ISSN: 2763-5724 / Vol. 05 - n 04 - ano 2025

FLOWS AND FUNCTIONS: AN EXPERIENCE REPORT ON USERS’

PERCEPTIONS OF THE FHS IN A PHU IN EUNÁPOLIS, BAHIA

Flaelma Almeida da Silva1

Brenda Ivny Lima Silva2

Bárbara Ivina Lima Silva3

Diana de Lima4

Tatiana Santana dos Santos5

Abstract: This article presents an academic experience developed within a university extension

project linked to the Medicine program at Faculdade Pitágoras de Eunápolis. The study adopts a

perceptual approach focused on analyzing users’ opinions regarding the service ow and the functions

performed by the multidisciplinary team of the Family Health Strategy (FHS) at the São João Batista

Basic Health Unit. Structured instruments were used for data collection, based on a questionnaire

composed of nineteen closed-ended questions applied to a sample of thirteen users. The results

showed that 61.5% rated the service as “regular” and 38.5% as “good” or “excellent”, with no negative

responses recorded. Regarding professional listening, 46.1% stated they are “always listened to” and

38.5% reported being listened to “sometimes”, indicating positive but inconsistent communication

practices. As for the team’s knowledge of community health conditions, 69.2% demonstrated a positive

perception, while 30.8% identied some degree of unawareness. The main challenges to accessing the

unit were long waiting lines (53.8%) and lack of information (23.1%). The most frequently mentioned

1 Master in Education, CETSC Professor at the Pitágoras Faculty of Medicine of Eunápolis

2 Student of the Medicine Course at the Pitágoras Faculty of Medicine of Eunápolis.

3 Specialist in Clinical Hematology - Centro Universitário Doutor Leão Sampaio.

4 PhD in Environmental Engineering Sciences, CETSC Professor at the Pitágoras Faculty of

Medicine of Eunápolis

5 Master in Health, Environment and Biodiversity, Professor of PINESC at the Pitágoras Fa-

culty of Medicine of Eunápolis.

ISSN: 2763-5724 / Vol. 05 - n 04 - ano 2025

improvement suggestions included enhancing the physical infrastructure of the unit, followed by

increasing the number of professionals and improving communication with patients. The experience

adhered to the ethical principles required for research involving human subjects, with all participants

signing an Informed Consent Form and formal authorization obtained from the Eunápolis Municipal

Health Department for the implementation of the activity. It is concluded that strengthening active

listening and integrating teaching, service, and community represent essential paths to improving

primary health care and enhancing the transformative effects of university extension.

Keywords: Family Health Strategy. Experience Report. University Extension. Primary Health Care.

User Perception.

Introduction

Primary Health Care in Brazil, guided by the principles of the Unied Health System (SUS)

and based on health prevention, promotion, recovery and rehabilitation actions. Its implementation

aims to reorganize the work process in the basic units, focusing on comprehensiveness, longitudinality

and bonding with the community (Arantes et al., 2016). In this context, active listening to users,

clarity in professional functions and the efciency of the ow of care become essential elements for

the effectiveness of care.

The relevance of investigating the users’ perception of the services provided by the FHS lies

in the understanding that the quality of care is inuenced not only by biomedical indicators, but also

by the patient’s subjective experience with the health system. As pointed out by Moimaz et al. (2010),

user satisfaction and perception reect, to a large extent, the functional performance of the unit and

the quality of the interactions established with health professionals.

By considering perception as an analytical category, it is possible to access more subtle

dimensions of the relationship between service and population, identifying gaps in communication,

failures in listening, and mismatches between institutional planning and the real needs of the

ISSN: 2763-5724 / Vol. 05 - n 04 - ano 2025

community. Attention to these aspects allows not only the technical improvement of the team, but

also the strengthening of a more humanized and responsive care (Garcia et al., 2020).

In this sense, the present study is justied because it is integrated with university extension

actions and promotes a formative experience that articulates teaching, research and service. The

activity was developed by students of the Medicine course at Faculdade Pitágoras de Eunápolis,

within the scope of the discipline Interdisciplinary Practices of Teaching, Service and Community

Interaction (PINESC), in partnership with the Municipal Health Department. The empirical eld was

limited to the Basic Health Unit (BHU) São João Batista, located in the urban area of the city.

