Educational technology as a strategy for the empowerment of people with chronic illnesses

DOI: http://dx.doi.org/10.12957/reuerj.2014.15509

ABSTRACT: The objectives of this study were to develop the group work in order to learn about the routine and the health/illness/care process of the persons with chronic illnesses; to analyze whether the group work has leveraged the empowerment and which educational technology is recommended in the educational practices by persons with chronic health conditions. A descriptive and exploratory study, developed with 16 people of an Academic Institution located in the municipality of Rio de Janeiro. The data were collected in 2014 by means of semi-structured interview and submitted to content analysis, and two categories emerged: Life as it is; potential for empowerment and Technologies - which one I prefer. The routine was unveiled by physical pain, cry, stress, and change in mood. We conclude that the educational technology may be used as an empowering strategy, considering its involvement in the group and the stimulus to reflection, thus allowing the exchange of ideas and mutual respect.

Keywords: Empowerment; educational technology; nursing; chronic disease

INTRODUCTION

Chronic health conditions require regular monitoring of individuals, partnership relationship development, involvement, motivation and knowledge about self-care. This fact is considered, due to reported evidence on the difficulties in overcoming the fragmentation of health actions and services and qualifying health care in the current context.

On the other hand, the emergence of chronic non-communicable diseases (CNCD) relates to the multiple causes, gradual onset, and uncertain prognosis with a long and indefinite duration. To this end, the recommendations of care usually require interventions soft, soft-hard and hard technology, associated with the change of lifestyle, in a continuous care process that does not lead to a cure¹.

The technologies are implemented processes from the everyday healthcare experiences and some, derived from research for the development of a set of activities produced and controlled by humans. It serves to generate and apply knowledge, mastering processes and products and transforming the empiric use in order to make it a scientific approach².

The role of technology is to enhance the individual skills, and/or assist in acquiring new attitudes seeking a transformation of oneself. The technologies are categorized in the healthcare field as follows: hard technology represented by the material, equipment, physical installation, tools; take hard technology, which includes structured knowledge in the healthcare field; soft technology enters the communication production process and relationships³.

Equally, the classification of the technology proposed by nurses is based on the following: educational technology represented by the set of scientific knowledge that involves the educational process; assistive technology, including systematized actions for a qualified care; management technology as a systematized process consists of theoretical and practical actions used in care management⁴.

The nurses in their daily experiences situations in which nursing action is directed toward education in healthcare and given the nature of their role as a professional procurer of knowledge, seeking options that can offer them support to intervene with people, groups and communities, in order to promote well-being, social inclusion and citizenship.

Complementing the previous idea and considering the complexity of the situations that involve the health-disease process, such as biological, economic, social factors and cultural rights, as well as their interconnections and consequences, there is a need to invest in health promotion. It is in this context, which lays the discussion on empowerment, focusing the attention for interventions that go beyond the criticized biomedical model.

Thus, given the above, the following question stands out: Can educational technology be used as an empowerment strategy for people in a chronic health situation? Therefore, the objectives were to: develop group work in order to meet the everyday and the health / illness / care of people with chronic illnesses; analyze whether the group work has enhanced empowerment and educational technology in educational practices is recommended for these people.

LITERATURE REVIEW

Nurses can collaborate on health promotion, requiring change in the relationship between professionals and the community, in which partnerships should be more valued than individual and paternalistic approaches. Therefore, it is believed that partners are individuals able to become even more empowered when they share knowledge, skills and resources⁵. Especially when the group meetings become a place of welcome, sharing life experiences, feelings and experiences of life situations, as in proven studies⁶. In such cases, it attests to mobilize resources and competences by motivating action of the group itself, favoring the formation of a supportive social network to address the problems of everyday life.

Thus, educational technology in nursing care can be an important tool to assist in caring for people, making it possible to still develop new forms of care that empowers professionals for the teaching of self-care and in skills development⁷.
Scholars in the field argue that educational technologies can be understood as tools used to broaden and enhance the empowerment of people^2,7,8. Empowerment is given its multifaceted concept that has had increasing visibility, mainly from the 1990s, deriven English language⁷. However, this was modified and reinterpreted by various authors⁹.

Thus, it is understood as an increase in the power and personal and collective autonomy of individuals and social groups in interpersonal and institutionalrelations¹⁰. Similarly, this concept has taken on meanings that refer to the development of potential, increased information and perception, with the intention that there be a real and symbolic participation, enabling democracy¹¹.

On the other hand, empowerment is an educational process proposed to help people broaden knowledge, skills, attitudes and knowledge needed to successfully assume responsibility with decisions about their health¹². In addition, it enables the individual to solve their own problems and needs, understanding how they can solve these problems with their own resources or with external support and promote more appropriate actions for promoting healthy living⁷.

