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RESEARCH ARTICLES

 

Arterial hypertension and popular knowledge: strengthening care

 

Lina Márcia Miguéis BerardinelliI; Taiane de Fátima Lopes de FigueiredoII; Sonia Acioli de OliveiraIII; Iraci dos SantosIV; Mariana Nepomuceno GironV; Juliana Pereira RamosVI
INurse, Associate Professor, Department of Medical-Surgical Nursing, Faculty of Nursing, University of the State of Rio de Janeiro.. Vice-Leader of the Research Group of the National Council for Scientific and Technological Development: Philosophical foundations, theoretical and technological developments in healthcare and nursing, Rio de Janeiro, Brazil, Email: l.m.b@uol.com.br
IIStudent of 8th Period of the Undergraduate Course in Nursing at the School of Nursing at the State University of Rio de Janeiro, Former Extension Scholarship holder and Complementary Intern at the same School, Rio de Janeiro, Brazil, Email: taianedefatimalf@hotmail.com
IIINurse, Associate Professor of the Department of Public Health Nursing, Faculty of Nursing, University of the State of Rio de Janeiro. Rio de Janeiro, Brazil, Email: soacioli@gmail.com
IVNurse, Full Professor in the Department of Fundamentals of Nursing, School of Nursing, University of the State of Rio de Janeiro. Productivity Scholarship holder of the National Council for Scientific and Technological Development, Leader of the Research Group: Philosophical foundations, theoretical and technological developments in healthcare and nursing, Rio de Janeiro, Brazil, Email: iraci.s@terra.com.br
VNurse, Master's Student in the Graduate Program in Nursing at the School of Nursing at the State University of Rio de Janeiro, Rio de Janeiro, Brazil, Email: marigiron20@yahoo.com.br
VIStudent of the 6th period of the Undergraduate Course in Nursing at the School of Nursing at the State University of Rio de Janeiro. Rio de Janeiro, Brazil, Scientific Initiation Scholarship Holder Email: julianapereiraramos@gmail.com


ABSTRACT: The contemporary sociocultural context suggests an information gap between the popular knowledge level and the scientific knowledge level, as far as arterial hypertension is concerned. The objective was to describe the popular knowledge on arterial hypertension and to analyze the scientific knowledge on health care education in arterial hypertension. A qualitative and descriptive study developed with 23 outpatients assisted in appointments and health care events in the municipality of Rio de Janeiro in 2010. The data were collected by means of semi-structured interview and submitted to content analysis. Results the popular knowledge on arterial hypertension showed some questions regarding the development, course of pathology, signs and symptoms, difficulties to control the medication and lack of information. We conclude that the educational actions have not awakened the critical awareness in users, with many questions remaining, and they have not achieved the objectives proposed in health care practice reorientation.

Keywords: Nursing care; arterial hypertension; health care education; self-care. 


 

INTRODUCTION

 

One of the most important and complex characteristics of contemporary sociocultural context is the distancing of information between the sphere of popular knowledge and the sphere of scientific knowledge with regard to chronic disorders, mainly on arterial hypertension (AH).

During the extension worker's care practices, planned between professors, students and social groups involved, considering the interests and needs of this group are developed health educational actions, survey of vulnerabilities, risk factors; verification of anthropometric data, measurement of blood pressure, capillary glycemia, among others. In this area of care, conflicting situations were perceived, which make part of health service users’ daily life are. Among them stands out, in this work, the imbalance between the doubts of subjects concerning the hypertension and the scientific knowledge about health education directed to hypertensive patients.

The infirmity cited is, notoriously, a multi factorial syndrome, in which complex interactions between genetic and environmental factors and psychosocial cause elevation of blood pressure, a consequence of the high prevalence national and world. The borderline values for adult hypertensive patients are defined by systolic blood pressure (SBP) between 130 and 139mmhg and diastolic blood pressure (DBP) between 85 and 89mmhg1. Their clinical evolution is slow, has a multiplicity of factors and when not treated properly, brings serious complications temporary or permanent in the lives of people2.

The chronic and silent characteristic hinders the perception of subjects vulnerable to this problem and due to silent symptoms end up compromising the quality of life of persons having as consequences; admissions, high complexity invasive procedures, leading to work absenteeism, early retirements, sequelae and victimizing young and productive individuals.

This scenario has drawn attention of many experts, organizations and national and international institutions that recognize the need for a paradigm shift and new approaches to health promotion in order to update health services in order to treat chronic conditions intervened in human groups, which are vulnerable to various diseases.

