“SOMETIMES, IT’S JUST A WORD”: HEALTH PROMOTION AS RESISTANCE IN AGING THROUGH THE BRAZILIAN UNIFIED PUBLIC HEALTH SYSTEM (SUS)ABSTRACT
Objective: to analyze the perceptions of older adults regarding active aging and health promotion actions developed in Primary Health Care based on their experiences in the territory.
Method: this is a qualitative study conducted in a Basic Health Unit on the coast of Santa Catarina with seven older adults participating in a walking group. Data collection included participant observation, individual interviews, and group negotiation. The statements were analyzed using the constant comparative method and systematized in a matrix of strengths, weaknesses, opportunities, and threats.
Results: the results show the existence of powerful care practices supported by affective bonds, active participation, and informal support networks. However, they also point to structural limitations, such as the absence of mental health professionals, the scarcity of adequate spaces, and a lack of systematized collective actions. Opportunities are associated with integration with other services and the daily inventiveness of older adults. Threats stem from illness, overload, and isolation.
Conclusion: when health promotion in Primary Health Care is built on listening to and empowering individuals, it takes on characteristics of resistance against the precariousness of public services and the invisibility of old age in health policies.
DESCRIPTORS:
Primary Health Care; Health promotion; Aging; Older adult; Qualitative research
RESUMO
Objetivo: Analisar as percepções de pessoas idosas sobre o envelhecimento ativo e as ações de promoção da saúde desenvolvidas na Atenção Primária à Saúde a partir de suas vivências no território.
Método: Pesquisa qualitativa realizada em uma Unidade Básica de Saúde do litoral catarinense com sete pessoas idosas participantes de um grupo de caminhada. A coleta incluiu observação participante, entrevistas individuais e grupo de negociação. As falas foram analisadas por meio do método comparativo constante e sistematizadas em uma matriz de forças, fragilidades, oportunidades e ameaças.
Resultados: Os resultados evidenciam a existência de práticas potentes de cuidado sustentadas por vínculos afetivos, participação ativa e redes de apoio informal. No entanto, apontam também limites estruturais, como a ausência de profissionais da saúde mental, a escassez de espaços adequados e a falta de sistematização das ações coletivas. As oportunidades estão associadas à integração com outros serviços e à inventividade cotidiana das pessoas idosas. As ameaças decorrem do adoecimento, da sobrecarga e do isolamento.
Conclusão: A promoção da saúde na Atenção Primária à Saúde, quando construída com base na escuta e na autonomia dos sujeitos, assume contornos de resistência frente à precarização dos serviços públicos e à invisibilidade da velhice nas políticas de saúde.
DESCRITORES:
Atenção primária à saúde; Promoção da Saúde; Envelhecimento; Idoso; Pesquisa qualitativa
RESUMEN
Objetivo: analizar las percepciones de las personas mayores sobre el envejecimiento activo y las acciones de promoción de la salud desarrolladas en la Atención Primaria de Salud, a partir de sus experiencias en el territorio.
Método: investigación cualitativa realizada en una Unidad Básica de Salud en la costa de Santa Catarina con siete personas mayores que participaron en un grupo de caminata. La recolección de datos incluyó observación participante, entrevistas individuales y negociación grupal. Las afirmaciones se analizaron mediante el método comparativo constante y se sistematizaron en una matriz de fortalezas, debilidades, oportunidades y amenazas.
Resultados: los resultados muestran la existencia de prácticas de cuidado eficaces, sustentadas en vínculos afectivos, participación activa y redes informales de apoyo. Sin embargo, también señalan limitaciones estructurales, como la ausencia de profesionales de la salud mental, la escasez de espacios adecuados y la falta de sistematización de las acciones colectivas. Las oportunidades se asocian con la integración con otros servicios y la creatividad cotidiana de las personas mayores. Las amenazas provienen de la enfermedad, la sobrecarga y el aislamiento.
Conclusión: la promoción de la salud en Atención Primaria de Salud, al basarse en la escucha y el empoderamiento de las personas, se caracteriza por la resistencia a la precariedad de los servicios públicos y la invisibilidad de la vejez en las políticas sanitarias.
