RESEARCH ARTICLES

Everyday health-related beliefs and practices among primary health care users

Amanda Nathale Soares^I; Bárbara Sgarbi Morgan^II; Fernanda Batista Oliveira Santos^III; Fernanda Penido Matozinhos^IV; Cláudia Maria de Mattos Penna^V
INurse, Specialist in Teaching and Management of Higher Education, Pontifical Catholic University/Minas Gerais. Master's Degree in Nursing from the Federal University of Minas Gerais, Brazil. Email: mandinha0708@yahoo.com.br.
^IINurse, Master's Degree in Nursing from the Federal University of Minas Gerais, Brazil. Email: barbarasgarbi2@yahoo.com.br.
^IIINurse, Specialist in Cardiovascular Care from the School of Nursing at UFMG. Master's Degree in Nursing from the Federal University of Minas Gerais, Brazil Email: fernandabos@yahoo.com.br.
^IVNurse, Specialist in Trauma, Emergency and Intensive Care, Faculty of Medical Sciences of Minas Gerais. Master and PhD student in Nursing at the Federal University of Minas Gerais, Brazil. Email: nandapenido@hotmail.com.
^VPhD in Nursing, Assistant Professor, Federal University of Minas Gerais. Email: cmpenna@enf.ufmg.br.

ABSTRACT: This qualitative case study based on the Comprehensive Sociology of Everyday Life aimed to understand cultural influences on health-related meanings and practices among users of the primary health care system and how those users establish relations with care services in small towns in Minas Gerais, Brazil. Data was collected by individual semi-structured interview of thirteen clients in July, 2010, and organized into four categories. The results show that care practices are influenced by beliefs. Faith was seen to emerge as a therapeutic resource. Users’ conceptions of health and disease are associated with their ability to perform daily activities and with body functionality. Accordingly, it was concluded that it is necessary to think about people’s established conceptions as they interact with the instituted truths of professional healthpractices.

Keywords: Health-disease process; faith healing; religion; knowledge, attitudes and practices in health.

INTRODUCTION

The current studies that focus on the health-illness of individuals show that the process of being healthy is the result of cultural relations that the population establishes in their daily life.

Given this reality, the government control programs should take into account the knowledge that people possess and acquire, since this may influence the conducts for disease control.

The daily routine of health services is permeated by social relations that the various actors maintain among themselves and should be based on dialogical posture and exchange of knowledge, promoting the exchange between the scientific and popular knowledge¹.

For this reason, it is important that the multi professional team is compromised of, democratization of knowledge, participation with the population in the definition of health problems and the strategies to be implemented and educational programs in health formulated with regional technologies sensitive to their differences².

In this context, this study aimed to understand the cultural influences on the health-illness meanings and practices for basic healthcare network users and how they establish their relations with the services in small municipalities.

LITERATURE REVIEW

In recent decades, with the deployment of current health policy in the country, discussions about effective educational practice for health promotion are faced with studies conducted on the integrality as the foundation for the practice in healthcare³.

Healthcare services should service the individual as an integral human being, subjected to different situations of life and work, which influence their health, illness and dying process. The individual is, in fact, a product of the environment; they are a being of experiences, conflict, emotion and reason⁴.

It is necessary, therefore, that health professionals grasp daily soft technologies⁵, which involve the subjectivities and the singularities of the subjects involved in the daily healthcare tasks, from a productive interaction qualitatively⁶.

Thus, there is urgent need to correct the tendency of acting on healthcare, fragmented, and based on a hierarchical posture, authoritarian and bureaucratic imposition of knowledge. It is fundamental to the interaction of scientific and popular knowledge and the involvement of the community, aiming at social participation the association of information and the development of a critical reflection on the reality and the determining factors of a healthy lifestyle⁴.

These findings refer to the integrality and enable them think it more openly. The complex construction and implementation process of integrality is perhaps; at the present time is the biggest challenge of healthcare in Brazil⁷.

Integrality is a principle that guides the healthcare practices⁸, the policies and the organization of the work process; it is not acceptable that healthcare services are organized exclusively to respond to the diseases of a population. Healthcare institutions must be organized in such a way as to achieve a seizure magnified the needs of the population, which it services⁷.

