Promotion of healthy lifestyles in Primary Care in Latin America. Bibliographic review
Promoción de estilos de vida saludables en la
Atención Primaria en América Latina. Revisión bibliográfica
Silvana Estefania Wilcaso Cando
Bachelor of Science in Nursing, Universidad Estatal
de Bolivar, silvana.wilcaso@ueb.edu.ec , https://orcid.org/0009-0006-1861-2197
Silvana Ximena López Paredes
PhD in health sciences, Universidad Estatal de
Bolivar
slopez@ueb.edu.ec, https://orcid.org/0000-0001-9289-8089
Ninfa Giovanna Yanez
Barragán
Bachelor of Science in Nursing, Universidad
Estatal de Bolivar, Venezuela
ninfa.yanezbarragan@ueb.edu.ec, https://orcid.org/0009-0003-5680-8578
)%20(inglés%20(americano)).fld/image002.png){kind=small}
The promotion of healthy lifestyles in Latin America
is presented as a priority issue in relation to social health problems, as it
occurs in the provision of primary services. This paper aims to examine the
close interrelationship between the practices of health professionals, social
interactions and health mediation in terms of its effectors. An
analytic-synthetic documentary research approach, an analysis of 19 scientific
articles produced between 2014 and 2024 and published in indexed databases such
as PubMed, SciELO and ScienceDirect was conducted. The most significant
findings suggest that health professionals are key players in teaching for
health promotion. Specific strategies, including motivational interviewing and
nurse-led initiatives, were effective in clinical practice in reducing risk
factors. These gaps also highlight the operational limitations that remain from
the systematic evaluation and use of technologies. Final recommendations call
for improving practitioner skills, modifying strategies to the local context,
and strengthening technology convergence in order to scale interventions.
Keywords: primary health care, chronic
diseases, healthy lifestyles, health promotion, health technologies
Resumen
La
promoción de estilos de vida saludable en América Latina se presenta como un
asunto prioritario en relación a las problemáticas sociales de salud, tal como
se da en la provisión de servicios primarios. Este trabajo se propone examinar
la estrecha interrelación entre las prácticas de los profesionales de salud,
las interacciones sociales y la mediación en salud en términos de sus
efectores. Un enfoque de investigación documental analítico-sintético, se
realizó un análisis de 19 artículos científicos producidos entre 2014 y 2024 y
publicados en bases de datos indexadas como PubMed, SciELO y ScienceDirect. Los
hallazgos más significativos sugieren que los profesionales de la salud son
actores clave en la enseñanza para la promoción de la salud. Estrategias
específicas, que incluyen la entrevista motivacional y las iniciativas
lideradas por enfermeras, fueron efectivas en la práctica clínica para reducir
factores de riesgo. Estas brechas también destacan las limitaciones operativas
que permanecen de la evaluación sistemática y el uso de tecnologías. Las
recomendaciones finales apuntan por la mejora de las habilidades de los
profesionales, la modificación de las estrategias al contexto local y el
fortalecimiento de la convergencia de tecnologías con el fin de escalar las
intervenciones.
Palabras clave: atención primaria, enfermedades crónicas, estilos de vida
saludables, promoción de la salud, tecnologías en salud
Introduction
The promotion of healthy lifestyles is a
fundamental strategy to address the growing caseload of people with chronic
diseases in primary care. Despite the challenges this represents for health
systems, with the implementation of evidence-based strategies, coupled with
adequate support, it is possible to significantly improve the health of
communities and even reduce existing health inequalities. This study offers a
comprehensive view of best practices and contributes to future research and
implementation of policies aimed at health promotion (Gil-Girbau et al., 2021)
.
In recent times, the promotion of healthy
lifestyles has gained considerable prominence in the field of public health
worldwide. The growing increase in chronic non-communicable diseases, such as
type 2 diabetes, arterial hypertension, cardiovascular diseases and obesity,
has put significant pressure on health systems, emphasizing the importance of
adopting and persisting in healthy lifestyle habits from a preventive point of
view. According to the World Health Organization (WHO), chronic diseases are responsible
for 71% of deaths worldwide, which highlights the need to implement effective
interventions that promote changes in people's lifestyles (Pan American Health
Organization, 2022) .