The central problem that guides this experience refers to the following question: how do

the users of the São João Batista UBS perceive the ow of care and the functions performed by

the professionals of the Family Health Strategy (FHS)? This question arises from the observation

that, despite the structural advances in Primary Care, many units still face difculties in clearly

communicating their internal processes and ensuring systematic and effective listening to the enrolled

population.

The theoretical basis that will support the data analysis is based on authors who discuss

the organization of the FHS, qualied listening, the longitudinality of care and the determinants of

user satisfaction with health services. Among them, the studies by Falkenberg et al. (2014), on health

education and humanization of care; Azeredo et al. (2007), who address the importance of home

visits in the construction of territorial bonds; and Kessler et al. (2019), who discuss longitudinality as

a structuring axis of problem-solving capacity in primary care.

In addition, the guidelines of the Ministry of Health (Brasil, 2000) establish territorialization,

interdisciplinarity and community participation as pillars of the ESF, which serve as a normative

reference for the critical analysis of the users’ responses. The contributions of Ferreira et al. (2019) on

continuing education also guide the understanding of professional training in health as a continuous

process, sensitive to the concrete demands of the territory.

The perception of the users, in this work, is understood as an expression of their experiences

ISSN: 2763-5724 / Vol. 05 - n 04 - ano 2025

accumulated in the daily use of the UBS services. This approach allows us to problematize aspects

of welcoming, interpersonal communication, access to information and clarity in the roles played

by community agents, nurses and doctors in the FHS. The analysis of these dimensions can offer

subsidies for improving the quality of care and strengthening social control.

The experience reported here also fullls an important pedagogical function by providing

students with a critical contact with the reality of the SUS, promoting an education that transcends

technical knowledge and reaches the ethical, relational and territorial dimension of care. Based on

active listening and systematization of the ndings, the proposal is to give back to the community

an analysis built on the basis of their own voice, respecting the principles of participation and co-

responsibility.

Thus, the present experience report proposes to describe and analyze, in the light of the

specialized literature, the data obtained from the users of the UBS São João Batista, with emphasis on

perceptions related to the ow of care, professional listening and the functions performed by the FHS

team. Thus, it seeks to contribute to the production of knowledge committed to the strengthening of

Primary Care and to the ethical and political qualication of medical education.

Methodology

The present experience report was developed within the scope of the integration of the

disciplines Interdisciplinary Practices of Teaching, Service and Community Interaction (PINESC)

and Science, Extension and Transformation of Health in the Community (CETSC), as a university

extension activity carried out by students of the Medicine course of the Pitágoras de Eunápolis College.

The activity took place at the Basic Health Unit (UBS) São João Batista, located in the municipality

of Eunápolis, Bahia, with the formal consent of the Municipal Health Department.

The methodological proposal adopted was quantitative-qualitative in nature, with emphasis

on the perceptive approach of the users of the Family Health Strategy (FHS). The instrument used

ISSN: 2763-5724 / Vol. 05 - n 04 - ano 2025

was a structured questionnaire, composed of nineteen objective questions with multiple-choice

alternatives, covering aspects related to the ow of care, professional listening, organization of the

unit and functions of the multiprofessional team.

The sample was composed of 13 (thirteen) users of the UBS, randomly and voluntarily selected,

respecting the diversity of age group, education and gender. The application of the questionnaires

was conducted by the students in a direct approach, with accessible language and attentive listening,

seeking to ensure the clarity of the questions and full understanding by the participants.

During the activity, the ethical principles that govern research with human beings were

strictly observed. All participants signed the Informed Consent Form (ICF), after being duly informed

about the objectives, methods and non-interventionist nature of the experiment. The identity of the

participants was preserved, ensuring secrecy and condentiality of the data.

The analysis of the results was carried out in two stages. First, the closed answers were

tabulated and organized in bar graphs, allowing the visualization of the relative frequencies for each

selected question. Next, the data were discussed in the light of the previously established theoretical

framework, with the objective of critically interpreting the perceptions reported by users and

confronting them with the principles and guidelines of the FHS.