DESCRIPTORES:
Atención primaria de salud; Promoción de la salud; Envejecimiento; Personas mayores; Investigación cualitativa
INTRODUCTION
Brazil is experiencing an accelerated process of population aging, without public policies keeping pace in terms of rhythm and depth with the transformations required by this new scenario1. Although the country has important legal frameworks, such as the National Health Policy for Older Adults (Política Nacional de Saúde da Pessoa Idosa)2, the National Health Promotion Policy (Política Nacional de Promoção da Saúde)3 and the National Primary Care Policy (Política Nacional de Atenção Básica)4, there is a gap between the normative provisions and the daily reality of health services5-6.
Primary Health Care (PHC) is considered the main gateway to the Unified Health System (Sistema Único de Saúde - SUS) and care coordinator, and is also the strategic space for promoting active and healthy aging. However, its actions in many localities remain weakened by underfunding, work overload and management logics that prioritize quantitative goals to the detriment of bonding and comprehensiveness7-8. This reality imposes limits on implementing collective actions, which are so fundamental for promoting health and strengthening the autonomy of older people9-10.
Given this, listening to older people becomes essential to understanding the meanings attributed to care practices, the challenges faced in primary health care, and possible paths for its transformation. When older people are involved in evaluation processes, they cease to be seen as a passive target audience and assume their place as protagonists of healthcare. Evaluation built with the subjects, and not about them, broadens the democratic horizon of the SUS and makes it possible to make visible experiences which escape managerial data and performance indicators11,12.
Listening to them is more than recognizing their demands: it is legitimizing their knowledge, giving visibility to the practices that support care in daily life, and strengthens the bond between services and users. Qualified listening allows us to not only identify the limits of the care offered, but also the strategies that the community itself mobilizes to resist and reinvent living13.
Thus, this article aims to analyze the perceptions of older adults about active aging and the health promotion actions developed in primary health care based on their experiences in the territory. This study seeks to understand the meanings attributed to care, the challenges faced, and the possibilities for transforming healthcare through the active participation of older adults.
METHOD
This article is part of an ongoing doctoral research project. The objective is to understand the challenges and opportunities for promoting active aging in primary health care. The approach is the Fourth Generation Assessment (FGA), by Guba and Lincoln14. It is a qualitative, constructivist, dialogical, and participatory method. Participants are recognized as co-authors of the process. Data collection and analysis occur through the Hermeneutic-Dialectic Circle (HDC), and Claims, Concerns, and Issues (CCIs) guide the process. The HDC promotes negotiation of meanings and collective construction of interpretations.
This stage of the study took place between February and April 2025. The field was a Basic Primary Health Care Unit (Unidade Básica de Saúde - UBS) in a municipality on the coast of Santa Catarina. The UBS was randomly selected from teams with regular actions to promote active aging. This preliminary survey, among the UBSs that did or did not develop actions aimed at active and healthy aging, was carried out in December 2024 by the researcher. At the time of data collection, the municipality had 18 basic primary health care units (UBS) and 28 Family Health Teams (Equipes de Saúde da Família - eSF).
Seven older adults from the UBS walking group participated. The group meets three times a week and is monitored by health professionals from the unit. The researcher conducted participant observation for approximately 70 hours. In addition, there was monitoring during walks, face-to-face conversations, and exchanges in the group’s WhatsApp. The researcher also kept a field diary to support the analysis.
The first participant was indicated by a Community Health Agent (Agente Comunitária de Saúde - ACS). The others were indicated in a chain by the participants themselves during the HDC. The inclusion criteria were age ≥60 years, affiliation with the UBS, active participation, and adequate cognitive conditions according to the Mini-Mental State Examination15. All met the criteria, and there were no refusals or withdrawals. Subsequent invitations were made by the researcher following the sequence of the HDC in face-to-face contacts and individual arrangements.
The interviews were conducted in the participants’ homes, on days and times defined by the participants themselves, and took place without the presence of third parties, ensuring privacy. Each interview lasted between 10 and 40 minutes. The script began with three trigger questions (actions offered by the UBS; impacts on health; suggestions for new activities). A total of 10 questions were incorporated at the end of the HDC based on the emerging CCIs. Data collection ended when successive interviews began to indicate stabilization of the CCIs and the negotiated constructions.
The interviews were audio-recorded using a smartphone, after formal consent was obtained in the Informed Consent Form (ICF). The participants chose the name of a tea that relates to the health practices of older people to ensure anonymity. The transcription was done manually with the support of Microsoft Word 365. The researcher is a nutritionist, holds a master’s degree in Health and Work Management, and is a doctoral candidate in Health Promotion. She has experience in qualitative research and carries out her work activities in primary health care. It is worth highlighting that there was no prior relationship with the participants. A reflective diary, triangulation between sources (interviews, observation, and validation), and recording of analytical decisions were used for reflection and bias control.