It assumes the comprehensiveness as a social action which results from the continuous interaction of actors in relation to supply and demand, in different planes of healthcare services - individual and systemic planes - in which the subjective aspects and goals are considered⁷.

In this sense, the knowledge about the subjective aspects that comprise the daily construction of health and illness of the individual and the population becomes relevant so that more specific healthcare policies can be developed.

METHODOLOGY

This is a case study with a qualitative approach based on the Comprehensive Sociology of Everyday Life, which favors the understanding and speech intelligibility as essential aspects inherent to social phenomena, revealing that the meaning and intentionality distinguish them from natural phenomena⁹.

The choice of qualitative research was based on the understanding that this kind of approach allows investigation of social reality beyond the observable on the surface as well as quantifiable. The social sciences have been gaining strength in actuality through the strengthening of the introspection of man and the observation of himself, highlighting issues that until then went unnoticed⁹.

We chose the qualitative case study, which has been used extensively in research in the area of social sciences, enabling the understanding of complex phenomena and the preservation of significant characteristics of real life events. We sought to achieve, in this study, the individual level considering the practices of everyday health developed by the subjects in their relations with the space and with their family, in conditions of work and leisure activities¹⁰.

This Article is part of a project being carried out in small and medium-sized municipalities in the State of Minas Gerais, Brazil, which was intended to establish relations between beliefs, knowledge and practices of healthcare of the basic healthcare network users and healthcare workers.

The results presented joined the discourses of thirteen users, men and women, over 18 years ago, serviced by the healthcare system of a municipality, and with conditions to answer the questions presented and who participated in the activities proposed by healthcare workers. All were invited personally and, after the explanation of the objectives of the study, those who have chosen to participate signed an Informed Consent Form, with guarantee of anonymity, according to Resolution no. 196/96 of the national Health Council. Thus, the participants are identified with the letter E followed by a number, in accordance with the approximation for the interview.

The data collection was performed in July 2010, by means of individual interviews conducted from a semi structured script of questions. The interviews were recorded and fully transcribed and analyzed by means of the technique of content analysis, which enables us to get to know the elements situated beyond the words, coming from other realities inserted in messages⁹. This technique was performed by means of the three fundamental steps, which are, the pre-analysis, which consisted of data organization by means of floating readings; the exploration of the material, which was developed for coding, the clippings in context units and record and the categorization, based on criteria of mutual exclusion, homogeneity, relevance, objectivity, loyalty and productivity; and, finally, the step of the results and the interpretation, in which the data were condensed in the search for patterns, trends or empirical relationships⁹.

With regard to ethical issues, this work was approved by the Research ethics Committee of the Federal University of Minas Gerais, under the protocol ETIC 088/07.

RESULTS AND DISCUSSION

In the data analysis emerged four categories: Treatment Alternatives: what they think, what they do ; Faith as a therapeutic resource ; Conceptions of health and disease ; and Doctor: alternative for the alternative?.

Treatment Alternatives: what they think, what they do

This category emerged from the fact that many are the practices related to healthcare that are part of the daily lives of people. The statements show the beliefs of respondents in treatment alternatives that govern aspects of their lives:

I had an inflammation in the uterus [...] I made juice from leaves and drank it. I healed the uterus inflammation with juice. (E1)

This interviewee uses the juice as practice to eliminate their illnesses. The experience behind the adoption of this popular resource, according to the perception of the individual.

In another stratification, it was noticed that the bath is another conduct of treatment adopted by the subjects of the study. This practice, according to the interviewee, contributes to solve their health problems:

I arrive at home and take a bath, I get rosemary, arugula, black vinegar, coarse salt [...] I don't dry myself, just put on my clothes [...] it is a discharge [...]. (E2)

The act of blessing and the use of plants are also presented as resources for treatment and have significant dimension in the solution of health problems. Many testimonies have been explained by the participants regarding these types of practice:

I bless the others. I cure others just by looking at them. [...] I bless everything [...] I cure myself [...]. (E4).

