This reflection chronicles the author's personal crisis and subsequent healing after losing his identity as a collegiate baseball player. The author's life, dedicated to the sport, collapsed when he tore his labrum two weeks into the season. The physical injury was followed by the devastating loss of his scholarship due to "lack of performance". This existential crisis was compounded by a tidal force of grief, including his father's brain tumor diagnosis, a cousin's death by suicide, and his grandfather's passing. Conditioned as an athlete and a man to suppress vulnerability, he experienced intense emotional isolation. Healing began through creative expression. He poured his emotions into painting and found control and presence in music, which became his "new field". This process enabled him to rebuild his identity around creativity, resilience, and passion, rather than performance. In a poetic twist, eleven years later, his new career led him to become the official DJ for a Major League Baseball team. The journey underscores that healing is non-linear and requires allowing oneself to be vulnerable and capable of transformation.
Cognitive linguistics is a newly emerging branch of linguistics whose primary foundation is based on the principle that language reflects the functioning of the mind and emphasizes the connection between mind and language. The introduction of the concept of conceptual metaphors in cognitive semantics is considered one of the most influential achievements of modern linguistics, first proposed in 1980 by George Lakoff and Mark Johnson. They emphasized that metaphors are essentially conceptual, not merely lexical. Metaphors are generally not based on similarity but are formed based on experiential correlations between two different conceptual domains. One of the abstract and significant concepts addressed by Omar Ibn Abi Rabiah in his poetry collection is the theme of love. Love and its related concepts are expressed metaphorically in his poetry. The present study examines the metaphor of love within the framework of cognitive semantics using a descriptive-analytical method based on Lakoff and Johnson’s theory. Accordingly, the concepts within his poems that evoke the notion of love are extracted and analyzed. The results indicate that the overarching metaphors centered on love include propositions such as: "Love is pain and illness," "Love is fire," and "Love is madness and insanity"—all reflecting that the poet views love as destructive, painful, and annihilating. In most of his metaphorical mappings of love, the poet moves from the mental towards the physical, although in some cases he employs more tangible mental mappings to deepen the understanding of love. Omar Ibn Abi Rabiah uses negative tangible expressions such as pain and illness, war, murder, fire, and theft, which reflect the hardships and difficulties of the path of love and point to its negative aspects. In contrast, he also employs positive and desirable expressions such as immortality, beauty, and healing. Some of the poetic mappings are dual-faceted. For example, in the conceptual metaphor "Love is sorrow and grief," although this grief is heartbreaking, for the lover, this pain and suffering are desirable and pleasant. The bitterness of this grief is accepted wholeheartedly by the lover, who willingly endures all kinds of humiliation and disgrace in this path.
Waganesh A. Zeleke, Yemataw Wondie, Mekdes Melesse Mekonen
et al.
Abstract Background Ethiopia is ranked among the top five countries with the highest number of internally displaced individuals. Several centers in Gondar City, Ethiopia, provide temporary accommodations for those forcibly displaced from their homes during the 2020–2023 period. Research shows that internally displaced people (IDPs) face stressors such as trauma, poverty, and the collapse of social support networks, resulting in mental distress, impaired relationships, and diminished coping abilities. Methods This Community-Based Participatory Action Research (CBPAR) and interpretative phenomenological research study engaged 42 stakeholders (including IDPs, service providers, community leaders, and governmental/non-governmental representatives) residing in Gondar, Ethiopia, who were selected using purposive sampling to explore narratives of trauma and healing shaped by lived experiences. Data were collected through six focus group discussions and nine in-depth interviews, then analyzed using template analysis. Results Findings reveal visceral and culturally embedded experiences of trauma, described as ‘wounds to the soul,’ ‘relational wounds,’ and idioms of distress that convey the profound impact of displacement. Collective healing emerged through cultural and spiritual practices, connection to ancestral traditions, and music. Barriers such as low trauma awareness and limited mental health access were also highlighted. Conclusion and implications This study underscores the interconnectedness in collectivist cultures and offers insights to develop culturally responsive trauma-informed programs. It calls for further research on healing processes that integrate individual and collective resilience.
