Aspectos psicossociais na adesão a tratamentos da hipertensão arterial e diabetes mellitus: concepções e ações de agentes comunitários de saúde

Abstract

Within the context of the primary attention to health, there are integrated actions of education and care for people with Arterial Hypertension and Diabetes Mellitus which, in Brazil, occurs through the Estratégia Saúde da Família (ESF), in line with the work of the Agentes Comunitários de Saúde (ACS). In common, such diseases are chronicle and if they are not controlled, may raise the risk of complications to health, pointing out the importance of suitable and continuous interventions to encourage the adhesion to its treatments. The adherence is the measure in which the behavior of the person corresponds to the prescriptions and recommendations of the health professional without restricting the mere obedience. Psychosocial factors can contribute and constitute barriers that may make adherence difficult. It is expected that the ACS have the knowledge and skills to favor the adherence in the cases they follow. Upon the complexity and relevance of the theme, there was a research aiming at investigating the perceptions of the ACS in which refers to the identification and handling of the psychosocial aspects that influence the adherence to the treatments of the users with diagnostics of Arterial Hypertension and/or Diabetes Mellitus, as per their experiences within the scope of the ESF of a city in Rio de Janeiro. Data collection was conducted with three nurses and sixteen ACS from three SFH teams and included multiple procedures: a questionnaire to obtain sociodemographic and professional data from the participants; semi-structured interview with the nurses; focus group and workshop to discuss clinic case with the ACS. The obtained material was categorized and analyzed according to the Content Analysis of Bardin. Good adherence to the treatment was understood by the ACS as acceptance of the disease/treatment, attendance to the consultations and active involvement in the treatment. On the other side, the results showed difficulties of adherence related to the use of medications, following the food diet and change in lifestyle, influenced by health service, psychological, familiar, social barriers and the treatment features. In order to deal with the adherence problems, they presented a strategic, creative and diversified action repertoire, backed to the intervention itself or to the search of support with other professionals and users’ families. In their interventions, they received support of the reference team, as well as from the team of matrix-based strategies. However, for a greater integrality of care to the user, they suggested to obtain a regular support of the mental health team, with special attention the Psychologist, besides the opportunity of more courses and capacitation oriented for the practice. In the workshops, they evaluated their experiences in a positive and contributive manner for the professional know-how. They showed a wide and suitable perception on the psychosocial aspects implied in the adherence and relevance in the performance. The work with the focus group was configured as an opportunity for reflection and professional improvement, enabling the experiences exchange between the ACS and a major awareness of their tasks. More studies on the theme on adherence to treatment within the scope of work are necessary, aiming at subsiding qualifications to such professionals for a more active and efficient performance and effective upon the several challenges of their practices.