Integrative Community Therapy and its Benefits for Primary Care : an Integrative Review

Paula Frassinetti Oliveira Cezário1, Laryssa Lins de Araújo1, Thiago Lívio Barbosa Pereira2, Olga Feitosa Braga Teixeira3, Arielle Wignna Brasil Abrantes4, Edjane de Sousa Andrade5, Nadja Gonçalves Almeida5, Maura Vanessa Silva Sobreira6, Jesana Sá Demasceno Moraes7, Petrônio Oliveira Cezário8, Ankilma do Nascimento Andrade Feitosa9, Anna Emíllia de Oliveira Maciel Freitas5, Saskia Carolino de Abreu Andrade Moreira10, Franscisca Karla Esmeraldo Neves5, Gerlane Cristinne Bertino Véras3


Introduction
The Integrative Community Therapy (ICT) emerged in the mid-1990s, through the Faculty of Medicine of the Federal University of Ceará, with the methodology creating interpersonal and intercommunity meetings, which favored experiences of sharing knowledge, experiences and later, promoted the creation of supportive links between the members of the group [1].
The instrument used by the group facilitates and proposes measures for the construction of solidarity networks because corroborate precisely with the five themes proposed; these are: Systems Thinking, Communication Theory, Cultural Anthropology, Paulo Freire's Pedagogy and concept of Resilience.Each axis is grounded in theoretical approaches that legitimizes the procedures to be followed [2].
When working the being as part of an indispensable context of a web of communication and relationship, there is the exchange and receipt of subjectivity, given that there is a need for bargaining and participation of the subject as a whole, which is responsible for building his own history, which means that the need for strengthening him during this trajectory.It is understood that when the being is in contact with groups there is a greater availability to cope [3].
Thus, the inclusion of ICT in healthcare is becoming more popular through different social actors, such as professionals from various areas, managers, users, family and community, which help to add and complement actions.
The inclusion of ICTs in the Family Health Strategy was an important milestone for the development of actions in the context of primary care, due to its effective functioning promote the discovery, verbalization and appreciation of positive sensations, thus providing the transformation of excluded individuals in the community in people with socio-cultural values that deserve to be respected and appreciated by the other members of the group [4].
From studies that show the importance of ICT as a tool for improving health in primary care, can highlight and direct therapy as an aid mechanism, while the same be referred consistently to a particular group, as this approach with different realities fosters a knowledge of empowerment.
Thus, this study aimed to describing how it is being implemented Integrative Community Therapy in the Family Health Strategy.

Method
We opted for the conduction of an integrative literature review, because it addresses, in a satisfactory manner, the established objective, in addition to performing, as a broad method, which allows the incorporation of several studies, thus resulting in a more comprehensive knowledge about the subject studied [5].
The integrative review process includes six distinct stages, similar to conventional research stages of development: 1 st ) Issue identification and selection of the research question.This step begins with the definition of the problem and formulates a research hypothesis, which must have relevance to the health of individuals.In this sense, the guiding question of the study was: How is being implemented Integrative Community Therapy in the Family Health Strategy? 2 nd ) Criteria for sample selection.On March 7 th , 2015, there was carried out the search of publications through research in databases of the Latin American and Caribbean Health Sciences (LILACS), Scientific Electronic Library Online (SciELO) and Medical Published -service of the US National Library of Medicine (PubMED).They used the descriptors: Community Therapy, Family Health, bond, Communitarian Therapy, Family Health, bond, communal therapy, and link.Inclusion criteria articles were: articles and/or books that addressed the selected descriptors, published in Portuguese, English or Spanish, in the period between 2009 and 2014.Thus, after performing the search they found 338 publications, of which, by using the inclusion criteria resulted in 8 articles found in SciELO, 2 publications of the Ministry of Health, 4 books, one article from the LILACS and 1 PubMED, totaling 16 publications.3 rd ) Identification of pre-selected or selected studies.Initially, there was performed a careful reading of the titles and abstracts of all selected publications trying to analyze if these were in line with the previously established inclusion criteria.Then it was performed a complete reading of publications to consolidate the suitability of these the goal of the study, resulting in the final articles it obtained 25. 4 th ) Categorization of studies.This step is considered similar to the collection of conventional data, for which we used a tool [6] that allows the researcher to evaluate, individually, selected studies, analyzing them methodologically and in relation to synthesis of the findings.Thus, studies were listed through a careful reading and inclusion criteria chosen.
5 th ) Analysis and interpretation of results.For analysis and subsequent synthesis of the articles, the results were divided into six topics: Integrative Community Therapy: historical and theoretical foundations; Pedagogy of Paulo Freire; Cultural Anthropology; Resilience; Theory of Human Communication; Systems Thinking; Integrative Community Therapy and its implementation in Primary Care; and benefits of Integrative Community Therapy in primary care.6 th ) Presentation of synthesis of knowledge.The knowledge gained by conducting this review was presented as a document, which forms the explicit content in this scientific work.Education [9][10], Gaucha Journal of Nursing [11,19], Science & Public Health [12,17], magazine USP School of Nursing [14], and Health & Society [15].The most publishers were published: Graphic LCR [2], University Publishing UFPB [4,7], Peace and Earth [8], and the Ministry of Health [16,18].