The analysis followed the Constant Comparative Method14. Thus, a floating and critical reading was performed, followed by line-by-line coding. The units of meaning were compared continuously, considering frequency, intensity, and relevance. There was iterative reorganization into provisional categories. Finally, the interpretation was integrated in light of the emerging CCIs, the field diary, and subsequently validated in the negotiation session with the participants.
Before the negotiation group, the participants received a transcript of their interview in advance to give their consent. After accepting the transcripts, the participants received a summary document. The document contained provisional categories and illustrative excerpts, serving for reading and comments. The final negotiation took place in April 2025 at the home of one of the participants, with five of the seven people attending. The meeting lasted approximately 90 minutes. The categories were presented and discussed, and the group acknowledged the results as legitimate. There were no requests for changes or exclusion of any of the categories.
The findings were organized into a SWOT (Strengths, Weaknesses, Opportunities, Threats) matrix. Strengths and weaknesses represent the internal environment of actions in primary health care, and opportunities and threats represent the external environment that influences their implementation. The matrix functioned as a pedagogical and dialogical device, making the tensions and potentialities pointed out by the older adults themselves visible.
The study was approved by the Research Ethics Committees of the Central Education Unit of Faem Faculty and Cesumar University. It was conducted and reported in accordance with the guidelines of COREQ-3216, and all data collected are fully available for free access and consultation on Mendeley Data.
A generative Artificial Intelligence tool (ChatGPT, version GPT-4) was used to improve textual clarity and spelling revision. This resource was exclusively used to support editing the manuscript, and was not used in the data analysis, interpretation or production, nor in writing the scientific text. The authors fully reviewed the final content and assume full responsibility for the integrity, originality and scientific rigor of the publication17.
RESULTS
The participants are between 60 and 80 years old, consisting of six women and one man. The length of time they had participated in the walking group ranged from two to 12 years. Participants reported conditions such as hypertension, diabetes, fibromyalgia, and other chronic diseases. None of them are originally from the municipality, but they chose to remain in the city to experience the aging process with a higher quality of life.
Based on this listening, a SWOT matrix (Table 1) was constructed which systematizes the meanings attributed to health promotion practices in primary health care, based on the experiences reported by the older adults. The matrix (presented below) is organized into four constructions: strengths, weaknesses, opportunities, and threats, elements which combined reveal both the potential and the limitations of the actions developed.
SWOT analysis of health promotion practices in Primary Health Care from the perspective of older adults. Navegantes, SC, Brazil, 2025. (n= 7).
We present the main findings based on the strengths that emerged in the narratives of the older adults below. The weaknesses, opportunities, and threats identified are subsequently presented. The constructs presented in the results correspond to the CCIs negotiated with the participants throughout the HDC.
Strengths: bonds, movement, and belonging in care within Primary Health Care
The strengths built by older people relate to their bonds with the eSF professionals, the regularity of collective activities, and the recognition of the group as a space for support and social interaction. The accounts highlight welcoming, listening, and presence in daily life, both at the unit and in the community.
As soon as we arrive at the door, they come with that big smile, with that joy of theirs, to greet us (Cavalinha).
They come to our homes. They talk, they help. They are very dear (Losna).
Everyone [...] is full of affection to offer, of love and hugs (Melissa).
Another recurring strength was participation in the walking group, described as regular physical activity that promotes social interaction, the organization of routines, and care for physical and emotional health. The walks were mentioned as a weekly commitment and a space for social interaction:
I have an appointment on Mondays, Wednesdays, and Fridays (Lavanda).
Walking helps me, otherwise I would just stay in the hammock (Alecrim).
The accounts also mention emotional benefits, such as improved mood, reduced isolation, and the possibility of sharing personal experiences.
My exercises pulled me out of depression and took away all the bad things (Cavalinha).
Sometimes I keep things bottled up, there’s no one to talk to, but on the day I go for a walk, I take advantage of the conversation and tell everything, the news [...] (Lavanda).
WhatsApp emerged as a territory of shared care during the pandemic. Even amidst physical distancing, the group remained active, sending recipes, advice, and words of encouragement. The digital world was reclaimed as a space for coexistence and solidarity:
We communicate through the group (WhatsApp)... we send strength, news (Cavalinha).
