INTRODUCTION

The political, economic and social transformations that have taken place over the course of the 20th century have led to profound changes in the way the world is perceived and viewed. Among the various changes that have taken place, it is important to reflect on the alterations made to the concept of health, particularly in terms of the World Health Organization’s guiding documents. Nevertheless, practices often prove unable to keep up with these changes, which has led to a distortion of the concepts themselves¹,².

Health training must be based on a paradigm shift that involves recognizing the multidimensionality of professional practice, namely technical/scientific, ethical, social and political, as a way of overcoming simplified and fragmented thinking about reality; the adoption of a pluralistic view of teaching concepts, integrating the diversity of fields of knowledge and a global vision of reality³.

From this perspective, training professionals requires the early insertion of students into the world of work, as well as the construction of a critical and reflective view of health, with health promotion as its central axis. This implies breaking away from the traditional teaching model, predominantly centered on disease prevention, towards a practice focused on the emancipation and empowerment of individuals⁴,⁵.

Although health promotion is a broad field of action aimed at the general population, it is necessary to focus on groups or segments that, in addition to their specificities, can be seen as more vulnerable to adverse health conditions. In this understanding, adolescents stand out, a population segment marked by vulnerability⁶.

In this way, curricular changes must choose health promotion benchmarks in order to resignify teaching, which implies transforming teaching practices, overcoming the biologicist model and the sectoral nature that characterizes the training and work of health professionals⁷. Significant changes need to take place in the teaching sector with a view to techno-professional performance and fulfilling the responsibilities of scientific, ethical and humanistic academic training. The Unified Health System has thus taken on an active role in reorienting care, treatment and monitoring strategies for individual and collective health, and it is in this same sense that there is a need to review the training methods for working in this health system⁸,⁹.

Thus, a study of the actions of nursing teachers in the practice of adolescent health promotion is justified, as it is essential to consider the need for differentiated health training, with a focus on health promotion, so that care is aimed at human needs, providing activities not only directed at individuals with a view to changing behaviors, but also changing the processes that determine behaviors.

Therefore, based on the reflections on the theme to be studied, the question arises: How are health promotion references being incorporated into adolescent care in the field of public health? In this direction, we present teaching practices that instigate praxis and have a pedagogical project centered on the student as the subject of learning and supported by the teacher as a facilitator and mediator of the teaching process.

Thus, this study aims to analyze the process of student training in the field of nursing aimed at promoting the health of adolescents escente from the perspective of Paulo Freire’s concepts.

METHODS

RESULTS

The organization of the data allowed for the final construction of the analysis, which is the elaboration of the study’s evidence.

For the category Perception of health education, the analysis from the perspective of Paulo Freire’s concept Reading the world, showed that this reading of the study participants is limited to the concept linked to quality of life and biopsychosocial aspects. This perception implies evidence of a view that is limited to the concept of health and not focused on the social determinants of health; the training of teachers and the knowledge and practices that lead to student learning and the knowledge constructed by the student based on what they have learned in the classroom. Chart 3 describes some of the thematic categories.

In the Teaching Practices category, the analysis from the perspective of Paulo Freire’s concept of Problematization showed that practices aimed at training students in the teaching of adolescent health promotion are still conducted through lectures, stimulating fragmented and specific practices in the services, which, when implemented, take place in groups and in the school context, When there are extension projects, they are aimed at specific audiences, leaving aside the questioning and knowledge brought by the students themselves, making it difficult for professionals to broaden their outlook in order to build care for adolescents.

In the category Student Experiences, the analysis from the perspective of Paulo Freire’s concept Significant Themes, showed that practices were carried out with specific themes, in a fragmented way, which distances itself from the reality of what would really be significant for adolescents, evading real social needs and taking away from adolescents the chance to seek new reflections.

The evidence from the analysis of the testimonies, when confronted, reveals that the fact that they were trained in the concept of health promotion is far removed from the broader concept, from the very concept of health promotion linked to the social determinants of health. This led to an extension program with ready-made themes, without considering social needs, without stimulating dialogue with a focus on building knowledge, but rather on passing on content covered in the classroom and, finally, with traditional methodologies that did not lead participants to reflect or criticize, making them passive subjects in the process.