Thus, the research problem is formulated: How to express popular knowledge on arterial hypertension? How to show scientific knowledge that supports health education on arterial hypertension?

It is believed that the people need to know about the health/illness process for care and to ensure their own health; while nursing, being a profession that takes care of the people, has an important role in education and health promotion, including its proximity to clients. What reverts responsibility to contribute to the advancement of the production and dissemination of knowledge in this area?

Starting from the initial considerations the objectives of this study were: to describe the popular knowledge on hypertension and analyze the scientific knowledge of health education on arterial hypertension.

THEORETIC REFERENTIAL

The most indicated chronic disease in the National Household Sample Survey, published by the Brazilian Institute of Geography and Statistics (IBGE), is hypertension. It is noteworthy that since 1998 hypertension was already the chronic disease most cited by the population3.

Comparing the data from the survey conducted by IBGE, the total number of cases of chronic diseases diagnosed in the year, 14% had hypertension, and 13.5% of disease in the spine or back. Still according to the study, arthritis or rheumatism corresponded to 5.7% of the cases; bronchitis or asthma to 5%; depression to 4.1%; heart disease 4%; and diabetes 3.6%. The remaining cases were of tendinitis, chronic renal failure, cancer, cirrhosis and tuberculosis3.

Society in general, research institutions and researchers, especially epidemiologists, seek evidence in laboratory tests that show what sickens the Brazilian population. Still according to the IBGE survey, 31.3% of the Brazilian population, or 59.5 million people, had at least 1 chronic disease, and 5.9% of people between 3 or older. Regions in the South (35.8 %) and Southeast (34.2 %) registered the highest percentage of people with at least one chronic disease, followed by Midwest (30.8 %), Northeast (26.8 %) and North (24.6 %)3. A percentage was also observed of women with chronic diseases higher than men, with indices, respectively, 35.2% and 27.2 %. In relation to age, it was found that the proportion of people with chronic diseases grew as their age increased3.

The survey also shows that the higher the income, the greater was the percentage of people who reported having at least one chronic disease. Among the population with income of up to one quarter of the minimum wage, 20.8% had at least one disease. Already among those with income above five minimum wages, the percentage had risen 38.5%3.

Assuming that users are not just consumers health guidelines of educational groups, by contrast, agents are co-producers of an educational process is necessary that the social practice of health education is based on and linked to an educational and social transformation not only in scientific discourse, far from the reality of the subjects4. In this sense, the construction of care based on these principles has adhesion with the emancipatory dimension of people.

This study is relevant, because it provides reflection among professionals in the health area, for the nurses and teachers, students, and all the scholars who are interested in the topic. It points to a reality of the subject whose movement necessary corroborates that envisions for the practice of health promotion, i.e. that these are continuous, construction and reconstruction of knowledge participatory to care for life according to the demands and needs of clientele5. In this case, understanding the real health needs of the population, as well as the social (re)production profiles help to understand how this social insertion occur, that carries with it distinct living conditions, potential health and survival of the subjects.

In this line of reasoning, we sought the theoretical foundation in health promotion; it is a way of seeing health and disease, whose approach enables relevant contributions that help to break with the hegemony of the biomedical model, promoting the autonomy of subjects involved in the process6.

The change in the health promotion practice adds value in thinking and doing of nurses in the field of popular education in health and in this perspective, renews its educational role, understanding the human being as a citizen, participatory and aware of their life's condition. This is going to encounter a proposal for action focused for the dialog and the intermediation of practices and knowledge that results from it and, therefore, allowing an encounter with the Freirean theory7, as a philosophical framework and a central axis of this study.

Topics were used related to critical theory, problematizing the following assertion: this research will be much more pedagogical as critical and much more critical, such as, ceasing to get lost in the narrow schemes of partial views of reality, impeding understanding of the totality. Noteworthy is also the conception of education that equips groups and social classes to understand the roots of inequality in producing health-disease found in Freire7.

METHODOLOGY:

This is a qualitative research, descriptive type, whose subjects were selected from the following inclusion criteria: age from 20 years old, be hypertensive, with capacity of understanding, both genders, without distinction of race and religion, have autonomy to answer all the questions and express the desire to voluntarily participate. Also the exclusion: stipulated age below, not being hypertensive and not having autonomy to participate and respond to the study questions. Therefore, the participants signed a Free and Informed Consent after reading and understanding the ethical procedures on anonymity, purpose, advantages, disadvantages of the study, in addition to the volunteerism.