The promotion of healthy lifestyles,
including a balanced diet, regular physical activity, abstinence from tobacco
and alcohol consumption, and stress management, have been identified as
indispensable strategies to reduce the burden of chronic diseases. Worldwide,
there are several initiatives and policies that have been implemented to
promote these healthy habits in the population (Córdoba García et al.,
2022) .
However, the effectiveness of these
initiatives may vary considerably among different regions and population
groups, related to external factors such as economic inequality, lack of
adequate infrastructure for physical activity, and difficulty in obtaining
healthy food. On the other hand, the growing demand for urban areas with no
space for exercise favors sedentary lifestyles, contributing to the adoption of
unhealthy habits. In addition, cultural diversity and socioeconomic differences
directly influence the perception of people to adopt healthy lifestyles, this
reality poses a real challenge for the implementation of programs that are
effective in promoting health (Romero González, 2020) .
Noncommunicable diseases (NCDs) cause
approximately 41 million deaths annually, accounting for 74% of all deaths
worldwide. Each year, an estimated 17 million people under the age of 70 die
prematurely from NCDs, 86% of these deaths occurring in low- and middle-income
countries, where 77% of all NCD deaths are concentrated. It has been determined
that the leading causes of death from NCDs are related to cardiovascular
diseases (17.9 million), cancer (9.3 million), chronic respiratory diseases
(4.1 million) and diabetes (2 million). These four pathologies are responsible
for more than 80% of premature deaths due to NCDs. Studies have shown that the
main risk factors are related to tobacco use, physical inactivity, harmful
alcohol consumption, unhealthy diet and air pollution. That is why early
detection, screening, treatment and palliative care are essential to combat
this type of disease (World Health
Organization, 2023) .
Promoting healthy lifestyles in the
population is not only essential to lower the incidence of NCDs, but has also
been shown to have a positive impact on general well-being, mental health and
quality of life. A well-balanced diet and regular physical activity not only
contribute to maintaining an age- and gender-appropriate body weight, but also
improve mood, energy and sleep cycle. In addition, eliminating tobacco use and
restricting alcohol reduces the risk of developing a wide range of diseases,
including cancer and liver disease.
From an economic perspective, the promotion
of healthy lifestyles can significantly minimize the health care costs
associated with NCD treatment, which is why investing in health promotion
through education and prevention activities can greatly alleviate the financial
burden on health systems and thus improve the productivity of the population.
Primary health care is currently in a
position that gives it a relevant role in strengthening the promotion of a
healthy lifestyle among citizens. Defined as the first line of care, health
personnel at this level contact individuals and groups, which in turn provides
a great possibility to educate, encourage and assist in the change or
introduction of healthy behaviors through brief and effective interventions.
Primary care physicians have the ability to assess for patient risk factors,
offer information and provide educational resources, and set personalized
health goals.
In parallel, primary care makes it possible
to establish active contact and trust in patients, which translates into the
possibility of adherence to the suggested behavioral modifications over a
longer period of time. Primary care should be complemented by health promotion
programs aimed at good nutrition and physical activity and, at the
pharmacological level, smoking cessation and the promotion of sport or physical
activity in order to control stress.
In the context of primary care, the
patient-centered approach of nurses is a valid strategy to reinforce the
adoption of healthy habits. Nurses generally have the most and best contact
with patients, which allows them to provide health interventions and ongoing
support. Nurses can assess what lifestyles patients have, which may be
habitual, and what aspects need to be changed and collaborate with them to
build viable courses of action (González, 2023; Sánchez-Franco et al., 2023).
They believe that the role of nurses includes
educating patients about the importance of a healthy lifestyle and providing
instructions to help them overcome restrictions. This also implies that nurses
must be able to consistently educate and integrate healthy living into the
daily habits of society. Dandu et al. (2022) argue that to these functions they
can also add training and promotion of healthy lifestyles.
