Cross-cultural adaptation of an environmental health measurement instrument: Brazilian version of the health-care waste management • rapid assessment tool.

BACKGROUND: Periodic assessment is one of the recommendations for improving health-care waste management worldwide. This study aimed at translating and adapting the Health-Care Waste Management - Rapid Assessment Tool (HCWM-RAT), proposed by the World Health Organization, to a Brazilian Portuguese version, and resolving its cultural and legal issues. The work focused on the evaluation of the concepts, items and semantic equivalence between the original tool and the Brazilian Portuguese version. METHODS: A cross-cultural adaptation methodology was used, including: initial translation to Brazilian Portuguese; back translation to English; syntheses of these translation versions; formation of an expert committee to achieve consensus about the preliminary version; and evaluation of the target audience's comprehension. RESULTS: Both the translated and the original versions' concepts, items and semantic equivalence are presented. The constructs in the original instrument were considered relevant and applicable to the Brazilian context. The Brazilian version of the tool has the potential to generate indicators, develop official database, feedback and subsidize political decisions at many geographical and organizational levels strengthening the Monitoring and evaluation (M&E) mechanism. Moreover, the cross-cultural translation expands the usefulness of the instrument to Portuguese-speaking countries in developing regions. CONCLUSION: The translated and original versions presented concept, item and semantic equivalence and can be applied to Brazil.

Perceptions of primary healthcare professionals towards their role in type 2 diabetes mellitus patient education in Brazil.

BACKGROUND: The aim of the current study was to analyze the perceptions, knowledge, and practices of primary healthcare professionals in providing patient education to people with type 2 diabetes mellitus. METHODS: A total of 23 health professionals working in primary healthcare units in Belo Horizonte, Minas Gerais State, Brazil, participated in a focus group in order to discuss their patient education practices and the challenges for effective patient education in diabetes self-management. RESULTS: The results were categorized as follows: 1) lack of preparation and technical knowledge among the health professionals on some aspects of diabetes mellitus and the health professionals' patient education practices; 2) work conditions and organization; 3) issues related or attributed to the clientele themselves; and 4) diabetes care model. CONCLUSIONS: This study highlights the importance of reorienting the patient education practices, health professionals' skills and work goals, and evaluation of the educational interventions, in order to establish strategies for health promotion and prevention and control of the disease. DESCRIPTORS: Health Education; Prevention of Diabetes Mellitus; Primary Healthcare.

[Local knowledge and dilemmas related to validity and applicability of scientific knowledge in rural areas]. / O saber local e os dilemas relacionados à validação e aplicabilidade do conhecimento científico em áreas rurais.

Based on previous experience from two research projects on schistosomiasis in rural populations, this article focuses on the relations between scientific health knowledge and health-related common sense in farming communities. The article discusses factors that affect the meaning of participation by these communities in exogenous programs, as well as the dilemmas related to the appropriation, validity, and applicability of multiple and non- contextualized health information offered by such programs. The article discusses how the acritical aggregation of large amounts of information, a feature of globalization, deepens the feeling of uncertainty in rural communities and the trend to impute diseases to fatality. Meanwhile, the consumption of medical technologies is viewed as a symbol of progress and is highly valued by these groups. The discussion addresses the important role of health personnel in valuing local empirical knowledge, fostering the incorporation of useful technical knowledge without compromising the cultural heritage on which the identity and health of such groups are based.

[Construction workers' reactions to educational materials: a debate on relations between health and work]. / Estudo de recepção de impressos por trabalhadores da construção civil: um debate das relações entre saúde e trabalho.

This study focuses on the reactions of construction workers to educational materials (posters, folders, and leaflets) produced by the Brazilian Ministries of Health and Labor. The authors conducted two focal groups at construction sites in the city of Rio de Janeiro to analyze four educational materials, employing thematic analysis. The article presents the workers' perspective on the themes discussed in the leaflets, classified in two groups of meaning: health and social control. They go on to discuss how workers' display an expanded vision of health to the extent that it includes social determinants of the health-disease process. The study identified the workers' limited participation in work-process surveillance activities and their lack of knowledge concerning workers' health measures adopted by the Ministry of Health. The authors conclude that the analysis of educational materials by their target public represents a privileged place for negotiating meanings and grasping ways of life in specific groups. They suggest educational activities using leaflets as a means to motivate critical analysis of the health-disease process.

