Tree as Metaphor: Reflections and Propositions of Community Health Workers on their Work in the Territory in the Context of Violence and COVID-19

Authors

DOI:

https://doi.org/10.5020/18061230.2026.17032

Keywords:

Community Health Agents, Primary Health Care, Public Policy, Family Health Strategy

Abstract

Objective: This study explores community health workers’ (CHWs) perspectives on territorial violence and mental health during the COVID-19 pandemic. Summary of data: Data were grounded in participatory methodologies that fostered dialogue between researchers and CHWs. Data production involved the construction of metaphorical trees representing CHWs’ perceptions regarding the research process, strengths, vulnerabilities, and future directions. These trees synthesized CHWs’ knowledge, practices, and learning experiences, while also generating proposals to improve care through stronger integration with health management and healthcare delivery. Furthermore, they enabled the exchange of experiences and emotions among participants through qualified listening and collective discussion, considering the actual training needs of professionals facing challenging living contexts involving violence, COVID-19, mental health, and the production of healthcare. Conclusion: This report highlights three key aspects that warrant attention. First, it underscores CHWs’ engagement with the feedback of research findings, including the validation of results by participants and the reinterpretation of these findings through collective discussion within their territories. Second, it emphasizes CHWs’ active participation in identifying challenges and opportunities to address the issues raised by the study. Finally, it points to the need, identified by CHWs themselves, for training processes and support mechanisms aimed at developing actions and tools to strengthen their work processes in territories marked by the daily experience of violence.

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Author Biographies

Franklin Delano Soares Forte, Federal University of Paraíba, João Pessoa, Paraíba, Brazil

PhD in Preventive and Social Dentistry from the School of Dentistry of Araçatuba, São Paulo State University (UNESP). Associate Professor in the Department of Clinical and Social Dentistry, Health Sciences Center, Federal University of Paraíba.

Andre Sá Oliveira, Oswaldo Cruz Foundation, Recife, Pernambuco, Brazil

PhD in Public Health from Fiocruz–Aggeu Magalhães Institute (IAM), with a concentration in Epidemiology and Disease Control; MSc in Geodetic Sciences and Geoinformation Technologies from the Federal University of Pernambuco (UFPE); Specialist in Epidemiology Applied to Health Services of the Unified Health System (EpiSUS Intermediate Program); Specialist in Environmental Auditing and Expertise; and Bachelor's degree in Geoprocessing. Senior Public Health Technologist (Geoprocessing) at Fiocruz Pernambuco–Aggeu Magalhães Institute, affiliated with the Statistics and Geoprocessing Center (NEG). Permanent faculty member of the Multiprofessional Residency Program in Public Health at Fiocruz Pernambuco and of the Professional Master's and Doctoral Programs in Public Health. Collaborating faculty member of the Academic Graduate Programs in Public Health and Biosciences and Biotechnology in Health at Fiocruz Pernambuco. Member and researcher of the Nós APS Brasil Network.

Maria de Fátima Antero Sousa Machado, Oswaldo Cruz Foundation, Eusébio, Ceará, Brazil

Bachelor’s degree in Nursing from the University of Fortaleza (1982), Master’s degree in Nursing from the Federal University of Ceará (2001), and PhD in Nursing from the Federal University of Ceará (2007). Postdoctoral training in Education at the State University of Ceará (UECE). Retired faculty member of the Department of Nursing at the Regional University of Cariri (URCA). Faculty member of the Professional Master's and Doctoral Program in Family Health (RENASF/FIOCRUZ-CE).

Neiva Francenely Cunha Vieira, Federal University of Ceará, Fortaleza, Ceará, Brazil

Bachelor's degree in Nursing from the Federal University of Ceará (1979), Teaching Degree from the State University of Ceará (1984), Master's degree in Education from the Federal University of Ceará (1991), and PhD in Health Education from the University of Bristol (1998). Full Professor at the Federal University of Ceará. Permanent faculty member of the Graduate Program in Nursing (CAPES score 7) and the Professional Graduate Program in Family Health (CAPES score 5), developed in partnership with Fiocruz Ceará. Undergraduate faculty member in the Nursing Program.

Andréa Silvia Walter de Aguiar, Federal University of Ceará, Fortaleza, Ceará, Brazil

DDS from the Federal University of Ceará (1989), Master's degree in Public Health from the State University of Ceará (2001), and PhD in Dentistry, with a concentration in Public Health, from the School of Dentistry of Pernambuco, University of Pernambuco (2006). Currently serves as Full Professor at the Federal University of Ceará.

Alice Maria Correia Pequeno, Ceará School of Public Health Paulo Marcelo Martins Rodrigues, Fortaleza, Ceará, Brazil

Bachelor's degree in Geology from the University of Fortaleza (1988) and Master's degree in Geology from the Federal University of Ceará (1998). PhD in Public Health from the School of Public Health, University of São Paulo. Postdoctoral training in Education at the State University of Ceará. Former permanent faculty member of the Professional Master's Program in Health Education at the State University of Ceará, where she coordinated courses on Active Teaching-Learning Methodologies and Learning Assessment. Permanent faculty member of the Professional Master's and Doctoral Program in Family Health (RENASF–UECE) and of the Nursing Program at Centro Universitário da Grande Fortaleza (UNIGRANDE). Teaches Environmental Health, Nursing Research Methodology, General Epidemiology, and Health Surveillance. Member of the ABRASCO Working Group on Health Surveillance (GT-VISA). 