The theoretical scope refers to the dialogic learning, developing critical position in which the individual reframes their own healthy / autonomous / personalized way of living. Noting that only the information, shared in the educational processes by itself will not modify the behaviors in relation to the problem situation. Although knowledge is a necessary condition for the process of change in a practice or behavior, other variables like the attitude will have to be changed so that particular harmful behavior is modified¹³.

It can be said that people more informed, involved and accountable, i.e., empowered interact more effectively with healthcare professionals trying to perform actions that produce health outcomes⁷. In this perspective, it is possible to empower people so that they learn, in the various stages of the process of living, facing the possible chronic diseases that affect health¹⁴.

Given the global circumstances, despite the discussions on CNCDs, scholars have pointed out that the biggest problems are consequences of the difficulties of changing models of health and health practices, which need to be innovated to qualify to meet the needs and interests of the population¹⁵.

In this case, it is understood that the health-disease-care process, individuals now enjoy greater autonomy and quality of life. Study Results have shown that in the health promotion field, treatment has to extend beyond the limits of the clinic and permeate the domestic environment. Patients and their families in need of support and assistance. The treatment for the CNCD must be re-oriented around the patient and family⁷.

METHODOLOGY

This is a descriptive study conducted at the Laboratory of Applied Physiology Physical Education and Health Promotion Institute at the State University of Rio de Janeiro (LFA/EDFI/UERJ) in 2014. The subjects were 16 patients, whose inclusion criteria specify the following: diagnosis and/or family history of CNCD, age group above 20 years, participants of the activities of the projects of the LFA/EDFI/UERJ, without distinction as to race, gender, and religion, interested in participating in all stages of research development on a voluntary basis.

The study was approved by Ethics Committee of UERJ, according to resolution No. 466/2012 National Health Council of research involving humans, under the Protocol 017.3.3012.

The participation of the subjects in the study was conditioned upon the signing of the informed consent, after reading and understanding of the ethical procedures on the anonymity, the goals, the advantages and disadvantages with regard to the implementation of the research.

The data were produced through semi-structured individual interviews with specific issues of the study, recorded on an electronic MP3 device, supported by a previously tested script. The subjects were identified as respondent 1 (N 1) and so on.

It applied a data saturation technique to limit the set of clients. From the 17th interview, the answers began to repeat, ending data collection with 16 subjects.

In the quantitative approach, the socio-demographic and clinical variables were subjected to statistical analysis, with calculation of absolute frequencies and percentages.

Similarly, the qualitative approach, data were transcribed, organized, distributed chronologically according to the answers, sorted and categorized according to the content analysis method¹⁶. The depositions revealed three categories namely: Life as it is; Potential for empowerment; and Technologies - which I prefer.

RESULTS AND DISCUSSION

Participant profiles

This section begins with a description of the demographic data of the study subjects. Of the 16 clients, 2 (12.5%) were male and 14 (87.5%) were female. The ages varies from 44 to 83 years, however, a half is over 71 years.

With regard to schooling, 7 (43.75 percent) have only elementary school, 6 (37.5%) had attended high school and 3 (18.75%) with complete higher education. On ethnicity, 6 (37.5%) declared they were black, 6 (37.5%) are white and 4 (25%) brown. Religious belief, 10 (62.5%) are Catholic, 1 (6.25%) is Protestant, 1 (6.25%) is messianic, 2 (12.5%) are spiritualists and 2 (12.5) are Jehovah's witnesses. As for occupation, 10(62.5%) are retired, 2 (12.5%) are self-employed, 2 (12.5%) are the homemakers and 2 (12.5%) are formal workers.

When it comes to income, 5 (31.25 percent) receive between 1 to 2 minimum wages, 7 (43.75%) from 3 to 4, 3 minimum wages (18.75%) of 4 to 6 minimum wages and 1 (6.25%) had received over 10 minimum wages. Most are resident in the neighborhoods of the North Zone of Rio de Janeiro.

From a clinical standpoint, four (25%) have fibromyalgia, 1 (6.25%) lupus, 6 (37.5%) systemic hypertension (SH), 1 (6.25%) Parkinson’s, 2 (12, 5%) cardiomyopathy, 1 (6.25%) fibromyalgia associated with hypertension and diabetes, and 1 (6.25%) claimed that it has no pathology, but has a family history of chronic disease and who attends the group's activities to stay healthy.

In this group, one can assess that the majority are women, retired, low education, low socioeconomic status, belonging to the Catholic religion, and from the clinical point of view has one or more chronic illnesses. The results show that they are engaged in the group activities for the knowledge process, self-care, quality of life and autonomy.