DISCUSSION

In view of the results, it can be seen that health training is still focused on technique, so that it is difficult to transmit knowledge so that students leave trained to meet social needs and thus meet the peculiarities linked to the adolescent public. This reality is present because managers and teachers use traditional methodologies, making it difficult to construct knowledge with a critical/reflective eye.

In this context, in relation to the participants’ reading of the world, it can be seen that this influences the practice carried out later, since it is seen as a relationship between the problematization of man and the world, allowing the individual to delve deeper into the reality to which he is inserted and for this transfer of knowledge to be led by what they believe, and in this case learn in the training process.

Human beings become capable of transcending their perceptions by reading the world, where they are able to reach new perceptions of reality, expanding their knowledge. Health training must be based on practices that problematize new modes of care, analyzing traditional teaching training and breaking away from technical training. Health training based on traditional centralized and vertical training models leads to poor care practices. Thus, training should not be restricted to the acquisition of knowledge and skills in an abstract way, but should be developed based on reality and experiences, requiring an expansion of theoretical and methodological frameworks for reflection¹¹,¹².

Thus, it can be understood that the reading of the world as discussed by Paulo Freire is related to the perception of reality, which in this study, obtained this reading through the perception of the individuals studied, where training is focused on educational practices with a focus on health, in order to build a critical awareness of their work process¹³.

And when it comes to health-promoting practices, they are effective and generate positive effects in all audiences where they are applied. However, given that health professionals will be responsible for promoting adolescent health, these practices should still be incorporated into their training process and should therefore be analyzed more closely¹⁴,¹⁵,¹⁶. In this sense, it should be noted that the study participants’ perceptions were limited to concepts such as health focused on biopsychosocial aspects, not with a broader view of health and, even less, linked to the social determinants of health, concepts to which health promotion is intrinsically linked.

Considering this reality, another study showed that this concept of health promotion was also perceived in this way, with professionals focusing on curative and preventive measures related to health. It is clear that in reading the world in terms of health promotion, the view of the study participants may be related to teacher training, which promotes a teaching practice limited to what is believed about the concept of health, which directly and indirectly reflects on the construction of student knowledge and their future practices¹⁷.

Health training focused on health promotion is somewhat problematized because teachers still persist with their hygienist and biomedical conceptions of health, and there is a lack of planning and knowledge on the part of the teachers themselves, making it difficult to apply the theme in the construction of students’ knowledge¹⁸,²⁰.

Health training should be based on a competency-based curriculum, based on meaningful learning, centered on the student and the teacher being the facilitator of the teaching-learning process, with the aim of preparing, motivating and empowering these students to take the lead in knowledge. However, there are gaps in health training in terms of implementing educational practices that are closer to the principles and guidelines of the Unified Health System, which has led and contributed to health practices that are still based on biomedical teaching³.

Higher education in health is still very much tied to hospital-centered and fragmented practices, which is deficient in meeting real social health needs²¹. For this reason, the changes suggested in practices aim to develop teachers, students and professionals involved in the process of building knowledge²². In this way, reading the world can clarify the existence of different visions, which will guarantee a health education where there will be an exchange of knowledge, guaranteeing new practices that meet the reality of the services and promote the quality of life of the individual and the population.

In the category of teaching practices, we noticed a practice based on processes that have already been defined, so that students are not allowed to investigate and question ways of building a care practice that meets reality. What is developed is established by the services in a punctual and fragmented way. With regard to Paulo Freire’s epistemological category, Problematization, a concept linked to the category in question, the importance of involving individual reality and questioning in broadening the view of certain activities is clear. The individual’s view makes it possible to build collective knowledge, where exchange is more important than established concepts²³.

With regard to the methodologies applied by teachers, there is a predominance of traditional methods, where students are trained to work with adolescents through the use of health education and conversation circles focusing on reproductive and sexual health. The applicability of problematization is important for teaching and professional training, contributing to intellectual autonomy. In addition, the new proposals of the National Curriculum Guidelines (DCNEM) and National Curriculum Parameters (PCNs) encompass a form with pedagogical principles and practices structured so that there is an interdisciplinary curricular organization²⁴.

