Profissionais de saúde da família e representações sociais do alcoolismo

• Autor(a) principal: Souza, Luiz Gustavo Silva
• Data de Publicação: 2012
• Tipo de documento: Tese
• Idioma: por
• Título da fonte: Repositório Institucional da Universidade Federal do Espírito Santo (riUfes)
• Texto Completo: http://repositorio.ufes.br/handle/10/6701
• topic: Alcoholism; Primary health care; Family health; Mental Health; Men s Health; Social representation; Social practice; Social identity; Psychosocial intervention; Alcoolismo; Atenção primária à saúde; Saúde da família; Saúde mental; Saúde masculina; Representação social; Prática social; Identidade social; Intervenção psicossocial; Psicologia; Família - Saúde e higiene; 159.9

Alcohol misuse is frequent worldwide. Primary Health Care (PHC) has an important role in approaching alcohol problems and alcoholism in specific. In Brazil, the Family Health Strategy presents the possibility of enhancing care to these problems and to mental health conditions in general. It is relevant to analyze how PHC professionals construct knowledge about (and actions towards) alcoholism, alcoholic patients and associated objects. The research reported here aimed at investigating and analyzing social representations and social practices constructed by Family Health professionals working in a Brazilian Southeast municipality about alcoholism and alcoholic patients. Three studies were conducted: a participant observation carried out in one Family Health Center (FHC) for approximately eight months (84 participants); the administration of semistructured interviews (40 participants from 11 FHC) and of questionnaires with case vignettes (120 participants from 16 FHC). Content analysis was used to treat the data gathered with the observation and with the interviews. Answers of the interviewed professionals were also submitted to ALCESTE software. Data from the questionnaires were treated with analyses of variance (MANOVA, ANOVA) using SPSS. With the participant observation, it was possible to verify the contextual construction (through processes of objectification and anchoring) of five Images of alcoholic patients: the absent alcoholic ; the alcoholic as a difficult case ; the alcoholic present although absent ; the comic drunk and the problem drunk . Practices focused on the traditional cure-centered paradigm were observed as well as practices leading to physical and symbolical exclusion of the alcoholic. It was verified the emphasis on the attribution of otherness (alterity) to patients in general, alcoholics and non-alcoholics. The interviews suggested the presence of ambiguity in the perception of alcoholism, simultaneously represented as multifactorial disease demanding comprehensive care and social problem related to the poverty of the slums . In the process of attributing causes to alcoholism, it was possible to notice the coexistence of the scientific rationality and some beliefs related to the different culture of the poor neighborhoods and of their multi-problem families . Family Health Centers were represented simultaneously as important and as impotent to provide treatment to alcoholism. Data from the questionnaires indicated that the alcoholic was objectified as atypical and difficult patient, towards whom professionals held negative attitudes and socio-cognitive elements related to stigmatization. Mainly social and psychological factors were perceived as causes of alcoholism, in contrast to the lesser importance attributed to genetic (biological) factors. Female alcoholism was possibly perceived as more difficult to explain but not necessarily as more difficult to approach. Results from the three studies are integrated in analytical level, leading to a comprehension of the representational system that oriented the social practices (which were also ambiguous). The construction of the investigated social representations is analyzed from a historical perspective. The tradition of coercion and its association to historical hygienism in professionalpatient interactions are highlighted. The psychosocial determinants of difficulties faced to approach alcoholism are discussed as well as some suggestions to overcome these obstacles. The analyses lead to theoretical and methodological contributions regarding social practices and psychosocial interventions.