RESEARCH ARTICLES

Family social representations for the family health strategy program team

Maria de Fátima Mantovani^I; Verônica de Azevedo Mazza^II; Ricardo Castanho Moreira^III; Daniel Ignacio da Silva^IV; Jeniffer Kelly Franco de Jesus^V; Vanessa Bertoglio Comassetto Antunes de Oliveira^VI

^INurse. Doctor. Associate Professor III of the Nursing Department of the Federal University of Paraná. Leader of the Multidisciplinary Study Group on Adult Health, Fellowship productivity 2 National Council of Scientific Development. Curitiba, Paraná, Brazil. Email: mfatimamantovani@ufpr.br.
^IINurse. Doctor. Associate Professor of the Nursing Department of the Federal University of Parana. Leader of the Research Group - Family Health and Development. Curitiba, Paraná, Brazil. E -mail: mazzas@ufpr.br.
^IIINurse. Doctor. Associate Professor at the State University of Northern Parana. Deputy Director of Campus Luiz Meneghel. Bandeirantes, Paraná, Brazil. Email: ricardocastanho@uenp.edu.br.
^IVNurse. Master. PhD student of the Graduate Program in Nursing at the University of São Paulo School of Nursing.Sao Paulo, Brazil. Email: daniel.silva1076@usp.br.
^VNurse. Member of the Group of Multidisciplinary Studies in Adult Health. Fellow Research of Araucaria Foundation. Curitiba, Paraná, Brazil. E-mail: jenifferkf@hotmail.com.
^VINurse. Master. PhD student of the Graduate Program in Nursing at the University of São Paulo School of Nursing. Curitiba, Paraná, Brazil. E -mail: vancomassetto@hotmail.com.
^VIIThis work is part of the results of the Project: The promotion and education in health: the representations of the team, funded by the National Council for Scientific and Technological Development, Universal Edict 2009. The authors acknowledge the funding and support.

ABSTRACT: Qualitative descriptive study aimed at identifying the social representations of health professionals on family health strategy program (FHS). Methodological analysis support was framed in the theory of social representations. Survey participants were 58 professionals from primary health units, conducting the FHP, in the municipality of Curitiba, PR, Brazil, in 2010. Data were collected through a recorded semi-structured interview. Categorical content analysis of the transcripts was made out of which three categories emeerged: Family, my safe harbor; Family, my background; and Family, caring ties. Social representation of family referred to the social and emotional protection that it offers to its members, the group of significant people integrating it and the heterogeneous ties they have. The representation of the family translates the social and ideological context guiding the care practices that allow for their reconstruction or maintenance, with a view to encourage their autonomy and development.

Keywords: Family; social representation; health; primary health care.

INTRODUCTION

 The family institution has performed as essential to the process of living of every human being, not just as an abstract idea, but as a phenomenon of a society that evolves with it.  Despite the changes in its structure and organization, the family, in turn, has been identified at different times, as a unit that cares for its members throughout their process of living and the different stages of life of every human being^1-2. This way, the family is not constituted by biological or natural elements, but as a product of distinct historical settings, which slowly organize as family institutions³.

The family can be understood as a set of individuals who cohabit the same space and that maintain biological, mental, social, cultural and environmental resources to live. The transitions in the life cycle of families require a constant movement in their organization⁴.

In recent decades, the family obtained prominence in health care, especially when health systems turned their attention from  a curative and biologicist model to the model based on primary health care, through prevention and promotion⁵.

Nowadays it has been emphasized that health actions are centered on family care, although this is recognized as a propellant or limiting element, able to influence the development of its members in order to get better resolution and effectiveness in the provision of community care⁶.

Therefore, health professionals should be able to follow these changes to capture the health needs of families, meet their internal organization and its resources, as well as recognize the potential and the limitations of it to base their practices in the development of health promoting standards of this family⁷.

Given the importance of the role of health professionals in caring for families and considering the model of care that is being implemented in Brazil, we developed this study, which aims to better understand the social representations of professional members of family health teams (FHT) about family.

THEORETICAL – METHODOLOGICAL REFERENCE

This is a descriptive qualitative research, which used as a methodological support analysis, the theory of social representations, which are understood as modes of thought, from which the subjects elaborate meanings attached to individual and collective behaviors by creation of cognitive categories and the relations of meaning that are required. They thus can function as group attribute for identification, acceptation or rejection⁸.

