Objective To analyze the strengths and limitations of the Family Health Strategy (ESF) from the perceptions of healthcare professionals and community. Methods Between June-August 2009, in the city of Vespasiano, Minas Gerais State, Southeastern Brazil, a questionnaire was applied to evaluate the ESF with 77 healthcare professionals and 293 caretakers of children under five. Health professional ESF training, community access to care, patient communication, and delivery of health education and pediatric care were of main interest in the evaluation. Logistic regression analysis was used to obtain odds ratios (OR) and 95% confidence intervals (CI). Results The majority of health care professionals reported their program training was insufficient in quantity, content and method of delivery. Caretakers and professionals identified similar weaknesses (services not accessible to the caretakers, lack of healthcare professionals, poor training for professionals) and strengths (community health worker-patient communications, provision of educational information, and pediatric care). Recommendations for improvement included: more doctors and specialists, more and better training, and scheduling improvements. Caretaker satisfaction with the ESF was found to be related to perceived benefits such as community health agent household visits (OR 5.8, 95%CI 2.8;12.1), good professional-patient relationships (OR 4.8, 95%CI 2.5;9.3), and family-focused health (OR 4.1, 95%CI 1.6;10.2); and perceived problems such as lack of personnel (OR 0.3, 95%CI 0.2;0.6), difficulty with access (OR 0.2, 95%CI 0.1;0.4), and poor quality of care (OR 0.3, 95%CI 0.1;0.6). Overall, 62% of caretakers reported being generally satisfied with the ESF services. Conclusions Identifying the limitations and strengths of the ESF from the healthcare professional and caretaker perspective may serve to advance primary community healthcare in Brazil.

In 2014, Family Success Alliance (FSA) was formed as a place-based initiative to build a pipeline of programs to reduce the impact of poverty on outcomes for children living in Orange County, North Carolina. In this study, FSA parents’ perception of child health, parent and child adverse childhood experiences (ACEs), and resilience were obtained by parent interview. Receipt of recommended health services were abstracted from primary care medical records of FSA children. Correlation coefficients investigated relationships among health, ACEs, and resilience. Among 87 parent-child dyads, 65% were Spanish speaking. At least 1 of the 7 ACEs measured was reported in 37% of children and 70% of parents. Parent perceptions of child health were lower than national averages. Routine preventive services included the following: autism screening at 18 months (15%) and 24 months (31%); ≥4 fluoride varnish applications (10%); lead screening (66%); and receipt of immunizations (94%). Parent perception of child health was moderately correlated with resilience.