ORIGINAL RESEARCH

Comprehensive men's health care policy: challenges for nursing

Jaqueline Inácio Correia Ferreira^I; Elizabeth Rose da Costa Martins^II; Raquel Conceição de Almeida Ramos^III; Cristiane Maria Amorim Costa^IV; Rafaela Nunes Alves^V; Bruna Lima^VI

^I Nursing undergraduate from Veiga de Almeida University. Rio de janeiro Brazil. E-mail: jaquelinelittrell@hotmail.com
^II Adjunct Professor, Faculty of Nursing, State University of Rio de Janeiro and Veiga de Almeida University. Rio de janeiro Brazil. E-mail: oigresrose@uol.com.br
^III Nurse. Policlínica Piquet Carneiro. Rio de janeiro Brazil. E-mail: raquel_rcar@msn.com
^IV Adjunct Professor, Faculty of Nursing, State University of Rio de Janeiro and Veiga de Almeida University. Rio de Janeiro, Brazil. E-mail: cristiane.costa@ig.com.br
^V Assistant Professor, Faculty of Nursing, State University of Rio de Janeiro and Veiga de Almeida University. Rio de Janeiro, Brazil. E-mail: rvelemem@hotmail.com
^VI Nursing undergraduate from Veiga de Almeida University. Rio de janeiro Brazil. E-mail: brumy.lima@gmail.com

DOI: http://dx.doi.org/10.12957/reuerj.2016.7631

ABSTRACT

Objective: to assess male workers' health-related knowledge, practices and beliefs. Methods: In this quanti-qualitative, descriptive study at a nursing school in Rio de Janeiro, 30 male students, teachers and administrative staff gave semi-structured interviews in October 2013. Results:transcript analysis led to the construction of two categories: comprehensive men's health care policy presented as a prime tool for health promotion and disease prevention; and spread of this policy, alerting to risks and diseases. It was shown that men still assume the role of provider, and choose not to miss work through a query and are unaware of the comprehensive men's health care policy. Conclusion: it is essential to review motivational strategies to sensitize men to self-care-related gender issues.

Keywords: Men´s health; nursing; health care; gender identity.

INTRODUCTION

This study aims to understand how man takes care of his health. From the beginning of the species, man is marked by the stigma of the head of the house, being attributed to him the economic responsibilities, arising from the patriarchal role¹.

In this context, the man is seen as invulnerable, strong and virile; however, these characteristics are shaken by the demand in the health services, which shows signs of weakness, fear and insecurity. The small male demand in primary care contributes to the development of pathologies that could be prevented and receive efficient treatment when diagnosed early, but when late, they have poor prognosis².

The motivation for conducting this study arose during the discipline Men's health promotion and prevention of diseases, during the undergraduate course, when the content on the National Policy for Comprehensive Care to Men's Health was approached. This policy is unknown of many academics, health professionals and especially of mem themselves.

Studies have shown that men do not take care of their health and few of them seek medical help. They understand that caring for the body is feminine. They are often seen as strong and invincible and therefore only seek medical help when disease is already aggravated and when they can no longer work and maintain their family³.

For psychoanalysis, seeing a doctor denotes recognition for one's vulnerability, which is against the image of virility created by society for men⁴.

In addition, the current media do not present effective results for the inclusion of men in primary care. According to a study, resources, advertisements and informative material are scarce for this population, and those existing do not please the male audience. In addition, health care is still focused on the maternal and child public¹.

Therefore, the objective of this study was to evaluate the knowledge, practices and beliefs of male workers about their health.

The achievement of this research is justified by the small demand of men in the primary care services and by the significant morbidity and mortality rates of the male gender. Despite the establishment of a public policy that addresses the uniqueness of the male population and the volume of scientific production and knowledge related to the issue, "the implementation of actions directed at men in health services is still a major challenge"^5:415-6.

LITERATURE REVIEW

According to the Brazilian Institute of Geography and Research (IBGE), there has been an increase in male mortality in the group of young adults aged 15 to 30 years, approximately, in relation to the female population. This phenomenon can be explained by the higher incidence of violent deaths, which affect the male population more intensely. Also, men also live on average 7 years less than women, and current statistics prove that men get sick earlier than women⁶.

Data from the National Cancer Institute⁷ point out to prostate cancer as the second most prevalent type of cancer among men, being the sixth most common type of cancer in the world, accounting for about 10% of total cases of cancer. According to the Brazilian Ministry of Health (MS), prostate cancer is considered an old-age cancer because about two thirds of its cases are among men aged 65 or over ⁸.