Despite the benefits of promoting healthy
lifestyles, there are currently numerous difficulties hindering all these
efforts. One of the main barriers is the lack of time and resources available
for primary care, which limits the ability of health professionals to give
sufficient attention to lifestyle education. Moreover, the lack of specialized
training in health promotion and in the mastery of counseling skills can
somewhat hinder the effectiveness of these interventions.
Another important challenge they face is
resistance to change on the part of patients, since changing deeply ingrained
lifestyle habits requires motivation, ongoing support and changes in the
individual's social and family environment. In addition, factors such as
poverty, low educational level and difficulty in making healthy choices can
limit people's ability to adopt healthy lifestyles.
The absence of effective promotion of healthy
lifestyles has been shown to have serious consequences for community health.
The high prevalence of chronic noncommunicable diseases not only affects the
quality of life of individuals, but also creates an overburden on health
systems, increasing health care costs and decreasing labor productivity. At the
community level, this situation can lead to an endless cycle of poverty and
disease, disproportionately affecting mainly the most vulnerable populations (De La Guardia Gutiérrez
et al., 2020) .
Latin America faces significant challenges in
promoting healthy lifestyles due to the social and economic inequalities that
characterize the region. These inequalities affect not only the ability to
access health services, but also the conditions necessary to maintain healthy
habits, such as the availability of safe spaces for physical activity and
access to nutritious food (Pan American Health Organization, 2022). In
addition, accelerated urbanization and the increase in sedentary lifestyles
have contributed to the rise in the incidence of chronic noncommunicable
diseases (NCDs), exacerbating the burden on health systems (Romero González,
2020).
In this context, primary care systems play a
crucial role as the first line of contact with the population, offering unique
opportunities to educate, prevent, and promote healthy behaviors (Córdoba
García et al., 2022). The promotion of healthy lifestyles, which includes a
balanced diet, regular practice of physical activity, abstinence from tobacco
and alcohol, and stress management, is fundamental to mitigate the impact of
NCDs. However, efforts to implement these strategies often face significant barriers,
such as lack of resources, resistance to habit change, and adverse
socioeconomic factors (De La Guardia Gutiérrez et al., 2020).
NCDs are responsible for approximately 74% of
all deaths worldwide, with a particularly high impact in low- and middle-income
countries, where 86% of premature deaths related to these diseases are
concentrated (World Health Organization, 2023). In Latin America, the
prevalence of NCDs such as diabetes, cardiovascular diseases and obesity is
closely linked to risk factors such as tobacco use, physical inactivity and
unhealthy diets, which are in turn influenced by structural and cultural
inequalities (González, 2023).
Considering the significant impact of
lifestyles on public health and the current challenges associated with their
promotion, it is important to conduct a comprehensive literature review to
identify effective strategies and areas for improvement. This study aims to
"Analyze the existing literature in the period (2014-2024) on the
promotion of healthy lifestyles in the primary care setting in Latin
America."
Methodology
This study adopts a documentary design with
an analytical-synthetic approach, focused on analyzing the role of health
professionals, the effectiveness of communication practices and strategies, and
the use of technology in the promotion of healthy lifestyles in Latin America.
The research is based on the collection, analysis and synthesis of information
from 19 academic papers and scientific papers selected from recognized
databases such as PubMed, SciELO and ScienceDirect.
The databases were selected for their
relevance and prestige in the publication of peer-reviewed scientific research.
The search was carried out using Boolean operators (AND, OR) to combine
keywords such as "health promotion," "lifestyle,"
"Latin America," "healthcare professionals," and
"technology in health promotion." These search strategies allowed
optimizing the retrieval of relevant information, ensuring accurate and focused
results in the regional context.
To ensure the quality and relevance of the
documents, inclusion criteria were established, such as relevance of the topic,
focus on Latin America, publication in indexed journals and timeliness of the
studies (2014-2023). Articles that did not specifically address health
promotion, lacked analysis on social determinants or were limited exclusively
to clinical interventions without considering preventive or community
strategies were excluded.
The analysis of the documents was structured
through a matrix designed to record key information, including aspects such as
the location of the study, main findings and authors' recommendations. This
tool facilitated the identification of patterns, comparisons between studies
and the grouping of information into three main categories: the role of health
professionals, the evaluation of the effectiveness of practices, and the use of
communication strategies and technology.
