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REVIEW ARTICLES

 

Social representations of families in vulnerable situations: a literature review

 

Joana Iabrudi CarinhanhaI; Lucia Helena Garcia PennaII; Denize Cristina de OliveiraIII

IPhD student of Graduate Program of College of Nursing at the University of Rio de Janeiro State. Nurse of Psychiatry Institute of the Federal University of Rio de Janeiro. Brazil. E-mail: iabrudi@yahoo.com
IIPhD in Health of Women and Child by the Oswaldo Cruz Foundation. Adjunct Professor of the Maternal-child Nursing Department of the Nursing School at the University of Rio de Janeiro State. Rio de Janeiro, Brazil. E-mail: luciapenna@terra.com.br
IIIPhD in Public Health by University of São Paulo. Professor of Graduate Nursing Program, College of Nursing at the University of Rio de Janeiro State. Brazil. E-mail: dcouerj@gmail.com


ABSTRACT: Families are influenced by social, cultural, economical and political factors, determining changes in their configuration and dynamics. Socio-economic inequality puts many Brazilian families in vulnerable situations, requiring new ways of understanding this social group. For analysis of the family unit, the Theory of Social Representations provides the framework necessary, aiming, in this study, to analyze the scientific production about the social representations of families in the context of vulnerability. The core elements of these representations by various social groups seem to be the ideal model of family, poverty/unemployment and fragile family relationships, which are associated with new family configurations, poor living conditions, domestic violence, and impaired biopsychosocial development and moral and cultural values. In conclusion, the representations of families in vulnerable situations contain elements of hegemonic representations and elements of the lived reality, indicating transformation of these representations and the need for further development in this field of studies, for better comprehension of the families, and qualification of interventions.

Keywords: Family; Health vulnerability; Social conditions; Social representation.


 

INTRODUCTION

Families are influenced by social, cultural, economical and political factors, which have been determining changes in their configuration and dynamics1-3. At the same time, it is within this unit that subjectivation and social interaction processes, which promote the development and reproduction of socio-cultural values and standards, as well as health care happen, determining the biopsychosocial development of its members and influencing the formation of future generations2,4-7.

Considering health as a process of subjectivation influenced by social, cultural and historical determinants, the situation of vulnerability, in which a large number of Brazilian families live, is associated with the context of poverty and unequal income distribution in the country8,9. In this perspective, according to the theoretical model of Castel10, vulnerability can be understood from two axes with a fluid perspective: from integration to exclusion in relation to work, and from insertion to isolation in relation to basic sociability. Thus, the situation of vulnerability associates the lack of work with relational lability.

The situation of poverty, and even misery, in which a major portion of the Brazilian families live, is evident with the statistics that show that approximately 15.8 million (26.2%) Brazilians belong to a household with an average income per capita of less than half the minimum wage11. Poverty is not a synonym for vulnerability (even though risks are still greater for this group)12, but this condition, from a historical perspective, brings on generations and generations of families living with restricted access to feeding, health care, housing, education and work, producing an environment of instability for the establishment of fundamental bonds due to daily tensions and conflicts, without the support of a dialogue that may relieve and help find solutions to the problems experienced8,13.

The needs and activities of daily living of these families involve a circuit that extends in space, tracing lines of mutual help and giving border to a network configuration, which makes imperative the need for attention to family dynamics that go beyond the limited field of observation of the healthcare professional2, requiring new ways of understanding this social group.

Understanding the family routine implicates unveiling thoughts, speeches and practices of the actors. In order to analyze the family unit, the Theory of Social Representations provides the necessary framework due to its interdisciplinary nature, and its good correlation with the concrete reality, considering the importance of the subjective, affective and cultural dimensions in the construction of knowledge and in the human actions, and the importance of considering them in the construction of scientific production and knowledge14,15. Social representations are thoughts and ideas that a person inserted into a social group has about an object, which are constructed from the conjunction between the dominant ideology in their social environment and their intellectual process of apprehension and transformation of received information16.

