Comunicação como direito no SUS: recomendações para a qualificação comunicacional em uma Unidade de Pronto Atendimento no Maranhão

Abstract

The objective of this study was to analyze communication practices between healthcare professionals and patients at the Parque Vitória Emergency Care Unit (UPA) in São Luís, Maranhão, from the perspective of communication as a fundamental right within the Unified Health System (SUS). The hypothesis is that the absence of systematized, user-centered communication strategies compromises the effectiveness of healthcare, directly affecting the autonomy and experience of those receiving care. A qualitative approach was adopted to investigate this issue, grounded in action research (Stringer, 1996), which enables the articulation of intervention and critical reflection in the empirical field. Additionally, participant observation (Minayo, 2001), per methodological guidelines, was employed to promote reflective immersion in the institutional daily life of the UPA, enabling systematic monitoring of communication practices. Data collection and organization were conducted using a field diary, an essential tool for detailed recording of the interactions and contexts observed. Data interpretation, in turn, followed the Content Analysis methodology (Bardin, 2016), which enabled the identification, categorization, and inference of latent and explicit meanings in communication practices, emphasizing their political, social, and symbolic dimensions. The results demonstrate that communication at the Parque Vitória UPA is conditioned by a technical-productivist model, characterized by fragmented flows, limited listening, and a lack of pedagogical mediation. These elements impact the user experience, restricting their ability to participate in and understand care. Based on habitus and health literacy concepts, the analysis demonstrates that these communication practices express social and institutional dispositions that reproduce inequalities and compromise the right to communication, a right guaranteed by legal instruments and international treaties. In addition to its findings and reflections, this study also served as the foundation for the development of the Guidelines for Communication and Health Care, as it highlights the need for communication qualification involving the institutionalization of reception and qualified communication protocols, the continuous training of multidisciplinary teams, and the production of accessible and contextually relevant informational materials, themes that are addressed in the guide. Strengthening dialogue, active listening, and user engagement are essential conditions for implementing the principles of comprehensiveness, humanization, and social justice in the SUS. Thus, this dissertation contributes to a critical understanding of communication tensions in the context of emergency and urgent care units, while also providing support for the formulation of public policies that promote a more democratic, inclusive, and equitable health system, in line with constitutional precepts and the contemporary challenges of health communication.