The analysis process was carried out in
several stages. First, an initial review of the documents was carried out to
identify recurrent themes and relevant keywords. Subsequently, the data were
organized into the defined categories, which allowed for a critical and
structured synthesis of the information. Finally, the findings were integrated
to highlight best practices, challenges and opportunities in the promotion of
healthy lifestyles.
This methodological approach ensures that the
results of the study are rigorous, evidence-based and oriented to improve the
health promotion strategies in Latin America. The combination of different
sources and the thematic analysis allows a comprehensive view to be obtained,
providing a solid basis for formulating recommendations applicable to health
systems in the region.
Results
The following tables present the results of
the analysis of the selected articles.
Table 1: Analysis of analysis category 1
|
Title |
Location |
Role of health
professionals |
|
Evaluation
of a distance education program in Health Promotion for Primary Care in Chile
(Salinas et al., 2014). |
Chile |
It
highlights that health professionals are fundamental in implementing health
promotion programs in primary care. They improved their skills through
distance education, contributing to the prevention of chronic diseases and
promotion of healthy habits. |
|
Health promotion in the General
Comprehensive Medicine specialty program in Cuba (Pupo Ávila et al., 2015). |
Cuba |
Physicians and nurses in the specialty of General Comprehensive
Medicine are fundamental in the promotion of health in primary care. They
implement preventive actions and promote healthy lifestyles within the
communities. |
|
Promotion
of healthy lifestyles in intercultural family health research and
intervention in the elderly in Manta and Jaramijó (Sabando Mera et al.,
2016). |
Ecuador |
Health
professionals, including students, promote active lifestyles in older adults
through recreational and physical activities, seeking self-management,
autonomy and disease prevention to improve physical, mental and social
health. |
|
Primary health care and active aging
(González Rodríguez, 2016). |
Cuba |
Emphasizes the central role of human resources in health in promoting
active aging, promoting physical, recreational and educational activities for
the elderly from primary care. |
|
Communication
at the first level of health care (Naipe Delgado et al., 2016). |
Cuba |
He
stresses that effective communication between physicians and nurses in
primary care is key to educate and inform about healthy behaviors,
contributing to the promotion of healthy lifestyles. |
|
Promotion of behavioral changes towards
healthy lifestyles in outpatient consultation (Quillas Benites et al., 2017). |
Peru |
He stresses that physicians should evaluate the phases of change and
use motivational strategies to promote healthy habits, such as good nutrition
and physical activity. |
|
Medical
training in Health Promotion from the social determinants approach (Pupo
Ávila et al., 2017). |
Cuba |
It
highlights medical training focused on social determinants, considering
physicians as key actors to influence the community through education and the
creation of healthy environments. |
|
Health promotion: evolution and challenges
in Latin America (Coronel & Marzo, 2017). |
Ecuador |
It emphasizes the active participation of professionals to improve the
quality of life of the population and reduce inequalities through health
education and the implementation of public health policies. |
|
Social
prescription, a dimension of health promotion in general integrative medicine
(Bonal Ruiz, 2019). |
Cuba |
It
highlights that family physicians can recommend non-medical services and
activities in the community to improve patients' overall wellness by linking
them to community resources such as exercise classes and recreational
activities. |
|
Lifestyle Medicine. An alternative to the
advance of non-communicable diseases (Bentivegna & Márquez, 2020). |
Venezuela |
It highlights that physicians and nurses play a key role in
encouraging healthy habits such as proper diet, exercise and stress
management to prevent and manage chronic noncommunicable diseases. |
|
Health
and its determinants, health promotion and health education (De La Guardia
Gutiérrez et al., 2020). |
Mexico |
He
points out that professionals should intervene in health determinants and
promote healthy habits, stressing that health promotion requires active
participation to improve quality of life. |
|
Primary Care Strategies in five Latin
American countries (Rojas Torres & Gil Herrera, 2021). |
Venezuela |
It highlights the crucial role of physicians and nurses in primary
care in implementing public health programs, promoting healthy lifestyles at
the community and family level. |
|
Strategies
