RESEARCH ARTICLES
Being a woman and taking part in a community health educational group: motivations and expectations
Joyce Mazza NunesI; Eliany Nazaré OliveiraII; Maria de Fátima Antero Sousa MachadoIII; Patrícia Neyva Pinheiro da CostaIV; Neiva Francenely Cunha VieiraV
INurse at the Family Health Strategy. Doctoral Student at the Graduate Program in Nursing at Federal University of Ceara. Fortaleza, Ceará, Brazil, Email: joycemazza@hotmail.com.
IINurse. PhD in Nursing, Professor of the Nursing Course at the State University of Vale do Acaraú. Sobral, Ceará, Brazil. Email: elianyy@homail.com.
IIINurse. PhD in Nursing, Professor of the Nursing Course at the Regional University of Cariri. Fortaleza, Ceará, Brazil, Email: fatimaantero@uol.com.br.
IVNurse. PhD in Nursing, Professor of the Nursing Course at the Federal University of Ceará, Fortaleza, CE, Brazil. Email: neyva@ufc.br.
VNurse. Professor of the Nursing Course at the Federal University of Ceará, Fortaleza, CE, Brazil. Email: nvieira@ufc.br.
ABSTRACT: This qualitative and descriptive study, conducted in 2009 with 11 women from a community in Fortaleza, aimed to understand what it means to be a woman in present-day society, to learn women’s concept of health and identify their motivation sand expectations in the community with regard to participating in an educational group. Information was collected in a focus group and analyzed using content analysis. The results showed that being a woman is regarded positively, although it is still difficult to reconcile family and employment. Their concept of health is closely linked to caring and taking care of oneself. Their expectations for participation in the group were positive, and revealed learning, the forging of new links and leisure. The formation of women’s groups in the community, with a view to promoting these subjects’ health, should be encouraged.
Keywords: Health promotion; health education; women’s health; group.
INTRODUCTION
Health policies in Brazil has been changing over the years and are now being conducted, primarily, in the health promotion and disease prevention fields without prejudice to the curative actions1.
According to the First International Conference on Health Promotion held in Ottawa, Canada, in 1986, health promotion is the process of training the community to act in the improvement of their quality of life and health, including a higher participation in the control of this process2.
In the international conferences for health promotion, especially the second, which took place in Adelaide (1988) and the third, in Sundsvall (1991)2, it is possible to identify the appreciation of the role of women, who have the right of self-determination in health and should be a partner in the formulation of public policies focused on health.
Women are frequent users of healthcare services in Brazil as a whole; whether in search of their care and/or accompanying their husbands, children and elderly parents in visits. They deserve special attention, especially by their needs for their healthcare, such as contraception, during pregnancy and puerperium, prevention of breast cancer and cervical cancer, among others.
In care to women, we need to enhance their knowledge and clarify their doubts, because it enhances the care and contributes with the recommended actions in public policies aimed at women's health3.
The family health strategy (FHS) should enhance gender issues inserted in the everyday work in healthcare, reflecting on how the gender and power relations happen. This primary healthcare service can contribute to the creation of spaces for listening, reflection and questioning of practices of domination and exclusion of women, reproduced daily in affective-marital relationships in their different configurations4.
Nursing plays an important role in primary healthcare, to promote programs and activities for health education, aiming at the quality of life of individuals and families, and the actions of the FHS should be integrated with care, so that they may be able to facilitate the changes leading to health and encourage the increased autonomy and citizenship of the involved5.
In healthcare services in general, educational practice is present and the nurse is the professional who often develops these activities, being potential agent of change, opening up possibilities for discussion between the scientific and popular knowledge6.
The quality of nurses who work in the family health strategy, acting together with a community on the outskirts of Fortaleza-CE, the authors of this research formed a group of women with the purpose of contributing to the health promotion of these users. This action will meet the need to necessitate discussions and decisions that will improve the living conditions of these people, and why not say, that it would allow a reduction of these historically established gender inequalities, what constitutes as a benefit sought by this work.
This study has the objective to understand the meaning of being a woman in today's society for women in the community, getting to know their concept of health, as well as identify the motivations and expectations about their participation in a group of female education in health.
THEORETIC REFERENTIAL
Health education is a strategy that should be used by nurses to contribute to the maintenance of individual and collective health of the subjects, with critical awareness and processing, permitting the exercise of citizenship and effecting personal and social changes7.