[Risk perception related to work in a rural community of Rio de Janeiro State, Brazil: pesticides, health, and environment]. / Percepção de riscos no trabalho rural em uma região agrícola do Estado do Rio de Janeiro, Brasil: agrotóxicos, saúde e ambiente.

The present study applies the risk perception analytical methodology based on rapid surveys. It took place in the micro-basin of the São Lourenço Creek in Nova Friburgo, Rio de Janeiro State, Brazil. The methodological approach was based on participatory observation, semi-structured interviews with 24 key informants selected among local farmers (N = 120), and evaluation of local work processes. Field data analysis revealed some issues related to the risk perception profile in the study population, including the development of defensive strategies to deal with work hazards, the importance of communication in developing workers' risk perceptions, the subjective responses to potentially hazardous situations, and the role of individual risk perception as a determinant of human exposure to pesticides. The results evoked the importance of systematically incorporating risk perception analyses into intervention strategies, especially in educational risk communication campaigns.

[Occupational exposure to pesticides and health professionals' interpretation of "nervousness" among rural residents]. / A interpretação dos profissionais de saúde acerca das queixas de "nervos" no meio rural: uma aproximação ao problema das intoxicações por agrotóxicos.

Occupational exposure to pesticides has a strong impact on Public Health in Brazil, since the country is one of the world's largest pesticide consumers. Harm to the rural population is reflected in high pesticide poisoning and case-fatality rates. The present paper focuses on the perspective of health professionals working in districts 5 and 7 of the Municipality of Nova Friburgo, Rio de Janeiro State, in the Family Health Program, concerning rural residents' complaints of "nervousness", verifying (1) whether health professionals perceive a link between "nervousness" and symptoms of pesticide poisoning, (2) the implications of their understanding on the reporting of work-related illnesses, and (3) medication for "nervousness" (use of tranquilizers) as a potential factor of social accommodation (as occurs elsewhere in urban groups) and as a potential cause of dual poisoning among workers exposed to pesticides. The methodology included interviews, participant observation, field notes, and consultation of previous studies in the area. The study highlights health professionals' discourse in relation to the association between "nervousness" and pesticides. The authors discuss factors related to this perception and make several suggestions for future research.

[Hospital leaflets and the dynamics of constructing their meanings: the perspective of health professionals]. / Impressos hospitalares e a dinâmica de construção de seus sentidos: o ponto de vista dos profissionais de saúde.

Based on interviews in a hospital in Rio de Janeiro, the authors analyze strategies, interests, assumptions, and concerns among producers of patient information leaflets on infectious diseases. Most such publications followed a linear communications model, according to which health messages produce a sole and single effect on their audience. Visual communications are seen as a field of knowledge over which physicians have no "command", but which raises great expectations on their part, principally in light of the limits of written language for an illiterate patient population. The most frequent concerns relate to the "adequacy of the language" (a denotative, non-semantic function of language) and on the increase in "dissemination". Leaflets are generally linked to the professional experience of providing health care, but the lack of pertinent research prior to the production of such publications leads to simplifications and generalizations concerning the patients' most common doubts and questions, reinforcing the stereotyping of the clientele based on their lacks and needs. In two exceptional leaflets, interaction with the clientele appears and expands the relationship between the health care professionals and the values and decisions made in distinct sociocultural contexts.

[Perception of work conditions in a traditional farming community in Boa Esperança, Nova Friburgo, Rio de Janeiro State, Brazil]. / Percepção das condições de trabalho em uma tradicional comunidade agrícola em Boa Esperança, Nova Friburgo, Rio de Janeiro, Brasil.

The impact of pesticide use on human and environmental health has received attention from the international scientific community for some time, especially in developing countries where such chemical agents are used extensively and indiscriminately. The present study adopts a methodological approach to risk perception analysis based on rapid surveys, including: participatory observation; semi-structured interviews with key informants; and evaluation of local work processes. Field data analysis revealed several issues related to the risk perception profile of the study population, including the development of defensive strategies toward work hazards, subjective responses to potentially hazardous situations, and the role of individual risk perception as a determinant of human exposure to pesticides.

[Shared development of printed material as a health education strategy with public school employees in Rio de Janeiro State]. / O desenvolvimento compartilhado de impressos como estratégia de educação em saúde junto a trabalhadores de escolas da rede pública do Estado do Rio de Janeiro.