and limitations of nursing health counseling: an integrative literature
review (Quintana Zavala et al., 2021). |
Mexico |
Nurses
use counseling as a tool to empower patients, encouraging self-care and
healthy lifestyles. |
|
Medical competencies for the use of ICT in
health promotion (Fernández, 2021). |
Venezuela |
It highlights that professionals are key actors in the intervention on
the social determinants of health, using digital tools to promote healthy
habits. |
|
Health
promotion: a critical look at its background and the role of health
professionals (Fl, 2021). |
Colombia |
He
emphasizes that professionals lead intersectoral teams and promote community
participation, transcending the biomedical model to adopt collective and
cultural approaches. |
|
The nursing professional in health
promotion at the second level of care (Herrera et al., 2022). |
Ecuador |
Focused on the role of nurses in the second level of care to promote
self-motivation, healthy eating and physical activity, educating for
self-care and disease prevention. |
|
Education
and health promotion from nursing (Izquierdo et al., 2022). |
Ecuador |
It
underlines the relevance of nurses in health promotion through education,
self-care and prevention of chronic diseases through specific activities. |
|
Social prescription and community health
assets for the promotion of people's health and well-being (Dandicourt et
al., 2023). |
Cuba |
It highlights the implementation of social prescribing by
professionals to link people with non-medical community resources, promoting
healthy lifestyles and general wellbeing. |
|
Role
of nursing professionals in primary prevention of cardiovascular disease:
literature review (Moriel-Galarza & Nava-González, 2023). |
Mexico |
Emphasizes
the role of nurses in leading interventions for primary prevention of
cardiovascular disease, including risk factor education and self-care. |
Table 2: Analysis of analysis category 2
|
Title |
Location |
Evaluation
of the effectiveness of the practices |
|
Evaluation
of a distance education program in Health Promotion for Primary Care in Chile
(Salinas et al., 2014). |
Chile |
Ninety
percent of the students successfully completed the course, and 82% of the
final projects were related to healthy lifestyles, evidencing the
effectiveness of the program in implementing knowledge acquired in practice. |
|
Health promotion in the General
Comprehensive Medicine specialty program in Cuba (Pupo Ávila et al., 2015). |
Cuba |
Evaluates how health promotion is integrated into the MGI specialty
curriculum, highlighting inadequacies in implementation due to limited
alignment of the curriculum with the needs of the health system. |
|
Promotion
of healthy lifestyles in intercultural family health research and
intervention in the elderly in Manta and Jaramijó (Sabando Mera et al.,
2016). |
Ecuador |
The
practices implemented through action research improved the quality of life of
older adults, promoting active lifestyles through recreational and physical
activities. |
|
Primary health care and active aging
(González Rodríguez, 2016). |
Cuba |
Evaluates how the promotion of active aging has improved the quality
of life of older adults. Recreational activities and physical exercise are
considered beneficial, but no concrete figures detailing such benefits are
presented. |
|
Communication
at the first level of health care (Naipe Delgado et al., 2016). |
Cuba |
It
highlights the importance of effective communication for the success of
promotion and prevention actions in primary care. |
|
Promotion of behavioral changes towards
healthy lifestyles in outpatient consultation (Quillas Benites et al., 2017). |
Peru |
Motivational interviewing and personalized interventions based on the
transtheoretical model have been shown to be successful in reducing risk
factors such as body mass index, cholesterol and blood pressure. |
|
Social
prescription, a dimension of health promotion in general integrative medicine
(Bonal Ruiz, 2019). |
Cuba |
It
highlights that social prescribing has been effective in guiding patients to
community resources that promote healthy lifestyles, such as exercise classes
and recreational activities. |
|
Lifestyle Medicine. An alternative to the
advance of non-communicable diseases (Bentivegna & Márquez, 2020). |
Venezuela |
Examines studies showing the effectiveness of Mdelev in preventing and
treating chronic diseases such as diabetes, obesity and cardiovascular
disease. Includes success stories in reducing risk factors and reversing
arteriosclerosis with changes in diet and exercise. |
|
Health
and its determinants, health promotion and health education (De La Guardia
Gutiérrez et al., 2020). |
Mexico |
It
promotes investment in prevention and promotion as a key strategy for
improving long-term health outcomes, although there is no systematic
evaluation of specific practices. |