Grayce Alencar Albuquerque, Regional University of Cariri, Crato, Ceará, Brazil

Registered Nurse. Tenured faculty member at the Regional University of Cariri (URCA). PhD in Health Sciences from the Graduate Program of the ABC Medical School. Postdoctoral training at Fiocruz Ceará. Leader of the Research Group on Gender, Sexuality, Sexual Diversity, and Inclusion (GPESGDI). Coordinator of the Violence and Human Rights Observatory of the Cariri Region at URCA. Permanent faculty member of the Academic Master's Program in Nursing and of the Professional Master's and Doctoral Programs in Family Health through RENASF. Vice-Coordinator of the Professional Master's and Doctoral Programs in Family Health through RENASF. Member of the Chief Scientist Program of the Ceará State Secretariat for Women (SEM), in partnership with UECE and URCA, where she develops the project “Addressing Violence Against Women in the State of Ceará: Propositions and Social Technologies in Public Policies.” Her current research focuses on Collective Health, Health Promotion, Public Health, and Nursing, with emphasis on cross-cutting themes such as sexuality, gender, race, sexual diversity, social inclusion, violence against women and vulnerable populations, drug use, risk behaviors, humanization of healthcare, and accessibility to health services.

José Maria Ximenes Guimarães, State University of Ceará, Fortaleza, Ceará, Brazil

Public Health Specialist. Bachelor's degree in Nursing from the State University Vale do Acaraú (1997); Specialist in Public Health (UVA, 2000); Specialist in Family Health (UNIFAP, 2003); Specialist in Health Management (UECE, 2012); Specialist in Mental Health and Psychosocial Care (Estácio, 2021); Master's degree in Public Health from the State University of Ceará (2007); and PhD in Collective Health from the State University of Ceará (2012). Completed a postdoctoral fellowship in Family Health at Fiocruz Ceará (2023). Permanent faculty member of the Graduate Program in Collective Health and the Graduate Program in Family Health at the State University of Ceará. Researcher in the Nursing, Clinical Mental Health Care, and Family Health Research Group, registered in the CNPq Directory of Research Groups. Municipal Health Council member in Fortaleza. Since 2022, he has worked as a nurse in Fortaleza’s Psychosocial Care Network, where he serves as a preceptor in the Collective Mental Health Residency Program. He is Associate Editor of RECIIS (Electronic Journal of Communication, Information and Innovation in Health) and serves as an ad hoc reviewer for several national and international scientific journals in the health field.

Elaine Ferreira Nascimento, Oswaldo Cruz Foundation, Teresina, Piauí, Brazil

Public Health Technologist and Researcher at Fiocruz Piauí. Bachelor's degree in Social Work from the Federal Fluminense University (1997), Master's degree in Science from the Fernandes Figueira Institute, Oswaldo Cruz Foundation (2002), and PhD in Science from the Fernandes Figueira Institute, Oswaldo Cruz Foundation (2007). Completed a postdoctoral fellowship in African Diaspora and Indigenous Peoples’ Cultures at the University of Pernambuco (UPE) in 2023.

Anya Pimentel Gomes Fernandes Vieira-Meyer, Oswaldo Cruz Foundation, Eusébio, Ceará, Brazil

DDS from the Federal University of Ceará; MSc in Pediatric Dentistry from the University of London, United Kingdom; PhD in Dentistry from the University of Toronto, Canada; and Postdoctoral training in Public Health from the University of California, Berkeley. She is a Senior Researcher at the Oswaldo Cruz Foundation (Fiocruz Ceará), where she also serves as Executive Secretary of the Northeast Network for Family Health Training (RENASF). In addition, she is a faculty member in the Dentistry Program at Unichristus. She is currently a Visiting Researcher at Harvard University (2024), affiliated with the David Rockefeller Center for Latin American Studies and the Takemi Program in International Health.

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Published

2026-05-29

How to Cite

Forte, F. D. S., Oliveira, A. S., Machado, M. de F. A. S., Vieira, N. F. C., Aguiar, A. S. W. de, Pequeno, A. M. C., … Vieira-Meyer, A. P. G. F. (2026). Tree as Metaphor: Reflections and Propositions of Community Health Workers on their Work in the Territory in the Context of Violence and COVID-19. Brazilian Journal in Health Promotion, 39, 1–11. https://doi.org/10.5020/18061230.2026.17032

Issue

Vol. 39 (2026)

Section

Experience Report

License

Copyright (c) 2026 Franklin Delano Soares Forte, André Sá de Oliveira, Maria de Fátima Antero Sousa Machado, Neiva Francenely Cunha Vieira, Andréa Silvia Walter de Aguiar, Alice Maria Correia Pequeno, Grayce Alencar Albuquerque, José Maria Ximenes Guimarães, Elaine Ferreira Nascimento, Anya Pimentel Gomes Fernandes Vieira-Meyer

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