The study was approved by the Ethics in Research Committee of the University Hospital of the University of the State of Rio de Janeiro (HU/UERJ), under protocol no. 290/09 and developed in a university hospital in the municipality of Rio de Janeiro.

The research was carried out in the period from March to June 2010, with 130 participants from the network and outpatient health events, which coexist with arterial hypertension in different stages. This study is part of a larger research, restricting the qualitative approach of the theme, performed with a portion of the clients.

The applied data collection technique was the semi-structured interview and individual, recorded in electronic MP3 apparatus, with the following questions: what do you know about the HBP? What you need to know to take better care, aiming at quality of life? The interviewees were identified by letter E associated with, the sequential number of participation, for instance: E1, E2, E3. We used the criterion of saturation of information to delimit the interviews analyzed in this study. Thus, the qualitative analysis of the testimonies refers to 23 subjects.

Subsequently, they were transcribed in full and organized in chronological order. After the interview, the data were transcribed, arranged chronologically, distributed according to the responses, classified and categorized, according to the method of content analysis proposed by Bardin, given that this is a set of techniques for analysis of the communications8. Such analysis involves both the content manifests that belong to the field goal, as the latent corresponding to those that are not apparent in the message, or are in the symbolic field.

Then identified the relevant content, namely, the excerpts that marked the depositions to be similar or different. After identification of the units of records, the data were grouped by content convergence, emerging the following analytic category: Doubts of popular knowledge on hypertension versus education in health. The following data were analyzed with the authors who discussed the topic1,2,4-7,9-14.

RESULTS AND DISCUSSION

We present some of the testimonies of the subjects, referring to the most relevant questions of popular knowledge about hypertension versus health education.

Doubts of popular knowledge concerning hypertension versus health education

It was noted, in the speeches of the deponents, mention the bodily changes, physical and emotional leaving between the lines, doubts, insecurity and the dissatisfaction of the people.

I have been hypertensive for 10 years and I am still unable to control my blood pressure, I need to know all the symptoms. I just know that I have a headache occasionally, how do I know if this pain is from high blood pressure. (E5)

My blood pressure is too high, I take medication and it doesn't go down, it makes me worried, I don't sleep well at night. Does high blood pressure cause insomnia? (E23)

[...]I know that I need control, diet, tranquility. How can I be healthy with my pressure up there? (E14)

I know that I need to take medication, and have a more frugal life. I used medication during 2 or 3 months, but I stopped on my own when the symptoms went away. (E16)

[...] I may know just a little and I was not satisfied with the treatment, because it did not work. I had to stop with one medicine; I stayed up the whole night to go to the bathroom. (E9)

In these testimonies, it is perceived that there is a lack of information and many questions on the problems caused by hypertension. Users may have received some type of information, however, it is noted, and that the matter was not sufficiently clarified in order to meet the specific demands for each case.

It is noteworthy that the chronic diseases accompany the people for a long period, and may have acute phases, moments of worsening or sensitive improvement. The prevalence of hypertension increases with age, which should serve as an incentive for the people had a greater concern about health care, having in view the hereditary character summed across age, environmental factors such as stress, inappropriate habits and a sedentary lifestyle, among others, are considered important risk factors for this disease2,9-11.

By Associating these testimonies with the educational practice of nurses allied with Freire's ideas, by pedagogy critical and reflexive it can transform or rebuild knowledge with a group that does not have the knowledge of the academic-scientific principle, at the same time that also appropriates the knowledge that comes from popular knowledge or common sense12-14.

In this perspective, the professionals have the opportunity to appoint and reflect on their own vehicles for health education. Also at the time of this encounter, creating the opportunity to know in another potential for self-care, listening to their concerns, their doubts, allowing a dialogic practice and leveraging to teach them to recognize their your own body, as well as the physical changes resulting from the problem.

Thinking about this question, angle of education, it is worth mentioning that for the educator, the dialog promotes the act of teaching, complementing this at the time of learning, and both only become truly possible when critical thinking and uneasiness of the educator does not stop the ability of the student also thinking critically7.

In This way, the subject needs to be recognized as the bearer of a knowledge on the health-disease-care process, able to establish a dialogical interchange with the professionals and health services and to be treated in their entirety as a human being, trying to understand what exists between the lines when they ask certain questions.

On the other hand, the literature shows that the health education focused on promoting health, appreciates the empowerment to intervene and help to understand the reality of people 4-6, and demonstrates how it should be performed. The reorientation of health practices recommends that health services must return it in the direction of a focus on health and not on sickness, and pointing to the integrality of the health actions. Proposes, in order for this there needs to be changes in the training of professionals and the attitudes of organizations of health services6.

