ABSTRACT
Objective: To systematically review studies examining the effects of home-visiting preventive parenting programs (HV-PPs) on improving the quality of mother-child interactions in early childhood. Method: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol, we identified 3,586 studies published between 2018 and 2022 by searching the following databases: PubMed, Web of Science, BVS/LILACS, SciELO, and PsycNET/PsycINFO. After applying the eligibility criteria, 17 articles were selected for review. Results: Most studies were conducted in high-income countries (53%) and the remainder were conducted in upper-middle-income countries, predominantly using a randomized controlled trial design and with strong methodological quality. The 17 studies applied 13 different HV-PPs, predominantly using video feedback, based on various dosages and schedules. Most studies (77%) showed significant positive effects on mother-child interactions by improving mainly positive maternal behaviors (e.g., sensitivity and responsiveness). Positive effects occurred independent of the study design, sample characteristics, measures, and constructs assessed. However, the findings suggest that the combination of fewer than six sessions, durations shorter than three months, and a very early start did not impact mother-child interactions, as expected. Few studies have explored negative maternal behaviors, children's behaviors, and dyadic interactions such as mutuality and synchrony. Conclusions: HV-PPs positively impacted mother-child interactions in early childhood despite the large heterogeneity across program designs, outcome measures, and overlapping constructs. Based on the results, we discuss the practical and economic implications of using parenting programs as a preventive approach.
Subject(s)
Mother-Child Relations , Parenting , Humans , Parenting/psychology , Infant , House Calls , Child, Preschool , Maternal Behavior/psychologyABSTRACT
Partnership between early childhood development interventions and primary health care services can help catalyse health care uptake by socially vulnerable families. This study aimed to assess the real-life effects of a large-scale home visiting programme [Primeira Infância Melhor (PIM)] in Brazil on the use of preventive (prenatal visits, well child visits, dentist visits and vaccination) and recovery (emergency room visits and hospitalization) health services. A quasi-experiment nested in a population-based birth cohort study was conducted. The intervention group was firstly defined as all children enrolled in PIM up to age 6 months, and afterwards stratified between those enrolled during pregnancy or after birth up to 6 months. Children receiving PIM were matched with controls on propensity scores based on 27 confounders to estimate effects on health service use from prenatal to age 2 years. Double adjustment was applied in outcome Quasi-Poisson regressions. No evidence was found for effects of PIM starting anytime up to 6 months (262 pairs), or for the children enrolled only after birth (133 pairs), on outcomes occurring after age 6 months. When the programme started during pregnancy (129 pairs), there was a 13% higher prevalence of adequate prenatal visits (prevalence ratio = 1.13; 95% confidence interval 1.01-1.27), but no effect on use of any other health service. Sensitivity analyses suggested longer participation in the programme with reduced visitor turnover might improve its impact on prenatal visits. Integration between PIM and primary health care was not adequate to affect overall patterns of contacts with health services. Nevertheless, prenatal home visits showed potential to increase health service contact during a sensitive period of development, indicating the need to start such programmes before birth, when there is more time for maternal care, and family engagement in a network of services is facilitated.
Subject(s)
Child Development , Maternal Health Services , Pregnancy , Child , Female , Humans , Child, Preschool , Infant , Brazil , Cohort Studies , Prenatal Care , House CallsABSTRACT
Background: In 2016, Brazil scaled up the Criança Feliz Program (PCF, from the acronym in Portuguese), making it one of the largest Early Childhood Development (ECD) programs worldwide. However, the PCF has not been able to achieve its intended impact. We aimed to identify barriers and facilitators to achieving the PCF implementation outcomes across the RE-AIM dimensions (Reach, Effectiveness or Efficacy, Adoption, Implementation and Maintenance) during the COVID-19 pandemic. Methods: This comparative case study analysis selected five contrasting municipalities based on population size, region of the country, implementation model, and length of time implementing the PCF. We conducted 244 interviews with PCF municipal team (municipal managers, supervisors, home visitors), families, and cross-sectoral professionals. A rapid qualitative analysis was used to identify themes across RE-AIM dimensions. Findings: Families' limited knowledge and trust in PCF goals were a barrier to its reach. While the perceived benefit of PCF on parenting skills and ECD enabled reach, the lack of referral protocols to address social needs, such as connecting food-insecure families to food resources, undermined effectiveness. Questions about whether the social assistance sector should be in charge of PCF challenged its adoption. Implementation barriers exacerbated by the COVID-19 pandemic included low salaries, temporary contracts, high turnover, infrequent supervision, lack of an effective monitoring system, and nonexistence or non-functioning multisectoral committees. The absence of institutionalized funding was a challenge for sustainability. Interpretation: Complex intertwined system-level barriers may explain the unsuccessful implementation of PCF. These barriers must be addressed for Brazil to benefit from the enormous reach of the PCF and the evidence-based nurturing care principles it is based upon. Funding: NIH/NICHD.