The following are the emergent categories

Life as it is

This category emerged after a group dynamic, revealing the participants' everyday tacit encounter with chronic problems, expressing how each experienced the moment and their impact, as shown by the following reports:

 My day to day hasn't been good after I discovered the fibromyalgia, about 8 to 9 years ago as a matter of fact, [...] felt a lot of pain, cried [...] they thought I was really stressed. What bothers me the most is the ignorance of people, because 4 years ago nobody had mentioned Fibromyalgia. Ignorance is big, it begins in the family. (N1)

Today my everyday life is almost normal [...] but before I walked all stiff today do my normal activities. I have lupus too. I've never had a serious crisis, I do the treatment. What bothers me is the hassle [...] where Lucia explodes; it works well in the group. (N2)

I tried to improve my day to day, I went to the doctor, did treatments, and who discovered the fibromyalgia was a dentist, because I was breaking all of my blocks [...] I even got better it was here in the UERJ group, because here has the group psychotherapy. What really bothers me is the noise, not because I work at school, loud sounds do not do me good. (N5)

 [...] a happy day, another sad, depress, I cried, I found myself unable, because everything I did could not do more, could not walk, I crawled practically inert. [...] Thank God, I walk today. I've always been hypertensive from 20 years ago and now I have diabetes. What bothers me is the pain, high glucose and numbness in the arm (E15)

After the group dynamics, participants pointed controversial sensations and feelings that occur in life when faced with reality and reported by those who actually lived through the experience. Daily life was revealed by physical pain, crying, stress, by not being able to perform the activities, by immobility, physical fatigue, numbness, depression, mood changes. Added to this, the discomforts caused by ignorance, annoyances, frustrations, discouragement, limitations and contempt.

Technological strategies have changed the way of life of a large part of humanity. However, the work done with group dynamics is a great challenge for all nurses and healthcare professionals when it aspires to create the exercise, sharing experiences and health practices in the form of collective construction.

It is worth reinforcing that group work is a catalyst for revelations that much can help in the teaching and learning of people who experience chronic health conditions in an attempt to rethink new technologies such as education strategy for empowerment, and new ways for care¹⁷.

Empowered Education is an effective healthy education and a preventive model that focuses on group action and direct dialogue of Community targets, aiming to increase the credibility of people in their ability to change their own lives¹⁸.
In their statements, then, participants express about their health situation:

 [...] We learned a few things, the triggers; it is a difficult disease to control, extremely painful. Untreatable and the end is very sad. Many do not accept, because they think it's only in the head. The more know about it, the better. (N2)

[...] I know it causes backache and shoulders and joints to swell and bother, there are days that it won't let me work right. With the Group, I intend to learn more. (N3)

[...] I learned that it is an autoimmune disease that has no cure, we can control and live well, according to the people and seek what's hurting us, which fires the trigger [...] example, teach in the municipality of Nova Friburgo and, there, it is very cold. Last week it was 2 degrees, even taking medication, taking a hot shower and with a sweater, I kept feeling pain. (N5)

I think it's a disgrace, generally speaking, back home, my sisters (6 women) and a man, then with 60 years of age, all of them became hypertensive, then when I became 60 I was hypertensive too. It can only be hereditary. (N6)

It can be hereditary, not abuse of salt these things, never stop doing an activity, not stand still; it's more or less this. In addition, if there's anything else, I want you to tell me so I can let you know. I want to know more and more and more every day. (N9)

As can be seen in these recent testimonials, random people possess limited knowledge about the process health/illness, all signaling interest in acquiring knowledge. This is an indication that they are open to new learning.

The strategy of educational technology brings many benefits to educational practices, however, for many health professionals, is still a distant reality of alternative healthcare services. Group work involves everyone on staff, both for the Organization of the whole sequence as the decision-making and promotes the feeling experience of reception, of belonging, the stories and sharing their everyday experiences, when dealing with their health histories.

Scholars state that the relationship between empowerment and health education outlines a model of empowerment as an alternative to more traditional models¹⁹. The three basic approaches that are employed to develop interventions in health education are highlighted in the following: The Preventive model, which focuses on the process of individual decision to adopt a healthy behavior for the prevention of diseases; Radical Political Model, where the focus is on social, environmental and political structures change, to attack the root of the problems of health and disease; and finally, the Model of Empowerment, whose purpose is to facilitate individual choice and community, for the acquisition of knowledge with values ​​clarification and decision making practice the skills of community organizing, through non-traditional teaching methods²⁰.