|
Strategies and limitations of nursing
health counseling: an integrative literature review (Quintana Zavala et al.,
2021). |
Mexico |
It evaluates that counseling programs, such as tobacco cessation and
cardiovascular prevention, produce tangible benefits, including improved
self-efficacy and risk factor reduction. |
|
Primary
Care Strategies in Five Latin American Countries (Rojas Torres & Gil
Herrera, 2021) |
Venezuela |
It
highlights achievements in the promotion of maternal and child health and
prevention of noncommunicable diseases, although challenges related to the
fragmentation of health systems are still faced. Cuba is an example of
effective universal coverage. |
|
Medical competencies for the use of ICT in
health promotion (Fernández, 2021). |
Venezuela |
It identifies successful practices such as the use of the
transtheoretical model in motivational interviewing, demonstrating
improvements in indicators such as blood pressure and cholesterol, and
encouraging healthy lifestyle habits. |
|
Health
promotion: a critical look at its background and the role of health
professionals (Fl, 2021). |
Colombia |
Evaluates
the implementation of approaches such as the Ottawa Charter, pointing out the
need to adapt them to local realities in order to maximize their impact. |
|
The nursing professional in health
promotion at the second level of care (Herrera et al., 2022). |
Ecuador |
It highlights the effectiveness of nursing interventions in preventing
and managing chronic noncommunicable diseases through the promotion of
self-care and standardized care plans. |
|
Education
and health promotion from nursing (Izquierdo et al., 2022) |
Ecuador |
Educational
interventions have been successful in facilitating individual responsibility
for health and self-care, reducing the risk of chronic disease. |
|
Social prescription and community health
assets for the promotion of people's health and well-being (Dandicourt et
al., 2023). |
Cuba |
It evaluates that social prescribing improves quality of life, health
perception and self-esteem, being effective in contexts that promote physical
activity and emotional well-being. |
|
Role
of nursing professionals in primary prevention of cardiovascular disease:
literature review (Moriel-Galarza & Nava-González, 2023). |
Mexico |
Nurse-led
interventions have reduced cardiovascular risk factors, improved adherence to
medications, and promoted healthy habits such as physical activity and
nutrition. |
Table 3: Analysis of analysis category 3
|
Title |
Location |
Communication
strategies and use of technologies |
|
Evaluation
of a distance education program in Health Promotion for Primary Care in Chile
(Salinas et al., 2014). |
Chile |
The
use of ICT in distance education through interactive online platforms that
facilitated communication between participants, tutors and teachers,
improving the learning and the implementation of health promotion strategies,
stands out. |
|
Communication at the first level of health
care (Naipe Delgado et al., 2016). |
Cuba |
Emphasizes the need to employ various forms of communication
(interpersonal, group, organizational and mass) in primary care to
effectively reach different audiences. |
|
Promotion
of behavioral changes towards healthy lifestyles in outpatient consultation
(Quillas Benites et al., 2017). |
Peru |
It
mentions the importance of effective communication between healthcare
professionals and patients, focusing on motivational interviewing as a
personalized tool, although it does not delve into the use of digital
technologies such as social networks or apps. |
|
Primary Care Strategies in five Latin
American countries (Rojas Torres & Gil Herrera, 2021). |
Venezuela |
It highlights the emerging use of technologies such as
teleconsultation and remote monitoring during the COVID-19 pandemic,
strategies that have improved access to health care and promoted healthy
habits. |
|
Medical
competencies for the use of ICT in the promotion of health (Fernandez, 2021) |
Venezuela |
It
identifies barriers such as the lack of ICT training and the limited
integration of these technologies in professional practice . It recommends
including ICT training in university programs to better prepare health
professionals. |
|
Health promotion: a critical look at its
background and the role of health professionals (Fl, 2021). |
Colombia |
Encourages the active inclusion of communities in decision-making
processes, promoting culturally relevant communication strategies adapted to
the reality of the communities to improve the sustainability of
interventions. |
|
Health
Promotion in Colombia and its scope in the complex national political
framework (1990-2019) |
Colombia |
It
highlights the importance of local and decentralized strategies that adapt
public policies to the specific needs of each region, improving their
effectiveness and sustainability. |