ABSTRACT
Poverty and teenage pregnancy are common in low-and-middle-income countries and can impede the development of healthy parent-child relationships. This study aimed to test whether a home-visiting intervention could improve early attachment relationships between adolescent mothers and their infants living in poverty in Brazil. Analyses were conducted on secondary outcomes from a randomized controlled trial (NCT0280718) testing the efficacy of a home-visiting program, Primeiros Laços, on adolescent mothers' health and parenting skills and their infants' development. Pregnant youth were randomized to intervention (n = 40) or care-as-usual (CAU, n = 40) from the first trimester of pregnancy until infants were aged 24 months. Mother-infant attachment was coded during a mother-infant interaction when the infants were aged 12 months. Electrophysiological correlates of social processing (mean amplitude of the Nc component) were measured while infants viewed facial images of the mother and a stranger at age 6 months. Infants in the intervention group were more securely attached and more involved with their mothers than those receiving CAU at 12 months. Smaller Nc amplitudes to the mother's face at 6 months were associated with better social behavior at 12 months. Our findings indicate that the Primeiros Laços Program is effective in enhancing the development of mother-infant attachment.
Subject(s)
Adolescent Mothers , Mothers , Adolescent , Brazil , Child, Preschool , Female , Humans , Infant , Mother-Child Relations , Parenting , PregnancyABSTRACT
As home-visiting programs expand, there is a need to develop cost-effective tools to monitor their quality at scale. We compare the Home Visit Rating Scales (HOVRS), an instrument to measure home-visit process quality widely used in the United States, to a checklist designed for the Peruvian national home-visiting program, Cuna Mas. Both instruments were administered to a sample of 554 home visits and an equal number of mother-child dyads by their 176 home visitors. While the HOVRS was scored on video recordings of the visits by trained coders, the checklist was scored live by Cuna Mas supervisors. We assessed the validity of both measures in their first application in rural Peru, compared their performance, and selected a subset of items in the checklist to propose a simplified, shorter, and more cost-efficient instrument. To this end, we reorganized checklist items into constructs that best mapped those covered by the HOVRS and selected the highest performing according to predefined criteria. We found that both the HOVRS and the checklist had high reliability and acceptable levels of validity. We argue that the simplified checklist could prove useful for quality monitoring of service delivery of at-scale home-visiting programs and as a tool to support in-service training.
A medida que los programas de visita a casa se expanden, hay una necesidad de desarrollar herramientas de costo eficaz para vigilar la calidad de los mismos a una escala. Comparamos las Escalas de Evaluación de Visitas a Casa (HOVRS), un instrumento para medir la calidad de los procesos de visita a casa ampliamente usado en los Estados Unidos, con una lista de control diseñada para el programa nacional de visitas a casa de Perú, Cuna Mas. Los 176 visitadores a casa le administraron ambos documentos a un grupo muestra de 554 visitas a casa y a un número equivalente de díadas mamá-niño. Los codificadores entrenados evaluaron HOVRS por medio de grabaciones de video de las visitas, mientras que la lista de control fue evaluada en persona por los supervisores de Cuna Mas. Nosotros evaluamos la validez de ambas medidas en su primera puesta en práctica en el Perú rural, comparamos su rendimiento y seleccionamos un subgrupo de categorías en la lista de control para proponer un instrumento simplificado, más corto y de costo más eficaz. Con este fin, reorganizamos las categorías de la lista de control en segmentos que mejor cubren aquellas que están presentes en HOVRS y seleccionamos las que presentan mayor rendimiento de acuerdo con criterios predefinidos. Nos dimos cuenta de que tanto HOVRS como la lista de control presentaban una alta confiabilidad y niveles aceptables de validez. Sostenemos que la lista de control simplificada pudiera demostrar utilidad en cuanto a la calidad de la supervisión del ofrecimiento del servicio de programas de visitas a casa a una escala y como una herramienta para apoyar la capacitación en el empleo.
