Therapeutic itineraries in the utilization of health services in the south of Brazil: A socio-anthropological approach

This study is part of a multicentric research focusing the trajectories of care-illness-health reported by users of Brazilian private health insurance. Ninety eight (98) interviews were performed with patients who have experienced situations considered to be tracers for assessing quality of care in three areas: cardiovascular – acute myocardial infarction/AMI, oncological – breast cancer, and mental health – alcoholism. These situations were chosen due to their epidemiological significance, impact on the health services, and comparability with national and international systems of evaluation. The sample was selected by criteria of intentionality, convenience, and snow ball. The data was analyzed based on a socioanthropological approach and using NVivo software. The results were organized into two categories: perception/explanation of health problem, and itineraries seeking to care. In relation to the first category, the explanation of health problem coincided with the biomedical point of view in the case of AMI; in relation to breast cancer the explanation of psychological suffering as a determinate of the disease predominated; and alcoholism is understood as the “denial disease”. In relation to the second category, the itineraries in alcoholism cases show a long route, identifying the use of the three cultural systems of care: the popular, the folk, and the professional system. In the AMI the itinerary reveals a “reverse line of care” once actions connected to health promotions start when the disease is already severely installed. In the case of breast cancer, the itinerary highlights the use of professional services to diagnoses and disease treatment but it is also relevant the search of emotional support in the popular and folk systems. The results are close to ethnographic studies and transcultural analyses, showing a multiplicity of interpretations, trajectories, and arrangements in search of health care.