SciELO - Scientific Electronic Library Online

 
vol.21 número68Modelo logístico de factores asociados al Síndrome de Burnout en el personal de saludDimensión práctica de las representaciones sociales de los agentes de salud comunitarios sobre la violencia doméstica contra la mujer índice de autoresíndice de materiabúsqueda de artículos
Home Pagelista alfabética de revistas  

Servicios Personalizados

Revista

Articulo

Indicadores

Links relacionados

  • En proceso de indezaciónCitado por Google
  • No hay articulos similaresSimilares en SciELO
  • En proceso de indezaciónSimilares en Google

Compartir


Enfermería Global

versión On-line ISSN 1695-6141

Enferm. glob. vol.21 no.68 Murcia oct. 2022  Epub 28-Nov-2022

https://dx.doi.org/10.6018/eglobal.508511 

Originals

Self-care of users with chronic diseases in primary care in the light of Orem's theory

Eloísa Araújo-de Carvalho1  , Tarcísio Tércio-das Neves Júnior1  , Isadora Lorenna Alves-Nogueira1  , Carlos Jordão de Assis-Silva1  , Ana Angélica Rêgo-de Queiroz1  , Rejane Maria Paiva-de Menezes1 

1Federal University of Rio Grande do Norte – UFRN, Rio Grande do Norte, RN, Brazil

ABSTRACT:

Introduction:

Chronic non-communicable diseases are considered the main causes of death and disability, both nationally and worldwide. They have multifactorial causes, and the main ones are cardiovascular diseases, cerebrovascular accidents, chronic respiratory diseases, diabetes mellitus and neoplasms.

Objective:

To describe the self-care of users with non-communicable chronic diseases in Primary Health Care, in the light of Orem's Self-Care Theory.

Method:

Cross-sectional, descriptive and exploratory study carried out in an area covered by a Family Health Unit in the city of Natal, Rio Grande do Norte, Brazil. The non-probabilistic and intentional sample had 80 users with chronic health conditions. Data were collected between January 2018 and December 2019, through a structured interview and through the use of a validated form for the analysis of self-care in adults. The results, presented in absolute and relative frequencies, have a confidence interval of 95%.

Results:

Among the sociodemographic variables, it was identified that 70% of users had elementary education and that 85% had cardiovascular diseases. As for self-care, all users were independent to perform body hygiene and to control bladder and bowel eliminations. 98.8% were independent to dress themselves; 96.3%, for walking; 87.5%, to chew and swallow; and 83.8%, to prepare food.

Conclusion:

Independence for activities of daily living and self-care were characteristics present among the participants. Such independence is considered important in the Self-Care Theory.

Keywords: Chronic disease; Primary Health Care; Self-care; Nursing

INTRODUCTION

Chronic non-communicable diseases (CNCDs) are considered the main causes of death and disability, both nationally and worldwide. In Brazil, they represent a challenge for public health and correspond to 72% of the causes of death1,2. Worldwide, data from the World Health Organization (WHO) report on CNCDs show that they are responsible for the main causes of death and are estimated to be responsible for 41 million deaths annually, which represent 71% of all deaths in the world3.

Chronic non-communicable diseases have multifactorial causes and present a more or less long or permanent course. Such causes may derive from individual or social factors. The main CNCDs are cardiovascular diseases, cerebrovascular accidents, chronic respiratory diseases, diabetes mellitus (DM) and neoplasms. All of them have modifiable risk factors in common, such as tobacco, unhealthy diet, harmful use of alcohol and physical inactivity4.

In the results of a similar study, such factors are related to the accelerated globalization and urbanization processes, since the population's life habits have changed. This happens because people are increasingly opting for a sedentary lifestyle, associated with the consumption of processed foods, as well as the harmful use of tobacco and alcohol, inducing them to make self-care secondary5.

It is observed that people's lifestyle associated with the development of some CNCDs can affect their quality of life and trigger considerable limitations for individuals, as these require complex treatment and require the affected persons to adhere to self-care behaviors, such as care with the diet and physical activity6.