Integrative Community Therapy: historical and theoretical bases
The therapy began to be worked informally, from informal meetings, each member of the community or the school participated in the meetings and dialogued with others so that everyone could hear and see each other.To that end they were forming the meetings, which always made mention of a therapeutic and preventive approach in mental health.
The method approached by Barreto [2], assumes the strengthening of social support networks, leaving be interconnected, since the formal organization, to the informal relationships, as in that a group connects to another it turns out to raise awareness and subsequently forming bond.
The ICT's allows you to view the group awareness where those involved are taken through a process of individual and collective transforma-tion, bringing them closer to the evident reality and strengthening the construction of networks in the society to which they belong.Thus, they are excluded from ICT spaces which are intended to check and/or monitor patients [7].
ICT is based on five pillars which are: Paulo Freire's Pedagogy, Anthropology, Resilience, systemic thinking and theory of human communication [2].

The Pedagogy of Paulo Freire
The pedagogy of Paulo Freire is employed in the ICT as a way to drive the man to the construction of his own history, because, from the moment that one reflects and becomes owner of his freedom, he begins to act naturally and build real relationships.Paulo Freire in some of his literary works [8,[20][21][22] makes mention of liberating education, and this is well known and discussed by educators around the world.In the study of liberation, man is directed to a literacy which forwards the popular learning, fitting to be experience and exchange knowledge learned with the environment.
The banking education was quite reprimanded by Paulo Freire through the book "Pedagogy of the Oppressed" [8], criticizing the approach taken by some educators.According to him, education was offered to students through imposition, and its vertical structure, ie only the teacher was able to think and to recognize all the knowledge and this knowledge should be neglected to the student, because the one who held all knowledge was the educator.In this form of education the student was "conditioning receivable" and not "returned no knowledge in half", thus making it devoid of reality and criticality.In this respect education was the oppressor that used the prior knowledge and oppressed the student, as this information would need to think and act.In Freire's [8] approach it can highlight the importance of working to popular education as the oppressed release mechanism.To the extent that the individual begins to think and act it stops being overwhelmed and begins to face its problems.And this approach with other realities allows ideologies of confrontation that culminates in context, questioning, and strengthening of man to the desire to communicate and interact with the environment.
The development of Freire's work has on the individual an ability to combine, multiply and divide the knowledge acquired, bringing a concern.It is very important that people, as well as health professionals, understand and put into practice popular education in health facilities, since no working health imposing knowledge of the suffering to which the patient shows at the time, and rather, inviting the others to share their negative moments [9].
With the insertion and applicability of educational practices at the facility, there will be a strengthening of ties between professionals, users and community.Another important factor that can be noticed is the accession of users to educational practices, as well as users who plan together with the health professional, ways to improve the community and territory which they live [9].

Cultural Anthropology
Cultural anthropology is mentioned in the ICT to present the traces of culture with simultaneous exposure of the representation of nature, the meaning and language.Man becomes the main objective of the study, while the anthropology to identify the social and cultural relations that it performs the environment they live [4].
The study of Adilha [10] reveals that culture cannot be left out because characterizes who we are, explains the means to relate and how we do it.This culture implies the act and thinks so because it is something that we are given early, following an individual and/or family line.
When looking to Brazil we see the cultural diversity that must be understood and understood.In contemplating the diversity we become more understandable and kind, and in this order, there will be a strengthening of mutual interests and civilizations that grow in fraternity, and everyone wins.Culture permeates generations, which explains the changes occurred with the individual, such as the influence in certain habits, customs and possible biological developments.As the culture generations will traversing it will incorporate other social values [11].
While there is the presence of a territorial delimitation where the man is inserted, cultural and ideological differences, make up the characteristic of each being who thinks and relates.Differences when used in order to criticize or separate what is different from what is understood as "normal" by a particular group, it becomes a weakness, needing to be worked to strengthen the ties [11].
Health professionals who work in a particular community know the problems of the territory.When they work the group differences, they allow the individual to understand the importance of being culturally different and promotes learning about the other [3].
Cultural anthropology in ICT is gratifying because those involved will learn to respect each other because of the diversity, given that, to the extent that the man understands and accepts his conditioning, tends to use strategies to relieve his pain, promoting thus targeting to resolve his anxieties.