Music, as an emotional expression and adjustment tool, has a significant impact on the mental health of teenagers. Through a four-week experiment, this study explored the influence of music on teenagers' emotional state, psychological resilience, anxiety level, self-cognition and life satisfaction. The subjects were divided into experimental group and control group. The experimental group listened to healing music for 30 minutes every day, while the control group conducted quiet meditation activities. The mental health status of the two groups of teenagers was measured and compared by psychological scales such as PANAS, RS, STAI, self-concept and life satisfaction. The results show that the experimental group is significantly better than the control group in emotion regulation, psychological resilience improvement and self-cognition, which proves that music has the potential to promote the mental health of teenagers. This paper discusses the theoretical and practical significance of these findings.
Angela Marinilli Pinto, Andrea Bazzoli, Johanny Mercedes
Commuter college students face unique circumstances and stressors that may impact their well-being, yet this is an area of research that has been largely unexplored. This study examines mental health and lifestyle health behaviors of commuter college students. Participants were 576 undergraduates (62% female, 81% non-White, 20.31 ± 3.02 years) attending an urban public commuter college. Participants completed a cross-sectional, anonymous, web-based survey that included validated measures of mood, anxiety, stress, sleep quality, and physical activity. Overall, 58.6% screened positive for depression, 37.8% screened positive for generalized anxiety, 57.5% had poor sleep quality, and only 23.3% met physical activity recommendations. More females screened positive for depression and anxiety and had poor sleep quality than males, and fewer females met activity recommendations. Being physically active and having good sleep quality were associated with better mental health. Findings reflect high rates of mental health problems and low engagement in health behaviors, particularly among women. Opportunities to address the well-being of commuter college students are discussed.
This paper integrates horticultural therapy and campus green space design, aiming to meet the physical and mental health needs of college students. Taking the Plant Germplasm Resources Development Center in Fengxian Campus of Shanghai Normal University as the renovation object, and relying on the characteristics of Taoyuan Building, through the comprehensive planning and detailed design of five plots, such as the optimization of flow lines, functional nodes, ecological purification, lighting art and healing landscape ornaments, the "Lingxi Flower Stream" and other characteristic spaces have been created, successfully practicing a horticultural and therapeutic campus green space. This study not only enriches the theoretical application of horticultural therapy in campus greening, but also proves its significant promoting effect on the ecological environment optimization and students' physical and mental health through practice, which provides a new perspective and empirical reference for the combined design of campus greening and horticultural therapy, and promotes the development of green campus to a deeper level.
Adriana Nunes Moraes-Partelli, Marta Pereira Coelho, Séfora Gasparini Santos
et al.
ABSTRACT Objective: To describe and discuss the participation of adolescents from a quilombola community in the transformation of the comic “Possible Story” (“Uma História Possível”), from the Comic on alcohol, into an educational game. Method: Implementation of the creative and sensitive method of art-based research, with adolescents from a quilombola community in the state of Espírito Santo, for the development of a board game. Results: The democratic and interactive space favored the problematization of images and narratives about alcohol consumption mediated in the comic book. The group selected scenes, reordered the story, devised questions and riddles, formulated true and false assertions in a 17-card composition of the board game. The potential of the game as a content mediating tool to promote learning, reinforcement, and fixation of scientific content was evaluated. Conclusion: The active and dynamic participation of adolescents took place from conception to evaluation of the board game, encouraging them to reflect on a community context of cultural permissiveness of alcohol use.
Berkembangnya pola kehidupan saat ini, membuat masyarakat untuk terus berkembang, mulai dari segi sosial, teknologi mupun juga dari segi ekonomi. Hal ini membuat rasa tertekan menjadi salah satu masalah terbesar yang dihadapi. Healing Environment pada umumnya ditujukan untuk bangunan fasilitas kesehatan yang mendeskripsikan pengaturan fisik dan organisasi budaya yang mendukung pasien dan keluarga dalam melewati tekanan yang dikarenakan oleh penyakit, kunjungan medis, proses penyembuhan, dan lainnya. Tempat yang tepat untuk merawat pasien dengan gangguan mental adalah rumah sakit jiwa ataupun tempat rehabilitas yang sesuai. Rumah sakit jiwa sangatlah bervariasi dalam tujuan dan metodenya. Apa saja prinsip-prinsip healing enviroment dan bagaimana penerapannya pada bangunan rehabilitasi mental. Metode yang digunakan yaitu metode yang digunakan yaitu deskriptif kualitatif dengan cara mengumpulkan beberapa sumber kemudian di deskripsikan melalui tulisan dan gambar. Berdasarkan hasil dari analisis prinsip-prinsip healing environment, terdapat beberapa hal yang dapat diambil dan dijadikan sebagai kesimpulan. Pada bangunan rehabilitasi mental prima harapan yang berlokasi di Bandung telah memenuhi sebagian besar prinsip-prinsip dari healing environment.
