Satisfação Do UsuáRio Na Perspectiva Da Aceitabilidade No CenáRio Do PSF

8/14/2019 Satisfao Do UsuRio Na Perspectiva Da Aceitabilidade No CenRio Do PSF

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Texto Contexto Enferm, Florianpolis, 2007 Out-Dez; 16(4): 617-25.

USER SATISFACTION FROM THE PERSPECTIVE OF ACCEPTABILITY INTHE FAMILY HEALTH SCENARIO1

SATISFAO DO USURIO NA PERSPECTIVA DA ACEITABILIDADE NO CENRIO DA SADE DAFAMLIA

SATISFACCIN DEL USUARIO EN LA PERSPECTIVA DE LA ACEPTABILIDAD EN EL ESCENARIODE LA SALUD DE LA FAMILIA

Vanessa Pirani Gaioso2, Silvana Martins Mishima3

1ThisstudywasfundedbyConselhoNacionaldeDesenvolvimentoCientcoeTecnolgico(CNPq),processn351742/1998-02RN,M.Sc.inPublicHealthNursingSchoolofNursingatRibeiroPreto,UniversityofSoPaulo.DoctoralStudentintheSchoolofNursing,UniversityofAlabamaatBirmingham(UAB).Alabama,UnitedStatesofAmerica.

3RN,AssociateProfessorInfant-MaternalandPublicHealthNursingDepartmentSchoolofNursingatRibeiroPretoUniversityofSoPaulo.SoPaulo,Brasil.

ABSTRACT: The purpose of this study was to assess users acceptability of the care offered and deliveredbyFamilyHealthteamsinRibeiroPreto,SoPaulo,Brazil.Thisexploratory-descriptivestudywasbasedonaquantitative-qualitativeapproachmethod.Thesampleconsistedof171users,registeredatthefourFamily

HealthUnitsthatcoverthebasicareaofasecondaryservice.Thestudyusedsemistructuredinterviewswithanalytical dimensions: infrastructure, accessibility, and team-user relationships. Descriptive statistics was usedforcalculationsofstandarddeviation,meanandmedian,assistedbyStatisticalPackageforSocialScience,andthematicanalysis.Theresultsshowpredominationofthefemalegender(87,7%),ageolderthan60yearsold(31.0%),andmonthlyincomeinferiortotwominimummonthlysalaries(34%).Usersindicatedconsiderateandaffective interpersonal relations as one point of satisfaction and one of the aspects that differentiates health care.Dissatisfactionpredominatedintermsofenvironment,alongtimespentinthewaitingroom,andorganizationalaccessibility,impairingcarelongitudinalityandcontinuity.Studieswithinthisthemegiveopportunitiestousers,strengtheningtheirparticipationintheplanningprocessesandexercisingsocialcontrol.

RESUMO:Objetiva-seavaliaraaceitabilidadedosusuriosquantoofertaeprestaodeassistncianaSadedaFamliaemRibeiroPreto-SP,Brasil.Estudoquanti-qualitativodecarterexploratrio-descritivo,sendoentrevistados171usurioscadastradosnasquatroUnidadesdeSadedaFamliaquecobremareabsicadeumservioderefernciasecundria.Utilizou-seentrevistasemi-estruturadacomdimensesanalticas:infra-estrutura,acessibilidade,relaoequipe-usurio,resolutividade.Utilizou-seestatsticadescritivacomclculosdedesviopadro,mdiaemediana,auxiliadopeloStatisticalPackageforSocialScience,eanlisetemtica.Predominou:sexofeminino(87,7%),idadeacimade60anos(31,0%)erendamensalinferioradoissalriosmnimos(34%).apontadasatisfaonasrelaesmarcadasporafetividadeeateno,aspectosdiferenciaisnaatenosade.Ainsatisfaosevolta:ambincia,tempodeesperaaltoparaconsultas,acessibilidadeorganizacional,prejudicandolongitudinalidadeecontinuidadedaassistncia.Estudosdestanaturezapermitemexpressodosusurios,contribuindoparaplanejamentoecontrolesocial.

RESUMEN:ElobjetivodeestainvestigacinesevaluarlaaceptabilidaddelosusuariosconrelacinalaofertayprestacindeatencinporlosequiposdeSaluddelaFamiliadeRibeiroPreto,SP-Brasil.Setratadeunainvestigacindecarcterexploratorio-descriptivo,centrndoseenunaaproximacincuantitativaycualitativa.Lapoblacindelestudioabarca171usuarioscatastradosenlascuatroUnidadesdeSaluddelaFamiliaqueatienden el rea bsica de un servicio secundario. Los datos empricos fueron recolectados mediante entrevistaparcialmente estructurada, con la utilizacin de dimensiones analticas: infraestructura, accesibilidad, relacinequipo-usuarioyresolutividad.Paraelanlisisdelosdatoscuantitativos,seutilizestadsticadescriptivacon

clculos de desvo patrn, media y mediana, recurriendo para ello, al auxilio del softwareStatiscalPackageforSocialScience.Paraelanlisisdelosdatoscualitativos,seempleelanlisistemtico.Elresultadodelanlisisdelosdatosmostrunpredominiode:sexofemenino(87,7%),conmsde60aosdeedad(31,0%),yconunarentamensualinferioradossalariosmnimos(34%).Losusuariosindicaroncomounodelospuntosdesatisfaccin,relaciones interpersonales atentas y afectivas, uno de los aspectos diferenciales en la atencin a la salud. Lasinsatisfaccionespredominaronenrelacinalambiente,muchotiempodeesperayaccesibilidadorganizacional,perjudicandolalongitudinalidadylacontinuidaddelaatencin.Estudiosdeestanaturalezapermitenlaexpresindelosusuarios,contribuyendoenlosprocesosdeplanicacinyejerciendoelcontrolsocial.

KEYWORDS:Healthservicesevaluation.Primaryhealthcare.Consumer satisfaction. Family

health.

PALAVRAS-CHAVE: Ava-liaodeserviosdesade.Atenoprimriasade.Satisfaodosconsumidores.Sadedafamlia.

PALABRAS CLAVE: Eva-luacin de servicios de salud.Atencinprimariadesalud.Sa-tisfaccin de los consumidores.Salud de la familia.

Usersatisfactionfromtheperspectiveofacceptabilityinthefamily...

VanessaPiraniGaiosoAddress:EscoladeEnfermagemdeRibeiroPreto(EERP),UniversidadedeSoPaulo(USP)Av.Bandeirantes,390014.040-902-CampusUniversitrio,RibeiroPreto,SP,Brazil.

Email:[email protected]

Artigooriginal:PesquisaRecebido em: 27 de fevereiro de 2007

Aprovaonal:15deoutubrode2007


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INTRODUCTION

TheevaluationofservicesintheeldofPublicHealthisextremelyimportantbecauseitallowstheofferingofdirectionsandoptionsintheprocessofplanninganditcanalsofavorthetechnicalandsocial

controloftheservicesandprogramsdeliveredtosociety. Studies on the evaluation of health services,programs,andofspecicactionshavebeenproduced.However,thereisalackofscienticproductioncon-cerninguserssatisfactionregardingservicesdeliveredin primary health care, especially those within FamilyHealth.ItisimportanttopointthattheFamilyHealthStrategy(SFH)wasimplementedinBrazilmorethanadecadeagoandhasbeenevaluatedbytheMinistryofHealth(HM)itself.TheMinistryhaspointedoutthe need for local studies in order to analyze how the

services related to the users.1-2

Thereareseveraldenitionsinthetheoreti-calapproachesregardingthequalityofcareintheevaluation of health practices, while the term ac-ceptability is that which is directly related to theexpectations and satisfaction of the users.3Accept-abilityisdenedasasetoffactorsinthephysician-patient relationship and patient-health care system.Acceptabilitycomprehendstheaccessibility,thephysician-patient relationship (here we include thehealth team-user relationship), the environment and

building,patientspreferencesregardingtheeffectsandtreatmentcostsandeverythingthepatientconsidersbeingfairandjust.3

Whenconsideringacceptability,theutilizationof health services will always refer to needs and ex-pectations, individual or collective, related to a healthproblem,ortoasetofproblems.Whenusingsuchservices,theindividualmayormaynothavehis/herneeds and expectations met; and the level of satisfac-tionallowsonetoinferqualityinseveralmomentsofassistance, in an interactive process that occurs fromthe entrance to the exit of the health unit.4

Whenevaluatinghealthsystemsand/orhealth services, we have to bear in mind that theservices/actionsdeliveredhavetheusersasagoal,whoarepartoftheorganizationalprocessandofthedelivery process of these actions.5Inthissense,theanalysisofthoseinvolvedintheservices/programs

regardingtheirexperiencesmustberecognizedasrational and analyzed in the historical and socialcontext of its production.