Social representations are considered to be a form of socially developed and shared knowledge and whose purpose is the interpretation of a common reality of a given social group, in this case the FHS team members. Because it is a collective production, therefore shared, it is built through communication, language in its various forms of expression⁹.

The purpose of social representations is to transform the unfamiliar into familiar, and this relationship established by the author relates to the consensual universe in which social groups are inscribed. The dynamics of representations is therefore familiarization, where objects, people and events are perceived and understood in relation to previous encounters and paradigms⁹.

There is also an important role in the dynamics of representations of social relations and practices in order that they can respond to four functions that are: the one that furthers our understanding and explanation of reality; the identity that allows the protection of the specificity of the groups and interfere in socialization; the guidance that directs the behavior and practices and the justifier that allows the explanation and justification of actions in a given situation¹⁰.

The survey was conducted during the months of August to November 2010. As sample for this study were interviewed 58 subjects, divided into 17 nurses, three doctors, three dentists, three oral health technicians, 28 nursing assistants and four oral health aids belonging to the nine health districts in the city of Curitiba, Paraná.

The researchers visited each selected UBS and invited practitioners to participate in the study. Those who agreed, signed the Informed Consent form and, subject to availability, participated in the interview. For data collected was used the semi-structured interview technique, which lasted approximately 15 minutes. The speeches were transcribed, typed and treated, according to categorical thematic analysis of Bardin¹¹, composed of three steps: data organization in order to operationalize and systematize the initial ideas to conduct the analysis; simplified representation of the raw data, and the processing of the results obtained; at this stage the occurs the articulation of the categories obtained from the speeches and the theoretical framework of social representations¹⁰.

With analysis of the speeches, we identified three categories: Family my safe haven; Family my base, and Family caregivers ties.Registration units drawn from the context units (interviews of participants) were presented and identified with the abbreviation (E) and sequentially numbered, ensuring the anonymity of respondents.

This research was approved by the Ethics Committee of the Sector of the Health Sciences of the Federal University of Paraná, by the Presentation of a Certificate of Ethical Analysis Nº 0010.0.091.000-10 and was authorized by the Curitiba Municipal Health Department through Protocol n° 56 / 2010.

RESULTS AND DISCUSSION

Family my safe haven

In the first category, the subjects consider that the family is the place where people can seek refuge and safety in times of difficulty during life:

It is all, it’s a safe haven, especially when you have a problem, if you don’t have a mother or father to talk to, ask questions, if the parents are not present or open to discussion, it’s complicated, there has to be friendship, unity. (E52)

Family, I think it's an everything in the life of people [...] family is the sun that shines on the life of people. (E35)

This category symbolizes the identity function of social representations that defines the specificity of groups, placing individuals within the social field, allowing the construction of social and personal identity compatible with the values and historically determined standards¹⁰.

They refer also that it is everything, a space where people feel safe for constituting dialogue, where you can dispel doubts, especially in difficult times, being able to protect members socially and emotionally⁷.

The participants recognize that the family is founded on the links between its members, which are possible through communication and mutual understanding. Its spatial configuration is designed from the locus where relationships are established between people who have close ties, living in the same household and take care of each other mutually¹².

The family was expressed as a safe haven, as the "housing is a physical dimension, set by the limits of the territory, and a social dimension, established by the relationships between family members and theirs with others"^12:28, or, a physical space which ensures the family their privacy, identity and the essential conditions for manifestation of care¹².

The discourse expressed the family as one that has a retaining or support function of its members, promoting the adaptation of the stress factors that come from the vital process⁷. Considered as a community of interacting people whose commitment between them is guided from the emotional bonds that form the basis of this association¹³. 

Family my base

The second category emerged from the social representations that drive behaviors and practices. And it is the individual's training core in which he receives all the basis for the formation of his character and subsidies to face life:

It is the foundation, it’s the basis [...] When you see a child so very careless, or a very careless adult [...] You may study the history of that person, and find there is a family problem. (E21)

Family for me is the basis, the mainstay of the individual [...] so that the individual will be able to overcome certain difficulties. I can say that is the basis of being human (E32).