The systematization of the data was not intended to generalize, but rather to deepen the

understanding of the community’s local experience with Primary Health Care services. As a report

of an extension experience, this methodology allowed not only the collection of signicant data, but

also the concrete academic experience of students in the interface between medical education and the

reality of the SUS.

Analysis and Discussion of Results

The interpretation of the data obtained from the users of the São João Batista Basic Health Unit

was guided by a theoretical framework that includes authors who critically discuss the functioning of

ISSN: 2763-5724 / Vol. 05 - n 04 - ano 2025

the Family Health Strategy (FHS), the principles of Primary Health Care and the subjective elements

that make up the user experience. The contributions of Arantes et al., (2016) were fundamental to

understand the ESF as a model that seeks to restructure the work process in Primary Care, with a

focus on integrality, territorialization and bonding. These principles served as a basis for analyzing

whether, in the perception of users, such guidelines are being effectively applied in the daily practice

of the unit investigated.

Active listening, pointed out by Garcia et al. (2020) as an essential professional skill in user

embracement, was identied in the users’ discourses as a present but inconstant practice. The literature

highlights that qualied listening involves more than hearing availability: it is a relational competence

that structures trust and the effectiveness of care. Neves (2021) adds that failures in communication

between professionals and users compromise the uidity of care, adherence to treatments, and the

clarity of institutional ows, indicating the need for permanent qualication of teams in this eld.

The absence of educational activities as an element positively highlighted by users is also

supported by the literature. According to Fernandes et al. (2019), although health education is one

of the pillars of the FHS, it is often relegated to a secondary role in the routines of the units, with

disjointed or punctual actions, which limits its formative and emancipatory function. This nding

reinforces the importance of valuing educational practices as a strategy for bonding, guidance, and

promotion of self-care.

Another relevant aspect refers to the users’ perception of the presence and knowledge of the

health team in relation to the territory. Azeredo et al. (2007) emphasize that territorialization, by itself,

does not guarantee a bond with the community: it is necessary for the team to develop effective actions

of approximation, such as home visits, recognition of local vulnerabilities and qualied presence in

spaces of collective listening. The data reveal that, although part of the participants perceive proximity

to the professionals of the unit, there are also manifestations of distancing, pointing out gaps in the

team-territory relationship.

The analysis of the data obtained from the thirteen users of the São João Batista UBS reveals

ISSN: 2763-5724 / Vol. 05 - n 04 - ano 2025

central aspects about the functioning of the Family Health Strategy (FHS) from the perspective of

the subjects themselves. By adopting a perceptive approach, the study sought to systematically show

how users interpret the quality of the service, the challenges of access and the role played by the

professionals of the unit.

Data were collected through a questionnaire with nineteen closed questions. For analytical

purposes, ve of these questions were selected for their representativeness in relation to the objectives

of the study. The answers were organized in bar graphs, allowing clear observation of the distribution

of perceptions.

The rst relevant nding concerns the general evaluation of the work of the FHS team. Most

users rated the performance as “fair, could be better”, while a smaller portion considered it “very

good, they help a lot”. None of the answers indicated ignorance of the team’s work or a negative

evaluation.

Graph 1: Evaluation of the work of the FHS team by the community

Source: Field research, 2024.

ISSN: 2763-5724 / Vol. 05 - n 04 - ano 2025

This data signals an intermediate perception of the performance of FHS professionals.

Although the service is not perceived as bad, the prevalence of “regular” evaluation demonstrates the

existence of expectations that are not fully met. This indicates that, even in the face of a performance

considered minimally satisfactory, there is a latent demand for improvement.

On the other hand, the fact that no responses were recorded in the “bad” or “I don’t know

their work” categories reveals a positive aspect: users recognize the presence and performance of the

team. This indicates that the professionals are inserted in the daily life of the community and that

there is a minimum of bond established.

The second question analyzed addressed the listening of users’ doubts and concerns by the

FHS professionals. Most answered that they “always listen and help”, followed by “sometimes they

listen, but it could be more”. Only two people said they “rarely listen,” and none indicated they “never

listen.”

Graph 2: Users’ perception of the professionals’ active listening

Source: Field research, 2024.

