Psicologia, Famílias e Atenção Básica à Saúde: modelos de atuação em Uberaba/MG

Abstract

This dissertation is the reunion of a literature review study and an empirical study. The main objective was to expand the knowledge on the performance of the psychologist in Primary Health Care (PHC) who attended families, taking as specific focus of investigation the PHC centers of the city of Uberaba (MG, Brazil). Literature points out that, depending on how the professional conceives what a family is, it influences on how they assist the families. Thus, highlighting this conception is a way of consolidating a reflection and promoting actions that are more adequate. The literature review had the objective of understanding how the idea of family is conceived among PHC professionals. Using the Evidence-Based Practice (EBP) as a tool, the corpus (10 papers) was formed by studies retrieved, published in the last 10 years, from the BVS, SciELO, MedLine and PsycINFO databases, with a previously given criteria. It was found to be consensual that the family is understood beyond the limits of a nuclear model, but still there are prejudicial formulations concerning what a family is. Another finding is that there is a consonance between how psychologists conceive the idea of family and what the SUS (Brazilian unified health system) advocates for, which indicates better possibilities of assistance. The empirical study, held in the PHC of Uberaba/MG, was based on the issue of lack of proper strategies and performance models a PHC psychologist should have for attending families in that context. The participants were PHC psychologists who claimed to have worked with families, in a direct or indirect way. Twenty-one professionals were interviewed through a semi-structured script, audio recorded and with full transcript. Using Bardin’s Content and Enunciation Analysis, three forms of performance were evident: focused on the family (three professionals), individual, with intervention in the family (nine professionals), and individual, with indirect work upon the family (nine professionals). In the first one, direct actions along with the Family Health Strategy (FHS) prevailed, being attended only severe cases and specific demands. In the second, individual appointments prevailed, with interventions that, according to the interviewees, were imperative to the effectiveness of the assistance. In the third one, there were professionals who attend strictly with the individual clinical model and believe that, indirectly, individual changes happen to reflect upon the familiar context. An important information is that psychologists and the FHS team mutually require each other a lot, except when professionals work strictly with the individual user, and receive only referrals from the team. In addition, the PHC requires the psychologist mostly for individual, curative demands, and then the professional brings the family to attendance, depending on the strategy they adopt. Main strategies identified in those practices were home visiting, groups, in-home attendance, and referrals to the PHC team and the families. Although the PHC advocates for a multiprofessional work, individual actions prevailed. Interviewees pointed some obstacles for an effective performance, such as lack of materials and transportation, and overload of demands concerning the user cure, law issues and the Tutelary Council. The conclusion is that psychologists have innovated their forms of assistant when working in groups and within the community, in a multiprofessional way, broadening their views on health, and inserting themselves in the FHS teams.