Therefore, considering that social contexts influence individual behaviors and these help to build social reality16, the authors aimed to approach the family from this psychosociological perspective. Accordingly, the objective of this study was to analyze scientific productions on the social representations of families in the context of vulnerability.

METHODOLOGY

An integrative review17 was performed accessing two health databases – the Scientific Electronic Library Online (SciELO) and the Latin American and Caribbean Literature on Health Sciences (LILACS, as per its acronym in Portuguese), and two other databases of theses and dissertations – the Coordination of Improvement of Higher Education Personnel(CAPES, as per its acronym in Portuguese) and the Public Domain in the Ministry of Education, all with broad national coverage. Family social representations was the term used for the search.

The choice for this path derives from the possibility of an overview of the knowledge produced about the family in a psychosocial perspective. Besides, it contemplates interdisciplinarity in knowledge construction17.

A total of 694 productions were found. Among the publications from journals in the SciELO and LILACS databases, 182 articles were found, however, reading their abstracts allowed to identify that only nine of them investigated the social representations of families in situation of vulnerability, even though this was not the only or main focus of the study. Likewise, with respect to dissertations and theses (512), only 14 (CAPES database) addressed the object of this study and were selected.

For this study, 13 productions that were available, in their entirety, on the Internet were used: eight articles, three dissertations and two theses. It is worth mentioning that an exhaustive search for the full text of the other 11 productions was performed, both in the websites of the journals and universities related to the theses, as well as in other databases.

Data were organized in a spreadsheet containing the following variables of the publications: title, year of publication, authors, place of publication, knowledge area of the researchers, theoretical framework, objectives and main results related to the object of study (family social representation).

After this initial data processing, the texts were subjected to the technique of thematic-categorical content analysis systematized by Oliveira18, seeking to assess the characteristics of the productions and the discussion of theories built and shared in common sense about the Brazilian families in situation of vulnerability, based on the theoretical framework chosen.

RESULTS AND DISCUSSION

Characteristics of the productions

The studies analyzed19-31 were published between 1999 and 2013, however, mostly as of 2005. Regarding the location where the studies were conducted, there was a concentration in the Southeast (six in São Paulo, two in Rio de Janeiro and two in Espírito Santo), followed by the Northeast region (one in Ceará, one in Pernambuco and another one in Bahia). This distribution reflects both the concentration of academic centers in the Southeast, as well as the places with higher production and dissemination of scientific knowledge, produced with the contribution of social representations32,33.

The studies were developed by authors from different areas of knowledge, reflecting the applicability and the appropriation of this theoretical framework by various fields. The distribution of the studies by discipline was as follows: three interdisciplinary (psychology, medicine, nursing and public health), four in psychology, two in nursing, two in social service, one in education and one in dentistry. Therefore, psychology followed by nursing were the areas that most used this framework in their studies about the family, and made efforts to build an interdisciplinary knowledge, particularly in the field of public health. In fact, nursing has shown the greatest contribution to the field of studies of the social representations32, confirming the interdisciplinary character of the theory and its potential for studying the various facets of a phenomenon.

Regarding the methodological paths adopted in the studies investigated, 10 field studies were found with qualitative approach and three theoretical studies. The field studies analyzed family social representations developed by different social groups, namely: health professionals (4), law professionals (1) and education professionals (1), as well as vulnerable children and adolescents (3) and low-income women (1).

The field studies used, preferentially, individual (8) or group interview (focus group) (2) for data collection. Furthermore, complementary methods, such as the projective technique based on drawings (3) and the technique of free association of words (1) were used to enrich the production of the study. For data analysis, six studies used the technique of content analysis, one used the phenomenological method for psychological research associated with the lexical analysis of the text made with the Alceste software, other used the analysis of similarity and two of them did not indicate the method used. These data are in line with another study34, indicating the relevance and adequacy of these methods to investigate social representations.