Inthisstudy,weareinterestedinanalyzingtheusers satisfaction from the perspective of acceptability,

withthepossibilityofcontributingtotheevaluationandqualityofhealthservices,stimulatingprocessesofreectionandinterventionoftheseservicesfortheorganization,andplanninghealthactions.Therefore,this study aims to evaluate the users acceptabilityregardingtheassistanceofferedanddeliveredbytheFamilyHealthteamsinthemunicipalityofRibeiroPreto,SoPaulo,Brazil.

METHOD

This is an exploratory-descriptive research

withaquantitative-qualitativeapproach.Theuseofaqualitative-quantitativeapproachisdesirableinevaluationprocessesbecauseoftheheterogeneityandcomplexity of the health services. The use of thesetwoapproachesallowsforadeeperunderstandingof the internal dynamic of the phenomenon studiedandconsequently,theunderstandingofthemultipleaspects of the services studied.5

TheresearchwascarriedoutinRibeiroPreto,intheNortheastSoPaulo,Brazil.AccordingtothedatabaseoftheDepartmentofInformaticsofthe

BrazilianNationalHealthCareSystem(Sistema nicode Sade - SUS), the population of the city in 2006 was559,650inhabitants,makingRibeiroPretooneofthelargestinthestateofSoPauloandBrazil.Thecityisascientic,technological,andhumanresourcescapaci -tatingcenterinseveralareasofknowledge,especiallyinthehealtharea.Intheprocessofregionalizationof care, the municipality assumed the condition ofaassistancecenter,becomingareferenceinmediumandhighlevelsofcomplexity.

This study was performed in the western

district of the municipality

,infourFamilyHealthUnits(FHU)thatdelivercaretothebasicareaoftheBasicandDistrictHealthUnit(UBDS)oftheWestDistrict,whichcountsuponserviceslinkedtotheUniversityofSoPaulo.

UnlikeotherBasicandDistrictHealthUnitsof the municipality, the population of the basic

The municipality comprises 5 health districts, organized in a way to provide the regionalization of the attention and the hierarchy of thehealth services. Each Health District is organized by a territorial area of around 100 thousand inhabitants. It comprises of one Basic andDistrict Health Unit (UBDS) that offers specialized care and 24-hour assistance for emergencies for the population of its district area, andbasic care for the population in its proximity. Each District has a certain number of Basic Health Units (UBS), which offer basic care tothe registered members of the population, and Family Health Units (USF).

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areaofthisserviceiscoveredbyFamilyHealthteamsthatareorganizedinfourUnits(FHUWhite,FHURed,FHUBlueeFHUGreen).Thisis the main reason these units were selected forthisstudy.Inaddition,theseweretherstFamilyHealthUnitsimplementedandqualiedinthemunicipality in 2001.

For the development of this research, the nor-msofResolutionCNS196/96oftheNationalRese-arch Ethical Committee were followed. The resear-ch was also approved by the Ethical Research Com-mitteeoftheCenterHealthSchooloftheMedicalSchooloftheUniversityofSoPaulo,protocolnumberN0185/CEP/CSE-FMRPUSP.SubjectswhoacceptedtoparticipateinthisstudysignedtheInformedConsentdocument.

For the selection of subjects for this study, weconsidered5%ofallthefamiliesregisteredineachoftheFamilyHealthunitsselected.Thus,foreachunit,fromthedataoftheInformationSystemoftheBasicCareSIABandfromthereportListofFamiliesby Micro-area6 of each unit provided by the referredsystem,arandomsamplewasselected,considering5%of the families of each unit.

Consideringonerespondentperhousehold,thefollowinginclusioncriteriawereused:individualsolderthan18yearsold,ifpossibletheresponsiblemember

of the household, who were at home at the momentoftheinterview;havingatleastoneexperiencewithadministrativeorhealthassistanceintheFamilyHealthUnitintheprevioussixmonths.Thislastcriterionaimedtoreachnotonlyregisteredusersbutserviceusers.