Gayatri mantra is one of the most sacred chants to be found in Hindu lore, where an entire philosophy of Indian culture is compressed into these few syllables. Gayatri is the considered as supreme source with infinite divine forces. One of them is ‘Chandra Gayatri’. Chandra (moon) has a strong relation in Indian Scripture. The aim of this perspective is to understand the importance of Chandra Gayatri Mantra in Vedic texts for reaching mental peace and stability.
Banyak korban yang menemukan keberanian untuk mengungkapkan pengalamannya tentang pelecehan seksual, namun ada juga ketakutan yang mempengaruhi keputusan untuk mengungkapkan pengalaman pelecehan seksual yang terjadi di tempat kerja kepada seseorang yang memiliki kewenangan untuk mendapatkan keadilan, salah satunya adalah workplace ostracism. Para korban yang mengalami dan mengungkap pengalaman pelecehan seksualnya di tempat kerja membantu mengungkap topik ini dengan sesi wawancara dengan peneliti. Hasil mengungkapkan bahwa pengucilan di tempat kerja memang terjadi pada mereka yang mengungkapkan pengalaman pelecehan seksual di tempat kerja baik disengaja maupun tidak disengaja. Dampak yang mereka tanggung sebagian besar bersifat psikologis dan mempengaruhi aspek perilaku atau sikap. Intervensi dan regulasi diperlukan untuk membantu para korban mendapatkan keadilan dan penyembuhan yang layak mereka dapatkan dan untuk menciptakan tempat yang aman bagi mereka untuk bekerja dan mengungkap pelecehan seksual.
Over the last decade, the number of Americans who took a single prescription drug increased by ten percent while the use of multiple prescription drugs increased by twenty percent.1 According to the Centers for Disease Control and Prevention (CDC), almost half of the U.S. population uses prescription drugs. The most commonly prescribed drugs are those used to manage high blood pressure and heart disease for patients 60 years of age and older.2 Additionally, the most commonly prescribed drugs for people ages 20 to 59 were antidepressants.3 This increase in prescription drug usage comes at a high price. In the past decade, the national pharmaceutical bill has more than doubled to a hefty $234 billion.4 This cost is expected to increase with the rise in population, the increase in acute and chronic medical conditions, and the growing cost of new pharmaceuticals. As these numbers continue to rise, it is important for healthcare providers (HCPs) and patients to seriously reconsider the value of pharmaceutical intervention. Current U.S. healthcare models emphasize the role of HCPs in fixing rather than foreseeing problems. A new, forward-looking preventive model could be effective in improving the public’s health outlook and would also reduce the need for bandaging health concerns by averting them altogether.
Health comprises dynamic and complex processes which encompass various mental and physical states. Similarly, preventive care relies on the dynamic and complex mechanisms at work within the purview of healthcare systems, as well as outside of them. Agencies both inside and outside this system have the ability to offer preventive care measures and have good reason to do so. In this essay, I will focus on the obligation that healthcare systems, HCPs, and governments are tasked with to provide and implement preventive care measures. Moreover, I will offer possible solutions to current barriers in this type of care, which will provide insight into future directions.
Encouraging Preventive Care in the Clinical Setting
Organizations such as hospitals, health systems, and accreditation programs have the ability to create an atmosphere that encourages a preventive model. Unfortunately, doctors-in-training spend less time with patients now than they have in the past. A recent study in 2013 conducted by researchers from the University of Maryland and Johns Hopkins University observed two different internal medicine training programs for a total of 900 hours.5 The researchers found that most of the doctors’ time was spent on indirect patient care such as writing notes, entering orders, and talking with other providers. More shockingly, researchers found that interns allocated only twelve percent of their time – the equivalent of eight minutes each day – to each patient.
Preventive care begins with a didactic conversation – talking to a patient about lifestyle, beliefs, and aspirations. This approach enables HCPs to care more appropriately for the patient as a whole and to provide interventions, which can result in substantial long-term effects. However, a new provider’s experiences can strongly influence her method of practicing.6 The new providers trained in U.S. programs and schools have the potential to reform our methods of practicing medicine. However, current institutional demands can shape what a future provider perceives as acceptable and unacceptable. A provider who hardly has time to converse with a single patient will be hard-pressed to recognize the signs and symptoms of disease before it manifests. Moreover, if a new provider is taught that spending eight minutes or less with a patient is standard, little room is left for the much needed conversations that may encourage behavioral change. If more time is devoted to patient-doctor interactions, specific behavioral interventions could significantly increase a patient’s quality of life.