I take a plant called Cow-Foot Leaf. When I touch garlic, I peel it, place it and tie it [...] it burns the spot, then [...] the headache goes away. This Cow-foot-leaf is also for stomach pain [...]. (E3)

Some of the speeches have the homemade tea as effective treatment for curing diseases. One of the interviewees excludes the necessity of drug use:

Tea of marcinica I recommend [...], without the need of taking analgesics. Then you teach cold bath warm and more a tea of marcinica [...]. (E3)

The use of therapeutic practices alternatives, with emphasis to the blessing, is also described in a study that addressed the therapeutic itinerary of elderly patients with cancer. The elderly reported demand for this treatment due to family tradition and consider the healer as someone with experience of similar life, which observes the disease also by social, cultural and psychological means¹¹.

The use of plants is also reported in a study that addressed the types of plants used by hypertensive elderly patients. There were 14 plants identified, by indication mainly family, are used for the prevention or control of hypertension. Among these, some are proven scientifically as potential anti-rheumatic, which confirms the popular culture as a source for scientific knowledge¹².

The use of teas and practices counterparts has been widely common in areas of basic healthcare services, being understood as a measure of self-care and autonomy of the population. In addition, the therapeutic nature of teas and other practices an important anthropological, arising from the redemption and validation of popular knowledge, which favors the self-esteem of users, often marginalized. In addition, by means of this redemption and of this validation, it considers its pedagogical essence, by the possibility of creating a dialogic relationship between health professionals and people who dominate this cultural knowledge; its economic aspect, by allowing access to the phytotherapic medication (lowest cost); and its ecological importance, by ensuring the perpetuation of plants that, in certain situations, are eliminated by plantations with interests, above all, non-profit organizations. It should be noted that the use of teas and practices counterparts also represents an opportunity for strengthening social and political, a time that, to achieve the plants, many people resort to their neighbors, consolidating their social support network¹³.

Faith as a therapeutic resource

This category emerged from speeches that attach to the faith the status of therapeutic resource, now as an essential element, but as an aid to other therapies:

There is a God, and when you trust in yourself, it disappears. (E5)

In addition, a cure that comes to my life directly with the power of faith through God I use the remedies to resolve my health problem. [...]. (E6)

The statements pointed out, also, that the faith can also be directed to therapeutic resources chosen for the treatment:

 If you have a glass of water that, has nothing and say: take this it will cure you, depending on how you do it, if you take and if you have faith in water it will heal you [...]. (E7)

As found in the speeches, it was found, in other studies, that the faith is urgent as an element that assists the individual to maintain hope and trust in something that can be done to help you^14-16. Faith in God or religious faith, described in sections explained, allows user to a feeling superior for happiness and courage, revitalizing its provision to the coping with the disease¹⁵. It is understood that by coping with the cognitive and behavioral efforts intended for the management of internal demands and/or external overload evaluated as to individual resources¹⁷.

Religious medicine is a practice that is contextualized social and culturally, being very influenced by family and/or social groups. This is inserted in a historical process, keeping them alive and recognized even in the face of technological transformations resulting from reality. The religious practices constitute signs and meanings collective and individual, which they carry in themselves attitudes of acceptance and solidarity, helping in the (re)formulation of the experience of suffering experienced and in the reorganization of postures facing life¹⁵.

The association between factors related to religiosity and health in a dimension biopsychical, shows evident in socio-cultural roots remote, which still manifest themselves strongly in contemporary reality^15,17. It appears that many people attribute to God the appearance and/or the resolution of the problems that the affect, turning to him to seek subsidies emotional, behavioral and cognitive for coping with the disease¹⁷.

Concepts of health and disease

This category has emerged from speeches that consider the concepts of health and disease, respectively, as the ability or the inability to perform activities:

The annoyance [...] hinders the development of the human person within their functions [...] makes it impossible to person of working, studying and strip the conditions to participate in any event, to distract, to go to the party. (E8)

Health is to have disposition for being able to work, study, and eat well [...]. (E9)

Health for me is putting the remedies, tidying up the things that I need. (E11)

Another idea associated with the conceptions about health and disease refers to the functional aspects of the body and to hygiene:

[...] what can happen if you do not have clean hands, the nails cut, a good bathroom, a good haircut, a healthy diet is that your health becomes precarious [...]. (E12)

In recent decades, studies on social representations of health and disease processes in Brazil have intensified, contributing to the understanding of cultural matrices of which emerge from the sets of meanings and actions relating to health and disease².