Resilience
The Resilience is employed in ICT as a means of emphasizing the values, which are highlighted as common factors in individuals, because each one brings some experience, whether gained through everyday experience or experience gained through studies and / or from school.To the extent that man experiences and recognize their experiences, it begins to highlight the importance of human values [11,23].
When a person begins to understand better about life, you begin to afford to live, to be free and be more transparent with others, with even more love and enthusiasm to tackle the problems affecting [24].
A resilient person is able to understand the problems that affect them can also be common to other families, learning to experience them through pain and are not necessarily individuals overflowing feeling and rancor to the next.In this perspective involved in ICT can transform weakness into a strength, which directs you to want to be someone better [11].
Resilience can and should be used as health promotion mechanism, since it serves as a foundation for families.Involved in the process begin to understand that the socioeconomic problems or diseases may affect the organizational structure of the house as well as the psychological those who suffer, but if people take the downside and not begin to give off or to share their problems, user will not be allowed to evolve and cannot live with the problem that affects him.It needs to develop family resilience capabilities to be able to overcome, adapt or forget the problem that affects [12].

The Theory of Human Communication
The Theory of Human Communication was created by Watzlawick, Helmick-Beavin and Jackson [13], one of the pillars used in ICT.Their study explains the man's behavior can be observed in the actions taken by the being, highlighting also how to act and to communicate, even when there is verbalization of any message.In this case, he may be canceling his perception in another reference as: "you do not exist" and "do not care" among other denials.
People who are experiencing the therapy begins to see that is not good cancel or ignore people, and this feeling results in a decreased self-esteem, generating guilt.
When the man begins to decode and implement his real nature, he will begin to understand what might have failed and given up many fights, but with determination and grit he can win some circumstances.The therapy aims to strenghten freedom and self-esteem of man, ditching the poor sufferer, who lives at the mercy of exclusion, be it family or social.With this thought the man takes care of his own direction [4,11].
Often in therapy or in the training of community therapists, participants are led to discover the false images they have made themselves, and that has trapped throughout life, or for long periods of time.When one begins to understand how someone who won many battles, someone who knew how to give a comeback in circumstances that could have it broken or deviated from its path, the concept of self begins to emerge in a positive manner [14,23].
The theory of human communication is of utmost importance to find ourselves as people who have insight and ability to face possible barriers that may hinder our journey.The theory explains that man is able to relate with the environment, whether through language, or through gestures.This understanding must be understood by the people so that they realize how much is unnecessary mistreat each other with aggressive and derogatory expressions.
When people are invited to participate in the therapy they begin to accept as they are, and do not question or regret for the events of his past.

Systemic Thought
Systemic thought has ancient traits, being represented by people who conceptualized and conceived our reality, such as the Maya or the ancient Greeks, and are also present during the creation of America and or Kogui mythology.According to Octavio Paz and Ramon, these people "have a more cohesive world, prior to any break of modernity and utilitarian rationalism" [7].
Corroborating the study, Ferreira Filho, Lazarte and Dias [7] present the possible existing systems in our country and even the complete explaining its functionality with the environment.There are among us the solar system and the human body, both carry out their functions in a balanced way, in order not to misalign any function.
Barreto [2] explains that the systems thinking helps us problems and can be used to understand them and solve them, as long as the person realizes that there is a connection or branch that directs the whole, and that all understand the biology (one involvement with the body), psychology (mind and emotions), and society (culture).Both are interconnected and act together, if one of these is changed the person goes into a breakdown, so the importance of working the system, since to identify the path, those involved begin to understand and seek an individual transformation.
As emphasized by Barreto [2], Systemic Thought helps in coping with problems, and work with this theme in the FHS becomes something advantageous.It is for the professional work of the health context of more comprehensive manner, refraining from the old biomedical model, in which health care was seen in a fragmented way.Thus, health needs to be crafted of multidisciplinary and shared, allowing the participation of social actors in treatment.