This article describes the process and results of an experience with preparing a mural entitled A Day in the Life of the School Lunch Cook, conducted with public school employees in the State of Rio de Janeiro by a team of researchers and students from the Specialization Course in Workers' Health at the Center for Studies on Workers' Health of the National School of Public Health, Oswaldo Cruz Foundation, in partnership with the School Employees' Union. "Health workshops" based on participatory research were used to raise questions related to daily work by school lunch cooks and kitchen staff. Produced to share the results of workshops with other schools, the mural is highly meaningful in terms of the reality of a specific segment of public employees and is intended as food for thought. Based on the Paulo Freire popular education model, six meetings were held, following a script for the production of an educational leaflet including the selection of contents, the communications approach, and the style and format of the leaflet. The creativity in the images prepared by the school lunch employees based on actual experiences from their daily work made the workshops an enriching moment of exchange, in which the participants shared their ideas, values, beliefs, feelings, and life histories.

[Communication prostheses and behavioral alignment in hospital leaflets]. / Próteses de comunicação e alinhamento comportamental sobre impressos hospitalares.

Review was made of publications that describe experience with printed material distributed to the lay public in hospital institutions. From the 146 leaflets examined, those aimed at professionals or disabled people, thus leaving 75 papers that illustrate the present pattern for the rationality behind the production, use and evaluation of this type of resource. In a general manner, such leaflets invest in the power of "ideal printed information" to align behavior with the hospital's biomedical agenda. The underlying rationality that permeates them perceives the "perfect information package" as one that efficiently describes its technical content for the purpose of unidirectional persuasion, is up-to-date in relation to readability scales and embellished by graphic design, and emphasizes the priorities defined by the professionals. Such "communication prostheses" should be capable of electronic validation by means of software suitable for proportioning the "doses" to the subject matter. Information as a drug, cognitivism, the lack of research on message reception and the need for communicative action for the deconstruction of systems of closed thinking within the hospital environment have been discussed.

Desigualdades sociais nas práticas de uso de inseticidas domésticos no município de Niterói - RJ / Social inequalities in household insecticide use practice in Niterói-RJ

Objetivo: Foi realizado estudo transversal com objetivo de descrever as práticas de uso de inseticidas utilizados no controle dos vetores no ambiente doméstico. Material e Métodos: Foram aplicados questionários em 122 residências no município de Niterói, na Região Oceânica em 2010. Destes, 61 foram realizados em condomínio de classe média alta e 61 em Comunidade de baixa renda. Resultados: Os resultados demonstraram que 92% do grupo Condomínio e 77,7% do grupo Colônia de Pescadores usam inseticidas. Em relação aos cuidados com manuseio de inseticidas, 62,2% dos entrevistados do Grupo Condomínio e 35,6% dos entrevistados do Grupo Colônia de Pescadores, disseram que não tomavam nenhum cuidado ao usar estes produtos. Os dados sugerem que pessoas com menor escolaridade têm mais chances de não usar adequadamente os inseticidas que são produtos potencialmente tóxicos. Conclusão: Conclui-se que aspectos relacionados ao nível educacional e local de moradia estão relacionados ao uso mais adequado de inseticidas domésticos. (AU)

Objetive: Cross-sectional study was performed in order to describe practices with insecticides used in the control of insect vectors in the household. Methods: Questionnaires were applied in 154 households in Niterói City, in the Oceanic Region of Rio de Janeiro ́s State, in 2010. Of these, 77 were performed in upper middle class Apartament Complexes and 61 in the low-income community both in the Oceanic Region of Niterói. Results:The results showed that 92% of Apartment Complexes and 77.7% of Fishermen Colony use insecticides. Regarding care handling insecticides, 62.2% of the respondents of the Apartment Complex Group and 35.6% of the respondents from the Fishermen Colony Group said they were not taking any care when using these products. Data suggests that people with low education are more likely to not properly use potentially toxic pesticides. Conclusion: We conclude that aspects related to educational level and residential location are associated to more appropriate use of household insecticides. (AU)

Formação em saúde do trabalhador e saúde ambiental: avaliação de experiência com atores locais / Training in workers' and environmental health: experience assessment of local actors

RESUMO O presente estudo tem como objetivo analisar a experiência de formação em saúde do trabalhador e saúde ambiental em base territorial local, adotando como matéria principal de interpretação as avaliações dos próprios trabalhadores. Por meio da técnica de análise de conteúdo, chegou-se a duas categorias empíricas de análise, sendo a primeira a interdisciplinaridade e construção coletiva do conhecimento, e a segunda, a intersetorialidade e os saberes advindos da prática. Ao final, constataram-se elementos formativos, de caráter crítico, que contribuem para a emancipação dos atores locais e as ações de políticas públicas integradas.