|
Strategies and limitations of nursing
health counseling: an integrative literature review (Quintana Zavala et al.,
2021). |
Mexico |
It emphasizes clear and humanized communication, avoiding
technicalities, as the key to strengthening the relationship of trust between
nurses and patients, thus improving health outcomes. |
|
Role
of nursing professionals in primary prevention of cardiovascular diseases :
literature review (Moriel-Galarza & Nava-González, 2023). |
Mexico |
He
mentions the use of traditional educational strategies together with
technologies such as mobile applications and SMS messages for patient
follow-up. These tools have been shown to improve self-efficacy in the
management of cardiovascular risk factors. |
Within societies, health professionals have
an important role as advocates and active participants in the promotion of
health care. Their responsibilities include actions in the social determinants
of health, education of the population and promotion of good practices (De La
Guardia Gutiérrez et al., 2020). Because of this, they are trained to build
control in the creation of structures that improve the life characteristics of
the population, so they are central in the solution of the situational picture
of people's health. This approach is consistent with the evidence provided by
Moriel-Galarza and Morales-Nava (2023) who highlight that nurses are the key to
the implementation of effective interventions that decrease cardiovascular risk
factors and improve self-care among patients.
The training, as well as the leadership of
these professionals, are pillars in the Latin American region. Pupo Avila et
al. (2017) support the need for training oriented towards social determinants,
which allows them to intervene directly in the community with the creation of
healthy environments. However, a number of challenges are noted, including the
lack of training in intersectoral skills and the prevalence of a biomedical
model that is inadequate for a holistic approach (Flórez-López, 2021). At the
same time, the role of professionals goes beyond providing care; they are also
involved in social mobilization and policy development that is inclusive in
character (Coronel & Marzo, 2017).
In community contexts, Sabando Mera et al
(2016) also explain how the activities of professionals, as well as students in
Ecuador, have been useful for the elderly in terms of their physical, mental
and social well-being. This reaffirms the concept of that professional people
should not act only as recipients of knowledge, but rather be agents of change
whose roles include empowerment and citizen participation (Flórez-López, 2021).
However, there is still a wider gap that needs to be filled, to align a professional's
education with global and local needs, such as the increasing prevalence of
non-communicable diseases (Bentivegna & Márquez, 2020).
Finally, the work of Rojas Torres and Gil
Herrera (2021) draws attention to physicians and nurses in the implementation
of public health programs in Cuba. The formation of intersectoral teams and the
work with the community have facilitated the solution of health problems.
However, fragmentation of health systems remains a problem in some countries in
the region. This underscores the need for such leaders to develop competencies
and communication skills so that the potential impact of interventions is maximized.
It is important to evaluate health promotion
practices to design optimal strategies and focus on bottlenecks. Nurse-led
interventions have been shown to significantly decrease some cardiovascular
risk factors and improve adherence to therapy and healthy choices
(Moriel-Galarza & Nava-Gonzalez, 2023). This success emphasizes the need to
develop evidence-based interventions that respond to particular health
problems.
Quintana Zavala et al. (2021) have emphasized
that health counseling programs improve self-efficacy and reduce risk factors.
The evaluation of these practices has shown positive results, particularly in
the control of chronic diseases. However, as pointed out by Gutiérrez et al.
(2020), some strategies are not systematically evaluated, which makes it
difficult to assess their long-term effect. In this sense, it is necessary to
integrate clear metrics and sound methodologies into promotion programs.
In the primary care setting, Quillas Benites
et al. (2017) praise the success of motivational interviewing, which has
resulted in decreases in indicators such as body mass index and blood pressure.
However, more research is needed to universalize these findings across
different populations. At the same time, Sabando Mera et al. (2016) were able
to observe an improvement in the quality of life of the elderly in Ecuador, a
fact that, however, lacks detailed statistical evidence in the article, making
it difficult to generalize broadly.