Du fait que les programmes de visite à domicile se développement, on voit un besoin de développer également des outils rentables afin de contrôler leur qualité à grande échelle. Nous comparons les Echelles d'Evaluation de la Visite à Domicile (en anglais Home Visit Rating Scales, soit HOVRS), un instrument destiné à mesurer la qualité du processus de visite à domicile largement utilisé aux Etats-Unis, à une checklist conçue pour le programme national péruvien de visite à domicile, Cuna Mas. Les deux instruments ont été utilisés avec un échantillon de 554 visites à domiciles et une nombre égal de dyades mère-enfant par leurs 176 visiteurs à domicile. Alors que la HOVRS était évaluée au moyen d'enregistrements vidéo des visites par des évaluateurs entraînés, la checklist a été évaluée en temps réel par les superviseurs de Cuna Mas. Nous avons évalué la validité des deux mesures dans leur première application dans le Pérou rural, comparé leur performance, et sélectionné un sous-groupe d'éléments de la checklist afin de proposer un instrument simplifié, plus court et plus rentable. Pour ce faire nous avons réorganisé les éléments de la checklist en structures cartographiant le mieux ceux couverts par les HOVRS et sélectionné les plus performants selon des critères prédéfinis. Nous avons trouvé qu'à la fois les HOVRS et la checklist faisaient preuve d'une fiabilité élevée et de niveaux de validité acceptables. Nous concluons que la checklist simplifiée pourrait s'avérer utile pour le contrôle de la qualité des prestations de service de programmes de visites à domicile à grande échelle et en tant qu'outil utilisé pour soutenir la formation continue.
Subject(s)
Checklist , House Calls , Postnatal Care , Child Development , Child, Preschool , Female , Humans , Infant , Male , Peru , Reproducibility of Results , Video RecordingABSTRACT
Abstract Objectives: to describe the process of development and the structure of an action-oriented guide for home visits (HVs) to mothers and infants by Community Health Workers (CHWs). The guide was adopted in a controlled trial aimed at assessing its efficacy in improving CHWs' performance. Methods: steps to develop the guide included: 1) Review of international and national standards and recommendations for community interventions for maternal and child care; 2) Assessment of perceived needs of CHWs and other Family Health professionals regarding prenatal and postnatal HVs; 3) Identification of elements to construct the guide. Results: the Guide provides action-oriented instructions for 10 HVs during prenatal and postnatal period up to 9 months instead of the 18 HVs currently recommended by Ministry of Health. Specific tasks for each visit including assessment and promotion of early child development (ECD) and an action-oriented risk classification are introduced as standardized operational practice. Conclusions: the described approach to guide construction allows adapting the guide contents to the health system context in Brazil and other countries interested in improving quality of HVs by CHWs. The guide, by identifying tasks to be carried out and actions to be taken at each HV, provides an innovative approach and represents a requisite for a more efficient and effective use of their time.
Resumo Objetivos: descrever o processo de desenvolvimento e a estrutura de um guia orientado por ações para visitas domiciliares (VDs) a mães e crianças por Agentes Comunitários de Saúde (ACSs). O guia foi aplicado em um estudo controlado visando avaliar sua eficácia em melhorar o desempenho dos ACSs. Métodos: os passos para desenvolvimento do guia incluíram: 1)Revisão das recomendações nacionais e internacionais para intervenções na comunidade em saúde materno-infantil; 2) Avaliação das necessidades de ACSs e outros profissionais das Equipes de Saúde da Família sobre VDs nos períodos pré e pós-natal; 3)Identificação dos princípios para construir o guia. Resultados: o Guia traz instruções para 10 VDs nos períodos pré e pós natal até os 9 meses, ao invés de 18 VDs atualmente recomendadas pelo Ministério da Saúde. Tarefas específicas para cada visita incluindo avaliação e promoção do desenvolvimento da primeira infância (DPI) e classificação de risco orientada por ações foram introduzidas como prática padronizada. Conclusões: a abordagem descrita para a construção do guia permite adaptar os conteúdos ao contexto do sistema de saúde do Brasil e de outros países interessados em melhorar a qualidade das VDs por ACSs. O guia, identificando tarefas e ações a serem realizadas a cada VD, oferece uma abordagem inovadora e representa um requisito para utilização mais eficiente e efetiva do tempo.