This category demonstrates the guiding role of social representations that drives behaviors and practices, interfering "directly in the definition of the purpose of the situation, determining a priori the type of relationships relevant to the subject"^10:29. The subjects represent the family in their teaching, guiding and educational function for humans, because it has an assignment prescribing behaviors or practices, and also expose their key role in the social relations of the individual, setting the rules and social connections and "what is lawful, tolerable or inacceptable in a given social context"^10:30.

Some expressions denote the family as a fundamental framework for education, influencing the behavior and activities towards life, and acting on the individual as the foundation for the educational, emotional, character, a base that can pass on human well-being for all his life¹⁴.

These representations are relevant to the health sector, as many families have expressed concern on knowing the standards of insight in raising their children, establishing limits, as well as many members of the health team are not paying attention to these relevant details, which form the paradigm of life of these families².

The family has, to the respondents, a decisive role in formal and informal education, being a place for the developed of ethical and moral values, and in which the bonds of solidarity deepen¹⁵. The family "has been, at different times, a unit that takes care of its members, despite the changes in structure and organization"^2:11.

Family, caregivers ties

Its caregiver feature allowed the establishment of the third category, in which subjects understand the family as an institution of affective unity, daily communion of activities and sharing of situations where its members are responsible for mutual care, in their daily lives:

And they commune daily with their daily activities. Sleep in the same place, plus they have a close bond. Whether they are fathers, or are mothers, whether they are children or stepfather. (E10)

They aren’t only inbred, but all living with that person in need of care [...] the concept of family, like that, today is no longer that plump thing [...] if they're participating, if they're helping, to me they´re family.(E29)

It's kind of hard for us to restrict the issue only towards the blood ties, only father and mother because sometimes it's someone else who takes care. I think that it’s very involved with the issue of coexistence and care. (E30) 

In this category, the subjects represent the family, according to the justifying function of the social representations, as a place of care where its members are responsible for mutual care in their daily lives and in situations of sickness¹⁶, and that in fact affects their behavior towards the family, with the function of "maintaining or enhancing the social position of the reference group"^10:30.

The actors "explain and justify their conduct in a situation or in view of its partners'^10:30 and seek the preservation and justification of social differences, apart from stereotyping the relations between groups. This feature allows members of a social group to justify the positions taken and their behavior, intervening in the evaluation of the action, giving the actors the explanation and defense of their actions in a given situation¹⁰.

The family is represented as a set of links as more characterized by the significant people in it and their care relations than by inbreeding. These ties, established between family members and the context in which they live, create their own identity and communicate a multivariate function within it¹⁷.

It may be noted that there is the recognition of different types of family today, so are not restricted only to the nuclear or traditional shape, they show the need to enter the world of families, their imagination, their dreams and their utopias, remembering the past, living the present and with the future in mind¹³.

It is true that family relationships can enable help, support, and other favorable conditions for the development of human beings18, but it should be understood that, despite its leading role as a model for its members, the family has not fulfilled this function, because it is often unstructured and without the necessary resources, leaving its components at risk of deviations¹⁴.

This representation expressed by the team shows that there is a need in their care relationships, to increase actions that allow the interaction of their personal and professional cultures with of its members¹⁹. Just as there is urgent, need to reorient the way for workers in the health sector, so that they can, in their practices, considering the social, historical contexts and use these resources as tools of work with families and communities²⁰.

CONCLUSION

The social representations of family expressed by FHS professionals were, in the first place, focused on social and emotional protection that the family offers to its members and the responsibility for the care of those who belong to it. They demonstrated the recognition of the family's role in the socialization process of its members, to give meaning to their practices, to guide actions and social relations.

Families are perceived as the basis for the protection of its members and place of refuge. It also provides answers to the issues presented by society, a space for care and affection. They recognize the different types of arrangements in its composition in today’s world and all actions of solidarity and care for their loved ones, and an affective commitment and of respect, providing a place of help and support of all its members. Three categories of representation have been described: Family, my safe haven; Family, my base and; Family, caregivers ties.

This study has limitations of applicability of the results in the practical field, in view of the plurality of the team members. The result of this study expresses the social and ideological context that guides the practices of care provided to families, and can be used in reorienting FHS teams in the reconstruction of care practices for families.

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