They always send important information there, about daily life, recipes, healthy things, always guiding us (Melissa).
In addition, the accounts highlighted the active participation of older people in organizing the activities. Among these, the welcoming of new members and the holding of get-togethers stand out, strengthening the feeling of belonging and coexistence:
We decide as a group what is best. [...] Today I have my projects (Cavalinha).
We also have our little parties [...] our get-togethers. This coexistence is wonderful (Melissa).
Weaknesses: structural limitations and instability of collective care
The weaknesses identified refer to structural and organizational limitations in health promotion actions within primary health care. One of the most recurring weaknesses concerns the lack of diversified activities and the absence of adequate spaces for integrative, social, and bodily practices. The statements express a desire for initiatives that broaden the possibilities of participation beyond walking:
We’re missing a support center for handicrafts, where we can [...] do handicrafts [...] (Cavalinha).
[...] if there was a Pilates studio, it would be good [...] a room, like that, for us to do it, once a week, one afternoon (Lavanda).
Another weakness pointed out was the absence of psychological care and therapeutic groups aimed at older adults. The statements highlight demands for qualified listening, emotional support, and structured spaces for conversation:
We could have [...] a psychology group, have [...] the psychologist there for us (Losna).
We are our own psychologists, our own therapists (Cavalinha).
The limitation of schedules and locations for physical activities emerges as a significant obstacle. The rigidity of the offer and the concentration of actions in a few shifts are factors that hinder access for part of the group:
It could be better if we could go on that day X and do our gymnastics [...] And at night is good (Losna).
[...] There’s that day, that early time. Otherwise, there’s nothing left (Camomila).
Finally, the reports point to a lack of systematized collective actions in PHC, perceived as unstable initiatives dependent on the performance of specific professionals. The continuity of activities is reported as linked to the people who conduct them, and not to a consolidated institutional organization.
Andréia started with our group at the health post [...] (Losna).
Along with this group, along with the girls from the UBS [...]. Lili goes with her little device [...] we lack nothing (Cavalinha).
Opportunities: gaps in daily life and expansion of care in the territory
The opportunities highlighted by the older adults relate to expanding health promotion actions beyond the unit. They emphasize circulation through social facilities and the possibility of expanding activities in the community. Integration with community services appears as a way to strengthen bonds and diversify experiences, supporting care in social and affective dimensions.
[...] most of our group is at the Social Assistance Reference Center (Centro de Referência de Assistência Social - CRAS) with other things [...] we [...] made layettes (Losna).
I participate in capoeira therapy, here in the sports gym, the gymnastics which is weight training. We also have the CRAS (Cavalinha).
In addition, they report opportunities related to mutual learning and recognition of the group as a space for daily exchange. The statements indicate that participation in the collective creates knowledge circulation and encourages self-care, including through small practical strategies shared in the community.
I even brought some from my friend here to do (the embroidery on the towel), because my friend can’t do it properly. I’m teaching her (Losna).
We learn a lot [...] sometimes we older people forget about water [...] we learn recipes, encouragement (Melissa).
Finally, older people recognize the group as an opportunity to reorganize their daily lives, with effects on social interaction and emotional well-being. Participation opens up space to leave the house, talk, circulate and maintain their own routine.
Now I go out, I talk [...] it’s been great, for my mind (Lavanda).
You have the joy of participating [...] that’s very good for us, right? For our emotional, for our psychological, for our physical well-being (Melissa).
Threats: when care dissolves in the silence of absences
The threats identified by older people refer to factors that hinder or interrupt participation in health promotion activities. Among them, health conditions, domestic overload, and social isolation stand out.
One of the most recurring threats is related to their own health conditions. Chronic diseases, physical symptoms, and medical advice impose pauses or absences from collective activities.
Due to the fact that I have fibromyalgia [...], age, each with its own problem (Melissa).
I’ve been inactive for almost three months [...] because I got dizzy [...] I avoided walking [...] (Losna).
[...] I had surgery on my head for skin cancer and the doctor forbade me [...] from walking in this hot sun [...] (Cavalinha).
In addition to physical limitations, domestic and emotional overload stands out, especially among older women. The statements highlight the accumulation of responsibilities in daily life and the emotional impact of this process:
For us, staying at home, in our old age, just taking care of our chores and grandchildren [...] brings depression, brings illness (Cavalinha).
Here inside our own homes [...] sometimes it’s just a word, just one word is enough [...] that makes a big difference (Losna).