ABSTRACT The study here reported had as objective to analyze the training experience in workers' and environmental health focused on local territory, adopting as interpretation main data assessments issued from the workers themselves. By means of content analysis, we arrived to two empirical categories of analysis. The first is interdisciplinarity and knowledge collective construction, and the second is intersectoriality and skills acquired through practice. At the end, formative elements of critical character were verified, which contribute to the emancipation of local players and actions of integrated public policies.

Propaganda de inseticidas: estratégias para minimização e ocultamento dos riscos no ambiente doméstico / Insecticides advertisements: strategies for minimization and concealment of household risks

Este trabalho tem como objetivo fazer uma análise e propor uma discussão sobre as estratégias adotadas pelas propagandas de inseticidas para uso no ambiente doméstico, e suas implicações para a saúde pública. Foram analisadas peças publicitárias de inseticidas veiculadas na mídia televisiva no período de 2008 a 2010. Como critério de seleção das peças, foram escolhidas quatro peças publicitárias de inseticidas que foram ao ar em dois canais de TV aberta, nos horários da manhã e da noite, ao longo do período citado. Para a análise dessas peças, utilizou-se a observação da propaganda na TV. O método utilizado foi a análise de conteúdo. As categorias geradas pela análise foram: apelo ao status do usuário; ocultação e minimização dos riscos; símbolos de modernidade e cientificidade; representações de um mundo asséptico; e representações de força, poder e controle. Concluímos, então, que todas as propagandas analisadas utilizaram estratégias que ocultam os riscos toxicológicos dos inseticidas no ambiente doméstico e não cumprem a legislação brasileira.

The study aims to analyze and propose a discussion on insecticide ads for domestic use and their implications on public health. We analyzed insecticide ads broadcast on the television between the years of 2008 and 2010. As selection criteria four insecticide ads were chosen, which aired on two television channels, in the morning and in the evening, over that period. The ads were analyzed by watching their broadcast on television. The method used was content analysis. The categories generated by the analysis were: appeal to the user's status; concealment and downscaling of risks; symbols of modernity and rationality; representations of an aseptic world; and representations of strength, power and control. We, therefore, conclude that all the evaluated ads adopted strategies that concealed the risks of domestic insecticides and did not comply with Brazilian legislation.

Domissanitários ou domitóxicos? A maquiagem dos venenos / Household cleaning or household toxics? The camouflage of poisons

ResumoO objetivo desta pesquisa foi avaliar o uso dos inseticidas usados no ambiente doméstico, relacionando-os com seus possíveis impactos na saúde e no ambiente. Utilizamos uma abordagem quantitativa-descritiva. Para coleta de dados, foram aplicados 125 questionários nas residências no município de Niterói, no Estado do Rio de Janeiro, entre 2009 e 2010, dos quais 50 foram realizados em um condomínio de classe média alta e 75 em uma comunidade de baixa renda. Nossos resultados demonstraram que 92% do grupo do condomínio e 77,3% do grupo da comunidade usam inseticidas. Os dois grupos pesquisados conheceram os inseticidas por meio das propagandas de televisão. Observamos nesta investigação que a vulnerabilidade do consumidor é independente da classe social, uma vez que todos se expõem aos inseticidas de alguma forma.

The objective of this research was to evaluate the use of insecticides in households, relating them to their impact on health and the environment. We used a quantitative, descriptive approach. For data collection, 125 questionnaires were applied in homes in the municipality of Niterói, Rio de Janeiro state, in 2010. Of these, 50 were conducted in an upper middle class condominium and 75 were carried out in a low-income community. Our results showed that 92% of the upper middle class group and 77.3% of low-income group use insecticides. The two groups surveyed learned about insecticides through television advertisements. Consumers’ vulnerability is high regardless of their social class, since both groups were exposed to risk in some way.

[Meanings and use of educational materials on Hansen disease according to public health officials in the Municipality of Rio de Janeiro, Brazil]. / Significados e usos de materiais educativos sobre hanseníase segundo profissionais de saúde pública do Município do Rio de Janeiro, Brasil.