ISSN: 2763-5724 / Vol. 05 - n 04 - ano 2025

This result is signicant, as it indicates that active listening is practiced, although with

oscillations. Listening is an essential element of comprehensive care, being an important marker of

humanization in Primary Care. The existence of answers in the category “sometimes listen” reveals a

certain irregularity in this aspect, which can affect the user’s trust in the service.

Even so, the most expressive data, that 46.2% always feel heard, demonstrates that part of

the team strives to establish empathetic communication. This suggests that professionals understand,

at least partially, the value of listening as an instrument of welcoming and care.

The third question analyzed investigated whether users feel that the FHS team knows the

health of the community well. The majority answered afrmatively, with ve people saying “yes, they

know a lot”, and four saying they “know a little”. Three said they “don’t know it well,” and one said

“I don’t know.”

Graph 3: Perception of the team’s knowledge of the community

Source: Field research, 2024.

ISSN: 2763-5724 / Vol. 05 - n 04 - ano 2025

These data demonstrate that most recognize some degree of proximity between the team

and the territory, which is consistent with the FHS model, based on territorialization and bonding.

However, the fact that there are responses that point to partial or total lack of knowledge suggests the

need to intensify actions such as home visits and community listening.

This perception of lack of knowledge may be associated with the turnover of professionals,

the overload of demands, or the absence of systematic health surveillance actions. As indicated by

Azeredo et al. (2007), the territorial bond is only consolidated with the active and regular presence of

the team in the population’s living spaces.

The fourth question addressed the main challenges faced by users to access UBS services.

The most frequent response was “long waiting list”, followed by “lack of information” and “lack of

nancial resources”. A small group declared that they did not face any difculties.

Graph 4: Top user-reported barriers to access

Source: Field research, 2024.

ISSN: 2763-5724 / Vol. 05 - n 04 - ano 2025

This nding reveals a structural dimension of the problem. The waiting list, as pointed out

by more than half of the interviewees, indicates a bottleneck in the internal ow of the unit. This is an

obstacle that negatively impacts satisfaction and continuity of care, especially when associated with

the lack of clear communication about schedules, available professionals, and forms of scheduling.

The absence of information as the second biggest challenge reinforces the idea that

communication between unit and community is still fragile. This can compromise adherence to

services and generate misinformation about the rights, ows, and therapeutic possibilities offered by

Primary Care.

The fth question investigated asked how users evaluate the overall quality of the care

received. Most answered “fair”, followed by “good” and only one answer for “excellent”. There were

no answers to “bad”.

The predominance of the “regular” answer is consistent with the other perceptions raised.

The data reinforces the notion that, although the service works and partially fullls its functions, there

are noticeable gaps for the user, especially with regard to welcoming, communication and access.

The answer “excellent”, although isolated, indicates that there are individualized positive

experiences, which can serve as an internal reference of good practices. However, the restricted

number of responses in this category shows that these good practices have not yet become standard

within the unit.

ISSN: 2763-5724 / Vol. 05 - n 04 - ano 2025

Graph 5: Evaluation of the quality of the care received at the UBS

Source: Field research, 2024.

In addition to the objective questions, the questionnaire had a nal stage in which users

were able to suggest improvements. The most frequent responses were the increase in the number of

professionals and the improvement of communication with patients. Other notes included the desire

for a greater supply of services and the appreciation of educational activities.

The suggestion of increasing the team, expressed by the users, is in line with studies that

relate the overload of FHS professionals to a precarious organization of services, marked by the

scarcity of personnel, excess demands and lack of territorialized planning. According to Assis et

al. (2020), the dissatisfaction of Primary Care workers is directly associated with the inadequate

distribution of human resources, compromising both the time of care and the ability to listen and

the problem-solving capacity of actions. The users’ perception of these aspects, therefore, offers a

strategic indication for management, in the sense of readjusting the composition of the teams and

ensuring greater effectiveness in care.

ISSN: 2763-5724 / Vol. 05 - n 04 - ano 2025

The demand for better communication, on the other hand, points out that, even with occasional

experiences of active listening, users still perceive failures in feedback, clarity of information and

continuity of care. Neves (2021) points out that communication between health professionals and users

remains one of the main obstacles in Primary Care, affecting the bond and adherence to treatment.