Because we got used to the group [...] but I’m like a bomb. There are days [...] that if you touch me, I might explode [...] (Losna).
Finally, social isolation also presents itself as a relevant threat. The absence of ties in the territory, associated with sadness and lack of motivation, directly interferes with adherence to collective actions.
I came from Rio Grande, I was like an animal. Because I wasn’t friends with anyone [...] (Camomila).
Sometimes we [...] wake up sad, full of pain, everything locked up, we don't want to leave the house [...] (Melissa).
[...] Because I was always at home alone, I slept in late [...] (Lavanda).
DISCUSSION
The perceptions shared by older people reveal that health promotion practices in PHC are still mainly built in the interstices of formal policies7,8,18. These practices are sustained by affective bonds, voluntary efforts, and one-off initiatives, and not by institutionalized guidelines or stable structural resources19. In order for healthcare to be emancipatory, it needs to be constituted as an encounter between subjects, and not as a linear application of protocols10.
In building strengths, the bond with eSF professionals emerges as one of the most powerful elements in the care experience5,7,20. It is a bond which goes beyond the technical dimension and is anchored in mutual recognition, constant presence, and built trust. When this presence is maintained over time, relational continuity gains density. For older people, it is related to more favorable outcomes, and less avoidable use of services. Thus, bonding is not just affection, it is a concrete form of sustaining care21.
However, this characteristic contrasts with the structural fragility of the SUS, which manifests itself in the turnover of professionals, precarious contracts and work overload20. Care then becomes a collective construction despite the system, and not because of it22.
These bonds extend beyond formal care spaces. Older people organize themselves to welcome new members and support those with greater physical limitations. They promote collective meetings and sustain moments of conviviality with their own resources. Birthdays and get-togethers become part of the group’s routine. These practices express autonomy and protagonism in aging, lived in everyday life9,18,22.
Similarly, the strength of the walking group and the affective networks which form around it reveal how much collective devices are able to give new meaning to the daily lives of older people18,22. Social participation operates as a mediator of meaning and connection in everyday life and sustains well-being in aging18,23,24. It is a practice negotiated within the territory, permeated by belonging, access, and everyday recognition. Through this, the group’s experience approaches a broader field of building connections and meaning in aging25.
As Buss, Pelegrini Filho, and Carvalho9 discuss, senses of belonging, identity, and well-being are forged in the community space. However, the persistent absence of policies which guarantee adequate spaces, qualified professionals, and continuity of actions points to a mismatch between the rhetoric of health promotion and its practical implementation. This mismatch reveals the limitations of approaches that recognize health promotion as discourse, but do not support it as a structuring public policy26.
The fragilities pointed out by the older adults reveal a daily life strained between the informal care that persists and the absence of institutional support. The lack of diversified activities and adequate spaces for integrative and social practices limits participation and silences demands related to leisure, creation, and strengthening of the body. Added to this is the absence of psychological care and structured therapeutic groups, especially in a context marked by losses, loneliness, and psychic suffering27. Loneliness, psychological suffering, and lack of emotional support permeate the experience of aging and impact social participation19.
The accounts highlight the collective effort to fill these gaps. Faced with a lack of psychological support, older people themselves create spaces for listening to each other. They share anxieties, offer emotional support, and care for one another. This self-managed care coexists with the perception of abandonment and normalization of precariousness.
The organization of services imposes barriers to participation. These barriers stem from the rigidity of schedules and the dependence on specific professionals for the maintenance of collective actions7. An absence of policies which support these initiatives as a right weakens the continuity of care. As a result, collective practices in primary health care become unstable6,27. These weaknesses are not limited to operational failures. They point to a way of governing that neglects aging and undermines collective health as a public policy28.
The organization of care also disregards the diversity of aging experiences. Physical limitations, medical contraindications, and climatic conditions interfere with participation. The logic of services imposes silent barriers. Care becomes dependent on the older person’s adaptation to the service, and not the service’s adaptation to their needs.
The opportunities recognized by the participants, such as integration with the CRAS, the desire for new activities, and autonomy in decision-making processes, point to powerful paths for a more inclusive, horizontal, and intersectoral PHC18. These proposals emerge from concrete experience and collective interaction. They are not abstract expectations and indicate possible paths for strengthening autonomy and co-responsibility in care7,22.
Opportunities are also built in everyday life. They emerge between walks, in informal conversations, and in spontaneous encounters. The group becomes recognized as a space for exchange, learning, and support. In this movement, care ceases to be merely an institutional offering and becomes collectively produced.
