This paper deals with issues of citizenship and people's participation in health services, based on an analysis of concepts displayed by a specific group, i.e., users of Primary Care Clinics in Program Area 3.1 in the city of Rio de Janeiro, Brazil. The paper analyzes health care users' ideas as the ones most heavily influencing the chapter on health in the Brazilian Constitution. The historical context is the discussion underway on the role of patients in the relationship to professional health care providers, who in turn face the challenge of building a "health and hygiene mentality" among the people. Data were gathered through a field study using a qualitative social research methodology and identify salient points among the ideas of people receiving care. There was a gap (or distortion) in their concept of citizenship alongside aspects which, if analyzed according to the subjective plane of these social agents, show that they expect channels to be created by which they can express their opinions, particularly at the practical level. The analysis thus points to the strategic role of day-to-day relationships in the social change process and the acquisition of rights, meanwhile seeking to shed light on the feasibility of this process in view of the subjectivity of the agents giving it life.