The semi-structured interview was used for thedata collection, which was recorded and performed inonly one moment. The instrument used to supporttheinterviewhadgeneralquestionsrelatedtothecharacterization of the respondent, and the secondpartoftheinterviewhadquestionsrelatedtotheusers

satisfaction on the perspective of acceptability. To putthe concept acceptability in practice, analytical dimen-sions were used: infra-structure, accessibility, team-userrelationship,problem-solvingcapacity.Theselectionof these analytical dimensions were based on the theo-reticalreferentialadoptedandfollowingtheNationalResearchofEvaluationoftheSUSUsersSatisfaction,performedbytheMinistryofHealthin2006. 2

Itis important tojustify the use oftheseanalytical dimensions in the construction of the

These Family Health Units are connected to the University of Sao Paulo, through agreement with the Municipal Health Secretary of Ribeiro Preto,State Secretary of Health of So Paulo and the Ministry of Health.

instrumentofthisstudyduetothelackofstan -dardization of instruments in the same country,whichmakesthecomparisonofresultsbetweenstudiesdifcult.7

The data collection was carried out in the period

of July to October of 2006, and 171 interviews wereperformedinthefourFamilyHealthUnits.Forthedataquantitativeanalysis,aspecicdatabasewasorganizedinExcel,withspecialcarefor:digitization,validation,and correction of errors. Then, the data was crosstabulatedusingtheStatisticalPackageforSocialScience(SPSS)version14.0forWindows.Descriptivestatisticsanalysis was used to calculate the standard deviation,theaverage,andthemedianofthedata.

Thequalitativedataobtainedintheusersspeechintheinterviewswasanalyzedaccordingtothecontent

analysis.Forthisstageoftheanalysis,thematerialoriginatedfromtheFamilyHealthunitsFHUBlueandFHUGreenwereselectedduetotheirhomogeneityand similarity in their areas of scope.

THE SUBJECTS AND THEIR EXPRES-SION OF SATISFACTION/DISSATISFAC-TION

Amongthe171users,thefemalegenderpre -dominated(87.7%).Intermsofage,thoseolderthan60yearsoldwerethemajoritywith53(31.0%)people,followedbythose51to59yearsoldwith36(21.1%)people.Regardingtheirmaritalstatus,53.8%ofthein-terviewedweremarried,15.8%widowed,15.2%single,10.5%divorced,and4.7%hadxedpartners.

Theaveragetimeofresidenceintheareawas15.41years,81.3%werenotemployedandthema-jority were housewives, followed by retired people.Regardingthesubjectseducationallevel,50.3%hadincompleteelementaryschool,followedby18.7%withcompletesecondaryschooland34%ofthesub-

jects had a monthly income inferior to two minimum

salaries.Fromthetotalinterviewed,only25.7%hadhealthinsurance,withcoveragefortwopeopleinthefamilyonaverage.Themainreasonsforseekingahealthservicewasmedicalconsultation(66.7%)andthepresenceofmorbidity(46.8%).

TheintervieweesusetheFamilyHealthunitmonthly(39.2%)andyearly(40.9%)byscheduledmedi-calconsultations(90.1%),useofproceduresingeneral(36.8%),whileinthemajorityforcontrollingarterial



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bloodpressureandforeventualconsultations(11.7%).Onlythreepeoplereportedusingnursingconsultationsandparticipatingineducationalactivities.Twopeoplereported household visits.

Access and accessibility of the Family HealthUnits

Accessreferstothepossibilityofusinghealthservices when necessary; expressed characteristics ofsupply that favor or hinder peoples capacity to use thehealthserviceswhenneeded.Accessbarriersoriginatein the system and the health service characteristics. Theavailabilityofservicesandtheirgeographicaldistri-bution,theavailabilityandthequalityofhumanandtechnologicalresources,thefundingmechanisms,theassistance model, and information about the system are

characteristics of supply that affect access.8Primaryhealthcarecomprisesaspectsrelated

totherstcontact,continuingcare,integrality,andcoordination.Theattentionintherstcontactrefersto characteristics of accessibility of the units, suchas,availableworkinghours,facilityofthecollectivetransportation,buildingsadaptedtophysically-decientpeople, possibility to schedule appointments, time spentinthewaitingroomforsuchappointments,andnolinguisticorculturalbarriers.9