Subject(s)
Child Development , Community Health Workers/education , House Calls/trends , Postnatal Care , Prenatal Care , Child , Pregnant Women , Maternal-Child Health ServicesABSTRACT
Este estudo teve por objetivo avaliar um programa longitudinal de apoio à transição para a parentalidade por meio da avaliação de necessidades e de processo. Um casal participou de uma intervenção longitudinal, com nove visitas domiciliares, focadas no desenvolvimento de habilidades parentais e empoderamento da dupla. As interações pais-bebê e reações do casal à intervenção foram gravadas em vídeo e posteriormente registradas no Protocolo de Avaliação de Processo. A análise dos dados evidencia que o casal sentiu-se satisfeito com o programa e fez uso das informações e estratégias recebidas, com impacto positivo nas dimensões da conjugalidade, com melhor comunicação e solução de problemas interpessoais e da parentalidade, com a construção de conhecimentos sobre o desenvolvimento do bebê, mudanças em crenças sobre práticas educativas parentais violentas, responsividade na relação com o bebê e menor estresse parental. São recomendadas replicações deste estudo em amostras maiores e avaliação de follow-up.
This paper describes a needs assessment and a process evaluation of a longitudinal support program to first-time parents. A couple participated in a longitudinal intervention, with nine home visits, focused on the development of parental skills and couple empowerment. The baby-parents interaction and the couple's reactions to the intervention were video recorded and afterwards registered into the Process Evaluation Protocol. Data analysis showed that the couple felt satisfied with the program and used the information and strategies received, with a positive impact on the dimensions of conjugality, better communication and interpersonal problem solving and parenthood, development of knowledge on the infant's development, change in beliefs related to violent parental educational practices and responsiveness in the relationship between the baby and the parents, besides lower parental stress. Replications of this study in bigger samples with follow-up evaluations are recommended.
La finalidad de este artículo fue evaluar un programa longitudinal de apoyo a la transición hacia la parentalidad mediante la evaluación de necesidades y proceso. Una pareja participó en una intervención longitudinal que constituye una serie de nueve visitas domiciliares, focalizadas en el desarrollo de habilidades parentales y empoderamiento de la pareja. Las interacciones padres-bebé y las reacciones de la pareja a la intervención fueron grabadas en video y posteriormente registradas en el protocolo de evaluación de proceso. El análisis de los datos demostró satisfacción de la pareja con el programa y la utilización de las informaciones y estrategias recibidas, con impacto positivo en las dimensiones de la conyugalidad, con mejor comunicación y solución de problemas interpersonales; y de la parentalidad, con la construcción de conocimientos sobre el desarrollo del bebé, cambios en creencias sobre las prácticas educativas parentales violentas, sensibilidad en la relación con el bebé y menor estrese parental. Se recomienda que el estudio sea reaplicado en muestras con más participantes y con evaluaciones de seguimiento.
Subject(s)
Humans , Male , Female , Adult , Family , Object Attachment , Program Evaluation , Domestic Violence/prevention & controlABSTRACT
Este estudo teve por objetivo avaliar um programa longitudinal de apoio à transição para a parentalidade por meio da avaliação de necessidades e de processo. Um casal participou de uma intervenção longitudinal, com nove visitas domiciliares, focadas no desenvolvimento de habilidades parentais e empoderamento da dupla. As interações pais-bebê e reações do casal à intervenção foram gravadas em vídeo e posteriormente registradas no Protocolo de Avaliação de Processo. A análise dos dados evidencia que o casal sentiu-se satisfeito com o programa e fez uso das informações e estratégias recebidas, com impacto positivo nas dimensões da conjugalidade, com melhor comunicação e solução de problemas interpessoais e da parentalidade, com a construção de conhecimentos sobre o desenvolvimento do bebê, mudanças em crenças sobre práticas educativas parentais violentas, responsividade na relação com o bebê e menor estresse parental. São recomendadas replicações deste estudo em amostras maiores e avaliação de follow-up.(AU)
This paper describes a needs assessment and a process evaluation of a longitudinal support program to first-time parents. A couple participated in a longitudinal intervention, with nine home visits, focused on the development of parental skills and couple empowerment. The baby-parents interaction and the couple's reactions to the intervention were video recorded and afterwards registered into the Process Evaluation Protocol. Data analysis showed that the couple felt satisfied with the program and used the information and strategies received, with a positive impact on the dimensions of conjugality, better communication and interpersonal problem solving and parenthood, development of knowledge on the infant's development, change in beliefs related to violent parental educational practices and responsiveness in the relationship between the baby and the parents, besides lower parental stress. Replications of this study in bigger samples with follow-up evaluations are recommended.(AU)
