Bruno José Barcellos Fontanella

Amostragem por saturação em pesquisas qualitativas em saúde: contribuições teóricas

The transparency and clarity of research reports, emphasizing the data collection stage, are considered important parameters for evaluating the scientific rigor of qualitative studies. The current paper aims to analyze the use of saturation sampling as a methodological concept, frequently employed in descriptions of qualitative studies in various areas of knowledge, particularly in the field of health care. We discuss and confront the following topics: definition of sampling closure by theoretical saturation; difficulties in the acceptance and operationalization of intentional samples (with examples), adequate size of the intentional sample, the significance of valuing what is repeated or the differences contained in the sample reports, inadequate uses of expressions containing the term saturation, and finally possible metaphors for understanding the concept.The transparency and clarity of research reports, emphasizing the data collection stage, are considered important parameters for evaluating the scientific rigor of qualitative studies. The current paper aims to analyze the use of saturation sampling as a methodological concept, frequently employed in descriptions of qualitative studies in various areas of knowledge, particularly in the field of health care. We discuss and confront the following topics: definition of sampling closure by theoretical saturation; difficulties in the acceptance and operationalization of intentional samples (with examples), adequate size of the intentional sample, the significance of valuing what is repeated or the differences contained in the sample reports, inadequate uses of expressions containing the term saturation, and finally possible metaphors for understanding the concept.

Amostragem em pesquisas qualitativas: proposta de procedimentos para constatar saturação teórica

A qualitative studys methodological transparency is considered a key factor for achieving its reliability and should be guaranteed by the researchers. Closing the sampling process by saturation is a common approach, but it is rarely made explicit in research reports. Qualitative researchers also commonly experience technical difficulties in objectively identifying saturation. This article proposes a method to organize sample closing by saturation, with a sequence of eight procedural steps for treating and analyzing data collected through open or semi-structured interviews or focus groups. The article aims to help researchers objectively explain how and when saturation occurred and to allow their readers to know how this process occurred.

Data collection in clinical-qualitative research: use of non-directed interviews with open-ended questions by health professionals

Entrevistas nao-dirigidas constituem o principal instrumento de coleta de dados nas pesquisas qualitativas no campo da saude. Estes estudos estao consolidados na literatura internacional. Para os profissionais de saude, saber o que as pessoas sentem e imaginam permite-nos uma relacao clinico-paciente mais adequada. E indispensavel saber o que os fenomenos da vida significam para os individuos, porque os significados tem uma funcao estruturante: em torno do que as coisas significam para nos, organizamos nossas vidas, incluindo os cuidados com nossa propria saude. A partir de pesquisas concluidas junto ao Laboratorio de Pesquisa Clinico-Qualitativa da Universidade Estadual de Campinas, Brasil, os autores abordam, neste artigo, os seguintes pontos: caracterizacao de entrevistas nao-dirigidas, diretividade das entrevistas, tecnicas de abordagem, observacao de manifestacoes nao-verbais e para-verbais, tecnicas de registro e transcricao do discurso e validade/confiabilidade das entrevistas nao-dirigidas. O texto quer ser util para interessados em pesquisa da graduacao e pos-graduacao.Non-directed interviews constitute the main data collection instrument in qualitative health research. Studies in which this is evident are well documented in international literature. For health professionals, knowing what people feel and imagine makes it possible to develop a more adequate clinician-patient relationship. It is indispensable to know what the life phenomena mean for individuals, because the meanings have a structuring function. People organize their lives around the meaning they attribute to situations or object. This is also relevant to their health care. From research conducted at the Laboratory of Clinical-Qualitative Research, State University of Campinas, Campinas (São Paulo), Brazil, the authors address, in this article, the following matters: characterization of non-directed interviews, directiveness of interviews, approach techniques, observation of non-verbal and paraverbal manifestations, registry techniques / speech transcription, and validity/reliability of non-directed interviews. This is useful for people interested in research at graduate and undergraduate level.