In order to change this scenario, in 2008, the National Policy for Comprehensive Care to Men's Health was implemented with a comprehensive care proposal, qualifying the primary care for the male gender, based on the increase in the mortality rate of men.

The National Policy for Comprehensive Care to Men's Health aims to qualify the care to the health of this population, safeguarding the comprehensiveness of attention. It guides actions of comprehensive care to men's health with the aim of stimulating self-care and by stating that health is a basic and citizenship social right of all Brazilian men⁸.

A study points out that there are a significant number of men who are unaware of the prevention methods advocated by the MS for prostate cancer, for example, which is nowadays a major morbidity/mortality factor in the male population¹.

METHODOLOGY

This is a descriptive study with quantitative and qualitative approach. It sought to describe and analyze aspects of a given phenomenon by valuing the frequency of occurrences and the universe of meanings and values that permeate the space of relations⁹. In the present study, the phenomenon refers to students and workers' knowledge about how they take care of their health. The research site was a university located in the city of Rio de Janeiro. It was attended by 30 subjects - 10 students, 10 professors and 10 workers of the administrative staff, randomly chosen, aged between 20 and 60 years, who performed their activities at the institution during the period of data collection.

The research was developed in accordance with Resolution No. 466/2012 of the National Health Council¹⁰, and its project was submitted and approved by the Ethics Committee of the University with Certificate of Presentation for Ethical Appreciation number: 13818313.0.0000.5291, under the number of opinion 400.486. After previous acquiescence of the deponents, when they were clarified about the objectives of the research and signed the Free and Informed Consent Form, the data collection was started. Aiming to preserve anonymity, respondents were identified by fictitious names. The collection was carried out in October 2013 through a semi-structured interview with 15 questions including items for the characterization of the study subjects, with emphasis on the age range and knowledge about the existence of the Program from Comprehensive Care of Men's Health.

After some interviews, single responses started to appear, indicating saturation of the data and the end of the collection. The identity of the subjects was protected by naming them by fictitious names.

Statistical analysis was performed to characterize subjects and thematic analysis was used for qualitative data. This is based on the following steps: pre-analysis, material exploration and treatment of results, inference and interpretation¹¹. For the systematization of the findings, authors performed floating reading, cut of the recording units, verification of the context units; classification of the units of meaning (UM) and coding to aggregate them, with generation of categories ¹². The UM were submitted to statistical analysis, by using absolute and percentage frequency calculations.

RESULTS AND DISCUSSION

Characterization of subjects

The first part of the questionnaire resulted in the characterization of the 30 subjects that were analyzed. Among them, 20 (66.67%) were in the age group of 20 to 30 years, with minority representatives of the other decades, and 25 (83.34%) did not have knowledge about the Program of Care to Men's Health.

The data led to the construction of two main categories:

The public policy of comprehensive care to men's health presented as a primary tool in health promotion and disease prevention; and dissemination of this policy, warning about risks and diseases.

The categories will be presented together with the reports that gave rise to the same categories.

The public policy of comprehensive care to men's health.

This category presented discussion on how the Program of Comprehensive Care to Men's Health can serve as a primordial tool in health promotion, since it was created with the purpose of stimulating this population to seek mainly for prevention services.

When asking the subjects how they took care of themselves, they expressed themselves in this way:

I take good care of myself; I do not need to go to the doctor because I feel nothing. (Carlos)

I am strong; I do not smoke, so I am not looking for a doctor. (Manoel)

When I feel something, I take some medicine on my own because I do not have time to go to the doctor. (José)

The speeches point out the difficulties that men present in relation to self-care, as proposed by public policies, and the reasons range from lack of time to not getting sick, going through self-treatment. This study evidences, as other researchers, the belief that men have of themselves, believing to be strong and virile, not needing to see a doctor ^1,2,3.

From childhood man is motivated to endure physical and emotional pain, to practice aggressive sports and not to expose his feelings. In this way, the disgust of men in the care of their health is associated with the depreciation of self-care, with the idea that man never gets ill, with his virility, with exposure to situations of risk and invulnerability, cultural traits of a hegemonic view of masculinity^13:658.

Public policies still face barriers when it is realized that many men still hold the responsibility of being the sole provider of the home. "The responsibility for family support has historically been attributed to the man, being more evident in those of low socioeconomic status and this role is considered a priority for them"^14:24. This condition makes the man not have the habit of attending regular consultations with the doctor.