La finalidad de este artículo fue evaluar un programa longitudinal de apoyo a la transición hacia la parentalidad mediante la evaluación de necesidades y proceso. Una pareja participó en una intervención longitudinal que constituye una serie de nueve visitas domiciliares, focalizadas en el desarrollo de habilidades parentales y empoderamiento de la pareja. Las interacciones padres-bebé y las reacciones de la pareja a la intervención fueron grabadas en video y posteriormente registradas en el protocolo de evaluación de proceso. El análisis de los datos demostró satisfacción de la pareja con el programa y la utilización de las informaciones y estrategias recibidas, con impacto positivo en las dimensiones de la conyugalidad, con mejor comunicación y solución de problemas interpersonales; y de la parentalidad, con la construcción de conocimientos sobre el desarrollo del bebé, cambios en creencias sobre las prácticas educativas parentales violentas, sensibilidad en la relación con el bebé y menor estrese parental. Se recomienda que el estudio sea reaplicado en muestras con más participantes y con evaluaciones de seguimiento.(AU)
Subject(s)
Humans , Male , Female , Adult , Program Evaluation , Family , Object Attachment , Domestic Violence/prevention & controlABSTRACT
A Estratégia Saúde da Família (ESF) busca se confirmar como intervenção emancipadora e transformadora dos sujeitos, consideradas a preocupação com o acolhimento e a especificidade da atenção, como no caso mães adolescentes. O objetivo deste trabalho foi estudar as condições para a implantação de um programa de visitadoras domiciliares para adolescentes puérperas em parceria com ESF. O trabalho teve como participantes 84 moradores e 15 profissionais de saúde, ao longo de 51 encontros e reuniões. Os resultados revelam mulheres e funcionários que se acusam mutuamente de "invasores", confrontando duas perspectivas em relação ao lugar da ação de saúde: a "UBS", marcada pelo controle técnico-institucional, e o "Posto", patrimônio da comunidade. Concluímos que a formação especifica de profissionais e estudos sobre as histórias das relações entre a comunidade e os serviços públicos são pontos de partida que profissionais e comunidade possam se reconhecer como parceiros das ações de saúde
The Family Health Strategy intends to be a liberating and transforming action for social subjects, dealing with clients' reception and specific attention, as in the case of teenage mothers. The aim of this work was to study the conditions for conducting a home visiting program for adolescent mothers in partnership with a FHS team. The study participants were 84 residents and 15 health professionals, over 51 meetings and gatherings. The results reveal that women and health professionals accuse each other of "invaders", comparing two approaches in relation to the place of a health action: the "Unidade Basica de Saude", within a technical and institutional remark, and the "Posto", a community heritage. We conclude that specific professional training must join studies about the history of relationships between community and public health services are a starting point to conduct professionals and community residents as partners of health actions
La Estrategia Salud de la Familia busca una acción liberadora de los sujetos sociales, considerando la preocupación por la acogida y la especificidad de la atención, como en el caso de adolescentes madres. El objetivo de esta investigación fue estudiar las condiciones para la aplicación de un programa de visitas domiciliarias para adolescentes puérperas, en colaboración con equipo ESF. Los participantes del estudio fueran 84 moradoras y 15 profesionales de salud, durante 51 encuentros. Los resultados revelan que las mujeres y los empleados se acusan mutuamente de "invasores", construyendo lugares para la acción sanitaria: la "UBS", marcada por el control técnico, y el "Posto", patrimonio de la comunidad. Así, entendemos la importancia de unirse la formación profesional específica y lo estudio de las historias de relaciones entre la comunidad y los servicios públicos como punto de partida para que los profesionales y la comunidad pueden ser socios de las acciones de salud
Subject(s)
Humans , Male , Female , Adolescent , Adult , Primary Health Care , Parenting , National Health Strategies , House Calls , BrazilABSTRACT
A Estratégia Saúde da Família (ESF) busca se confirmar como intervenção emancipadora e transformadora dos sujeitos, consideradas a preocupação com o acolhimento e a especificidade da atenção, como no caso mães adolescentes. O objetivo deste trabalho foi estudar as condições para a implantação de um programa de visitadoras domiciliares para adolescentes puérperas em parceria com ESF. O trabalho teve como participantes 84 moradores e 15 profissionais de saúde, ao longo de 51 encontros e reuniões. Os resultados revelam mulheres e funcionários que se acusam mutuamente de "invasores", confrontando duas perspectivas em relação ao lugar da ação de saúde: a "UBS", marcada pelo controle técnico-institucional, e o "Posto", patrimônio da comunidade. Concluímos que a formação especifica de profissionais e estudos sobre as histórias das relações entre a comunidade e os serviços públicos são pontos de partida que profissionais e comunidade possam se reconhecer como parceiros das ações de saúde.(AU)