Such accessibility allows people to reach the ser-

vices, that is, this is one of the aspects of the structureofasystemorhealthunitrequiredfortherstcontact.Itisthestructuralelementnecessaryfortherstcare.To offer it, the local of assistance must be easily ac-cessible and available.9

Accessibilityistheresultofasetoffactorsofdif-ferentdimensionsthatcanbeclassiedasgeographical,organizational,socio-cultural,andeconomicorder.10

Asignicantexpressionofsatisfaction(93.6%)wasobservedamongtheusers,whenquestionedaboutthegeographicalaccessibility.Whentheempiricalma-terialoriginatedfromtheinterviewsoftheFHUBlueandGreenwasanalyzed,weveriedtherecurrentex-pressionofsatisfaction,whichisinagreementwiththequantitativedata.UsersreportedthegoodlocalizationoftheFHU,theshortdistancebetweentheunitandtheirhouses,thepossibilityofgoingonfoottotheunitandtheshorttimetotravel,reinforcingthefacilitytogettotheunitsandthebenetstotheneighborhood.

Thegeographicalaccessibilitymustbemeasuredconsideringhowlongittakesthesubjecttoreachthehealthassistancethroughthepublictransportation.Inaddition to the distance between the population and

the resources, the physical characteristics of the terri-tory must also be considered, since they can impedeor hinder the populations access.10

Theorganizationalaccessibilityisrelatedtotheobstaclesthatcomefromtheorganizationoftheas -

sistance resources, both at the entrance and inside thehealth unit.10 This is a central issue in the narrativesoftheFHUBlueandGreenusers,whoexpresstheirdissatisfactionsregardingobstaclesthathindertheinitialcontact(workinghoursoftheFHU,accesstoconsultation) as in the inside of the health unit (non-distribution of medication and procedures; references;timespentinthewaitingroom)sincetheseunitsarethe entrance to the health system.

TherewasahighlevelofapprovalregardingtheFHUworkinghours,60.3%oftheusersclassieditas

excellentandgood,whilearound40%classieditasregular,poor,andextremelypoor.Thiscontradictioncan be better understood if we analyze the content oftheinterviewsoftheFHUBlueandGreenusers.Ahighexpectancyinextendingworkinghours,evenwhenclassifyingitasgoodandexcellentcanbeobservedintheirspeeches.Additionally,someofthemexpressedtheir perception that more professionals were neededin order to cover for others in the shift turns.

OthersmanifesteddissatisfactionandalackofunderstandingregardingthehoursandperiodstheFHUstaysclosedforitsteammeetings.Thesemeetingsaim to discuss situations experienced by the familiesassisted and who need an approach not only in medicalterms but also in terms of health and social aspects.There are also moments for the teams permanenteducation and the discussion of administrative actions.Somesuggestedthesemeetingsshouldbeheldaftertheworkinghoursorbeforetheunitisopened.

However,therearesomeuserswhoaresatisedwiththeworkinghoursandsaythereisnoneedtoex-tendingworkinghourssincetherearebackupservicesavailable24hoursneartheFHU.

Studies11onsatisfactionpresenthighlevelsofusers satisfaction. These results are criticized on theallegationthatusershavedifcultiesinpointingoutnegativeaspectsinthehealthservice,afraidtheiropin-ions would compromise their access to the services.

Theavailability,type,quantityofservices,andresources(nancing,human,andtechnological),geo-graphicallocalization,localmedicalculture,ideologyofthehealthdeliverer,amongothers,areaspectsofsupplythatinuencetheconsumptionpatternofthe

individuals. On the other hand, the individual choices

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are also crucial, while not all the needs are convertedin demands and not all the demands are met.12

The majority of the users of the four servicesstudiedissatisedbothwiththeaccesstothescheduledappointment(62%)andwiththeaccesstotheeventual

appointment(66.6%).However,whenanalyzingthenarratives we perceive that the majority of the users hadexpectations and wished the scheduled appointment tobe scheduled in a shorter period of time. They reportittakesthreemonthsonaveragetoscheduleanap-pointment.Also,regardingtheeventualappointment,despitecomplaintsforthetimespentinthewaitingroom,usersexpresssatisfactionforgettingassistanceonthesameday.Itcanbeobservedthatusershavedifcultexpressingtheirdissatisfactionsbecauseevenwhen they express their dissatisfaction, they classify theaccesstotheserviceasexcellentorgood.

