Autogestão ineficaz da saúde de homens adultos em adoecimento crônico: estudo teórico empírico

Abstract

This study aims to analyze the phenomenon of ineffective health self-management from the perspective of adult men experiencing chronic illness. It is a qualitative study based on a theoretical analysis of data from scientific literature and empirical analysis of the narratives of adult men residing in Salvador, Bahia, Brazil, between 2019 and 2020. The concept of “Ineffective Health Self-Management” was analyzed using Fawcett's Theoretical, Empirical, and Structural Concept Analysis Model, followed by field research involving 67 men, who participated in individual interviews guided by a semi-structured instrument validated through a pilot test. The Reflective Thematic Content Analysis method proposed by Braun and Clarke was used, interpreted in the light of Nola Pender’s Health Promotion Model. Ethical considerations were adhered to, with the study approved by the Research Ethics Committee under opinion number 3.313.517/2020. As a result, the Health Promotion Model framework proved sensitive to the investigated phenomenon, allowing for the identification of concepts and directions for Nursing practice, thereby expanding and strengthening the use of standardized language systems and defining the scope of care provision. In terms of the empirical dimension of the investigated phenomenon, the study revealed men’s distancing from bodily perception and self-awareness of health, prioritizing other dimensions (e.g., work) over health, which uncovered personal factors related to ineffective health self-management. However, the men studied recognized benefits in managing their own health while living with chronic illness, with an emphasis on reducing potential harm and complications related to the disease. They developed mechanisms of self-efficacy to improve their health status/condition, expressing feelings of self-fulfillment, satisfaction, and achievement.The men voiced demands and preferences for self-managing their health, highlighting the importance of self-care, social interaction beyond the illness, and a desire for health improvements. To this end, they established strategies and care practices through an action plan that supports adopting health-promoting behaviors. In conclusion, the study highlighted that ineffective health self-management lacks conceptual understanding in terms of its theoretical and empirical structure, indicating the need for interpretation from a health promotion perspective. The effectiveness of health self-management relies on the harmonious integration of individual and collective elements, including men’s socio-affective cycle (friends, community members, leisure and work spaces), the construction and (re)construction of masculinities, family, health professionals, access to goods and services, and universal health coverage for comprehensive health care aimed at self-care and health promotion. Lastly, Nola Pender’s Health Promotion Model, employed to understand the phenomenon, proved to be effective and comprehensive.