COLETA DE DADOS NA PESQUISA CLÍNICO-QUALITATIVA: USO DE ENTREVISTAS NÃO- DIRIGIDAS DE QUESTÕES ABERTAS POR PROFISSIONAIS DA SAÚDE

Entrevistas nao-dirigidas constituem o principal instrumento de coleta de dados nas pesquisas qualitativas no campo da saude. Estes estudos estao consolidados na literatura internacional. Para os profissionais de saude, saber o que as pessoas sentem e imaginam permite-nos uma relacao clinico-paciente mais adequada. E indispensavel saber o que os fenomenos da vida significam para os individuos, porque os significados tem uma funcao estruturante: em torno do que as coisas significam para nos, organizamos nossas vidas, incluindo os cuidados com nossa propria saude. A partir de pesquisas concluidas junto ao Laboratorio de Pesquisa Clinico-Qualitativa da Universidade Estadual de Campinas, Brasil, os autores abordam, neste artigo, os seguintes pontos: caracterizacao de entrevistas nao-dirigidas, diretividade das entrevistas, tecnicas de abordagem, observacao de manifestacoes nao-verbais e para-verbais, tecnicas de registro e transcricao do discurso e validade/confiabilidade das entrevistas nao-dirigidas. O texto quer ser util para interessados em pesquisa da graduacao e pos-graduacao.Non-directed interviews constitute the main data collection instrument in qualitative health research. Studies in which this is evident are well documented in international literature. For health professionals, knowing what people feel and imagine makes it possible to develop a more adequate clinician-patient relationship. It is indispensable to know what the life phenomena mean for individuals, because the meanings have a structuring function. People organize their lives around the meaning they attribute to situations or object. This is also relevant to their health care. From research conducted at the Laboratory of Clinical-Qualitative Research, State University of Campinas, Campinas (São Paulo), Brazil, the authors address, in this article, the following matters: characterization of non-directed interviews, directiveness of interviews, approach techniques, observation of non-verbal and paraverbal manifestations, registry techniques / speech transcription, and validity/reliability of non-directed interviews. This is useful for people interested in research at graduate and undergraduate level.

Saturação teórica em pesquisas qualitativas: contribuições psicanalíticas

La tecnica metodologica de saturacion teorica, comun en la investigacion cualitativa, en particular en la clinica, se puede beneficiar de ambas la teoria y practica del psicoanalisis. A pesar de cierta imprecision en el tamano de la muestra final sea inevitable e inherente a los metodos cualitativos, esto no debe dar lugar a tecnicas y procedimientos que debiliten o pongan en peligro la validez y la credibilidad del analisis empirico y conclusiones. Este ensayo analiza aspectos de las dimensiones cognitiva y afectiva presentes durante la recoleccion de datos a traves de entrevistas, del participante y del investigador. Para ello, utilizamos los conceptos freudianos de transferencia y contratransferencia y las nociones de reverie y elementos beta, realizados por Wilfred Bion. Se postula que estos fenomenos ayuden a determinar si la cantidad de datos procedentes de los elementos de la muestra es suficiente, necesario y posible para ahondar sobre el objeto estudiado.

Relato de experiência: o uso de simulações no processo de ensino-aprendizagem em medicina

Este trabalho relata a experiencia, construida ao longo de dois anos, com o uso de estacoes de simulacao da pratica profissional no processo de ensino-aprendizagem do curso de graduacao em Medicina da Universidade Federal de Sao Carlos. Seu referencial pedagogico esta ancorado na concepcao construtivista da aprendizagem e parte da premissa de que aprender nao e reproduzir a realidade, mas ser capaz de elaborar uma representacao pessoal sobre esta e seus conteudos. Assim, a partir da vivencia de situacoes simuladas, os estudantes sao estimulados a ressignificar seus conhecimentos construindo novos saberes. Na Unidade Educacional Estacoes de Simulacao da Pratica Profissional, o estudante se defronta com pacientes simulados e tem a oportunidade de aprender fazendo, errando e aprendendo com os proprios erros. Ao refletir sobre o erro, constroi seu aprendizado por meio da identificacao de lacunas de conhecimento e fundamenta cognitivamente suas capacidades. Professores acompanham o desenvolvimento dos estudantes, atuando ora como avaliadores, ora como facilitadores, ora como consultores. Esta estrategia pedagogica pode ser um instrumento poderoso para o desenvolvimento de competencia na area clinica.