The theoretical studies sought to review and reflect on the representations constituted in the family and their ramifications for the professional practice. They were more focused on the content related to the problem of interest - context, family relationships - than on the social representations as the object of study. One of them analyzed six dissertations and theses on the representations of women and/or men, children, health managers and professionals, in relation to the family. The other two studies developed a reflection about the vulnerability of families based on the representations of these social groups.

Different levels of use of the Theory of Social Representations were observed. In general, the studies presented the theoretical foundations, but did not establish a relationship between the theory and the results found, moving on to the description and discussion of the content of the representations. With regard to the approaches of the theory, the procedural aspect predominated, but two studies that used the structural approach and which developed an approximation with the theory stood out. Accordingly, only one study actually made a further analysis and discussion of the results using the Theory of Social Representations, including the discussion of the formation process of the representation and its implication for social practices.

Social representations of families in vulnerable situations

Components of the family social representations, developed by different social groups, were verified: family models, living conditions of the family, family relationships, and ethical, moral and social values. From these elements, the three dimensions of the social representations were identified - cognitive (information), affective-evaluative (attitudes) and structural (field representation), as proposed by Moscovici16.

A coexistence is observed between traditional family models (nuclear family, consisting of a father, a mother and children in a harmonious monogamous marriage relationship, maternity and fixed social roles, with the concrete setting of the home as reference) and modern models (extended family with a network configuration which is not determined by blood ties nor restricted to a core or even a physical space for housing, but by the importance of relationships to the survival of the people who compose this network)24,25,28-31.

However, the nuclear configuration predominates in the minds of the subjects, and what does not meet this model is considered a deviation, characterizing the destabilizing factor of the family environment and which generates social and health dysfunctions19,20,22,24,25,28,29,31. This reflects how much the new family configurations cause strangeness, naturally inducing some rationalization, since they must be somehow understood35,36, even if it is through the bias of the deviation.

The living condition of vulnerable families is another central element of the social representations. These are families characterized by the poverty arising mainly from unemployment or underemployment19,21,23,26,31. It involved the persistence of hegemonic representations historically constructed by elites, in which the poverty/irregular family relationship is associated with popular social classes, placing economic determination in the center of the argumentation about the factors that lead to difficulties in maintaining family ties37.

Associations around the central core, work and lack of work, constitute a social representation ruled by the concept that the insertion of the individual in the world of work will enable satisfactory social reproduction and living conditions23. According to Castel12, work is a privileged support for social structure entry, so that the person at the edge of work floats in the social structure, being in a situation of vulnerability and even disaffiliation. This is evident when this core of family representations, is associated with situations of home abandonment, child labor, low education, ignorance/misinformation, suffering, alcoholism and drug use, crime/theft, malnutrition/starvation, prostitution, illnesses19,22,23,26,28,31.

Castel10 highlights that impoverishment arises as a result of a sequence of ruptures in the participations and failures in establishing bonds, placing the subjects in a state of fluctuation, making it difficult for them to establish a form of belonging. This can be verified in the family social representations in which aspects related to the family relations become visible. It basically involves the wearing or weakening of family ties, especially between mother and child, in which there is a trivialization of affections, feelings and bonds23,26,28,31.

Interpersonal violence38 is, therefore, noteworthy, based mostly on gender differences and which works as an attempt to restore normal relations within the family (male dominance, female subordination and obedience of children, characterizing the traditional model of family organization)24,25,28. It can be said that there is a naturalization of violent relationships in this space, whether from the acceptance of aggression as an educational method for children or the legitimacy of marital violence, one of the facets of gender violence, which is based on the power of man over women. Such relationships have negative consequences for the human development, because they lead to the difficulty of socialization, produce helplessness, grief, low self-esteem, new aggressive actions and reactions, and reduce one’s ability to love and be loved19,20,23,26.

The family appears as a moral value that legitimizes social roles and regulates the behaviors of men and women. The man is represented as the provider of the family needs and, in general, is naturally violent, despite being the figure necessary to preserve family authority. The representations of women are basically associated with maternity, so not even the various transformations in society and in the lives of women, which occurred during recent decades, were sufficient to dissociate the role of women from the role of mothers, blaming the deviations of the family on the absence of working mothers - these representations are an example of the expression of a network of meanings grounded in naturalizing convictions20,25,31.