Aninterestingissue,whichallowsexpandingthediscussion exposed here, refers to the way expectationsareexpressed.Inthenarrativeoftheolderusers,whentalkingabouttheaccesstothescheduledconsultation,theypointouttheneedforweeklyassistance.

Someauthorshighlightthatinthepublicsector,the evaluation done by the users involves a more com-plexinteractionoftheelements,includingthosethatinuenceperceptionsaboutpublicservices.Thefeelingofgratitudewouldbecommoninperipheralcountries,which hinders a more critical view of the assistance.Patientswouldavoidcriticizingtheservicesduetothisbias,bothforfearoflosingaccessandbecauseoftheirdependency on health professionals.

On the one hand, the culture, the principles, andthespecicvaluesofthepublicsector,andontheotherhand, the expectations of each user, formed by theirprevious experiences and by information transmittedbythemediaareaspectsthatmustbetakenintoac-countintheseevaluations.Perceptionsarepartofthepoliticalandcivicculture,comprisingvalues,beliefs,representations,andattitudesregardingcitizensrightsandobligations,whichareconstructedfrompresentandpastexperiences.Inveryunequalcontexts,forcertainsegmentsofthepopulation,theusualdifcultyinaccess-ingassistanceleadstolowexpectations.Thesimplefactofbeingassistedcangeneratesatisfaction,becausethesepeople do not expect much of public institutions.11

AmongtheobstaclesfacedbyusersinsidetheFamilyHealthUnitsarethenon-distributionofmedi-cation and the non-performance of procedures (suchasclinicalexams,dressings,aerosol,vaccination,simplesutureexcision,amongothers)intheunititself.

Themajorityofusersclassiedasregular,poor,extremely poor, or could not tell whether the distribu-tion of medication and procedures were performedinthehealthunit,reaching71.09%ofdissatisfaction.When this data is confronted with the interviews withtheusersoftheFHUBlueandGreen,thispercentageiscorroborated,conrmingtheusersdissatisfactionwiththelackofaccesstotheseprocedures.Thenarrativesmanifestedthedifcultyinthecontinuingcare,whichforcestheuserstoseekanotherservice,inthiscase,aser-vice of reference in the secondary care level to performsomethingthatisoftheprimarycarescopeintherstlevelofcare.Theyalsoreportdifcultyinreachingthisother service because of the distance and the problemsfaced with lines in this secondary health service.

Somethingunusualwasremindedbyoneofthe users, the collection of the blood sample in the

householdinspecicsituations,pointingoutthatthehealth service can provide special care in situations ofextremefragilityoftheuser,althoughtheperformanceofclinicalexamsintheFHUisaverystrongexpecta -tion of the interviewed users.

One of the exclusive aspects for the evaluationofprimarycareistheintegralitythatinvolvesseveralkindsofinformation.Thedevelopmentofactivitiesis one of them which is related to the needs of thepopulation. These needs include primary and second-ary preventive activities, such as immunizations, health

education, and procedures of referred exams, as wellasactivitiesdirectedtothedetectionandmanagementof health problems in the assisted community.9

Thelackofdistributionofmedication,collec -tion of materials and procedures may indicate thatmedicalactivitiesarebeingprivilegedinthesehealthunits,compromisingtheintegralityandcontinuingcare, even when there is the possibility of continuityof these actions, considered basic in the primary care,tobedoneinotherhealthservices.Thelackoftheseactivitiesispointedoutbyusersasgeneratorsofdis -

satisfactionregardingthehealthservice.Anotherveryimportantitem,whichtsinthe

organizationalaccessibilityandwhichinterferesintheassistance to the user inside the unit refers to the timespentinthewaitingroomforboththescheduleandeventual appointments.

Userscomplainaboutthedelayinthemedicalassistanceinthewaitingroom,especiallywhenitisaneventual appointment, because the user arrives at theunitwithaspeciccomplaintanddesirestobeassistedimmediately.However,othersunderstandthatwhenit



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is an eventual appointment the user has to wait, unlessitisasituation/problem/complaintthatdemandsim -mediate intervention by the part of the team.

