Processo de adesão ao tratamento da tuberculose no contexto da Atenção Primária à Saúde: teoria fundamentada

Abstract

Adherence to tuberculosis treatment is one of the main challenges for the control of the disease. The strategies adopted so far are not considered effective enough to guarantee therapeutic success in all realities. The absence of a theory that adequately explains this adherence makes progress in research and development of this action difficult. In this context, this research aimed to understand how the process of adherence to tuberculosis treatment occurs in Primary Health Care. This is a qualitative study, which followed the Straussian strand of Grounded Theory as a methodological framework. Twenty people participated in the study, distributed into three sample groups: 1 – eleven people who underwent complete tuberculosis treatment between 2018 and 2019; 2 – seven professionals from Basic Health Units in the city of Cajazeiras-PB, being three doctors, three nurses and one Community Health Agent; 3 – two relatives of participants in the first group. Data were collected through interviews, from 2019 to 2021, concurrently with the analysis. Open, axial and integration coding procedures, construction of diagrams and memos, as well as analysis for context and process were considered. A theoretical model was developed, considering the paradigm, an analytical tool that helps to classify concepts and establish relationships. The NVivo® software (version 12 as a technological support for data organization) was used. The study was approved by CEP/UFRN, under opinion nº 3.246,634. The three components were named: conditions – feeling threatened with recovery; actions-interactions – carrying out the tuberculosis treatment and consequences – restoring health. The categories, subcategories and their respective concepts were interconnected and represented by the theoretical model, whose central category was “Feeling threatened, undergoing tuberculosis treatment and recovering health: transmuting suffering into a new life”. The main target of the people who adhered to the treatment was the recovery and solution of health threats. For this, they needed to modify the situations experienced, from the transformation of circumstances that generate suffering to those that promote a new life. Based on the constructed theoretical model, the contextual and procedural nature of adherence to tuberculosis treatment was observed, which permeates the experiences of the affected individual from before diagnosis to completion of treatment. The interaction with the data, theoretical and methodological procedures also showed that adherence to tuberculosis treatment is linked to aspects of life that existed prior to the illness, in the individual, family, social and labor spheres. It is considered that the results support the thesis: that people with tuberculosis act in relation to their care, anchored in what it represents for them. Therefore, the beginning of treatment is marked by physical, psychological and programmatic threats, which leads to questions about recovery. The second moment is marked by the beginning of the recovery process, leading to a process of resignification of life and awareness of being transmuted from suffering to a new life when undergoing the treatment.