Health systems must also promote preventive prescriptions. Instead of utilizing the prescription pad for pharmaceutical interventions when treating an illness, HCPs should have the ability to write prescriptions that promote complete physical, mental, and social well-being. Organizations such as Health Leads work to connect low-income patients with basic health-related resources.7 A patient may continually return to a physician’s office with complaints of respiratory problems; however, the etiology of this condition may be due to poor ventilation – a problem that medication neither addresses nor can resolve. Health systems partnering with Health Leads can prescribe food, fuel, housing, and, in the example of the patient with respiratory issues, proper ventilation. Preventive prescriptions can decrease costs and preclude less chronic and reoccurring diseases that are due to environmental factors.8
Taking Time to Talk
Proper preventive care would rely on a strong fiduciary relationship between the patient and HCP. However, this certainly would require time, which is lacking in many clinical settings. Even if healthcare systems change their teaching methods and encourage physicians to spend more time with each patient, the HCPs must also ensure an appropriate amount of time is spent with the patient. Not only does a limited amount of time result in inadequate observations and diagnoses, but it also can lead to lower patient satisfaction, negative outcomes, and inappropriate prescribing.9 HCPs require time to talk with the patient, address hopes, discuss fears, and inspire long-lasting changes in regimens.
The responsibility to be present with the patient requires the HCP to exercise proper self-care. Primary care physicians are just one of many groups of providers who are reporting less time with their patients, which consequently results in greater stress and burnout.10 Moreover, patients of more satisfied HCPs are more likely to show up for appointments and adhere to treatment.11, 12 Encouraging self-care not only improves the metrics over which hospital advisory boards debate, but also encourages a trusting and caring relationship between HCPs and patients. More time allows for an extended conversation about smoking cessation or the risks of over-eating, and may encourage preventative behavioral change before it may be too late.
If given adequate time, HCPs can focus on instilling long-lasting change through behavioral treatment rather than solely relying on pharmacological intervention. For example, in psychiatric treatment, the combined effects of psychotherapy and medications indicate faster recovery rates, decreased rate of relapse, improved compliance and satisfaction, and lower long-term health costs.13 In bariatric medicine, HCPs who provide nutritional counseling have been shown to increase cost-effectiveness and are estimated to extend the life-span of patients.14 Patients also show a two-fold increase in smoking cessation when HCPs intervene and speak directly to their patients about smoking, agree upon a quit date, and schedule follow-up visits.15 Behavioral interventions, when implemented prudentially, have the potential to save money and lives. Educating patients on the value of proper nutrition and exercise could help to lessen the impact of chronic conditions such as cardiovascular disease or diabetes. Instead of prescribing a beta- blocker, HCPs could act earlier in the patient’s life by writing prescriptions for daily cardiovascular exercise or for complete servings of fruits and vegetables with every meal. Whether the intervention is aimed at fostering personal meaning or developing a personal diet, behavioral intervention offers specialized care without immediately prescribing pharmaceuticals that appear to work for the average patient.
Constructing for Health
The duty to provide preventive care does not rest solely in the hands of HCPs or the health system – the surrounding community should also be responsible and held accountable. Governments can encourage preventive care and thereby improve community health by structuring environments towards healthy choices. For instance, rates of daily walking have declined drastically in the United States in recent decades, contributing to increased respiratory problems and childhood obesity.16 Promoting urban design of communities to maximize ease of walking, rather than driving, is one simple way for governments to encourage this change. Moreover, communities that provide shared pedestrian-friendly public spaces are likely to see increased social interaction and a feeling of belonging in the community.
On a city-wide level, localities can work to create biophilic cities that encourage a healthy rapport between human beings and other living organisms. Human interaction with nature has shown to reduce stress, aid in recovery from illness, enhance academic performance, and moderate the effects of childhood illness.17 Urbanists and city planners can advance this design rather than view such healing effects as an afterthought. Implementing biophilic design can also help to eliminate food scarcity and encourage proper nutrition by supporting community gardens. Initiatives such as biophilic cities, guerrilla gardening, and pedestrian-friendly communities can encourage a more equitable distribution of environmental preventive healthcare resources across communities.