A tool that enables the exploitation of knowledge, practices of the subjects, and contributes to the formation of opinions and attitudes is participation in groups because, in interaction with others, the members may feel more at ease to talk and share experiences, distracting a feeling of mutual aid3.
In this perspective, the educational groups is highlighting, especially in primary health care and pass to be widely encouraged by health policies and programs in the national scenario, because in addition to expanding the understanding of the subject about their health situation, also encourage changes in life habits1.
People, while participating in a group with goals that unites them, are positioned according to the collectivity, reformulating their rules. The participation experience in a group allows the modification of our habits, work situations, and even, our goals in life. The group still has an indispensable aspect, which is the space of socialization, to promote emotional support. Furthermore, the use of the dynamic educational group activities enhances creative attitudes when participants themselves are surprised with their skills at times of group interaction8.
Here are some questions that must be observed during the planning and development of group work. The selection of participants is the basic step of planning. The decision by group activities should be a consensus between the health professional and the participants, because they directly interfere on accession of people in the proposal group. A contract in the group should be established, recognizing the expectations of each and setting rules and norms of the group. For this reason, it is essential to consider the needs and possibilities of the components9.
Nursing, in the development of groups, is not new, because, by nature, the nurse is a professional who carries out their work with groups.
METHODOLOGY
This is a descriptive study with qualitative approach, developed in July of 2009, in a community on the outskirts of Fortaleza-CE, Brazil, with assistance from the FHS.
The subjects were 11 women, invited randomly by Community health agents (CHAs) to participate in a group health education, with the aim of promoting the exchange of knowledge and learning; strengthen the self-care and the promotion of women's health and, consequently, contribute to the increase of their autonomy and citizenship, among others.
Right at the first meeting after the presentation of the objectives of the group of women in the community, a discussion about women's health and women's participation in educational groups in health was developed. For this reason, a focus group was conducted, which is a type of interview in-group that appreciates the interaction and communication between the participants of the research, in order to generate information. This means that, instead of the researcher ask each person to respond to a question of time, people are encouraged to talk to each other, to ask, to exchange experiences and stories and comment on the points of view of each other10.
This meeting happened in the community itself, at the home of one of the participants, local and accessible in neighborhood, which offers ample outdoor space, placed at the disposal of this study. The chairs of the participants were placed in a circle and we talked about the following topics: How is it being a woman in today's society? What does it mean to have health? Why are you interested in participating in the women's group? What are your expectations about participation in a women's group in the community? The discussion lasted approximately three hours and was moderated by the researcher, who is a community FHS nurse, she is therefore, already known by the majority of the women participants.
This activity allowed the sharing of knowledge of all the women and allowed the exchange of experience between them and the health professionals present at the meeting (nurse and three CHAs). Women actively participated, were not shy and spoke openly about the theme.
The discussion in its entirety, with the women was recorded, with their consent. Subsequently, this recording was transcribed in full, read and reinterpreted and the results were organized according to content analysis, whose systematization proposal follows, basically, three stages: pre-analysis, analytical description and interpretation11.
This research was approved by the Research Ethics Committee of the Fluminense Federal University of Ceará (UFC), with protocol No. 153/ 09. It obeyed Resolution 196/96, of the National Health Council on research involving human beings12.
The subjects were adequately informed about the nature of the study, formalizing their participation with the Free and Informed Consent Form. To preserve the anonymity of each woman participant names of flowers were used to identify them.
Among the 11 women participants, only one was illiterate, five had incomplete elementary education and five studied up to high school. Half were homemakers and three were sellers of female products; the other three were, respectively, student, teacher and seamstress. The majority of women maintained a stable conjugal relationship and had children, with the exception of two participants, who were unmarried and without children. They had a family income of up to three minimum wages.
The results revealed the following categories: Being a woman in today's society; Concept of health; Motivation to participate in a group of women; and Expectations about participation in the women's group.
RESULTS AND DISCUSSION
Being a woman in today's society
Note that, for the women of the study, being a woman in today's society is a positive fact, although it is not so easy, because, from day to day, they are faced with many difficulties, is to take care of the family, the house or take care of themselves. Being a woman is being warrior, fighting and strong, without ever giving up of their struggles. It is the woman who appreciates various contexts of their lives, family, school, workplace...