On the other hand, Bentivegna and Marquez
(2020) reviewed studies indicating that Lifestyle Medicine can prevent chronic
diseases. However, they emphasized that the adoption of such practices
encounters obstacles related to training and resources. In Cuba, Pupo Avila et
al. (2015) found that even if health promotion is part of the training of
General Practice physicians, its implementation is not satisfactory due to
limitations in practical skills.
Finally, Flórez-López (2021) emphasizes that
all promotion strategies should be designed and adapted to specific market
structures and their particular characteristics, which could improve the
effectiveness of promotion strategies. On the other hand, he argues that the
use of such measures in several papers remains weak or totally absent, and this
resulted in a misunderstanding of the influence that such intervention can
have. Therefore, it is very critical to implement evaluation systems that allow
accurate and continuous measurement of the impact achieved.
Health promotion interventions do not achieve
their full potential unless they make use of communication strategies
consistent with the objectives of the intervention itself. For Naipe Delgado et
al (2016), effective communication serves to educate and inform patients and
thereby encourage healthy behaviors. Salinas et al (2014) postulate that the
use of technology such as mobile apps and online sites, among others, has
improved access to information and strengthened patients' self-efficacy. But
even so, as Fernández (2021) points out, training in the use of ICT is still
deficient, which prevents its use in professional practice.
Quintana Zavala et al. (2021) emphasize the
importance of using humanized communication, which improves the bond of trust
between patients and professional staff. On the other hand, Quillas Benites et
al. (2017) point out that focusing on direct communication, such as
motivational interviewing, does not allow the use of technologies that could
have an expanded range of beneficial objects of influence. This highlights a
possibility of integrating conventional approaches along with digital tools.
In Cuba, Rojas Torres and Gil Herrera (2021)
reported on the adoption of emerging technologies during the COVID-19 pandemic,
such as teleconsultations and remote monitoring. These strategies not only
improved access to care, but also encouraged healthy behaviors. However, in
many Latin American countries, unequal distribution of technology remains a
serious obstacle.
Flórez-López (2021) emphasizes the importance
of designing culturally appropriate strategies that are relevant to the local
context. This includes not only language, but also the application of
technologies that are appropriate for the communities. These strategies,
although they have potential, require substantial investment in technological
infrastructure and the training of professionals to operationalize them.
Conclusions
Both WHO and PAHO stress the importance of
promoting healthy lifestyles to reduce the burden of noncommunicable diseases
(NCDs), which accounted for 71% of deaths worldwide, particularly in low- and
middle-income countries. Sedentary lifestyles, unhealthy eating, tobacco,
alcohol, and pollution are modifiable. Primary health care is essential to
provide context-specific preventive interventions based on educational
strategies and technology, however, the literature indicates that there are
several problems related to the availability of material and human resources at
the primary health care level, which contributes to the fact that activities to
promote healthy lifestyles are not carried out in the most effective way.
Health professionals are critical agents in
the promotion of healthy lifestyles, occupying positions of importance in
health education, community leadership and social mobilization. However, for
their impact to be optimal, it is imperative that their training in
intersectoral approaches, intercultural communication and cultural competence
be strengthened to facilitate the implementation of promotion strategies that
are relevant to local contexts and address the limitations imposed by the
prevailing biomedical model.
The impact of health promotion interventions
such as interventionist nurse management or motivational interviewing has been
quite positive in terms of decreasing risk factors and improving health
indicators. However, there is no systematic evaluation and there are no clear
metrics for a good number of interventions that are considered to measure their
long-term impact. It is important to design monitoring and evaluation systems
that ensure that practices change to meet the requirements of local environments
and, therefore, are durable.
Mobile applications, teleconsultations and
the use of online platforms can be used to promote health in relation to their
use in primary care. However, ineffective use of ICTs is due to insufficient
training and gaps in the domains of the technological environment. It is
essential to implement appropriate technological infrastructures and also to
train professionals to assist in a more equitable and culturally appropriate
use of such tools in order to maximize their reach and usefulness in the most
vulnerable communities.
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