Vozes da atenção primária no enfrentamento da violência: diagnóstico situacional, preparo profissional e estratégias educativas

Abstract

Violence constitutes a complex and multifaceted problem, with high epidemiological magnitude and profound social, health-related, and institutional repercussions, representing a strategic challenge for Primary Health Care (PHC) within the Brazilian Unified Health System (Sistema Único de Saúde – SUS). The objective of this study was to analyze professional preparedness, training needs, and the potential for engagement with Information, Education, and Communication (IEC) tools for addressing violence in PHC. This is a methodological study with a mixed qualitative–quantitative approach, developed in sequential phases. In Phase 1, a situational diagnosis was conducted, comprising three stages: (2a) development of the instrument “Voices of Primary Health Care in the Detection and Management of Violence”, grounded in a literature review, analysis of previously used instruments, and Classical Test Theory (CTT), with the definition of constructs, analytical dimensions, and scoring criteria; (2b) pre-testing and content validation of the questionnaire, conducted with 15 PHC professionals from the state of Ceará, using the Content Validity Index (CVI) and Lynn’s criteria, with integrated qualitative and quantitative analysis; and (2c) descriptive analysis of pre-test data, which guided operational adjustments and the consolidation of the synthetic indices. Finally, a cross-sectional study was conducted with 79 PHC professionals from Fortaleza, Ceará. The results revealed significant gaps in professional preparedness for managing violence in PHC. Less than half of the participants adequately recognized multiple physical and psychological signs of violence and demonstrated satisfactory knowledge of formal institutional care and referral pathways. Only a small proportion reported prior use or operational proficiency with the Notifiable Diseases Information System (Sistema de Informação de Agravos de Notificação – SINAN), indicating weaknesses in the articulation between clinical practice and health surveillance. Conversely, more than two thirds of the professionals recognized violence as a relevant issue in their professional practice and expressed the need for additional training, reflecting a high perceived level of theoretical and practical gaps. Regarding educational strategies, a high potential for engagement with IEC tools was identified, particularly those that are digital, objective, and accessible. Most participants expressed a preference for interactive resources, concise content applicable to routine PHC practice, and tools with offline functionality, reinforcing the relevance of approaches aligned with health social marketing. The application of Classical Test Theory enabled the selection of items with adequate discriminative power and conceptual coherence, resulting in the construction of three synthetic indices: the Professional Preparedness and Readiness Index for Violence Management in PHC (IPPMV-APS), the Training Needs Index for Violence Management in PHC (INF-MVAPS), and the Engagement and Attractiveness Index of Educational Tools (IEAEE-VAPS), with interpretative scores classified as low, moderate, and high. It is concluded that the situational diagnosis revealed important challenges and opportunities for strengthening violence-related health surveillance within PHC, highlighting the strategic role of IEC tools and health social marketing as mechanisms to support professional qualification, promote equity, and enhance public policies aimed at violence prevention and response within the SUS.