It is very difficult; I do not have time to take care of myself; I have to work. (Pessanha)

When asking the subjects whether they knew the Program of Comprehensive Care to the Men's Health, most answered they had never heard about a program to take care of men, as the following speeches evidence:

I have never heard of it, it is a woman thing. I do not need it. (Vinícius)

I have never heard of it. Does it take care of only the man? (Pedro)

Machismo (chauvinism) is constructed, expressed and maintained through the times in social structures, going beyond the individual will of each man. And it is well known that the education given to men is different from that given to women. Whereas the woman is cared for and educated with the idea that she is and always will be a being that needs to be protected all the time, the idea of protector, invulnerable is always preached to man. Mechanisms are used during childhood so that the man does not demonstrate pain or suffering, such as not crying ¹⁵, as the following speech points out:

I do not need to go to the doctor, I do not feel anything. Sometimes I feel pain, but I take medication and it goes away. (Cipriano)

The Program of Comprehensive Care to Men's Health is still unknown and this fact, besides others, hinders the participation of men in this program. Self-medication and the attitude of avoiding seeking care in the health system, especially in primary care, makes these people more susceptible to chronic diseases, which could be avoided by actions of prevention and health promotion^13,16.

Talking about promoting men's health and disease prevention is something that is not part of their daily lives. They feel far from disease and only begin to worry when they are already in a more advanced stage of the disease.

I only look for a doctor, when there is no way. (Patrício)

I do not have time to take care of myself because I have to work to support the family. I only go to the doctor when I am sick. (Fontes)

In this sense, man becomes a person without the necessary protection to maintain his health, undergoing unnecessary procedures⁸.

Dissemination of this Policy, warning about risks and diseases.

When asking whether the study subject would seek a health service as a way of promoting health and preventing diseases, most of them answered that they did not need to and could not do it.

I would look for it only as a last resort. (Mário)

It is worth mentioning that the man does not have as habit to look at himself, touch himself, seeking the prevention of diseases. On the other hand, the testimony evidences that, in order to attend primary care services, they need to be absent from work during one or more days, which, in some cases, cause consequences such as pay cuts due to absence, and even dismissal.

I cannot skip work. If I do it, I get fired. (Marcus)

How will I explain that I need to be absent? (Tarso)

It is clear that among the 30 interviewees, only two men missed work this year due to illness. This shows that the labor market does not formally guarantee the accessibility of the man, as a worker, to primary care services, making him feel threatened in his role of provider¹⁴.

In view of this, the health system must be close to people and must be effective in welcoming them¹⁷. This issue becomes obvious when the study subjects are asked whether they would like to take care of themselves envisioning health promotion and disease prevention. Here is the answer:

I would like to, but how? (Tarso)

In their totality, men answered that they would like to be seen with a view to promoting health with a focus on preventing diseases, such as prostate cancer. This is a major concern for most men, since rectal examination is a procedure that brings insecurity and permeates men's thinking, which makes that a large portion of men escape from the prevention of prostate cancer.

There is that examination for the man, of the prostate, I would like to do it. (Gilvan)

But, at the same time, the man is not only the prostate, he is a whole, complex and that it is necessary to start thinking about taking care of oneself so that statistics of male mortality (greater than the female) begin to decline.

The Program of Comprehensive Care to Men's Health highlights the principle of comprehensiveness and follows a line of care that starts in primary care, aiming to promote systemic interventions that include social determinations on health and disease, besides adopting medical and biological measures⁸. However, as identified, this line of care is still only a goal to be achieved.

CONCLUSION

As far as knowledge is concerned, the practices of the interviewees still need to be debated and built for the full implementation of the Public Policy Care to Men's Health. Some barriers are still perceived, such as the option of not missing work to go to an appointment, creating a parallel universe in which man does not have the right to take care of his own health.

Many men still do not have the habit of attending regular appointments for health control, sometimes because they do not know the importance of prevention or even the policy directed at them, and sometimes because of their own belief that they are invulnerable to diseases.

Nurses must be able to assist this target audience who, because of cultural issues, feels embarrassed to seek help and arrives at primary care influenced by myths, beliefs and taboos related to diseases and procedures that may be necessary for diagnosis.

There must be a change in the attitude of health professionals and sensitivity to gender issues.

Subsidies should be provided for improving the quality of men's health by encouraging health promotion and disease prevention.

This study is expected to enable delving into the universe of this population, seeking a way to raise awareness for the valorization of their health by including men in primary care, valuing masculinity and alerting them to risks and chronic diseases.

Among the limitations of this study, we highlight the small sample and a single scenario, which prevents the generalization of the findings.

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