The absence of educational activities as a highlight in the interviewees’ statements reinforces this

diagnosis: according to Fernandes et al. (2019), despite being provided for in the FHS guidelines,

health education actions are often secondary or executed in a disjointed way, which compromises

their emancipatory power.

Finally, the data analyzed allow us to visualize a scenario in which the performance of the

FHS team is recognized, but still limited by operational and relational barriers. The predominance

of “regular” evaluation among users is related, according to Silva et al. (2015), to the fragmentation

of institutional communication, the insufciency of continuous welcoming practices and the fragility

of the territorial bond. These limitations, although they do not constitute a negative perception of

the service, indicate the urgency of strengthening local planning, with a focus on qualied listening,

effective territorial presence and the restructuring of internal care ows.

Active listening, although present in some situations, still lacks systematization that

guarantees its effectiveness as a central practice in welcoming and humanizing care. According to

Garcia et al. (2020), listening is not just listening, but requires specic communication skills, empathy,

and interpretation of the reality experienced by the user from the professional. When this listening

occurs in a fragmented or unqualied way, there is a loss of bond and a reduction in adherence to

care. In addition, as Neves (2021) points out, the absence of organizational communication strategies

impairs the understanding of internal ows and compromises the user’s journey through the services,

generating confusion, insecurity, and discontinuity in care.

The users’ perception of the team’s level of knowledge in relation to the territory reafrms

the importance of territorialization as a structuring axis of the Family Health Strategy. However, as

demonstrated by Azeredo et al. (2007), the mere presence of the team in a given geographical area

ISSN: 2763-5724 / Vol. 05 - n 04 - ano 2025

does not guarantee an effective bond with the community: this bond is built through regular actions,

such as home visits, community listening and recognition of the singularities of the territory. When

these actions are absent or inconsistent, users tend to evaluate the service as distant and disjointed

from their real needs. This fragility compromises the logic of continuous and comprehensive care, as

was also identied by Silva et al. (2015) when analyzing the perception of users in other SUS units.

Final Thoughts

The data obtained in this experience report allowed us to understand, from the users’

perspective, the main aspects that favor and limit the functioning of the Family Health Strategy in a

basic unit located in the city of Eunápolis/BA. The analysis showed that, although there is recognition

of the team’s performance, challenges related to communication, active listening and territorial

knowledge persist. These dimensions, although structuring in the conception of the FHS, are still

manifested in a partial way, compromising the integrality and humanization of care.

The predominance of evaluations classied as “regular” reveals an intermediate perception

regarding the quality of the service, indicating that users identify the existence of care, but also

perceive failures in the organization of care and in the ow of information. The absence of spontaneous

mentions of educational actions and health promotion reinforces the need to rescue these practices

in the daily lives of the teams, in accordance with the guidelines of Primary Care. Such gaps show a

scenario in which access is guaranteed, but the problem-solving capacity and the bond still need to

be strengthened.

Listening to users as a strategy for evaluating the service proved to be fundamental for

the recognition of elements that often escape the classic quantitative indicators. The suggestions for

improvement presented, such as the increase in professionals and the improvement of communication,

signal not only specic demands, but structural challenges that require human resources planning,

review of institutional ows, and continuous qualication of teams. By highlighting the voice of

ISSN: 2763-5724 / Vol. 05 - n 04 - ano 2025

the user, this study reafrms the value of social participation in the construction of public policies

sensitive to the territory.

It is concluded that the present study, by valuing the perception of the subjects as an

instrument of analysis and transformation of services, contributes to a broader approach to health

evaluation. The experience reported here reinforces the strategic role of university extension in

bringing teaching, service and community closer together, favoring the production of knowledge

committed to social reality and to the improvement of the SUS. The replication of research with this

approach can strengthen qualied listening as a methodological and political tool, guiding actions that

are more coherent with the needs of users and with the principles of comprehensive care.