Integrative Community Therapy and its implementation in basic care
The reform of primary health care was a landmark event, coming from highly stable countries to countries less structured economically.This change was necessary due to the high costs generated by health, which were being produced in the budget.In an effort to ensure proper compliance with the new without increasing public spending, it was necessary to reorganize the healthcare facilities, to better work with the group of elderly and patients with chronicities [15][16].
The health service was implemented in order to meet people and study the affections that cause the diseases.In this respect, health became a state responsibility, which should guarantee the solving of problems, and professional duty to understand what the health service and develop strategies to improve service to clients [23].
To ensure adhesion and resolution of cases of health professionals began working educational activities.Thus, to the extent that the user is invited to share his problem, this is being sensitized to understand the concept of his illness and how it should be conducted to reduced comorbidity [17].
In 1994 it was created the Family Health Program by the Ministry of Health, which is now called FHS, a project designed to strengthen the actions carried out in primary care.This arose from the need to reorganize the current biomedical model at the time.To do this, it set up the implementation of the health unit in a location covering a large population group, which in this environment people would receive approach of health professionals, and this mutual approach would promote the formation of a bond of trust and co-responsibilities between everyone involved in this process [23].
In primary care health actions it should be aimed at promotion, prevention and rehabilitation, should be worked out clearly and objectively the population, thus providing the fulfillment of the objectives set by the SUS, working in a comprehensive and humane way in service to users.However, the reality observed in these places consists of a fragmenting care and weakened, without the right multidisciplinary effort [3,19].
ICT is to affirm the need to have the other in our midst, to seek, to include and understand human behavior in its active functionality.ICT should be developed in primary care linking their community to the benefit of performance and providing a subjective and dynamic work, which can be done with people from different groups, with extremely low financial cost.Another advantage approaching its actions to primary care is related to the fact that ICT work preventive measures, promotion and rehabilitation, which promotes benefits for professional users and the community [3].

Benefits of Integrative Community
Therapy in the basic attention Barreto [2] in his studies highlights the advantages of working in the ICT community.The method approached by ICT rests on five pillars, which are essential to live well anywhere where there is the presence of a group.This theme addressed the person is invited to better understand and seek a possible solution to the problems that affect you.
Because the territory be inserted in a given geographic area, there is a delineation of health care performances, as well as recognition of the area, favoring the distribution of health service actions in both adjacent and vertical lines, which are the centers of health for references [19,25].
The advantage of having the ICT as an aid tool in primary care is that this will serve as input to users for better understanding and conduct their difficulties.In addition to enabling those involved a broad knowledge, whether acquired through scientific and / or popular knowledge [4].ICT promotes a welcoming approach, helping people to integrate and feel safer by helping them thus express their daily suffering.This makes it possible to work more efficiently and problem-solving way the mental health of those involved within the community therapy [10,19].
The proper functioning of ICT in health facilities results in qualified listening and improving interpersonal relationships, and everyone involved in this process sensitized by other problems, which im-pacts directly and indirectly on the mental health of all subjects [25].
ICT is applied seeking to promote a reorganization of ideas and thoughts.Thus, the subject can work subjectivity and understand that they should seek a solution to address their problems.Thus, when working with therapy, there is the stimulation and strengthening of social networks, resulting in one solving health problems.

Conclusion
Some articles point out that the implementation of ICT in primary care is clearly taking place, as well as having satisfactory results for the accession of the participants.ICT works in staff educational activities, which are simultaneous consolidation of social networks of these individuals, which provide for professionals, community members and the strengthening of the bond, thus promoting the fight for the health of all.
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Table 1 . Characterization of publications according to the authors, title, journal/publisher, year, from 2009 to 2014. Authors Title Journal/Publisher, Year
[9]sch TMP et al.[9]How primary care practitioners understand and develop Popular Education in Health?Interface Communication, Health, Education, 2014 Adilha CS, Oliveira WF [10] Community therapy: practice reported by network professionals of SUS in Santa Catarina, Brazil Interface Communication, Health, Education, 2012 Rocha IA et al. [11] Integrative community therapy: situations of emotional distress and coping strategies presented by users Gaucha Nursing Magazine, 2013