Application of an Educative Health Technology in the Training of the

Caregiver Family

Zélia Maria de Sousa Araújo Santos

, Paula Dayanna Sousa dos Santos

Maria Helena de Agrela Gonçalves Jardim

, José Manuel Peixoto Caldas

July Grassiely de Oliveira Branco

, Mirna Albuquerque Frota

, Karla Maria Carneiro Rolim

Amabili Couto Teixeira de Aguiar

, Rithianne Frota Carneiro

, Ariane Pontes Soares

Ana Carolina Bezerra Moreira

and Laurineide de Fátima Diniz Cavalcante

Program in Collective Health, University of Fortaleza, Fortaleza, Ceará, Brazil

University of Madeira, Funchal, Madeira, Portugal

Hospital Geral Dr Waldemar de Alcântara, Fortaleza, Ceará, Brazil

Faculdade do Nordeste, Fortaleza, Ceará, Brazil

Unidade Básica de Saúde (UBS), Caucaia, Ceará, Brazil

Keywords: Family Caregiver, Educational Technology in Health, Health Education, Arterial Hypertension.

Abstract: The focus of this research is the use of an Educational Technology in Health (ETH) to train the family

caregiver in the adherence of hypertensive users to treatment. The participation of the effective family is a

factor that can interfere favorably in the other factors, due to its salutary importance in the involvement of the

health-disease process of its members. Participant research with the objective of evaluating the changes in the

participation of the family caregiver in the adherence of the hypertensive user to the treatment with the

application of the Educational Technology in Health, carried out in a Primary Health Care Unit (PHCU) in

Fortaleza, Ceará, Brazil, with a group of eleven family caregivers (CF) indicated by the same number of

hypertensive users registered in the cited PHCU. The ETH was elaborated based on the assumptions of health

education. The ETH consists of 11 (eleven) weekly meetings, with an average duration of sixty minutes. The

information was organized through the Bardin content analysis. After the analysis of the results with the

application of ETH, we noticed the occurrence of learning among the FC, but in an unequal way. It is seen

that the deficit of previous knowledge about arterial hypertension and the treatment differentiated between

them, since each one reported diversified experiences.

1 INTRODUCTION

The focus of this research is the use of an

Educational Technology in Health (ETH) for

training the caregiver family (CF) in the adherence

of hypertensive users to treatment. The Systemic

Arterial Hypertension (SAH) is a serious health

problem in Brazil and in the World (Who, 2013).

The SAH is correlated with clinical

complications that lead a significant number of

person brazilians to death. Many complications

could have been avoided and/or minimized, such as

acute myocardial infarction, stroke and renal

failure, if they had adhered early to the therapeutic

plan (Piccini et al, 2012).

The family is paramount in the care of its

members in both health and disease conditions and

its importance has been related to a greater

adherence to treatment by individuals with a health

problem, especially when it is included as a

participant in the health-disease process, since it

contributes substantially to the promotion of health

(Squarcini et al, 2011).

For Martins et al (2012), the family context is

the first space of identification and explanation of

the illness of its members and where the phenomena

of health and disease acquire greater relevance. The

impact of the disease falls on all family members,

just as family interaction has an influence on their

cure.

Santos, Z., Santos, P., Jardim, M., Caldas, J., Branco, J., Frota, M., Rolim, K., Aguiar, A., Carneiro, R., Soares, A., Moreira, A. and Cavalcante, L.

Application of an Educative Health Technology in the Training of the Caregiver Family.

DOI: 10.5220/0006573603950401

In Proceedings of the 11th International Joint Conference on Biomedical Engineering Systems and Technologies (BIOSTEC 2018) - Volume 5: HEALTHINF, pages 395-401

ISBN: 978-989-758-281-3

395

The follow-up of coping with the disease in the

family depends on some factors. These refer to the

stage of life in which the family finds itself, to the

role played by its sick member, to the implications

of the impact of the disease on each of them and to

the way it is organized during the period of illness

(Brazil, 2006).

Regarding the interaction and family

participation, the assistance to SAH has been

approached and highlighted by numerous studies,

where, increasingly, there are studies that show the

success that can result from the association between

family care and care (Lopes and Marcon, 2009).