Relate the importance of the family, being a mother and working daily, contributing to the livelihood and the maintenance of the home. Understand that women are increasingly recognizing their rights in today's society and being respected. Behold, then, some of their statements:
We women are we valuing more in life and in society, we have our own opinion. (Camellia)
IS to be flexible, is working all day and have patience with the small things, such as her husband, family, children, is be strong, warrior, fighting and in addition to all this proud and sensitive. (Acacia)
Being a woman is to be fighting, the woman is warrior, she cares for her husband, their children, and never get tired, she loves, suffers and cries, but she never gives up. No man takes their rights, being a woman is to be happy! (Azaleia)
It is known that, culturally, in a historical process, the woman has discredited position relative to men; women must assume responsibility for home and family, while men breach the support of home and family. Thus, the condition of being a woman requires a walk in the direction of the quest for equality, because she always has been subjected to an unjust patriarchal system. This is changing in the last few decades, because women earn increasingly more rights and spaces in the labor camps, but this inequality is still present in society, especially in less privileged social classes. The study participants visualized these advancements.
This Study revealed that the job is one of the essential values of life of women, whose direction was molded from childhood through family cultural heritage13. In actuality, the movement of social and economic changes have contributed to changes in labor relations and the social integration of women14.
Many studies are insisting on the absorption of women by the labor market, but they cling to put the men in gear contrary, bringing them the division of tasks in the household15.
Being a woman is no longer synonymous with mother and homemaker, having a full life just dedicated to the family; today, the woman is inserted in public spaces, have more opportunities for personal fulfillment, which also implies greater responsibility4.
In a social and cultural perspective, care always been link to females. Historically, women play the role of caregiver for their family and home16. The figure of the woman-mother as primary caregiver appears as a consensus, in discussions about the health care in the context of the family, being cared for by woman is a worldwide phenomenon17.
Concept of health
Seeking to know the concept of health for women and participants identified that they recognize the importance of being healthy for strength in coping with life's difficulties.
For them the concept of health is closely linked to care and take care of themselves, obviously, and in particular, in the feminine conception. There is a significant understanding about health and care at different stages of their life. There is a section in the speeches of conception of health facing the individual and lack of appreciation of the social determinants, because some have referred mainly to disease prevention and health care in certain stages of life, such as pre-natal care and prevention of cervical and breast cancer.
Other express a design more expanded to health, including the psychological, spiritual and emphasizing the care with the beauty, the female vanity and the importance of interaction with other women. Recognize that there are still many difficulties in attention to the health of women and that care needs to be expanded.
It is always is caring, is to go to the doctor, be strong when you have a health problem, because the woman without health can be considered invalid, while healthy, we face everything that lies ahead. (Carnation)
The health of the woman, it is not only the health of the body, such as having to go to the gynecologist, but also the spiritual health, able to talk to friends, share the joys and sorrows, and take care of your hair, the body, and their nails. (Acacia)
Women's health is very important because we have to take care of us, making prevention, but for this, we need opportunities in health, because we still have much difficulty. (Dalia)
The health concepts can incorporate personal values of each subject and help to understand the fundamental aspects for the integrality of care and conceptual (re)formulations18.
In relation to the concepts of health related to the woman, it was observed that often, the conceptions about the female gender are preferentially oriented aspects of anatomy and biology of the body, valuing the reproductive function and the motherhood as being their main attributes3.
Health should not be seen only in the traditional concept of prevention, diagnosis, treatment and rehabilitation, and should be addressed in the context cultural, historical and anthropological viewpoint, where the subjects are inserted. It is necessary to design a new concept of health that consider the full awareness of citizenship of individuals, which requires new positions and cultural systems19.
Motivation to participate in a women's group
Seeking to identify what the motivated to participate in the group of women in the community, they responded that they believe to be something more to occupy their time in their own neighborhood. When they received the invitation to join the group, they expressed curiosity in knowing what it was, and emphasized that it would be an opportunity to learn more about women's health. The following are testimonies:
For me, part of the group would be something else in my afternoon because well, I had something to do. (Dalia)
I was invited by my colleague and I found it interesting, because I would learn the experiences of others and take care of myself better. (Azaleia)
I was curious, also to be more on the inside of woman's health. (Sunflower)
The women express interest in participating in the group, believing that the proposal will be useful to them, because it can learn and teach each other, with the participation of all. They have, also, the expectation of knowing other women and make new friends in the neighborhood.