Self-care in relation to chronic diseases is the sum of care of two orders: individual and nursing. For satisfactory results, people affected by CNCDs need to understand them, in order to know how to deal with the recommended treatment, with emotional adjustments and with interpersonal readaptations in their basic activities of daily living and instrumental. In this sense, nursing works through educational actions aimed at the persons and the families, in order to assume responsibility for their individual health care needs, with the potential to promote the autonomy of these people7.

Thus, it is relevant to understand the essence of self-care in the prevention and treatment of CNCDs. From this perspective, for this study, Orem's General Theory was adopted: Nursing Theory of Self-Care Deficit as a reference to discuss the results achieved. It is a comprehensive theory, which involves central and interrelated concepts of self-care8. In addition, it has significant relevance in the area of Nursing and is considered a reference to conduct care practices, and can be used as a care instrument, in addition to being valid to respond to the needs of the individual affected with a chronic disease9.

The Nursing Theory of Self-Care Deficit was described, at first, in terms of its functions, as a general theory of nursing, consisting of three others: 1. Self-Care Theory, which refers to the performance of self-care itself, in addition to explaining and justifying the need for self-care for health; 2. the Self-Care Deficit Theory, which consists of explaining when and why nursing becomes necessary and important to the person in relation to the care process; 3. The Nursing Systems Theory, which refers to the person in a situation of self-care deficit, so that, in order to compensate, nursing care is needed9.

Orem's Theory8 clarifies the meaning of self-care as the practice of actions performed that generate contributions and benefits for the improvement and maturation of the people who perform and develop them, within specific moments, with the objective of preserving life and personal well-being. This theory also reiterates that self-care is a human activity intentionally performed by people themselves or by someone who performs for them, in order to maintain life, health and, therefore, well-being.

In addition, this theory is considered a foundation for understanding the conditions and limitations of people in the development of self-care actions that can benefit themselves from nursing10.

The context of health care for people affected by CNCDs requires a set of factors that integrate the health care system, health professionals and users, in an attempt to have effective, efficient and quality control of these diseases. This happens because the impacts generated by disabilities and limitations require changes that demand spending on the disease and services4-11.

In order to minimize the prevalence of CNCDs, Brazil12 instituted a plan that focuses on defining and prioritizing the actions and investments necessary to prepare the country to face and stop CNCDs in the next ten years. In this plan, primary health care is understood as an important part of carrying out health actions, including care and longitudinal monitoring of users with these diseases.

The professional nurses who work in the context of Primary Health Care (PHC) stand out for being at the forefront of the development of actions and practices of education, health promotion and prevention of diseases/problems in the community13. Such characteristics are fundamental for the implementation of health care for people with CNCDs, given that health promotion actions provide a look not only at the disease, but, above all, at people's living conditions, as well as of families.

Thus, CNCDs are one of the main health and development challenges of the 21st century, as such diseases contribute to the increase in the incidence, prevalence and mortality of the affected population both in Brazil and in other countries, thus identifying the need to reinforce coping actions in health, as well as the services offered by PHC14, with an emphasis on self-care.

However, some challenges regarding the guarantee of attendance to the principle of integrality, satisfactory family guidance and accessibility persist, which implies the need for improvement, mainly related to the development and execution of expanded actions beyond injuries and diseases15.

In view of this problem, the objective of this study was to describe the self-care of users with chronic non-communicable diseases treated at a Family Health Unit in the city of Natal, Rio Grande do Norte, Brazil, from January 2018 to December 2019, in the light of Orem's Self-Care Theory.

MATERIAL AND METHOD

This research is a cross-sectional, descriptive and exploratory study with a quantitative approach. The study was carried out in an area assigned to a Family Health Unit, belonging to the Western Sanitary District in the city of Natal, Rio Grande do Norte, Brazil.

The choice of this location was due to the fact that it is a neighborhood in a peri-urban region, with a high population rate (around 110,000 inhabitants and 44 years of existence), characterized by some factors, such as low levels of education and income, with the most people in the reproductive stage of work.