The testimonies, hereinafter, express revelations important for the life of the people and deserve a careful reading.

My job is very stressful, I suffer from high blood pressure, I do exams when I go to the doctor's office and the other day everything changed, cholesterol, triglycerides so I started to take more drugs, not sure what to take first. (E7)

How can I control the pressure with the pressures of life? I have many problems and my pressure lives at its peak. (E15)

I use medication for hypertension, for heart and cholesterol, but I don't take it at the right times, does this hurt the pressure? (E13)

I was advised that I needed to do physical exercise to improve my blood pressure and help to decrease weight and cholesterol, but I have difficulty in doing exercises due to a prosthetic left leg. (E21)

In these discourses, it identifies important questions in relation to the care with the arterial blood pressure similar to another study9, the example: dealing with the work stressful, not knowing the medications that use, does not know the risk factors that cause hypertension, not having control of the pressures of life and does not have condition for performing physical activity. Some of them even mentioned that these factors are a result of the difficult socio-economic situation. All these data require a greater vision with multidisciplinary joint treatment2.

It is noteworthy that the users cannot be treated only by biological parameters universal health specific, individual needs have to be recognized to be incorporated into the therapeutic process5. Furthermore; each client needs to be recognized as a subject of history, which reflects and acts on the reality to transform them7. Considering these testimonials how simple it may seem, it is appropriate, so that the professional can bring to the debate reflections of reality for the collective space, critical, problem-solving education, discuss them with the group and thus be able to ask questions, clarify understanding and the values ​​that each individual has.

The health promotion strategy also includes personal and social development through the dissemination of information, education for health and intensification of skills vital for maintenance of life. The reorientation of health proposes, as well as development of personal skills: empowering people to learn through life and to prepare for all stages5.

Scientific Studies have pointed out that the subjects are aware of how inadequate or partial the risks of uncontrolled hypertension, which favors the non adherence to drug treatment, ineffective practice of self-care and the need to guide the change of habits and life-style that offer health risks4.

In this perspective, it is clear that the words knowledge and education are repeated, and that there is an interest on the part of the subject of wanting to learn how to deal with their health issues, but the scientific discourse has not yet managed to achieve the central focus of the demands of the client. The literature from the past five years still sometimes presents health education the ancient form of public health at the expense of health promotion, at the same time when speeches are found in superficiality and sometimes only as a survey of the situation. There is a distance between what you want and what you do.

The lines of action of the Ottawa Charter and the Declaration of Alma reaffirm that it is necessary to intensify the actions of strategies for health promotion in the daily routine of services and promote the autonomy of persons, individuals and professionals, for which together can understand health as result of the conditions of life and provide a more equitable social development6. It is necessary to accept more calmly individual needs during nursing consultations, explaining in detail what care the subject’s request.
In this sense, the guiding health education need to worry about the clients, with the application of knowledge, with changing attitudes and behavior of man, having as main objective the transformation of reality to improve the quality of life10-14. It is worth mentioning that one of the limitations of the present study is the complexity of the phenomenon and cultural anthropological/interfaces with health education and its practice. The complexity can lead to erroneous interpretations or rejection, which constitute limitations.

CONCLUSION
 
In this study, the popular knowledge on hypertension showed doubts in relation to the development and course of the disease, signs and symptoms, the difficulties of control of medication, diet and even the question of sleep and rest. Thus, the difficulties and differences in daily life situations impose unnecessary, burdensome as the insecurity in dealing with the unknown and the lack of information, which expresses the ignorance of their own body.

The great challenge for health promotion, especially in the Brazilian context, is the change of scenario, which still prevails a notorious social inequality with deterioration of the living conditions of the majority of the population, along with the increase of risks to health and reduction of resources to cope with them. The struggle for health means the improvement of quality of life (work/income, education, transport, leisure, housing and other) and must be present in the main strategies for health promotion.

The literature recommends care that need to be incorporated into the daily activities, during the whole care of users, however, the various contexts, conceptions of caring, educating and guidance on health, sometimes confused and diverge the desires of clients. There is a need to create activities in small groups, whose interaction stimulates reflection and construction of knowledge together, in order to reorganize, stimulate learning, understanding and facilitate the commitment of subjects with their health.

For both, it becomes inevitable to know the individuals for whom they are intended health actions, their knowledge, their beliefs, their ways of living and to relate with life, which is opposed to the imposition, in educational actions. With the participation of the subjects, it is possible to ensure the effectiveness of healthcare actions.

REFERENCES

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