Terminologia e cognição: acessibilidade textual e terminológica sobre diabetes mellitus tipo 2 para pacientes idosos no Sistema Único de Saúde

Abstract

This doctoral dissertation investigated the semantic-terminological structures in the health communication process, with a specific focus on the interaction regarding Type 2 Diabetes Mellitus (T2DM). The study was delimited to a population group of ten elderly individuals, aged 60 or over, with schooling up to the 5th grade of elementary education, assisted by the Unified Health System (SUS) in municipalities of the Central-South region of Sergipe. The research problem stemmed from the observation of a communicational misalignment between the specialized and technical-scientific discourse of health professionals and the linguistic and sociocultural repertoire of the patients, which often results in failures in treatment adherence and self-care (Roter et al., 2006). The central hypothesis was that medical terminology proved to be cognitively inaccessible, forcing patients to resort to intralingual translation strategies (Jakobson, 1959) based on their embodied experiences (Rosch, 1978) to make sense of the information. Thus, the defended thesis was that the misunderstanding of medical information by this public arose, to a large extent, from a terminological, cognitive, and sociocultural inadequacy between the discourses. To investigate this issue, the objectives were: (1) to describe the conceptualization processes of the terms diabetes, health, and disease; (2) to identify the metaphors and discursive strategies that shaped the understanding of these concepts; and (3) to propose an educational product adapted to the needs of this population. The mobilized theoretical framework was the Sociocognitive Theory of Terminology (TST), which understands terms as dynamic cognitive constructions (Temmerman, 2000), and the Conceptual Metaphor Theory (Lakoff; Johnson, 1980; Lakoff, 1987). The methodological procedures employed a qualitative approach, based on semi-structured oral interviews, with the data being examined through content analysis (Bardin, 2011). The analysis results confirmed the hypothesis, showing that the elderly resorted to metaphors and simplifications to understand health terminology. Structural, ontological, and orientational metaphors were identified. Such cognitive constructions revealed gaps in the communicative process that hindered adherence to self-care. For future directions, the thesis was not limited to diagnosis, materializing its conclusions in the production of an educational video titled “Understanding Diabetes with Simple Words”. This audiovisual product was designed to serve as an intervention tool, using accessible language and constructive metaphors, based on the principles of Textual and Terminological Accessibility (Finatto, 2020; Finatto; Paraguassu, 2022) to promote more humanized, citizen-oriented, and effective communication practices in the SUS.