The Family Health Strategy intends to be a liberating and transforming action for social subjects, dealing with clients' reception and specific attention, as in the case of teenage mothers. The aim of this work was to study the conditions for conducting a home visiting program for adolescent mothers in partnership with a FHS team. The study participants were 84 residents and 15 health professionals, over 51 meetings and gatherings. The results reveal that women and health professionals accuse each other of "invaders", comparing two approaches in relation to the place of a health action: the "Unidade Basica de Saude", within a technical and institutional remark, and the "Posto", a community heritage. We conclude that specific professional training must join studies about the history of relationships between community and public health services are a starting point to conduct professionals and community residents as partners of health actions.(AU)
La Estrategia Salud de la Familia busca una acción liberadora de los sujetos sociales, considerando la preocupación por la acogida y la especificidad de la atención, como en el caso de adolescentes madres. El objetivo de esta investigación fue estudiar las condiciones para la aplicación de un programa de visitas domiciliarias para adolescentes puérperas, en colaboración con equipo ESF. Los participantes del estudio fueran 84 moradoras y 15 profesionales de salud, durante 51 encuentros. Los resultados revelan que las mujeres y los empleados se acusan mutuamente de "invasores", construyendo lugares para la acción sanitaria: la "UBS", marcada por el control técnico, y el "Posto", patrimonio de la comunidad. Así, entendemos la importancia de unirse la formación profesional específica y lo estudio de las historias de relaciones entre la comunidad y los servicios públicos como punto de partida para que los profesionales y la comunidad pueden ser socios de las acciones de salud.(AU)
Subject(s)
Humans , Male , Female , Adolescent , Adult , National Health Strategies , House Calls , Parenting , Adolescent , Primary Health Care , BrazilABSTRACT
Entendendo as visitas domiciliárias enquanto tecnologia de interação no cuidado à saúde da família, este artigo teve por objetivo compreender os significados atribuídos por essas famílias à visita domiciliária realizada pela Estratégia Saúde da Família (ESF), com a intenção de reconhecer as dificuldades e potencialidades dessa prática. Nessa perspectiva, utilizou-se abordagem qualitativa, em que os dados foram coletados através de entrevista aberta e analisados segundo a Teoria das Representações Sociais. A pesquisa foi realizada no território de abrangência de uma Unidade Básica de Saúde da Família (UBSF) localizada na zona leste do município de São Paulo, sendo selecionadas cinco famílias aleatoriamente (sorteio). Os resultados mostraram que a visita domiciliária, apesar de apresentar limitações devido à concentração em torno de práticas curativistas direcionadas aos indivíduos, que tornam secundárias a produção de autonomia e a corresponsabilização das famílias no cuidado à saúde, foi concebida como importante meio de aproximação entre as famílias e a ESF, favorecendo o acesso às ações e aos serviços de saúde, sendo apontada como instrumento de humanização da atenção à saúde ao propiciar a construção de novas relações entre usuários e profissionais e a formação de vínculo entre esses.
Understanding home visiting as interaction technology in family healthcare, this article aimed to apprehend the meanings attributed by these families to the home visiting performed by Estratégia Saúde da Família (ESF - Family Health Strategy), with the purpose of recognizing the difficulties and potentialities of this practice. In this perspective, a qualitative approach was used. Data were collected through open interviews and analyzed in accordance with Social Representations Theory. The research was carried out in the catchment area of a Primary Family Health Care Unit, which is located in the east zone of the city of São Paulo, and five families were randomly selected (through a draw). The results showed that home visiting presents limitations because of curative practices directed to individuals, which makes autonomy production and accountability of the families in taking care of their health become secondary. However, home visiting was considered an important way of making the families and ESF become closer, favoring the access to health actions and services. It was pointed as a humanization instrument in healthcare, as home visiting enables the construction of new relationships between users and professionals and the formation of links among them.