The non-probabilistic sample was intentional and composed of 80 participants. It presented as inclusion criteria: individuals affected by a CNCD registered in the Basic Health Unit, over 18 years old, with maintained physical and cognitive functions and adequate to participate in an interview; as an exclusion criterion, users registered in the unit who did not present any condition or chronic disease. The study presented the following research question: “which self-care measures are performed by users with CNCDs in Primary Health Caré”

The enrollment of subjects took place in the waiting room of the Health Unit, while they were waiting for care, with the support of health professionals at the time. A priori, all users with CNCD were invited. Volunteers and those who met the aforementioned criteria participated in the interview.

The collection period took place between January 2018 and December 2019, always on Fridays, a day made available by the Health Unit. A structured interview and a form validated by Santos16 were used, containing closed and open questions about sociodemographic information and factors related to health and aspects of self-care for CNCDs. It should also be noted that it is a form based on the self-care model for chronic conditions (SCMCC), adapted in Brazil by Mendes17, for monitoring users with CNCDs in primary health care.

For the analysis of the results, we used the framework of Orem's Theory of Self-care18. Regarding the Self-Care Theory, a diagram is presented with the concepts that comprise the theory, which made it possible to interpret the results of this research.

Source: own authorship (2021), based on Orem's theory8

Figure 1: Synthesis of concepts involving the theory of self-care. 

Box 1 presents the constituent factors proposed by the Self-Care Theory, as well as their association with the variables used. It is possible to identify the relationship of these concepts with some of the results achieved in this study.

Box 1. Association of the concepts that make up the Self-Care Theory with the self-care variables used in the form for data collection. Natal, 2021. 

Source: own authorship (2021), based on Orem's theory8.

To identify the self-care profile of the subjects, the data collected were tabulated and organized in Microsoft Excel and analyzed in the Statistical Package for Social Science (SPSS), version 20.0, using descriptive statistics, with presentation of relative, absolute and 95% confidence intervals, presented through tables.

The research followed the ethical precepts of Resolution number 466/2012 of the National Health Council and was approved by the Research Ethics Committee of the Federal University of Rio Grande do Norte (CEP-UFRN), under protocol number 94030518.5.0000.5/2017.

RESULTS

The analysis of sociodemographic variables showed that most users self-declare as brown (53.8%), had a partner (53.8%), were female (87.5%), with a practicing religion (62.5%), with no employment bond (71.25%), with elementary education (70%) and income greater than or equal to 1 minimum wage (86.3%). As for reported morbidity, the majority (85%) had cardiovascular diseases, followed by endocrine diseases (56.3%), dyslipidemias (6.25%) and chronic respiratory diseases (3.75%), as described in table 1.

Table 1. Characterization of sociodemographic variables with users affected by non-communicable chronic diseases, in Primary Health Care. Natal-RN, 2021. 

Source: own authorship (2021).

*CI:Confidence interval.

Regarding the self-care characteristics of users, most respondents (81.3%) reported not practicing sports, not having addictions (cigarettes, alcohol, drugs, coffee) (53.8%), not having an appropriate diet (54.2%), not having difficulties in chewing and swallowing (90.3%) and not being dependent on food preparation (83.8%). Most respondents also report receiving visits from family members (72.6%) and friends (82.5%), not having an active sex life (58.7%) and suffering from anxiety (61.3%).

As for dependence on personal hygiene, all of them (100%) said they were independent; with regard to dependence on oral hygiene, 93.8% of them said they were independent. With regard to dependence to get dressed, 98.8% report that they do not have dependence; for bladder and bowel eliminations, 100% said they were independent; with regard to independence for walking, 96.3% affirmed independence; to administer their own medication, 97.5% do so regularly. The findings are described in table 2 below.

Table 2. Self-care characteristics of users affected by non-communicable chronic diseases. Natal-RN, 2021. 

Source: own authorship (2021).

