Processo de rastreamento do câncer do colo uterino: uma análise socioecológica das percepções de mulheres com vulnerabilidades sociais

Abstract

Young women with low education and living in the poorest countries in the world account for 85% of people affected by Cervical Cancer (CC). Given its relevance, the objective of this research was to analyze the cervical cancer screening process in primary health care and the factors related to its adherence from the perspective of socially vulnerable women. More specifically, we sought to (i) describe the perceptions of women in social vulnerability regarding the examination for prevention and early detection of cervical cancer and (ii) characterize the factors that facilitate and limit the screening process for this cancer in primary health care from the women's perspective. Therefore, this study, of a qualitative nature and with a descriptive design, was carried out with 20 women beneficiaries of the federal income transfer program and users of a primary health care unit in the city of Rio de Janeiro. Data collection was carried out between May and July 2023 through semi-structured and individual interviews. Data interpretation was based on the thematic analysis by Braun and Clarke (2006) and the social ecological model of health. The thematic categories of the study were: Perceptions of socially vulnerable women regarding preventive CC screening and Factors related to the CC screening process. The results indicate that participants have positive and negative perceptions about CC screening. In the first case, the appreciation of preventive examination and the understanding of its importance for women's health stand out positively, while, from a negative point of view, it is observed that feelings such as fear, shame, and discomfort were expressed. The factors hindering CC screening were access barriers and difficulties with information about CC screening, preventive tests follow-up, and embracement by healthcare professionals. The main barriers include factors related to the institutional level of the social ecological model of health and which impair the quality of care in the screening process. However, there are factors that facilitate this process and are related to the potential of the service, such as satisfaction with the service and organizational structure, the bond with the team, and easier access to care. The results indicate that it is necessary to increase investment in health education and public health campaigns, together with actions to change the attitude of health professionals, to improve the adherence of socially vulnerable women and the quality of CC screening in primary care. Despite advances in preventive examination coverage with the expansion of the Family Health Strategy (ESF) in the municipal primary care network, there are still obstacles to achieve the recommended coverage for the CC screening in the female population, and these barriers have to be faced so as that health inequities, especially in the most vulnerable population group, are overcome. Women's perceptions about the preventive exam determine their preventive behaviors and knowledge about CC screening influences self-care, reinforcing the role of the nursing professional in embracing this vulnerable population and providing health education to improve the care process.