CRITICAL ARTICLE REVIEW
vanessa29
SocialDeterminantsofHealthfromanAdolecentsPerspective.pdf
Marim TD, Partelli ANM. Social determinants in health from the...
J Nurs UFPE on line. 2019;13:e239114
https://doi.org/10.5205/1981-8963.2019.239114
SOCIAL DETERMINANTS IN HEALTH FROM THE ADOLESCENT'S PERSPECTIVE: PHOTO VOICE
DETERMINANTES SOCIAIS EM SAÚDE NA ÓTICA DE ADOLESCENTES: FOTO VOZ DETERMINANTES SOCIALES EN SALUD EN LA ÓPTICA DE ADOLESCENTES: FOTO VOZ
Thais Delabarba Marim1, Adriana Nunes Moraes Partelli2
ABSTRACT
Objective: to investigate, from the point of view of adolescents, which social determinants influence their health and the community where they live. Method: it is a qualitative, descriptive study, using the Sensitive Creative Method, through the Dynamics of Creativity and Sensitivity photo voice, with ten adolescents of elementary school of a public school of periphery. The photographs were recorded in the neighborhood where the adolescents live, answering the question that generated debate: "For you, what factors influence your health and the health of the community where you live?" The adolescents were then encouraged to report the motivation for carrying out the photographic record. It was adopted to classify, order and systematize the empirical material, the technique of Content Analysis in the Thematic Analysis modality. Results: two themes were obtained: "Social situation in which one lives: images of social reality" and "From naive to critical consciousness: the voice of adolescents". Conclusion: it was pointed out that when adolescents were given voice, it was observed that they identified the social determinants and reflected how they influence their lives and the community. It is reported that this process can contribute to the transformation of realities and reduce vulnerabilities. Descriptors: Adolescent; Community-Based Participatory Research; Photography; Health Promotion; Social Determinants of Health; Awareness.
RESUMO
Objetivo: investigar, sob a ótica de adolescentes, quais determinantes sociais influenciam a sua saúde e a da comunidade onde vivem. Método: trata-se de estudo qualitativo, descritivo, empregando o Método Criativo Sensível, por meio da Dinâmica de Criatividade e Sensibilidade foto voz, com dez adolescentes do ensino fundamental de uma escola pública de periferia. Registraram-se as fotografias no bairro onde os adolescentes vivem, respondendo à questão geradora de debate: “Para vocês, quais os fatores influenciam a sua saúde e a saúde da comunidade onde vivem?”. Estimularam-se, em seguida, os adolescentes a relatar a motivação para a realização do registro fotográfico. Adotou- se, para classificar, ordenar e sistematizar o material empírico, a técnica de Análise de Conteúdo na modalidade Análise Temática. Resultados: obtiveram-se duas temáticas: “Situação social em que se vive: imagens da realidade social” e “Da consciência ingênua para a consciência crítica: a voz dos adolescentes”. Conclusão: ressalta-se que, quando se deu voz aos adolescentes observou-se que eles identificaram os determinantes sociais e refletiram como eles influenciam suas vidas e da coletividade. Informa-se que esse processo pode contribuir para a transformação de realidades e reduzir vulnerabilidades. Descritores: Adolescente; Pesquisa Participativa Baseada na Comunidade; Fotografia; Promoção da Saúde; Determinantes Sociais da Saúde; Conscientização.
RESUMEN
Objetivo: investigar, bajo la óptica de adolescentes, qué determinantes sociales influencian su salud y la de la comunidad donde viven. Método: se trata de un estudio cualitativo, descriptivo, empleando el Método Creativo Sensible, por medio de la Dinámica de Creatividad y Sensibilidad foto voz, con diez adolescentes de la enseñanza fundamental de una escuela pública de periferia. Se registraron las fotografías en el barrio donde viven los adolescentes, respondiendo a la cuestión generadora de debate: "Para ustedes, ¿qué factores influencian su salud y la salud de la comunidad dónde viven?". Se estimuló entonces, a los adolescentes a relatar la motivación para la realización del registro fotográfico. Se adoptó, para clasificar, ordenar y sistematizar el material empírico, la técnica de Análisis de Contenido en la modalidad Análisis Temático. Resultados: se obtuvieron dos temáticas: "Situación social en que se vive: imágenes de la realidad social" y "De la conciencia ingenua para la conciencia crítica: la voz de los adolescentes". Conclusión: se resalta que, cuando se dio voz a los adolescentes se observó que ellos identificaron los determinantes sociales y reflejaron cómo influencian sus vidas y la colectividad. Se informa que este proceso puede contribuir a la transformación de realidades y reducir las vulnerabilidades. Descriptores: Adolescente; Pesquisa Participativa Basada en la Comunidad; Fotografía; Promoción de la Salud; Determinantes Sociales de la Salud; Concientización. 1,2Federal University of Espírito Santo, University Center North of Espírito Santo/UFES/CEUNES. São Mateus (ES), Brazil. ORCID :
https://orcid.org/0000-0003-2459-0861 Email: [email protected] ORCID : http://orcid.org/0000-0001-9978-2994 Email:
How to cite this article
Marim TD, Partelli ANM. Social determinants of health from the adolescent’s perspective: photo voice. J Nurs UFPE on
line. 2019;13:e239114. DOI: https://doi.org/10.5205/1981-8963.2019.239114
ORIGINAL ARTICLE
Marim TD, Partelli ANM. Social determinants in health from the...