Regarding the association of the self-care variables of this study with the concepts of Orem's theory of self-care8, there was a similarity between the concept "self-care actions" with the self-care characteristics "practice of sport", "food preparation", “dependence for body and oral hygiene”, “dependence to get dressed”, “dependence for bladder and bowel eliminations” and “dependence for walking”. Furthermore, a relationship between the sociodemographic characteristics “sex” and “education” with the concept of the “basic conditioning factors” of the theory was noted.

Regarding the concepts “Universal self-care requirements” and “Therapeutic self-care requirement”, these were associated with the characteristics “eating adequate diet” and “Receiving visits from family and friends”, as shown in Box 1.

DISCUSSION

According to the sociodemographic profile of the interviewees, in relation to the variable “age group”, the most expressive results are located in the age group between 18 and 59 years (48.8%). In a study carried out with individuals with DM and/or arterial hypertension in PHC, it was identified that most of the interviewees were between 41 and 81 years old19. Such results differ from the findings of this study and this may be related to the difference between the age indices of both studies. According to WHO estimates20 in 2012, of the 5.1 million deaths caused by CNCDs, 2 million were considered premature deaths, that is, before reaching 70 years of age. In this sense, the study needs more specific analyses between the aforementioned age groups.

Regarding the variable “marital status”, more than half of the users (53.8%) had a partner/spouse. This result corroborates a similar study carried out with hypertensive elderly people, which found that 54.2% of the participants were married21. Regarding the variable “sex”, it was observed that most participants were female (87.5%). Similar results were found in a recent study carried out with 100 elderly people with CNCDs, which showed that the majority were women22. Another study, which addressed actions for self-care supported in primary care in relation to arterial hypertension, concluded that 76.2% of the participants were also female23.

Taking these data into account, it is estimated that the prevalence of females is associated with the fact that women are more present than men in health services, enabling preventive actions for the diagnosis and treatment of some health conditions23.

Regarding the variable “education”, it was identified that more than half of the participants (70%) had elementary education. Similar to this, in current studies23,24, CNCDs were more prevalent in the female group and in groups with less education. This social indicator suggests that the low level of knowledge impairs empowerment over the disease and, consequently, over the prevention of CNCDs. Individuals with these diseases need to understand them in order to adhere to the recommended treatment and the demands of basic life activities7.

According to Orem's theory, the basic conditioning factors influence the ability to self-care and, in such factors, sex and education level are considered, among which the latter can interfere, positively or negatively, in self-care actions8.

Although the results suggest a low level of education of the users, the self-care theory emphasizes that self-care is also understood by other factors, among them, the experiences and standards of life and health status9.

As for the characteristic "diseases", the results indicate that the diseases most mentioned by users, among CNCDs, were cardiovascular diseases (85%). This result corroborates a recent survey, which analyzed self-care practices and the level of dependence of the elderly for CNCDs25.

According to Malta4, the main CNCDs are cardiovascular diseases, chronic respiratory diseases, diabetes mellitus (DM) and neoplasms. Within the prevalent category of this study, “cardiovascular diseases”, is arterial hypertension (SAH), which, according to the Brazilian Society of Cardiology (BSC), is considered a health problem because they are incident and prevalent diseases in the population.

In this context and considering the results of the variables related to self-care, it was seen that the “practice of sport” was not mentioned by 81.3% of the users. Physical activity helps both in the prevention and treatment of CNCDs, showing itself to be capable of reducing the harmful effects that such diseases cause26. Another similar study, carried out with participants with CNCDs to assess the participation of these subjects in physical activity, found that most of them also did not exercise, a factor that increased the risk of developing chronic diseases, including hypertension18.

Regarding the category “dependence for food preparation”, the findings indicated that 83.8% of users were independent to prepare their own meals. This result is similar to a recent study, which concluded that 91.1% of respondents reported not needing help to perform this activity27.

Thus, these results are in line with one of the concepts that underlie the theory of self-care: the self-care actions. As already described, this concept is related to the person's ability to perform care practices on his/her own behalf. Thus, taking into account that most users proved to be independent in the preparation of meals, it is considered that they are able to develop the self-care actions proposed in the theory9.