In the context of problematization, questioning is established, which is important for the construction of new knowledge. Thus, educational practices based on problematization help teaching and enable the creation of broader visions²³. The incorporation of active methodologies into the teaching-learning process in undergraduate nursing courses makes a significant contribution to building autonomous students in relation to their learning process, making them protagonists and no longer mere recipients of this process⁴.

Thus, with regard to health promotion actions, new actions must be implemented that can promote the evolution of professionals and the autonomy of individuals in relation to their health process. In turn, teaching practices while training health professionals are a challenge that fosters the concept of health. When identifying which practices would be carried out by professionals and from the perspective of nursing students, it was observed that coordinators and teachers emphasize the difficulty of practices for adolescents, but that these should be based on existing programs focused on health promotion. The students, on the other hand, although they also believe in the strength of the Health in Schools Program, consider groups and conversation circles to be an empowering methodology that should be better worked on during their undergraduate studies.

The result corroborates the evidence found in the study by Jorge and authors, where although teachers believe that there should be integrality in training, as well as the need to build a new form of curricular organization, there are still remnants of training practice for exclusive disease care, showing contradictions between perceptions and what is actually carried out in practice²⁵.

It should therefore be emphasized that health care for adolescents needs to be consolidated through actions that take into account the real needs of health care and education, which makes it essential that the professionals who develop them are able to deal with the issues involving this age group, in order to ensure their effectiveness.

The study by Rentala and the authors shows health promotion techniques for adolescents, carried out in India, where support groups are run for adolescents on topics such as educational stress, anxiety and depression, moving away from common topics for this public, such as sexual and reproductive education. The results also show that the students’ experience is based on developing specific and fragmented practices, where the real needs are not determined²⁶.

Thus, in relation to significant themes, it is important to develop new strategies and content, so that it is possible to achieve what is intended. Particularly in health promotion, addressing topics that are really useful to that audience is fundamental to improving health aspects. Meaningful themes help in the search for content that values social knowledge and coping strategies. These themes contribute to the construction of innovative actions and reflections, but for this it is important to know the reality²³.

One-off, fragmented activities that disregard social needs and practices that are far removed from reality are not enough to change health scenarios. It is known that many students’ experiences are merely practices established by the services themselves. Paulo Freire reveals that these themes are not just investigated ideas, in an empty way and without any commitment, but in such a way that those interested raise questions about what to do and how to do it to change this fact²⁷.

Thus, it is necessary to carry out health promotion actions that are really important, using current themes and means for the adolescent public, such as: internet-based programs²⁸,²⁹. Working to promote health is a way of responding to social demands and requires reflections on four fundamental axes: the concept of health, the management of the work and education process, the training of health professionals, participation and social control. The elements of these axes should guide health practices, imprinting the logic of the techno-care model which is under constant construction based on important themes³⁰.

Health promotion is a set of actions that should not only be carried out by health or education professionals, but also learned and carried out by the agents themselves, in this case adolescents. Thus, it is encouraged that the very agent to whom health promotion is directed is capable of executing and passing on this information to whoever is necessary³¹.

Professional nursing training must be based on a globalized vision, in order to produce and disseminate knowledge. However, there is an urgent need for new pedagogical proposals that transform the profile of nurse training from a perspective of developing competencies, skills and attitudes. Thus, curricula must be designed to ensure solid training, in line with the precepts of the Unified Health System, capable of preparing professionals to deal with global challenges and transformations.

The importance of training based on each individual’s reading of the world can be seen, identifying different perspectives and different realities, enabling discussion and new questions to be asked, in order to provide professionals with a different look at the actions that need to be taken, focusing on themes that really need to be addressed, guaranteeing improved quality of life and better results in health promotion care practice.

The study has limitations inherent to qualitative research, but these did not compromise the development and analysis of the research, mainly due to the analytical method chosen and the rigor with which it was used. In addition, data was collected in proportion to each group, which allowed for an adequate division and perceptions that can bring the reality of health training to health-promoting practices for adolescents.

CONCLUSION

Health promotion practices for adolescents are still incipient in health training, as there is still a focus on the use of traditional methodologies in theory and in practice the prioritization of ministerial programs focused on adolescents’ sexual and reproductive health. However, it is noteworthy that although the participants have broad perceptions of health and health promotion, there is still traditional training, as well as application to the adolescent public.