The participants perceive the group meetings as a time of sharing among women, a learning experience that cannot be purchased in individual consultations at the family health center (FHC), as noted in comments:
It is the exchange of experiences, it is to have more time to get doubts that in consultations do not of time, is to have a moment only for us women. (Jasmine)
The group of women is very good, because everyone learns more things, knows more girlfriends, knows more about woman and, for me, is a very special [...] meetings. (Lily)
Everybody is talking about, learning more about health, and putting it to work. (Orchid)
These testimonies are important for the proper development of group activities, because, since the beginning of the meetings, they perceive that learning can be established between the participants and not only with the health professional who leads the process.
Producing this discussion in the first meeting of the group of women was important to know their ideas and to better plan meetings, in an individualized way and according to their reality.
The women participating in this study include that the group favors the exchange of experiences, which is not the case in individual consultations in the FHC. Likewise, women in a healthcare unit, who participated in a discussion group, reported that the exchange of experiences and opportunities for conversation were essential, since the consultations, commonly, they are passive, receiving information and interventions3. In fact, we understand the importance of the formation of groups of women in the community, especially those that are coordinated by the family health teams.
The group interaction occurs as the people felt secure and quiet to share aspects of their intimacy, in a climate of mutual trust, acceptance and development20. This interaction in-group allows the formation of opinions and attitudes, because, as a group, people can feel more at ease to talk and share experiences, distracting a feeling of mutual aid.
In its many aspects, health education is a strategy that brings the clients of healthcare professionals in the context of exchange of knowledge and realization of a humanized care21. In health education activities, the participation of the subjects should be the guiding element, because, when they are involved, they feel more motivated and, consequently, share responsibility for their health and by changing the reality22.
Expectations about participation in the women's group
The women's expectations regarding their participation in the group were very positive: they sought the learning and participation of all; believe will be new friendships and encounters are for fun times. They emphasize that they must actively participate in meetings, giving their opinions, sharing their teachings.
My expectations is to know the women in the group better. I hope that all the meetings are very interesting and I can learn from the experience of each one. (Azaleia)
I hope that the group is important not only for me, but for the other women who want to take care and stay well in their lives. (Jasmine)
I hope performance on our part, to not miss the meetings, that we increasingly have fun and learn more of our colleagues, and ourselves because we have lessons to share with each other. (Dalia)
They were receptive to the idea of the creation of the group of women in their neighborhood and have expressed interest in participating. From the beginning, believed in the proposal of the group of women in the community and their expectations were quite positive, recognizing the contribution of the group for their health.
It is seen that, for each woman, the group could have distinct meanings, as also being a therapeutic space and creating relationships. This fact leads us to reflect on positive values such as friendship, mutual support, and the need to create a space of acceptance of women within the community where they live, because, many times, she is the head of the family and the only person responsible for home and by children, therefore, does not have time to talk with other women about health.
In a study carried out with a group of women assisted by a basic health unit, the proposal for the creation of the group was gradually gaining the confidence of the users of this service, after the establishment of the dialog, the exchange of experiences among the participants and respect their culture23.
In a female care group, the participants noticed this joint activity as a legitimate space to discuss issues in health, so more interactive and educational, as a circle of conversation3.
Group activities promote several therapeutic factors, among them imparting of information, cohesion, universality, interpersonal learning, and development of socialization techniques, altruism, imitative behavior and instillation of hope24.
CONCLUSION
The study objectives were achieved, having the same if shown on relevant, in so far as, brought to the wheel of discussion, the importance of the educational practice of nursing along the women of the community, especially those assisted by the FHS.
Being a woman in today's society is something positive, although it is not so easy to reconcile professional work with the personal care and with the family. The concept of health for these women is very connected to care at different stages of their life.
The women in the study believe in the training of community groups, they believed to be an important action for the promotion of health; they are receptive to joining this community activity. Their expectations in relation to participation in the group relate to learning and the construction of new friendships. Therefore, it is necessary to encourage the creation of educational groups in health, along with the women of the community, because they strengthen the female participation and contribute to the promotion of the health of these users.
In this perspective, it is essential that health professionals and managers will realize to take care, in fact, women, because, despite the progress achieved, there are still major challenges in women's healthcare. For this, it is worth stressing the importance of continuing education for health professionals, such as a policy that should take care of this activity and new skills, enhancing communication, essential to educational practices.
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