Regarding the variable “adequate dietary intake”, 52.5% of the interviewees indicated that they did not follow an adequate diet, according to the proposal of the universal requirements of the self-care theory. In this theory, Orem considers that such requirements are common to all human beings, emphasizing that the quality of food is a contributing factor for self-care and for helping to maintain health and well-being8-10.

With this, it is understood that the users of this study, even independent for the activities of daily living and, therefore, for the preparation of their meals, indicated not to make use of an adequate diet.

According to the WHO28, changes in dietary patterns are related to increased production of processed foods and lifestyle changes. In addition, another factor that interferes with the way the population chooses food is the level of education. It is believed that this choice can be influenced by knowledge about food and nutrition29. According to the result of this study, 70% of the participants had only elementary education, suggesting little knowledge about health on their part, which can influence an inadequate dietary practice.

As for the results on the variables "receiving family visits" and "receiving visits from friends", it was concluded that 72.6% and 82.5% of users, respectively, are contemplated with this activity of social interaction, and such variables are described in the self-care theory as one of the universal requirements. At this point, Orem deems it necessary to maintain a balance between being alone and social interaction, and that this dynamic conditions well-being8,9.

Self-care characteristics - such as the ability to feed, dress, stay continent, walk around and perform personal hygiene - are considered basic activities of daily living, based on which basic and usual self-care behaviors are assessed30. In view of this, the following characteristics are associated with those mentioned above. Thus, referring to “Dependence on body hygiene” and “Dependence on bladder and bowel eliminations”, all users (100%) reported being independent to perform these activities of daily living. Similar to this, in a research carried out with elderly people from a health unit, who had DM, it was found that 80% and 95% of them were also independent to perform the bath and physiological eliminations, respectively26.

Regarding the variables “Dependency to walk” and “Dependency to dress”, the findings of this study showed that almost all participants - 96.3% and 98.8% - were able to dress and walk themselves, without assistance, respectively. Similar results indicated that 94% and 96.3% of respondents reported being able to dress and walk, in that order, without help27.

Self-care actions are conditions for activities of daily living; consequently, performing these actions demonstrates the person's ability to perform them and, in this sense, provide self-care, maintaining quality of life. Within the activities of daily living, Orem also emphasizes the ability related to elimination and food, activity and rest, balance between being alone and having social interaction, as well as promoting the functioning and development of human being within social groups8,9.

Thus, it is understood that the theory of self-care describes the importance of this theory and seeks to understand the conditions that affect its provision, verifying that the analyzed data pointed to satisfactory self-care for users. In this context, the participation of nurses, as a professional category, in prevention and health promotion actions, as well as in the recovery of people with CNCDs, is essential7.

Thus, the work of the professional nurses must awaken in people the awareness and maintenance for self-care, allowing educational reflection and understanding of the subjects, mainly, about the causes and consequences of their health status. Therefore, it is necessary to encourage the autonomy of people and communities, through health promotion actions, in order to carry out health care independently15.

As a limitation of this study, we mention the lack of analysis and discussion of the results in a perspective of differentiation between self-care in adults and the elderly people, since the need for care of the elderly people has its particularities. From this perspective, it is suggested that studies seek to investigate these possible differences and convergences for a better understanding of the phenomenon in question.

CONCLUSIONS

Most of the participants in this study were independent to carry out their activities of daily living, demonstrating potential for self-care. The practice of physical exercise was the activity with less frequency, a worrying fact, considering the fact that a sedentary lifestyle is a risk factor for CNCDs.

Based on the analysis of the self-care of users with CNCDs, it was inferred that most of them were independent to perform self-care actions, according to Orem's self-care theory, or they had the ability to develop self-care practices that included activities of daily life, as well as meet universal and developmental requirements. In addition, they showed to be influenced by basic conditioning factors, such as education, proposed by Orem, with regard to sociodemographic characteristics, but which do not interfere with the ability to engage in self-care actions. Thus, it is believed that Orem's theory is adequate to guide the nursing process in the context of care for people with chronic diseases in PHC.