Manysuggestedthatassistancemustbepri-oritized,accordingtotheseverityoftheproblem;

the more severe and acute the problem, the faster thepatient should be assisted. Others had already perceivedthis is already done.

ThewelcomingintheFHUisperformedbynurs-ingauxiliaries,whostayatthereceptionandbythenursewhenneeded.However,therearemanycomplaintsregardingthewaittimewhenthepatientisfeelingsick.Sometimes, the user does not understand the severityofhis/herproblemorwhether(s)hecanwaitthetimedemandedbytheunit.Additionally,othervaluesareinvolved such as immediate culture and others.

However,ingeneral,wecanobservethatthewaitingtimevariableisverysubjectiveandrelativetoeachindividual,dependingalotontheusersexpecta -tionsandpreviousexperiences.Regardingthewaitinglimit, some say the ideal would be to be immediatelyassisted;otherswouldtolerateadelayof30minutes,otherseventwohours,otheruserscomparethewaitingtime in the private service, and others would wait thenecessary time with no problem.

Inthepublicsector,theusercaneitherputhim/herselfintheconsumerrole,evaluatingtheservices

fromhis/herindividualgains,orinthecitizenrole,evaluatingtheservicestakingintoaccountthesocietyasawhole.Asaconsumer,(s)hecandesireashorterwaitingtimefortheappointmentsandfasterassistance.However,asacitizen,(s)hemaywantallpeopletobeassisted,whichimplieslongerwaitingperiods.11

Humanization of the Family Health assis-tance details that make the difference in the

production of health care

The interaction between the team and theuseroftheFHUprovidesgreatsatisfactionforthe users because it represents a differentiatedrelationship,markedbyattentiveandaffectiveinterpersonalrelationships.Theusersreportbeingtreatedwithrespect,courtesy,beingwelcomedintheunit,perceivinginterestandconcernfortheircomplaints,anattentiveanddigniedassistance,aqualiedlistening,andresponsibilityregardingtheirproblems.Theyemphasizethewarmingassistance,

easy access to professionals, even the physicians,and the existence of a certain familiarity, bond, andthepresenceofcontinuingcare.

Smallgestures,smalldetails:the physician shakeshands when leaving. (002FHU GREEN).Gesturesthat

are valued by the user as essential in the health caredelivered to the solution of a health problem, butoftentimesnotvaluedandnottaughttothehealthprofessional,becausetheyseemtooobvious. 14:54

Oneoftheimportantquestionsinestablishingbondsinhealthcareworkistheexibilitylearn-ing,qualiedlistening,attentivetowhatisnotsaid,identicationofotherneedsthataremarkedbythe subjectivity present in the relationships [] thecomplexityofthemeetingsthatfavorqualitybonds,revealingthelearningthatgoodmeetingsdependon

the care with small but important details.14:59-64

De-tails present in everyday routines, but permanentlyavailabletoactinhealth,beingnecessaryhowever,that they are perceived and valued.

Themedical,nursing,andreceptionassis-tance,aswellastheworkoftheCommunitarianAgentswerehighlightedasmarkedbythepresenceofamorehumane,personalcare,awelcomingposture;usersrecognizetheprofessionalbyname,bond,familiarityforlivinginthesameneighbor-hood,forknowinghis/herfamily,house,which

seemstoformthecontinuingcareasanessentialelementinprimaryhealthcarework.Inthedifferentspacesofcare,thereiscom-

munication between professionals and users and thepossibilityofestablishingintercessorspaces,whereexchangesbetweenprofessionalandtheuserandintervention about the users problem are present inuniquemoments,singleinthesearchofproductionof care that meet the needs and expectations of theusers.Inthatsense,theeducationalgroupsdevelopedintheFHU,althoughlittlementionedbyusers,canbe

momentsofexchangeandintervention.The user hopes to be welcomed in the relation-shipwiththehealthworker,ndasolutionforhis/herproblem, and to observe actions that are effective andsatisfactory.Inthissense,theexchangeofinformation,experiences,andknowledge,inwhicheverybodysee0themselves as one who teaches and learns; seem to befundamental in the production of care in health.14

Care that is also expressed in the physicalspace where the care is processed, in the ambience,

This concept has been used by the Ministry of Health, in the National Policy of Humanization, expanding its meaning and the meaningof physical space and infra-structure.15

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The users included in their speeches the issueofqualityandquantityofequipments,asanaspectofqualityintheassistanceofFHU.Themajority(83.6%)reportedthattheexistingequipmentsareingoodworkingconditionsanditseemsthereisadequatequantity,alsomentioningthemostusedequipments,suchas:infantandadultscales,sphygmomanometer,stethoscope,glycosometer,ostoscope,speculum,andultrasonicdetector.Thedissatisedusersmentionedquantityasanobstacleintheassistance,reportingfewtypesofequipmentwerefunctioningandmanyinterns, which increase delay in the assistance, withsomeafrmingthereistheneedforotherequipmentintheFHU,suchasanX-Ray.