Os usuários de álcool, Atenção Primária à Saúde e o que é "perdido na tradução"

Discute-se o paradoxo presente na Atencao Primaria a Saude (APS) de, por um lado, haver tecnologias clinicas e oportunidades para se abordarem pacientes que fazem uso problematico do alcool e, por outro, verificar-se que este tipo de atencao nao se efetiva para parcela consideravel desses usuarios. Fez-se uma revisao bibliografica critica de cunho narrativo, cujos resultados abordam: a delimitacao do paradoxo; as dificuldades pelas quais passariam os profissionais de saude e seus pacientes para, respectivamente, disponibilizarem e solicitarem intervencoes sobre padroes considerados problematicos de consumo de alcool; as aplicacoes e limitacoes das tecnicas motivacionais, como as intervencoes breves, na APS, e, por fim, discutem-se algumas questoes relativas a formacao profissional em saude. Conclui-se que esta problematica envolve a necessidade de se promover uma agenda de investigacoes que aprofunde a compreensao sobre seus complexos significados psicoculturais, particularmente no Brasil.

Percepção da síndrome de dependência por pacientes em tratamento

ABstrAct The perception of the dependence symptoms is a key factor on the treatment seeking process by people who suffer from it, and its understanding is a relevant health issue. Objectives: The aim of the present study is to identify and understand the subjective meanings of the perceived dependence symptoms among patients who have sought treatment. Methods: Qualitative study conducted on an intentional sample of 13 substance dependents seeking formal treatment; in-depth semi-structured interviews. Results: The diagnostic criteria on substance dependence were spontaneously reported by the participants. They show a clear understanding of the process of treatment, compulsion and lack in controlling substance-taking behavior; withdrawal state; tolerance; neglect of alternative pleasures or interests; perception of harmful consequences due to substance abuse. Conclusions: The interviewees have a proper understanding on the seeking treatment process and seem to evaluate subjectively and carefully the distress related to the dependence symptoms. These results need special attention of health professionals, especially in primary care settings and, once approached, it may collaborate with treatment searching.

Possíveis novos determinantes da qualidade de vida de pacientes com câncer de tireoide tratado: um estudo qualitativo.

The aim of this study was to develop a qualitative approach of determinant factors of the quality of life of treated patients with papillary thyroid carcinoma. Sixteen in-depth interviews were conducted with individuals 18 to 45 years old regarding their disease representations and experiences, followed by statements content analysis. The results show issues already provided in structured questionnaires about quality of life, although others were only partially assumed in these surveys (management of the concept of disease etiology; the “forced” patient introduction into the medical conceptual universe; the fear of the prognosis and positive changes in lifestyle). The results interpretation were benefited from recently developed theoretical elaborations: the anxieties related to illness experience seem to be configured as a “modern risk”, in the context of a “risk society”. The development of structured questionnaires on quality of life requires frequent qualitative studies to capture changes in subjective aspects of the construct, given the dynamic changes of historical, cultural and psychological meanings of the health disease process, constantly influenced by technological innovations and continuing epidemiological interpretations.

Sexual health care of two generations of men: continuities and volatilities of scripts and habitus.

To acquire in-depth understanding of meanings attributed by young men to sexual health care, the similarities and asymmetries present in a corpus of 60 reports of men from two different generations were analyzed regarding this type of care. A process of in-depth hermeneutics was undertaken under the theoretical sociological perspectives of sexual scripts, male habitus and generation. Fifteen analytical categories were grouped together into the three dimensions of sexual scripts (intra-psychic, interpersonal and cultural). Some findings indicate the presence of provisions which were not enduring and have not been transposed to the next generation. However, striking cultural similarities or habitus around male sexuality were also found in the two different socio-historical contexts, allowing for an interpretation on the as yet inconstant use of condoms among the young.