Finally, Orem's theory of self-care, adopted as the background of this study, presents important concepts for the research problem investigated. which were identifiable, namely: self-care actions, basic conditioning factors, therapeutic requirement and universal self-care requirements.

REFERENCIAS

1. Brasil. Ministério da Saúde Secretaria de Vigilância em Saúde. Departamento de Vigilância de Doenças e Agravos Não Transmissíveis e Promoção da Saúde; 2018. [ Links ]

2. Malta DC, Silvânia SCA, Taís PO, et al. Probabilidade de morte prematura por doenças crônicas não transmissíveis, Brasil e regiões, projeções para 2025. Revista Brasileira de Epidemiologia. Abr 2019; 22:1-13, 2019. [ Links ]

3. Brasil, Organização Pan-Americana da Saúde. Novo relatório da OMS busca reforçar os esforços de combater as principais causas de mortes urbanas [Internet]. 2019. [citado em 13 de fevereiro de 2021]. Disponível em: https://www.paho.org/bra/index.php?option=com_content&view=article&id=6054:novo-relatorioda-oms-busca-reforcar-os-esforcos-de-combater-as-principais-causas-de-mortesurbanas&Itemid=839. [ Links ]

4. Malta DC et al. Noncommunicable diseases and the use of health services: analysis of the national health survey in brazil. : analysis of the National Health Survey in Brazil. Revista de Saúde Pública. 2017; 51(1): 1-10. [ Links ]

5. Morais HCC. et al. Modifiable risk factors for chronic non-communicable diseases among university students. Revista da Rede de Enfermagem do Nordeste. 2018; 19: 1-5. [ Links ]

6. Bernal RTI, Felisbino-MMS, Carvalho QH, et al. Indicadores de doenças crônicas não transmissíveis em mulheres com idade reprodutiva, beneficiárias e não beneficiárias do Programa Bolsa Família. Revista Brasileira de Epidemiologia. Out 2019; 22(2): 1-13, 2019. [ Links ]

7. Galvão MT, Janeiro JM. Self-care in nursing: self-management, self-monitoring, and the management of symptoms as related concepts. Revista Mineira de Enfermagem. 2013; 17(1): 226-231. [ Links ]

8. Orem DE. Nursing Concepts of Practice. 8ª ed. Boston: Mosby; 2006. [ Links ]

9. Braga CG, Silva JV da. Teorias de Enfermagem. 1ª ed. Iátria: 2011 [ Links ]

10. George JB. Teorias de Enfermagem: Os Fundamentos à Prática Profissional. 4ª ed. Artmed: 2011 [ Links ]

11. Mendes EV. Entrevista: a abordagem das condições crônicas pelo sistema único de saúde. Ciência & Saúde Coletiva. 2018; 23(2): 431-436. [ Links ]

12. Brasil, Ministério da Saúde, Secretaria de Vigilância em Saúde, Departamento de Vigilância de Doenças e Agravos Não Transmissíveis e Promoção da Saúde. RELATÓRIO DO III FÓRUM DE MONITORAMENTO DO PLANO DE AÇÕES ESTRATÉGICAS PARA O ENFRENTAMENTO DAS DOENÇAS CRÔNICAS NÃO TRANSMISSÍVEIS NO Brasil, Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Análise de Situação de Saúde. Plano de ações estratégicas para o enfrentamento das doenças crônicas não transmissíveis (DCNT) no Brasil 2011-2022. Secretaria de Vigilância em Saúde. Departamento de Análise de Situação de Saúde. Ministério da Saúde; 2011. [ Links ]

13. Becker RM et al. Nursing care practices for people with Chronic Noncommunicable Diseases. Revista Brasileira de Enfermagem. 2018; 71(6): 2643-2649. [ Links ]

14. Cesse E, Freese E, Fontbonne A, et al. Rede de atenção ao portador de doença crónica não transmissível: estudos realizados pelo Laboratório de Avaliação, Monitoramento e Vigilância em Saúde (LAM SAÚDE) da Fiocruz/PE. Brasil. Avaliação em Saúde, Ciência Aberta e Gestão de Conhecimento (Suplemento 2) 2016; 15(2): 11-16. [ Links ]