A Lifetime of Difference
With the rise in chronic conditions and prescription drug usage, it is imperative for health systems, HCPs, and governments to consider more effective and less costly alternatives. Spending more time with the patient, considering behavioral interventions, and constructing environments to promote healthy behavior will contribute to this process. Preventive models have the ability to extend access to healthcare by reshaping environments while reducing patient costs and stressors. Incentivizing increased time with the patient and the use of prescriptions for basic utilities and goods can start now within our health systems. We should be having these necessary conversations and encouraging preventive care throughout society. The decision to handle health conditions solely as curative rather than integrating preventive care is a moral decision and there is good reason to integrate both into modern healthcare.
Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.18 By encouraging preventive measures, we not only aid in healing, but also foster well-being connectedness, and human flourishing. Similar to health, prevention is multi-faceted and depends on many agents and parties to produce meaningful change. Changes such as spending additional time with patients, encouraging behavioral interventions, and changing our very landscapes have the potential to make a difference for a lifetime.
References:
1 Gu, Qiuping, Charles F. Dillon, and Vicki L. Burt. "Prescription drug use continues to increase: US
prescription drug data for 2007-2008." NCHS data brief 42 (2010): 1-8.
2 Ibid.
3 Ibid.
4 Almashat, Sammy, Charles Preston, Timothy Waterman, and Sidney Wolfe. "Rapidly increasing criminal and civil monetary penalties against the pharmaceutical industry: 1991 to 2010." Washington DC: Public Citizen's Health Research Group (2010).
5 Block, Lauren, Robert Habicht, Albert W. Wu, Sanjay V. Desai, Kevin Wang, Kathryn Novello Silva, Timothy Niessen, Nora Oliver, and Leonard Feldman. "In the wake of the 2003 and 2011 duty hours regulations, how do internal medicine interns spend their time?." Journal of general internal medicine 28, no. 8 (2013): 1042-1047.
6 Hafferty, Frederic W. "Beyond curriculum reform: confronting medicine's hidden curriculum." Academic Medicine 73, no. 4 (1998): 403-7.
7 "Health Leads." Health Leads. Accessed January 14, 2015.
8 Sayer, Caroline, and Thomas H. Lee. "Time after Time—Health Policy Implications of a Three-Generation Case Study." New England Journal of Medicine 371, no. 14 (2014): 1273-1276.
9 Dugdale, David C., Ronald Epstein, and Steven Z. Pantilat. "Time and the patient–physician relationship." Journal of General Internal Medicine 14, no. S1 (1999): 34-40.
10 Friedberg, Mark William, Peggy G. Chen, Kristin R. Van Busum, Frances Aunon, Chau Pham, John Caloyeras, Soeren Mattke et al. Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy. Rand Corporation, 2013.
11 Linn, Lawrence S., Robert H. Brook, Virginia A. Clark, Allyson Ross Davies, Arlene Fink, and Jacqueline Kosecoff. "Physician and patient satisfaction as factors related to the organization of internal medicine group practices." Medical Care (1985): 1171-1178.
12 DiMatteo, M. Robin, Cathy Donald Sherbourne, Ron D. Hays, Lynn Ordway, Richard L. Kravitz, Elizabeth A. McGlynn, Sherrie Kaplan, and William H. Rogers. "Physicians' characteristics influence patients' adherence to medical treatment: results from the Medical Outcomes Study." Health psychology 12, no. 2 (1993): 93.
13 Teasdale, John D., Zindel V. Segal, J. Mark G. Williams, Valerie A. Ridgeway, Judith M. Soulsby, and Mark A. Lau. "Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy." Journal of consulting and clinical psychology 68, no. 4 (2000): 615.
14 Olsen, Jens, Ingrid Willaing, Steen Ladelund, Torben Jørgensen, Jens Gundgaard, and Jan Sørensen. "Cost-effectiveness of nutritional counseling for obese patients and patients at risk of ischemic heart disease." International Journal of Technology Assessment in Health Care 21, no. 02 (2005): 194-202.
15 Wilson, Douglas M., D. Wayne Taylor, J. Raymond Gilbert, J. Allan Best, Elizabeth A. Lindsay, Dennis G. Willms, and Joel Singer. "A randomized trial of a family physician intervention for smoking cessation." JAMA 260, no. 11 (1988): 1570-1574.