Furthermore, the mutual learning processes observed in collective practices strengthen support networks, encourage self-care, and reposition older adults as an active subject in the production of health11,18. Autonomy and decision-making constitute structuring dimensions of healthy aging in community contexts22,23. However, as Burmann and Custódio29 warn, these opportunities remain fragile initiatives without the institutionalization of these practices as a right and without the recognition of old age as a priority on public agendas, largely sustained by individual efforts.
In turn, the threats highlight the effects of institutionalized neglect: psychological suffering, isolation, physical barriers, and emotional overload which fall, above all, on older adult women27. The State abdicates its role by delegating responsibility for self-care to the individual.
This shift is not accidental. AbuElKheir-Mataria and Chun30 describe this movement as part of neoliberal reforms, which prioritize privatization, competition, and economic efficiency to the detriment of universality and equity. In this process, care ceases to be a right and becomes treated as a service. This is the same logic that transforms social policies into commodities and weakens the redistributive function of the State28.
Psychological suffering appears as an obstacle to participation. Sadness, discouragement, and isolation permeate daily life. At times, staying at home becomes necessary. The absence of structured spaces for listening amplifies these difficulties and weakens adherence to collective practices.
In this context, health promotion paradoxically appears as a resistance movement; resistance to the logic of productivity, to the medicalization of aging, to the irresponsibility of the State6; resistance which takes place in peer care, in sharing recipes on WhatsApp, in the hug given in the hallway of the primary health care unit. Aging through the SUS is revealed in ordinary practices. It manifests itself in the groups that persist, in the relationships that are maintained, and in the strategies built to continue participating. Care reinvents itself in everyday life between institutional limits and affective bonds.
More than a record of narratives, the listening performed in this study took on an evaluative character, constituting itself as a participatory and emancipatory practice, in line with the assumptions of Fourth Generation Evaluation14. As Carneiro and Ayres11 state, becoming visible is also a political act. We present each account herein as a claim for the centrality of old age in public health projects. Because sometimes, as Losna said, “it’s just a word. Just one word is enough” to care, to resist, to continue.
The territorial scope stands out among the limitations of this study, being restricted to a single UBS and a specific activity group. However, this scope does not compromise the interpretative depth, as it is based on the internal coherence between method, theory, and data produced. Future studies could expand this approach, exploring other territories, interest groups, and intersectoral articulations, in order to deepen the debate on the centrality of old age in public policies.
CONCLUSION
This study showed that powerful and mobilizing experiences still emerge in health promotion practices in primary health care, even in a scenario marked by the precariousness of public policies, and especially in the context of aging. The voices of older people revealed both the limitations imposed by institutional absences and the ability to create networks, bonds, and collective meanings that sustain life in its broadest dimension.
Listening to older people proved essential to understanding the contradictions that permeate the daily life of health services: on the one hand, the weakness of structures and the fragmentation of actions; on the other, strengthening ties and the protagonism of collective experiences. When health promotion actions are built on affective bonds and the recognition of subjectivities, they become spaces of resistance against the productivist logic and the medicalization of aging.
Reaffirming the place of older people as subjects of rights and active voices in the care process is a political act. More than a target audience, it is about recognizing in this population a collective that resists, proposes, and transforms. And sometimes, as one of the participants taught us, it all starts with a word. You just have to listen.
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NOTES
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ORIGIN OF THE ARTICLE
Extracted from thesis- “Desafios e oportunidades para a promoção da saúde à pessoa idosa na Atenção Primária: Avaliação de Quarta Geração”, ongoing, from the Postgraduate Program in Health Promotion of the Universidade Universidade Cesumar, in 2026.
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FUNDING INFORMATION
Not applicable.
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APPROVAL OF ETHICS COMMITTEE IN RESEARCH
Approved by the Research Ethics Committee of the Central Education Unit of Faem Faculty, opinion no. 7.299.301, Certificate of Presentation for Ethical Review 141739/2024, and by Cesumar University, opinion no. 7.377.012. CAAE 009094/2025 (UNICESUMAR).
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TRANSLATED BY
Christopher J. Quinn.
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DATA AVAILABILITY
The dataset supporting the results of this study is available upon request from the corresponding author Aliny de Lima Santos.
Edited by
The dataset supporting the results of this study is available upon request from the corresponding author Aliny de Lima Santos.