Experiencing a disease is relate to form troublemaker with the social, because the individual will feel sick when leave to carry out their activities that allow them belong to the context in which they live. On the other hand, it is a way of knowing, since that; they learn to overcome to cope with it. It is based the necessity of the representations, which are considered in the formulation of public policies in health as a reflection of the combination of aspects of the experiences of individuals and socio-cultural conditions^2,18.

The representations express a relation with the object; fall in ownership of the subject, in their way of thinking and to interpret reality. It is from the representations that allow you apprehend the facts of everyday life and the knowledge of common sense, of health and disease built from the experience and knowledge¹⁹.

Doctor: alternative for the alternative?

This category emerged from the consensus that the health care professional, here contemplated in the figure of the doctor, constitutes an alternative when other possibilities are not able to restore health. Despite the advances made in medicine, alternative practices were not forgotten in the past nor even been fully replaced by scientific precepts.

It is perceived that the interviewees tend to say that they are looking for the doctor, but also show their affection by the use of alternative practices and by faith:

First when I am sick, I seek God. I pray to God and trust in God first. And secondly, I seek a health clinic[...] I look for the doctor [...] Always the people pray to God and, in the second place, I take the stalk of a sugar cane, a leaf of pitanga, mint, parsley [...]. (E1)

The last interviewee, within the same speech, arrives to sort the search by medical aid as the second alternative. Although he recognizes the role of the medical professional, he still prefers to use alternative practices.

It can also be noted that the physician is sought in accordance with the severity of the disease, i.e., it is the option for the worsening of the disease:

When it is a thing so simple, I treat it right at home. I make a tea [...] and I'm fine. However, when the thing is more serious I seek a doctor. (E12)

We identified a single speech that shows aversion to the doctor. The interviewee seems to have a history of lack of visits or visits insecure when they need the healthcare service:

They don't care for us when we go there. [...] Anyone who wants to be a thief is studying for lawyer and whoever wants to be assassin studying for doctor. Because doctors are killers (laughter). (E13)

The first use of alternative practices for the resolution of diseases and the recurrence to medical assistance only with the aggravation of the pathological condition were also verified in research conducted with residents of an old and traditional riverside community of Mato Grosso state, Brazil. In this study, it was found that the official medicine represents a source of funds that is not engaged so unconditional, representing one of the alternatives to be used. In addition, the demand for health care professionals or by services of official medicine occurs, in general, in the last instance and does not represent the abandonment of the therapeutics adopted until then, i.e. the use of plants and/or rituals, but complements²⁰.

In another study, cancer patients, it was found that a primary accession to medical care, which are exempted from the feelings of satisfaction and gratitude, in detriment to therapeutic practices alternatives. This difference can be attributed to finding the severity of the oncologic condition, however it denotes that, also in this study and in others, religion appears as an important component for coping with the condition of illness^21,22.

CONCLUSION

This study has limitations with regard to the municipal and regional locality in which it was performed and the amount of participants. However, its delineation permitted evidencing socio-cultural aspects that permeate and sustain the health and disease processes of individual and collectives. Features such as faith, the tea and the blessings, founded on cultural context, configure alternatives to therapy, denoting-if the need of the roots and the social meanings attributed to these therapeutic modes being addressed in the daily routine of healthcare.

Assuming these socially constituted operational arrangement characteristics it is proposed that a reflection on the concepts and the truths established in professional practice, seeking to assist individuals in order to contemplate the existential totality of your vital process and not hierarchy of scientific knowledge on the popular knowledge. In addition to this is the need to enter the dialog in relations between health professionals and users as a means of (re)making and updating the horizon of normative practices in health based on real demands of individuals and the population.

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