The participation of the effective family is a

factor that can interfere favorably in the other

factors, due to its salutary importance in the

involvement of the health-disease process of its

members. Among the relatives, usually one and at

most two stand out in the care with the others.

However, in the provision of effective and adequate

care, the FC should be trained to perform preventive

actions and/or control of injuries to the health of the

member, especially when it comes to a chronicity.

Thus, we agree with Soares et al (2011) at

affirming that, when the CF properly trained and

with adequate knowledge about SAH is a great

facilitator of the treatment adherence process.

Although the perception of the benefits regarding

the adoption of measures for the prevention and

control of hypertension does not necessarily imply

the coherence and effectiveness of actions in search

of adherence.

Therefore, it is very important to provide the

person with hypertensive elements so that he can

understand the treatment leading him to believe that

he will have positive results if he follows it

properly. Because of the fundamental importance of

family participation in determining hypertensive

patient adherence to treatment, the need arose to

empower or empower CF through an ETH with the

purpose of making their participation effective and

efficient in adhering to the hypertensive person to

the treatment, as well as, to adopt preventive

measures of the risk of the SAH between the

relatives, since this aggravation is hereditary.

The ETH are important tools for the

performance of educational work and the caring

process. The ETH integrates the group of light

technologies, called relationship technology, such

as hosting, bonding, automation, accountability and

management as a way of governing work processes

(Merhy, 2002).

The technologies are processes materialized

from the daily experience of health care and some

derived from research for the development of a set

of activities produced and controlled by human

beings. It serves to generate and apply knowledge,

to master processes and products and to transform

empirical utilization, so as to make it a scientific

approach (Nietsche et al, 2014).

The use of these technologies contemplates the

existence of a dynamic work object, in continuous

movement, no longer static, passive or reduced to a

physical body. This object demands from health

professionals, especially nurses, a differentiated

ability to look at it so that they perceive this

dynamicity and plurality, which challenge subjects to

creativity, listening, flexibility and sensitivity (Rosso

and Lima, 2005).

The recommendations for care usually require

interventions of light, hard and soft technologies,

associated with changes in lifestyle, in a process of

continuous care that does not lead to cure (Brazil,

2014).

So, based on the relevant performance of the

family caregiver in the hypertensive user's adherence

to the treatment, we asked: What does the CF know

about SAH and treatment? How has the CF

experienced participation in hypertensive treatment

adherence? and the ETH can facilitate the

participation of the CF in the adherence of the

hypertensive user to the treatment?

Based on these questions, we opted for this study

with the objective of analyzing the participation of the

caregiver family in the adherence of the hypertensive

user to the treatment with the application of an

educational technology in health.

The results of this study will be presented to the

Coordinator and Family Health Teams of the Primary

Health Care Unit (PHCU) (study locus) with the

purpose of contributing to the (re) planning of the

actions directed to the training of CF for effective

participation in the adherence of the hypertensive

person to the treatment by Implementation of ETH, as

they will also be published in article formats or in

book chapter.

2 OUTLINE OF OBJECTIVES

To evaluate the changes occurred in the participation

of the family caregiver in the adherence of the

hypertensive user to the treatment with the

application of the Educational Technology in Health

(ETH).

3 STATE OF THE ART

Before any discussion about health promotion

through health education, it is necessary to

HEALTHINF 2018 - 11th International Conference on Health Informatics

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understand the health-disease process considering it

as a result of a certain social experience and diverse

influences as factors linked to education as culture,

intellectuality, education, and also related to the

environment such as sanitation, transportation,

housing, drinking water and, finally, the economic

aspect. These factors influence and characterize

social life and quality of life. Therefore, it is

perceived that "health" has varied meanings and

intimate relation with well-being and conception of

the environment (Longhi, 2013).

In educational practice, health promotion actions

seek to intervene in people's living conditions, so that

they are dignified and appropriate, helping in the

decision-making process towards quality of life and

health. On the other hand, preventive educational

actions guide actions to detect, control and weaken

risk factors, focusing on actions that distancing or

avoiding the disease (Pinafo et al, 2012).

Thus, empowering people with illness through

health education is a way of motivating them to cope

and accept their health condition and enable them to

comply with the prescribed therapeutic plan (Brazil,

2014).By becoming caregivers, people share their

perceptions, emotions, feelings, values, and

knowledge as being in their care (Oliveira and

Carraro, 2011).