15. Schenker M, Costa DH da. Avanços e desafios da atenção à saúde da população idosa com doenças crônicas na Atenção Primária à Saúde. Ciência & Saúde Coletiva 2019; 24 (4): 1369-1380. [ Links ]

16. Santos RS. Autocuidado apoiado aos hipertensos: Construção de um protocolo. Rio Grande do Norte, Natal/RN. Tese (Doutorado em Enfermagem na Atenção à Saúde) - Programa de PósGraduação em Enfermagem, Universidade Federal do Rio Frande do Norte; 2016. [ Links ]

17. Mendes EV. O cuidado das condições crônicas na atenção primária à saúde: o imperativo da consolidação da estratégia da saúde da família. Brasília: Organização Pan-Americana da Saúde, 2012. 512 p. [ Links ]

18. Orem DE. Nursing: concepts of practice. 6ª ed. St. Louis: Mosby; 2001. [ Links ]

19. Rocha MF, Wanderley FAC, Santo AAS. Programa educativo na prevenção de doenças crônicas não transmissíveis: diabetes e hipertensão arterial. Ensino, Saúde e Ambiente 2020; 13(3): 94-109. [ Links ]

20. Organização Pan-Americana da Saúde. Fatores de risco para doenças crônicas não transmissíveis nas Américas: Considerações sobre o fortalecimento da capacidade regulatória. Documento de Referência Técnica REGULA. Washington, DC; OPAS, 2016. [ Links ]

21. Cassiano AN et al. Efeitos do exercício físico sobre o risco cardiovascular e qualidade de vida em idosos hipertensos. Ciência & Saúde Coletiva. 2020; 25(6): 2203-2212. [ Links ]

22. Mota TA et al. Factors associated with the functional capacity of elderly individuals with hypertension and/or diabetes mellitus. Escola Anna Nery. 2020; 24(1): 1-7. [ Links ]

23. Ulbrich EM et al. Escala para o cuidado apoiado na atenção primária: um estudo metodológico. Revista Gaúcha de Enfermagem. 2018; 38(4): 1-7. [ Links ]

24. Sato TO et al. Doenças Crônicas não Transmissíveis em Usuários de Unidades de Saúde da Família - Prevalência, Perfil Demográfico, Utilização de Serviços de Saúde e Necessidades Clínicas. Revista Brasileira de Ciências da Saúde. 2017; 21(1):35-42. [ Links ]

25. Côrrea CS, Deyvylan AR. Práticas de autocuidado do idoso com diabetes mellitus em um município amazônico. Revista Eletrônica Acervo Saúde.2020; 12(10):1-14. [ Links ]

26. Cruz MS da; Bernal RT, Claro RM. Tendência da prática de atividade física no lazer entre adultos no Brasil (2006-2016). Cadernos de Saúde Pública. 2018; 34(10): 1-14. [ Links ]

27. Pinto AH et al. Capacidade funcional para atividades da vida diária de idosos da Estratégia de Saúde da Família da zona rural. Ciência & Saúde Coletiva. 2016; 21(11): 3545-3555. [ Links ]

28. Brasil. Organização Pan-Americana da Saúde. Organização mundial da saúde. Folha informativa - Alimentação saudável [Internet]. 2019. [citado em 14 de março de 2021]. Disponível [ Links ]

29. Moura AF de, Masquio DC. A influência da escolaridade na percepção sobre alimentos considerados saudáveis. Rev. Ed. Popular. 2014;13(1): 82-94. [ Links ]

30. Farías-Antunez S et al. Incapacidade funcional para atividades básicas e instrumentais da vida diária: um estudo de base populacional com idosos de pelotas, rio grande do sul, 2014. Epidemiologiae Serviços de Saúde. 2018; 27(2): 1-14 [ Links ]

Received: January 25, 2022; Accepted: June 29, 2022

Creative Commons License Este es un artículo publicado en acceso abierto bajo una licencia Creative Commons