This article reflects on the communications processes in the Hansen Disease Control Programs under the Unified National Health System (SUS) in Brazil, analyzing how professionals at two public health services in Rio de Janeiro perceive the educational materials on the disease. The article discusses how analysis of printed materials favors negotiation of prevailing meanings and practices on Hansen disease in the programs. Thirty-eight different educational materials were analyzed (produced from 1993 to 2005 by governmental and nongovernmental institutions) through two focus groups with program staff. Six materials were examined during the focus groups. The findings showed the communications processes are vertical and fragmented, with an emphasis on campaigns, centralized production of materials, homogenization of target publics, and a focus on biomedical knowledge. Horizontal and participatory activities were uncommon. A gap was identified between the institutionalization of the discourse on Hansen disease as an alternative to leprosy terminology and its circulation and uptake among different social actors.

Significados e usos de materiais educativos sobre hanseníase segundo profissionais de saúde pública do Município do Rio de Janeiro, Brasil / Meanings and use of educational materials on Hansen disease according to public health officials in the Municipality of Rio de Janeiro, Brazil

O artigo objetiva refletir sobre os processos comunicativos de Programas de Controle de Hanseníase (PCH) do Sistema Único de Saúde (SUS), por meio da análise da recepção de materiais educativos por profissionais de dois serviços de saúde pública no Rio de Janeiro, Brasil. O trabalho discute em que medida a análise de impressos favorece a negociação dos sentidos e das práticas sobre hanseníase vigentes nos PCH. Foram analisados 38 materiais produzidos entre 1993 a 2005, por instituições governamentais e não-governamentais e realizados dois grupos focais com profissionais atuantes no PCH. Durante os grupos focais 6 materiais foram examinados. Os resultados revelaram a verticalidade e fragmentação nos processos comunicativos, expressas pela: ênfase em campanhas, produção centralizada, homogeneização dos públicos e conteúdos e privilégio dado ao saber biomédico. As atividades horizontais e participativas não eram comuns. Foi identificada uma lacuna entre a institucionalização do discurso da hanseníase, como alternativa à terminologia da lepra, e a sua circulação e consumo entre os diferentes atores sociais.

This article reflects on the communications processes in the Hansen Disease Control Programs under the Unified National Health System (SUS) in Brazil, analyzing how professionals at two public health services in Rio de Janeiro perceive the educational materials on the disease. The article discusses how analysis of printed materials favors negotiation of prevailing meanings and practices on Hansen disease in the programs. Thirty-eight different educational materials were analyzed (produced from 1993 to 2005 by governmental and nongovernmental institutions) through two focus groups with program staff. Six materials were examined during the focus groups. The findings showed the communications processes are vertical and fragmented, with an emphasis on campaigns, centralized production of materials, homogenization of target publics, and a focus on biomedical knowledge. Horizontal and participatory activities were uncommon. A gap was identified between the institutionalization of the discourse on Hansen disease as an alternative to leprosy terminology and its circulation and uptake among different social actors.

O saber local e os dilemas relacionados à validação e aplicabilidade do conhecimento científico em áreas rurais / Local knowledge and dilemmas related to validity and applicability of scientific knowledge in rural areas

Com base em experiências prévias de dois projetos de pesquisa sobre esquistossomose em populações rurais, o artigo debate as relações entre o saber sanitário e o senso comum sanitário em comunidades agrícolas. O artigo refere-se a fatores que interferem com a noção de participação destes grupos em programas exógenos, bem como com a apropriação, validação e aplicabilidades das múltiplas informações científicas em oferta em tais programas. A multiplicidade de informações que aportam no nível local, como uma das facetas marcantes da globalização, agrega de forma acrítica conhecimentos científicos descontextualizados, aumentando a sensação de incerteza nas comunidades e a tendência a se atribuir um caráter aleatório às doenças. Por outro lado, o consumo de tecnologias médicas é bastante valorizado e compreendido como símbolo inequívoco de progresso. Discute-se a importância da atitude dos profissionais da saúde como aliados na valorização do senso comum e da experiência empírica das populações rurais, que beneficiem a incorporação do saber técnico de utilidade pública sem prejuízo do patrimônio cultural que está na base da identidade e da saúde destes grupos.

Based on previous experience from two research projects on schistosomiasis in rural populations, this article focuses on the relations between scientific health knowledge and health-related common sense in farming communities. The article discusses factors that affect the meaning of participation by these communities in exogenous programs, as well as the dilemmas related to the appropriation, validity, and applicability of multiple and non- contextualized health information offered by such programs. The article discusses how the acritical aggregation of large amounts of information, a feature of globalization, deepens the feeling of uncertainty in rural communities and the trend to impute diseases to fatality. Meanwhile, the consumption of medical technologies is viewed as a symbol of progress and is highly valued by these groups. The discussion addresses the important role of health personnel in valuing local empirical knowledge, fostering the incorporation of useful technical knowledge without compromising the cultural heritage on which the identity and health of such groups are based.