References

ARANTES, L. J.; SHIMIZU, H. E.; MERCHÁN-HAMANN, E. Family Health Strategy:

aspects related to the performance of teams that inuence user satisfaction. Ciência & Saúde

Coletiva, Rio de Janeiro, v. 21, n. 9, p. 2939–2950, 2016. Available at: https://www.scielo.br/j/csc/a/

QhK6nmLjqSYnNfsRXZTL3mx. Accessed on: June 30, 2025.

ASSIS, B. C. S.; SOUSA, G. S.; SILVA, G. G. da; PEREIRA, M. O. What factors affect satisfaction

and work overload in primary health care units? Revista Acervo Saúde, vol. 12, n. 6, 2020. Available

at: dialnet.unirioja.es+15researchgate.net+15acervomais.com.br+15. Accessed on: 2 jan. 2025.

AZEREDO, Catarina Machado et al. Evaluation of housing and sanitation conditions: the importance

of home visits in the context of the Family Health Program. Ciência & Saúde Coletiva, Rio de Janeiro,

v. 12, p. 743–753, 2007. Available at: https://www.scielo.br/j/csc/a/GcWprrMZxKh5JfYKfWzcb4R.

Accessed on: June 30, 2025.

BRAZIL. Ministry of Health. Implementation of the Family Health Unit: primary care notebook

nº 1. Brasília: Ministry of Health, 2000. Available at: https://bvsms.saude.gov.br/bvs/publicacoes/

implantacao_unidade_saude_familia_cab1.pdf. Accessed on: 17 out. 2024.

FALKENBERG, Mirian Benites et al. Health education and health education: concepts and

ISSN: 2763-5724 / Vol. 05 - n 04 - ano 2025

implications for public health. Ciência & saúde coletiva, v. 19, p. 847-852, 2014. Available at:

https://cienciaesaudecoletiva.com.br/artigos/educacao-em-saude-e-educacao-na-saude-conceitos-e-

implicacoes-para-a-saude-coletiva/12279?id=12279. Accessed on: 2 nov. 2024.

FERNANDES, M. C. P. et al. Users’ perception of the practice of health education in the FHS:

challenges and contradictions. Saúde e Debate, 2019. Available at: https://www.scielo.br/j/sdeb/a/

yNsMtwXgbLKLCbKcqYkNkgb/?utm_source. Accessed on: 7 jan. 2025.

FERREIRA, Lorena et al. Continuing Health Education in primary care: an integrative literature

review. Saúde em Debate, v. 43, n. 120, p. 223-239, 2019. Available at: https://www.scielo.br/j/sdeb/

a/3wP8JDq48kSXrFMZqGt8rNQ/. Accessed on: 2 Nov.2024.

GARCIA, S. M. F. et al. Qualied listening as a welcoming tool in a Family Health Strategy. Revista

Congrega, Itapetininga, v. 14, p. 20-25, 2020. Available at: https://congrega.faccat.br/index.php/

congrega/article/view/1516. Accessed on: June 30, 2025.

KESSLER, Marciane et al. Longitudinality of care in primary care: evaluation from the perspective

of users. Acta paulista de enfermagem, v. 32, n. 2, p. 186-193, 2019. Available at: https://www.scielo.

br/j/ape/a/BFN6xzjDDQgk6qcGQY5PbpH/. Accessed on: 2 nov. 2024.

MOIMAZ, Suzely Adas Saliba et al. Satisfaction and perception of SUS users about the public health

service. Physis: Journal of Collective Health, v. 20, p. 1419-1440, 2010. Available at: https://www.

scielo.br/j/physis/a/mhKYHzfQFwKrLKct9WW4rBb/abstract/?lang=pt. Accessed on: 17 out. 2024.

NEVES, T. C. L. Communication and care in APSESF: evidence, reections and challenges. Doctoral

thesis, Fiocruz, 2021. ICIT. Institute of Scientic and Technological Communication and Information

in Health. Available at: ppgics.icict.ocruz.br+1dialnet.unirioja.es+1. Accessed on: 10 out. 2024.

SILVA, S. A.; FRACOLI, L. A. et al. Evaluation of primary health care: perception of users and

professionals in the FHS. Latin American Journal of Nursing, 2015. Available at: https://www.scielo.

br/j/rbem/a/ftNptfq55ML58tm3DqRwvHj/?utm_source. Accessed on: 8 out. 2024.