The educative interventions - health education workshops and home visits - achieved positive results in the knowledge and grasp of individuals with hypertension regarding the disease and risk factors. There was an increase in knowledge on the disease in both intervention groups, especially in Group 2, thereby demonstrating the greater effectiveness of home orientation. These results underscore the importance of follow up and dialogic, participative health education, considering the low level of schooling of the participants and unsatisfactory knowledge of this population regarding their own health status prior to the intervention.
The acquisition of knowledge about the disease, and ways to control it, favors adoption of attitudes that can influence health at family and community level (25). Health awareness is preceded by full access to information and education as a way to make individuals and communities capable of greater control over their own wellness, which is an essential goal in public health, especially on the primary health care level (7,10,26).
In Group 2, the home orientation strategy - privileged intervention locus - led to beneficial changes in diet, with an increase in the consumption of foods considered either protective or without health risk, especially the consumption of whole-grain cereals. In Group 1, which only underwent the health education workshops, there was also a tendency toward better eating habits, as there was a reduction in the intake of risk foods and an increase in the intake of protective foods, even though there was no statistically significant difference in the consumption of the different food groups before and after the intervention.
The home orientation strategy had a more significant effect on the reduction in oil and sugar intake. As the intake estimates of these foods were calculated based on monthly availability in the residence, one may suppose that the home orientation led to an important alteration in intake not only for the women studied, but also for their families, which demonstrates the importance of home visits in the context of the FHP.
The reduction in salt intake was not statistically significant in either intervention group. A number of studies in the literature indicate that, despite the understanding of individuals regarding the association between salt intake and high blood pressure, this dietary change is not achieved easily (7,26,27,28). However, in the group that received home orientation, those individuals who had an initial salt intake greater than 15 g/day achieved a significant reduction in this parameter by the end of five-month period, thereby demonstrating the positive impact on the home intervention to correct large deviations in salt intake.
The greater adherence of group 2 was confirmed by changes in clinical and nutritional variables. Group 2 achieved a significant reduction in weight, BMI, waist circumference, systolic BP and glucose, whereas Group 1 only achieved a reduction in waist circumference. However, the reduction in waist circumference in Group 1 indicates significant and important dietary modifications, since the abdominal obesity is related to an increased risk of myocardial infarction, stroke and premature death (29). It should be stressed that the educative workshops Group 1 underwent were held with the participants actively engaged in a participative, dialogic, interactive process.
It was not possible to establish a statistical association between dietary changes and alterations in the clinical and biochemical parameters assessed in the different intervention groups. The increase in protective foods - rich in fiber, vitamins and minerals and poor in fat and salt - may at least partially explain the positive results in the clinical, anthropometric and biochemical variables in the group that received home orientation, as demonstrated in studies relating eating patterns and risk factors for cardiovascular disease (30,31).
The home visit, in the context of health education, is an important tool in the consolidation of new practices encouraging the adoption of healthy lifestyles through health promotion and prevention of diseases and disorders. In this sense, the visit allows the understanding of psycho-affective-social and biological characteristics of individuals and families, recognizing the family activity as a privileged locus for interventions. The diagnosis of the home visit prioritizes the individual's reality and education initiatives. It is a key instrument of intervention in family health and continuity of care, being programmed and used in order to support interventions and to provide comprehensive care for individuals and families. It brings a new meaning in the practices of the professionals of the FHP allowing that the socio-economic and cultural surrounding habits, customs and beliefs are considered in their approach. The challenge is to incorporate the home visit as an individual, family and community activity aimed at solving real life problems. In addition, home visit is an important strategy to motivate the individual, family and community to participate in the planning, organization and control of the therapeutic project.
However, the management of home visits in a compulsory manner by health professionals presents serious operational problems. The first concerns the optimization of resources available for health care. The high number of registered families and the high demand for services in the Unit of Primary Health Care makes it impossible to respond to all families through the home visit. Associated with that, are also the work schedules and chores, difficulties related to time and way of locomotion of the team to the households (long walking distances and steep terrain, rain, excessive heat), and fear and ignorance of the population about the purpose of home visit that can disable and/or impair this kind of visit.
Despite the individuals in Group I have demonstrated knowledge acquisition on hypertension and their ways of controlling this alone was not sufficient to promote changes and adoption of the dietary modifications recommended for hypertension. It has been demonstrated that knowledge regarding hypertension does not necessarily imply a change in behavior (7,25).
While reinforcing this in the literature, that points out to the advantages of home visits, especially in regard to the approximation of the health service, represented by the technician, with the reality of family life. It is noteworthy that these results are preliminary and punctual, based on a limited sample, which has major limitations for further generalization of data. This limitation relates mainly to large cities, given the disproportion between the number of cities participating in the program and the enrolled population, generated by the difficulty to expand the Units of Primary Health Care in large cities that face the challenges inherent to the health sector, in addition to the problems posed by urban complexity, such as violence.