16 Ewing, Reid, Tom Schmid, Richard Killingsworth, Amy Zlot, and Stephen Raudenbush. "Relationship between urban sprawl and physical activity, obesity, and morbidity." American Journal of Health Promotion 18, no. 1 (2003): 47-57.
17 Beatley, Timothy, Biophilic Cities: Integrating Nature Into Urban Design and Planning, Washington, DC: Island Press, 2010.
18 Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946.
Kaur Mannat, De Boer Robert J., Oates Amanda
et al.
Restorative justice is an approach that aims to replace hurt by healing in the understanding that the perpetrators of pain are also victims of the incident themselves. In 2016, Mersey Care, an NHS community and mental health trust in the Liverpool region, implemented restorative justice (or what it termed a 'Just and Learning Culture') to fundamentally change its responses to incidents, patient harm, and complaints against staff. Although qualitative benefits from this implementation seemed obvious, it was also thought relevant to identify the economic effects of restorative justice. Through interviews with Mersey Care staff and collecting data pertaining to costs, suspensions, and absenteeism, an economic model of restorative justice was created. We found that the introduction of restorative justice has coincided with many qualitative improvements for staff, such as a reduction in suspensions and dismissals, increase in the reporting of adverse events, increase in the number of staff that feel encouraged to seek support and a slowing down of the upward trend in absence due to illness. It also improved staff retention. The economic benefits of restorative justice appear significant. After corrections for inflation, acquisitions and anomalies, we found that the salary costs averaged over two fiscal years were reduced by £ 4 million per year, coinciding with the introduction of a just and learning culture in 2016. In addition, Mersey Care reaped around £ 1 million in saved legal and termination expenses. We conservatively attribute half of these savings to the introduction of a just and learning culture itself, and the other half to non-related factors. Using this assumption, we estimate the total economic benefit of restorative justice in the case of Mersey Care NHS Foundation Trust to be about £ 2.5 million or approximately 1% of the total costs and 2% of the labour costs.
Luana Carla Santana Ribeiro, Alain Giami, Maria Imaculada de Fátima Freitas
ABSTRACT Objective: To analyze the representations constructed by people living with HIV on the infection and their influence on the late search for diagnosis. Method: A qualitative study, conducted through an open interview with people who had a late diagnosis of HIV infection. The theoretical framework adopted was the Theory of Social Representations based on a critical approach. For data analysis, was used the Structural Analysis of Narration method and the MAXQDA 12® software. Results: Eighteen people participated in the study. The following original representations were unveiled: AIDS as a transmissible and dangerous disease; disease of the other; severe, incurable and deadly disease; and denial of risk due to trust in a steady partner. These representations contributed to the late search for diagnosis, either because of the attitude of distance from susceptible people, or because they did not perceive or deny the risks to which they were exposed in their life trajectories. Conclusion: Understanding the reasons that lead people to a late diagnosis of HIV is imperative in the current epidemic scenario for the planning and implementation of new strategies and policies for the timely diagnosis of the infection.
Vanderléa Aparecida Silva Gonzaga, Ana Luiza Vilela Borges, Osmara Alves dos Santos
et al.
RESUMO Objetivo: Identificar barreiras organizacionais para disponibilização do DIU nos serviços de Atenção Básica à Saúde na perspectiva dos coordenadores da área de saúde da mulher. Método: Estudo quantitativo realizado com responsáveis pela área técnica de Saúde da Mulher dos municípios da macrorregião Sul de Minas Gerais, com preenchimento on-line de instrumento estruturado e análise descritiva dos dados. Resultados: Participaram do estudo 79 trabalhadores responsáveis pela área técnica. Dentre os municípios, 15,2% não disponibilizam DIU e 8,3% não referenciam a mulher para outros serviços, 53,7% não disponibilizam o DIU nas unidades básicas de saúde. Dentre os que disponibilizam o DIU, 68,7% não possuem protocolo específico e 10,5% não adotam a gravidez como condição que impossibilita a inserção do DIU, e 80,6% adotam condições desnecessárias, como infecção vaginal. Como critério para acesso ao DIU, 86,5% referiram prescrição médica, 71,6% realização de exames, 44,6% idade acima de 18 anos e 24,4% participação em grupos, todos sem base em evidências científicas. Apenas o médico inseria o DIU. Conclusão: Foram identificados problemas no acesso ao DIU, por meio de barreiras organizacionais para sua disponibilização e inserção, como a não disponibilização do método ou o excesso dos critérios desnecessários para disponibilizá-lo.