6.D. Skills building seminar: Family Vulnerability Scale: Why and how to use at Primary Health Care to promote health equity?
Authors:   Organised by: Hospital Israelita Albert Einstein (Brazil),   Chair persons: Ilana Eshriqui (Brazil), Lorrayne Belotti (Brazil)
Published: October 2024

Family vulnerability encompasses multiple perspectives that are interconnected with the health needs of each family member. Families experiencing vulnerability face heightened risks of poor health outcomes. Nonetheless, these vulnerabilities are further compounded by systemic inequalities within healthcare systems, where biological or clinical factors are exclusively considered to organize and/or prioritize access, especially given the scarcity of valid instruments to measure family vulnerability. Primary Health Care (PHC) plays a pivotal role in addressing health inequalities, especially considering its bond with community. From this context, the Family Vulnerability Scale for Brazil (EVFAM-BR, in Portuguese) was developed and validated, been composed of 14 items about four dimensions (income, healthcare, family and violence) (2019-2023). By reducing the gap between science and practice, the implementation process of EVFAM-BR was started at the same year the scale was validated (2023). First, it occurred at 14 PHC services in São Paulo (Southeast Region, Brazil) and second, since 2024 has been implemented at Boa Vista (North Region, Brazil). Also, between 2024 and 2026, the implementation of EVFAM-BR is expected to take place in other Brazilian states participating in the third phase of the PlanificaSUS project, which is developed aiming to support State health departments to implement the Health Care Planning method to organize and integrate PHC and specialized outpatient care based on population health care needs. At this stage, capacity building is needed to align the concept of family vulnerability and to train PHC managers and health professionals on how to apply and use results from EVFAM-BR. This training has already been performed for around 1,000 health professionals from two different regions of Brazil, including managers, Community Health Workers, nurses, and physicians. The present workshop proposal aims to disseminate the EVFAM-BR and to offer the EVFAM-BR experience. It proposes knowledge transferring throughout participants engagement at three activities. Activity 1) “Family Vulnerability: From concept to a scale validity and application”: it is designed to engage participants to discuss about the family vulnerability concept and applicability at PHC, and to discuss on how EVFAM-BR implementation process has been occurring at Brazil and how can be tailored to other contexts. Activity 2) “Role Play: Practicing EVFAM-BR”: Two cases will be used for role play dynamics that will take place in trios, in which one will represent the community health worker, another will be the patient and the third will be the observer. Activity 3) That ones that assumed observer role will share their experiences of using EVFAM-BR. Finally, a discussion will be facilitated based on the participants’ impressions and a review of the main points covered throughout the workshop.

Key messages

• Family vulnerability stratification (through EVFAM-BR) is essential to plan services achieving equity and qualified population-based care management and to qualify patient approach and care.

• Family Vulnerability Scale (EVFAM-BR) training represents efforts to reduce the gap between research and practice and contributes to address social determinants of health on healthcare.