Another aspect revealed in the representations of vulnerable families is the centrality in the mother, especially because of her potential to love20,21,28 - which reflects the hegemonic representation of unconditional maternal love as part of women's nature and the social role expected for them, which in the historical and cultural dimensions occurs in consequence of the first. The father figure, in turn, is represented ambiguously, according to the experience of each one, but without the same intensity of the relationship with the mother, even with feelings of hatred20,21,28.

The family is represented by feelings such as love, affection, happiness, togetherness - as the happy family that is disseminated in movies, soap operas, story books and fairy tales. Thus, family is valued as the forms of interaction based on the relationships of friendship, affection, caring, that is, by significant others with whom a relationship of support and exchange is developed - not necessarily the original family21,28,30. This idealization of the family that appears in the representations of the subjects can also be understood as a form of protection against the suffering that the reality brings, deeply affected by hardship and abandonment21.

Additionally, is worth noting the feelings and values of health, education and law professionals on vulnerable families, beyond the values involved in family relationships that have been highlighted, namely: suffering, distress, sadness, shame, indignation and powerlessness in the face of the context of psychosocial vulnerability in which many families live22,23,29. On the other hand, prejudice, devaluation and difficulty in understanding the logic of operation of divergent families in relation to their own family, or of the hegemonic logic were also found19,29. A central idea to Moscovici35 is that tensions, crises and conflicts are generators of changes. Thus, conflicts between hegemonic representations of family and family dynamics found in everyday practice mobilize or tend to lead to a change in representations and/or in social practices.

From these findings, there is a relativization of the hegemonic ideal family model, so that the family is understood as a space of experiences and of building relationships that provide support, but also produce conflicts, crucially determining the evolution of human development in a process that goes from socialization to disaffiliation, but that can be redeemed/overcome by resilience. Thus, there is a social representation conception that the family is the basis of everything - of social relations, human development and health-disease process, in a way that it is at the center of the functions of care and represents the first level of health care19,21,22,27,29.

CONCLUSIONS

Reaching the proposed objective, it was possible to identify a structure and components of social representations of the various family groups investigated in the productions analyzed. The core elements seem to be the family model, poverty/unemployment and fragile family relationships, which are associated with new family configurations (extended family network), poor living conditions, domestic violence, especially marital, impaired of biopsychosocial development, moral and cultural values.

The representations of family in vulnerable situations contain elements of hegemonic representations of the nuclear family, which is harmonious, protective and affectionate (in many situations indicated as the ideal to be achieved) and of the poor family as dysfunctional, socially deflected, violator of rights and blamed for the misfortunes and failures of its components. Moreover, they are also constituted by elements of the lived reality as new family configurations, the complexity of relationships and practices experienced within it, or even the feelings involved in this relationship. This refers to the transformation process of the family social representation, since new elements are apparently being incorporated, especially in relation to the configuration and dynamics of the family, marked by broader social changes related to the work market / means of production, asymmetrical gender relations and the various manifestations of violence.

The considerations regarding the family unit guide the attitudes and behaviors of the components of the families as well as the professionals who will work with them. Therefore, further studies on the relationship between social representations and everyday practices, as well as the transformation process resulting from this interconnection, seem a fruitful way to extend the understanding of families. This field of study also seems to contribute to improve strategies for working with this social group, because of the possibility of taking in consideration the gaps between representation/thought and practice/action, making the intervention more feasible and potent for producing transformations.

Reflecting on the family social representations allowed to understand that the work with families in vulnerable situations requires three main elements: sensitive listening of the subjectivities of each family member (considered in a network); identification of the supportive points (significant people who compose the network of relationships, regardless of blood ties) as well as the weaknesses in the family dynamics; and the reflection (with family and professionals) regarding the problems experienced, especially those that seem insurmountable, such as those resulting from socioeconomic inequality.

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