Estudo de recepcão de impressos por trabalhadores da construcão civil: um debate das relacões entre saúde e trabalho / Construction workers' reactions to educational materials: a debate on relations between health and work

Trata-se de um estudo de recepcão de mensagens por trabalhadores da construcão civil. Utilizamos como mediacão os materiais educativos (cartazes, folders e cartilhas) produzidos pelo Ministério da Saúde e Ministério do Trabalho e Emprego. Realizamos dois grupos focais, em dois canteiros de obra no Município do Rio de Janeiro, Brasil, para a análise de quatro materiais educativos; utilizamos análise temática. Apresentamos o ponto de vista dos trabalhadores sobre os temas discutidos nos impressos, classificados em dois núcleos de sentidos: saúde e controle social. Discutimos que os trabalhadores apresentam uma visão ampliada de saúde à medida que inclui os determinantes sociais ao processo saúde-doenca. Identificamos a pouca participacão dos trabalhadores nas acões de fiscalizacão dos processos de trabalho, e o desconhecimento das acões de saúde do trabalhador desenvolvidas pelo Ministério da Saúde. Concluímos que a análise de materiais educativos por seus destinatários, representa um lugar privilegiado de negociacão de sentidos e de apreensão dos modos de viver de grupos específicos. Sugerimos a realizacão de atividades educativas que utilizem os impressos como mediacão para motivar a problematizacão do processo saúde-doenca.

O processo de construção de mapas de risco em um hospital público / The process of building risk maps in a public hospital

O artigo apresenta uma reflexão sobre a experiência de construção coletiva do mapa de risco em um hospital público, no município do Rio de Janeiro, fundamentada nos conceitos de biossegurança, qualidade total e vigilância em saúde do trabalhador. Partiu da etapa de sensibilização dos trabalhadores e gestores do hospital, da identificação dos riscos, da elaboração do mapa, até a discussão sobre as medidas preventivas e a apresentação dos resultados pelos trabalhadores em centro de estudos. A elaboração do mapa de risco serviu como um processo educativo, que possibilitou socializar conceitos da área de saúde do trabalhador, integrar os trabalhadores, sistematizar o processo de trabalho e refletir sobre a forma de organização do trabalho, gerando desdobramentos práticos sob o ponto de vista da intervenção no ambiente de trabalho.

The paper presents a discussion about the experience of building a risk map by workers in a public hospital, in Rio de Janeiro city, resting on concepts of occupational health surveillance, total quality and biosafety. It goes from the first step to persuade the workers and managers, to identify the potential sources of risk in the work environment, the elaboration of the map, until the discussion about the preventive measures and the presentation of the results by the workers at a scientific meeting in the hospital. The elaboration of the risk map acted as a learning opportunity to socialize concepts in the work health area, to integrate workers, to systematize the work process and to discuss work organization, having practical consequences which have furthered changes in the working environment.

Comunicação por impressos na saúde do trabalhador: a perspectiva das instâncias públicas / Communication of workers'health issues using leaflets: the perspective of public agencies

O artigo apresenta os resultados de uma pesquisa que investigou os processos comunicativos mediados por impressos (cartazes, fôlderes, cartilhas) de instâncias públicas atuantes no binômio saúde-trabalho. Objetivamos oferecer subsídios teórico-metodológicos para que a Saúde do Trabalhador possa aprimorar as práticas comunicativas em curso. Realizamos a análise de 80 impressos produzidos por cinco instâncias e entrevistas com atores centrais de Programas de Saúde do Trabalhador. Verificamos que a segmentação do público é raramente abordada pelo pólo emissor, que discute simultaneamente uma série de temas, privilegiando sua própria perspectiva. As intenções do pólo emissor são as de informar o leitor sobre processo saúde-doença relacionado com o trabalho e orientá-lo quanto à adoção de procedimentos e comportamentos para promoção de saúde. Consideramos que o pólo emissor apresenta uma concepção instrumental de comunicação, fundamentada na transmissão de conhecimentos de forma linear e verticalizada. A saúde é discutida de maneira restrita reproduzindo os discursos dos modelos sanitário e biomédico. Concluímos que há uma tendência a utilizar os impressos como um fim, o que contribui para demarcar a distância entre os interlocutores no processo comunicativo mediado.