Since the earliest times, the family has played an

important role for the individual and is therefore

considered a primary social system within which the

individual is cared for and develops on a physical,

personal and emotional level (Sarmento et al, 2010) .

There are several reasons why the family

member performs this caregiver role, among them:

duty or obligation; gratitude/retribution; financial

dependence; degree of kinship; genre; physical and

affective proximity; marital status; family tradition.

Many are also the difficulties faced by the caregiver.

According to studies, the main difficulties are related

to the type of care, financial problems and social

restriction. The prior relationship with the person

being cared for, the cause and degree of dependence

of the elderly, the help given by other family

members, the demands placed on caregivers, the

family income, the caregiver's health status and the

acceptance of the caregiver. Care are factors that

generate stress to the family caregiver (Cruz et al,

2010).

The CF show a set of needs, which should be

privileged focus of attention and intervention of

nurses. These professionals should then orient their

interventions to adequately meet these same needs

and thus obtain the desired health gains and well-

being of caregivers (Melo et al, 2014).

The tasks attributed to the caregiver often without

adequate guidance and the support of the institutions

that attend the family member under care have an

impact on their quality of life (Amendola et al, 2008).

Thus, understanding the family's interactions with the

disease allows the practitioner to realize that CF also

need care, counseling, and strategies for stress relief.

Thus, they may have better living conditions and,

consequently, may provide better quality care for the

sick relative (Manoel et al, 2013).

The role of this approach is a challenge for health

and education professionals, who demand

intersectoral attention (Barros et al, 2006) to promote

the general health of families and the community

(Leão et al, 2011).

The practices of Health education (HE) involve

three segments of priority actors: health professionals

who value prevention and promotion as well as

curative practices; managers who support these

professionals; and the population that needs to build

their knowledge and increase their autonomy in care,

individually and collectively. Although the definition

of Ministry of Health (MS) presents elements that

presuppose this interaction between the three

segments of the strategies used for the development

of this process, there is still a great distance between

rhetoric and practice (Falkenberg; Mendes.; Moraes;

Souza, 2014).

For Melo et al (2014) to provide caregivers with

the knowledge and skills they need is important, not

only to take better care of their family members, being

a facilitating factor for a healthier performance of

functions.

Thus, HE seen as a social practice began to be

rethought as a process capable of developing

reflection and critical awareness of the people about

the causes of their health problems, prioritizing the

event of a process based on dialogue, so that people

can move to work and not to people (Freire, 1983;

Brazil, 2007).

In this regard, Alves and Aerts (2011) explain

strategies of educational action as: the participation of

health professionals in the training of individuals and

population groups, in order to assume responsibility

for their health problems; understand that the subjects

of this process have different visions about social

reality and that these should be the starting point of

the educational action; popular participation and the

strengthening of the role of the health service.

For Daniel and Veiga (2013) even though the

identification of the diagnosis is considered easy and

there are efficient therapeutic measures for the

maintenance and effective control of the therapeutic

regimen related to SAH, it has been an arduous task.

This situation has been experienced by the patient, his

family, professionals and health institutions.

Application of an Educative Health Technology in the Training of the Caregiver Family

397

Early detection of SAH and interventions for risk

factors, such as changes in lifestyle, favor the control

of this disease, since it has no cure. In addition, the

knowledge of its risk indicators can be of great value

in directing health policies (Silva et al, 2014).

Adherence to therapy by patients with chronic

diseases such as hypertension has been discussed as a

complex and multifactorial process. From the point of

view of the individual, adherence is related to the

recognition, acceptance and adaptation to health

condition, as well as to the identification of risk

factors in the adopted lifestyle and the development

of self-care and healthy habits and attitudes (Reiners

et al, 2008).

In view this context, the importance of the

association between health services, the health team

and the family, where each one plays a role of

relevance to adherence to treatment is perceived.

Health services collaborate in adherence to the

control of Systemic Arterial Hypertension (SAH)

through previously scheduled and routine

consultations. The health professional is responsible

for transmitting his theoretical skills, taking the role

of educator and health promoter through the health

guidelines for patients and their families. The family

represents a link, giving continuity to the treatment.