Anotheraspectthatemergedfromthesetofnarratives,whichdemonstratequalityintheassis-tance, was the supply of some services and assistance

bytheFHUthatdifferentiateitfromotherhealthunits in the primary care level. The most cited oneswere the collection of exams in the household, thecommunication by telephone to warn patients incase the exam is altered, the visit in the residence tofollow up the family health situation, educationalgroupsintheunit,theteamresponsibilityforthepatient(theteamseekstolearnthereasonpatientsdid not return to the units).

UsersafrmtheirdispositioninindicatingtheFHUtosomerelativeorfriend,justifyingtherelation-shiptheyhavewiththeteam,thegoodassistance,therespectful, affective, attentive and polite way they aretreated and because of the bond established with theteam.Theyhighlighttheproximityoftheservicetotheir house, besides the fact that the health service iswhere all the follow up is performed, while some reporttheFHUisbetterthanaprivateservice.

Theresolutiveactionmeansgoingbeyondtheconduct,inawaytheworkerknowshowtouseallthetechnologyavailabletogettotheadequatediagnosisandtreatmentforeachcase,changingtheusers condition in a satisfactory way.14 The concept ofproblem-solvingcapacityimpliesthatwhenapersonseeksassistance,orwhenthereisaproblemofcollec-tiveimpactinhealth,thehealthservice,accordingtoitscompetencies,canmeettheexistingdemand.

FINAL CONSIDERATIONS

Theevaluationofthehealthservicesthroughthe perceptions of users has been considered an im-portantinstrumentinthemanagerialworkprocess,

asitallowsmanagersoftheseservicestorethink

theassistancedeliveredandconsequently, satisfythe expectations of these users.16

Thepossibilityofdevelopingaquantita -tive-qualitativestudy allows fora differentiatedanalysis, because despite the satisfaction expressed

bytheusersevidencedby thequantitativedata,contradictions were observed in the speeches ofthese same users. Thus, this mixed analysis per-mittedthe identication anddeepening oftheirdissatisfactions,revealingaspectsof theservicesthatneedtobeimprovedandthus,contributingtothedecisionmakingprocess.

This study counts upon the analysis of dis-tinct dimensions and acceptability indicators, as-suringamoreamplecomprehensionoftheservicesin the view of users for each dimension explored,

allowingamorepreciseactiononthefactorsthatmust be improved.The evaluation of satisfaction of the users

ofpublicservicesgivestheusersopportunitiestoexpress themselves, who can provide support tomonitor and control the activities of the publichealthservices,favoringtheirparticipationintheplanningprocessesandexercisingsocialcontrol.7

Werecognizethatthereisasetofcommentariesandlimitationsregardingstudiesonuserssatisfactionthatrelatestothesubjectiveaspectofthecategory

satisfaction,whichpossessesseveraldeterminantssuchas:degreeofexpectationandindividualdemandsregardingtheassistanceandindividualcharacteristicsofthepatient(age,gender,socialclass,andpsychologi-cal state).7However,thequalityofservicesdependsonaninteraction,anexchangerelationshipbetweenthe subjects who experience the same social condition.Thus, it is essential to analyze the satisfaction of theuser, the one who is directly favored by the serviceandispartoftheorganizationanddeliveryprocessesof these actions. Therefore, these studies allow for

the construction of alternatives jointly to the healthservicesandusers,regardinginterventionsinagree-mentwithproblemsandidentiedsituations,aimingatimprovingtheroutineofthehealthservices,permittingimportant advancements in the scope of the produc-tionofcareandmanagementofhealthservices.

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Satisfação Do UsuáRio Na Perspectiva Da Aceitabilidade No CenáRio Do PSF

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