Potential for empowerment

Participants were asked if they received some kind of healthcare orientation and how they would like to be oriented during monitoring. This can be seen in the following:

Yes, in the physical education lab. In the group which treats fibromyalgia. Here, we learned to [have] our responsibility and to know each other. You have to be very strong, people say you have nothing. (N4)

I haven't received any information. All I know was the experience with the group. However, if I could choose, I like lectures, in a group; it's always nice to know about what we have. (N5)

No, only here the Group of UERJ, with this teacher, he was explaining it to me... I'm having the greatest learning experience, every hour they are talking about a subject. Yes, I want to learn more. It's better to know to know to react. (N6)

Of course, I already knew a lot. Here [in the Group] everything is driven from the beginner class, doing gymnastics in accordance with what you can do, without exaggeration. After a while, I was getting better. When I started, taking a diuretic, two medications for hypertension, and simvastatin for cholesterol. (N9)

We know that is a chronic disease and that there is no specific treatment for it. I think you actually have to have acceptance, but fighting it. About diabetes, it has already reached the kidney function; I am profound and severe hypertensive. I have received and I am still receiving a lot of support, thanks to God, for a lot of guidance. Here we are treated like a human being, we can talk, and we can express our feelings. (E13)

After the dynamics held in-group, subjects reveal in part who know their health problems, those who know little, and are still in the process of learning, were sincere in saying they learned on that occasion, in-group discussions, or at least were able to talk about what they were feeling. Moreover, with that they felt like people. They exercised the democracy and citizenship.

In this sense, people, if reveal to the group, create a movement and interaction, everyone ends up knowing the problem and help with their experiences in certain situations. The reception and respect for others are fundamental aspects. In this process, they are all are partners in the search for solutions to everyday problems and sufferings. All comments are relevant and included in the group²¹. Therefore, building this reality, which makes it possible to discuss the educational intent, represents the possibility of change in teaching and learning process and, at the same time, the certainty of being empowered. In addition, it is noticed that the group coordinators are fulfilling their real function.

Technologies-what I prefer

On the aspect of educational technology as a strategy for empowerment of people with chronic health problems, the participants stated that:

The way it is being done today [in-group], with lectures of various professionals. Here, you learn that you have to take care of you first. (N2)

[...] group dynamic is very good, it is good to know that there are other people with the same situation of people and how they take care of themselves, too. (N3)

[…] lecture, sometimes comes an expert to talk about the group. Lucia, a teacher, is always commenting on other diseases. It can be through these dynamic, lectures and internet, so that I receive the information. (N5)

Watching, who guides me. Developing my reasoning. I also like to have something in writing, because you may remember and be oriented anywhere. (N10)

Groups of information, brochures, meetings, dynamics. That helps us a lot, gives us strength. (N15)

The placement of participants was unanimous in saying that they would like to keep the strategy of group dynamics, lectures, causing them to reflect, developing the reasoning and participating actively.

Therefore, organizing the pedagogical work, which reflects the intent of the educational activity, and formalize this intention, plan, assume overcome the fragmented character of educational practices and achieve the goals of the educational strategy.

Thus, define collectively the necessary conditions in order to perform this process, is part of the organization which it has as its democratic work perspective. Define actions; in a collective and democratic space is a possibility to strengthen the group in the confrontation of conflicts and contradictions, building critical education, indispensable for those involved in the process22.

Vale registrar that one of the limitations of the study is the complexity of the phenomenon empowerment/subjectivity and the search for quality of life. The other two points to the reduced sample and a single scenario, which prevent the generalization of the findings.

CONCLUSION

Analysis of customer testimonials arose the three categories called: Life as it is; Potential for empowerment; and Technologies - which I prefer.

With this study, it was found that educational technology could be used as a strategy of empowerment of people affected by CNCD, whereas during the whole process the participants became involved in the group, reflected from the reality of the other, learned to listen, stimulating the reasoning, the exchange of ideas and mutual respect.

The strategy of the group work, although it is ancient in the classrooms, is advantageous and current health institutions. From this dynamic, it was possible to know the behind the scenes of everyday life of the participants, confirming the finding on the health situation it was difficult to mobilize emotions, such as feelings of sadness, beyond pain, crying and ignorance of the health / illness / care of people with chronic illnesses.

In the same way, it was very positive to analyze, through the testimony of subjects such as the strategy of group, dynamics potentiated the empowerment. In addition, the group dynamic was the most desired by them, adding to the lectures, conversations, informational pamphlets, among others.

One of the biggest challenges of this study was to transform this space, in a critical, fundamental place on health issues, where those involved could be heard, exchange experiences, look at them self and reflect their health condition and, above all, do not give up fighting for their quality of life and autonomy.

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