Educational technologies are tools that aid the

assistance and teaching-learning process that are used

by professionals through health education, where

there is a transfer of knowledge, allowing

participation in the whole process allowing the

exchange of experience and the improvement of

Skills (Barros et al, 2012).

The HE should be seen as a technology in the

work process of health professionals, reorienting their

work practices, based on the principles of SUS,

causing changes in the lives of users and health

professionals themselves.

In this context, it is possible to notice the

importance of the association between health

services, health team and family, where each one

represents a relevant role for adherence to treatment.

Health services collaborate in adherence to the

control of SAH through previously scheduled and

routine consultations.

The health professional is responsible for

transmitting his theoretical skills, taking the role of

educator and health promoter through the health

guidelines for patients and their families. The family

represents a link, giving continuity to the treatment.

For Ayres (2004), the organization of health

practices and therapeutic relationships in the

production of care with an emphasis on light

technologies enables the effective and creative

manifestation of the subjectivity of the other, based

on the mechanisms of reception, attachment,

autonomy and accountability contained organization

of health care.

A valuable alternative to seek health promotion in

order to deepen discussions and increase knowledge

are the educational work in groups, so that people

overcome their difficulties and obtain greater

autonomy, better health conditions and quality of life

(Silva, 2003).

4 METHODOLOGY

4.1 Type of Study

Participating research. This research modality

provides the researcher with the knowledge of the

target reality, but also enables the participants-

researchers to integrate, through a continuous action-

reflection-action of the defined situation, the

awareness and understanding for decision making,

aiming at transformation (Guarient and Berbel,

2000).

We emphasize as a central point of this

methodology the concern with the process itself and

not with the product. To that end, Guariente and

Berbel (2000) emphasize that the interaction between

the researcher and the researched group becomes

essential, providing space, where people speak for

themselves, revealing their reality, interacting and

teaching each other. In this sense, the population

involved in the Participating Research has part in the

whole process. Population and researcher become

partakers of the process under construction for

transformation.

4.2 Research Site

The study was carried out in a Primary Health Care

Unit (PHCU) of the Regional Executive Secretariat

VI (RES VI), in Fortaleza-Ceará-Brasil. The stages of

the participant research are: approximation of the

target population, with presentation and acceptance of

the research proposal; delimitation of the objective of

the research by the population involved, through the

educational area; data collection for greater

knowledge of the participants, through interview;

delimitation of the objectives of research by the

participating group from their interest; and collective

knowledge construction, through the analysis of the

data emitted by the participants, of the identification

and prioritization of the study objectives, with

classification of the situations by the explanations and

relationships that arose between the contrast of

HEALTHINF 2018 - 11th International Conference on Health Informatics

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everyday knowledge and the systematized

universally. Still in the final stage of the research, the

elaboration of propositions of transformative actions

for the situations raised (Guariente and Berbel, 2000).

4.3 Study Subjects

Participating in the study were a group of 11 (eleven)

of the 15 (fifteen) caregivers family (CF) indicated by

the same number of hypertensive users enrolled in the

PHCU regardless of age, schooling, color, etc. We

opted for this number through the possibility of

evasion, as in fact occurred, because 04 (four) gave

up. We call CF, that member of the family who stands

out most in the care of the hypertensive users.

4.4 Work Development

We try to make a reflective description of the process

to be experienced by the participants through three

moments so planned:

First stage - pre-process participatory process,

with data collection with the CF of the PHCU;

Second stage - period of the participatory process,

with transcription, categorization and analysis of the

speeches issued at the meetings of the participating

group; and

Third stage - participatory post-process period,

with a new data collection with the subjects

participating in the research, for the purpose of

evaluating the changes in the participation of the CF

in the adherence of the hypertensive user to the

treatment with the application of the Educational

Technology in Health (ETH).

The ETH was elaborated based on the assumptions

of health education. We opted for this theoretical-

methodological referential, since we consider it of

great relevance to explain the adoption of behaviors

that may help in the prevention and control of

diseases and also to predict the acceptance of

recommendations on care for the health of self and

the people of their conviviality.

The ETH consists of 11 (eleven) weekly meetings,

with an average duration of sixty minutes.

