-2022 [Internet]. Brasília (DF): Ministério da Saúde; 2019 [cited 2022 Sept 09]. Available from: http://www.aids.gov.br/pt-br/pub/2020/estrategia-nacional-para-enfrentamento-da-hanseniase-2019-2022
4. Ministério da Saúde (BR), Secretaria de Vigilância em Saúde. Situação epidemiológica e estratégias de prevenção, controle e eliminação das doenças tropicais negligenciadas no Brasil, 1995 a 2016. Bol Epidemiol [Internet]. 2018 [cited 2022 Sept 09];50(n.esp.):1-15. Available from: http://www.saude.gov.br/boletins-epidemiologicos
5. Pieri FM, Touso MM, Rodrigues LBB, Yamamura M, Pinto IC, Dessunti EM, et al. Patients’ Perceptions on the Performance of a Local Health System to Eliminate Leprosy, Parana´ State, Brazil. PLoS Negl Trop Dis. 2014;8(11). https://doi.org/10.1371/journal.pntd.0003324
6. Bolorino N. Avaliação do Agente Comunitário de Saúde para as ações de controle da hanseníase na Atenção Primária à Saúde [master thesis on the internet]. Londrina: Universidade Estadual de Londrina, Programa de Pós-graduação em Enfermagem; 2020 [cited 2022 Sept 09]. 139 p. Available from: http://www.bibliotecadigital.uel.br/document/?code=vtls000231997
7. Ferreira NMA. Determinantes Sociais em Saúde e sua relação com a hanseníase no espaço em Londrina [dissertação de mestrado]. Londrina: Universidade Estadual de Londrina, Programa de Pós-graduação em Enfermagem; 2018 [cited 2022 Sept 09]. 79p. Available from: http://www.bibliotecadigital.uel.br/document/?code=vtls000221094
8. Ferreira NMA, Furuya RK, Storer JM, Ramos ACV, Crispim JÁ, Arcêncio RA, et al. Tempo para o diagnóstico da hanseníase e sua relação com fatores sociodemográficos e clínicos. Ciênc Cuid Saúde. 2020. https://doi.org/10.4025/cienccuidsaude.v19i0.53967
9. Aromataris E, Munn Z, editors. JBI Manual for Evidence Synthesis [Internet]. Adelaide: JBI; 2020 [cited 2022 Sept 09]. Available from: https://synthesismanual.jbi.global. https://doi.org/10.46658/JBIMES-20-01
10. Laboratório de Pesquisa em Engenharia de Software (LaPES): StArt – State of the Art through Systematic Review [Internet]. São Carlos: Universidade Federal de São Carlos [cited 2022 Feb 21]. Available from: http://lapes.dc.ufscar.br/tools/start_tool
Submission: 02/10/2022
Approved: 08/08/2022
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AUTHORSHIP CONTRIBUTIONS |
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Project design: Ferreira NMA Freitas FMB, Pieri FM Data collection: Ferreira NMA, Freitas FMB, Bolorino N, Ribeiro LCG, Tiroli CF, Montanha RM, Luquini VC, Pieri FM Data analysis and interpretation: Writing and/or critical review of the intellectual content: Ferreira NMA, Freitas FMB, Bolorino N, Ribeiro LCG, Tiroli CF, Montanha RM, Luquini VC, Pieri FM Final approval of the version to be published: Ferreira NMA, Freitas FMB, Bolorino N, Ribeiro LCG, Tiroli CF, Montanha RM, Luquini VC, Pieri FM Responsibility for the text in ensuring the accuracy and completeness of any part of the paper: Ferreira NMA, Freitas FMB, Pieri FM |