In the meetings, educational workshops were

developed through group dynamics, aiming to

motivate and strengthen the affective bonds in the

outpatient environment, favoring the collective

construction of the knowledge about hypertension

and treatment. The consolidation of an adhesion

group is referred to by Silveira (2005) as a space of

solidarity that allows access to information, exchange

of experiences, exchange of motivations, mutual

support and the experience of a plurality of situations

that create opportunities. For the subjects to position

themselves, to answer their doubts, to interact and

overcome difficulties in the treatment process.

We emphasize that the determination of the

day of the week and time for the meetings were

determined with the CF, so as not to hinder their daily

routine.

4.5 Data Analysis

The information was organized from the content

analysis, following the postulates of Bardin (1977),

according to the steps for the analysis and

interpretation of the collected data:

- Pre-analysis. We have done an exhaustive

reading of interviews and notes in the field diary.

-Exploration of material. After reading, we

identify and construct the categories -

sociodemographic and sanitary characterization of

family caregivers; description of CF' knowledge

about systemic arterial hypertension and treatment;

description of previous experience of CF with

participation in hypertensive treatment adherence;

and evaluation of the changes that occurred with the

application of educational technology in health -, and

later the excerpts from relevant statements were

selected.

- Treatment of results. Based on the results

obtained, we proceed to the interpretation, based on

the assumptions of health education, and in the

selected literature.

4.6 Ethical Aspects

This research was developed in accordance with

Resolution 466/12 of the National Commission of

Ethics in Research (NCER), which regulates research

with human beings. At participants were guaranteed

anonymity and the right to withdraw consent at any

time they wish. The data were collected after signing

the Free and Informed Consent Term(FICT) and

issuing the favorable opinion of the Ethics Committee

of the University of Fortaleza (UNIFOR), under

number 1.540.566. The subjects were identified by

the letter E, followed by the relative numeration of the

number of participants (E01 to E11).

5 EXPECTED OUTCOMES

After the analysis of the results with the application

of the Educational Technology in Health (ETH) we

noticed the occurrence of learning among the

caregivers family (CF), but in an unequal way. It is

Application of an Educative Health Technology in the Training of the Caregiver Family

399

seen that the deficit of previous knowledge about

systemic arterial hypertension (SAH) and the

treatment differentiated between these, since each

one reported diversified experiences.

With the application of ETH, the CF

experienced learning experiences mediated by

information exchange, dialogue, socialization of

experiences, clarification of doubts and link

establishments, and beyond the CF commitment

with self-care. We perceive in the CF report the

commitment to seek knowledge to provide a quality

care to the hypertensive person. The changes that

took place were highlighted in the learning and

commitment of CF with self-care.

The regular participation in the meetings

emphasizes the interest of learning about what one

wants to take care of efficiently and effectively.

Women, culturally, have stood out as

caregivers, not only in the family system, to a

certain extent in other systems - health and social.

Regarding the family system, participation is of

fundamental importance for the hypertensive

person to be treated.

The mode of participation of the CF was

revealed by the collaboration, integration and

solidarity between the members of the family;

performance as a multiplying agent of educational

guidelines on the control of hypertension; and in the

monitoring of the conducts of control of this

aggravation. Participation has led to a change in

lifestyle, with the adoption of healthy habits, and the

conviction that the family environment is

fundamental to this change.

The participation of the CF was facilitated by

the experience with the same grievance; nearby

residences; hypertensive user acquiescence; and

love of life. The forms of participation revealed by

CF consisted of: guidance on SAH and treatment;

reminder about medication; preparation of meals;

option for collective meals; acquisition of

medication in case of absence in the UAPS;

monitoring in the consultations; monitoring in

physical exercises; use of alternative therapies;

stress management; medication administration; and

reminder about the date of the consultation.

The results of the study may allow the (re)

planning of health education strategies by the

Family Health Team with CF in order to lead

hypertensive users to adherence to the therapeutic

management of hypertension and health and

wellness promoters, consequently minimizing the

problem of public health, which will expand with

the prevalence of the elderly in the brazilian

population, predicted for 2020, which is likely to

increase the prevalence of this condition, since it

increases with age, if all possible efforts for its early

detection and/or control are not implemented, since

SAH has been a preponderant risk factor for

cardiovascular and cerebrovascular diseases.

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