J Nurs UFPE on line. 2019;13:e239114
https://doi.org/10.5205/1981-8963.2019.239114
It is known that health has, as determinants
and conditioning factors, food, housing, basic
sanitation, environment, work, income, among
other aspects that evidence the social and
economic organization that reflects in people's
lives in the place where they are inserted1 in a
certain time-space.2 The territory is related to a
delimited area where life happens subject to
certain interrelations, rules or norms.
It is believed that the recognition of the
territory by the health professional is a basic step
for the characterization of the residents and their
needs, as well as for the analysis of the effect of
the services on the health levels of the
population, making possible the development of
practices according to the daily life of individuals, 3 that is, directed to the real needs of the
population.
Tem-se discutido, nos últimos anos, o emprego
de estratégias que visam ao desenvolvimento de
uma visão crítica no indivíduo de forma que este
possa ser participativo no processo de mudança.
Confia-se que a participação comunitária é o
fundamento para o exercício da cidadania, tendo
como componente fundamental o empoderamento
da população pelo fortalecimento, construção da
autonomia e cidadania no controle dos
condicionantes e determinantes de saúde.4-5
In this context, it is referred to the Popular
Education in Health, initially systematized by
Paulo Freire, who had pioneered the production of
knowledge associated with practice,5-6 recognizing
the user as a subject capable of establishing a
dialogical dialogue with the health service and
developing a critical analysis of reality, making it
possible to increase strategies of struggle and
coping.7 In this sense, education should be thought
of as a collective exercise in individual creativity
and in the appreciation of experiences8 at all
ages.
It is understood that adolescents are often
placed as agents of the present, but they have few
spaces to participate in the political and social life
of their community.9 In Brazil, in 2010, more than
34 million people in the age group of ten to 19
years, representing 18% of the population.10 It is
composed by this expressive population, one of
the research priorities of the National Agenda for
Priorities in Health Research, because it is
exposed to risks and vulnerability relationships to
be overcome urgently.11
It is necessary that health professionals use
strategies that aim to develop a critical vision in
the individual, so that it can be participatory so
that the process of change can make sense and be
meaningful in their daily lives.12
Therefore, in this research, we adopted
methodologies that provide greater autonomy and
freedom for adolescents, in addition to valuing the
experiences, thoughts and opinions in relation to
the environment in which they live through
criticism, 13 because, when encouraged to
participate actively in the process of health care,
adolescents develop awareness and co-
responsibility for the real health needs in the
place where they live.14
• To investigate, from the perspective of
adolescents, which social determinants influence
their health and that of the community where
they live.
Participatory research, 15-6 with a qualitative
research approach, was used in the group space of
the Sensitive Creative Method (SCM), a type of
research based on art.17 Through participatory
research, it is possible to produce knowledge in
the collective space by sharing experiences,
experiences and knowledge of knowledge, and the
participant actively acts in their social reality.
They approach researchers and participants who
distance themselves from the scenario where
research is taking place to develop strategies for
social change15-6 and, when developed in
conjunction with SCM, artistic expression served as
a way of accessing the human experience, giving
more freedom to reflect and act with the
mediation of art.17
The research was carried out with students
enrolled in elementary education at a public
school located in the periphery of BR 101, in the
Litorâneo neighborhood, in the municipality of São
Mateus, Espírito Santo. This school was selected
because it is close to the university, because it
facilitates access by researchers who carry out
research and extension projects and because it is
located in a region of great social vulnerability,
according to the number of families enrolled in
the Federal Government's Single Register for Social
Programs.18
It is reported that ten adolescents participated,
with five girls and five boys, aged 12 (eight
adolescents) and 13 (two adolescents), who met
the inclusion criteria: 1 - age between 10 and 19
years (according to definition of the World Health
Organization); 2 - carrying out general health and
citizenship test and 3 - being among the top ten in
the test. Students with cognitive, intellectual and
motor deficits that compromised their
engagement in the dynamics were excluded. The
Free and Informed Consent Term was signed by all
the participants and they signed the informed
assent agreement agreeing to participate in the
research.
In order to capture the images of the social
determinants that influence the health of the
OBJECTIVE
METHOD
INTRODUCTION
Marim TD, Partelli ANM. Social determinants in health from the...
J Nurs UFPE on line. 2019;13:e239114
https://doi.org/10.5205/1981-8963.2019.239114
adolescent and the community in which they live,
the dynamics of creativity and sensitivity (DCS)
foto voz19 do SCM.17
It is explained that the SCM is an alternative
research tool where the groups elaborate artistic
productions and develop a group discussion
mediated by Freire's critical-reflexive. As a
fundamental axis, the DCSs are presented for
answering a question that generates debate
(QGD). They become the dialogues, in the group
space, enlightening and, in this way, the
consciousness is expanded, revealing opinions, and
the group then assumes a new reality,
transforming the naive consciousness into critical
consciousness.19 This method is performed in five
moments: in the first, the reception, the
presentation and the group interaction take place,
adopting some device of relaxation and
sensitization. The QGD is presented and the
objectives of the dynamics and its development
process are described. It develops, in the second,
individual or collective work to promote group
interaction and awaken the creative and sensitive
dimensions. The texts generated are presented in
the third, and can be verbal, imagistic and
written, which helps to state existential
situations. The fourth is reserved for the collective
analysis of production, codification of existential
and existential situations in generative themes
founded on the reflexive critique of group
dialogue. The group focuses on the collective and
individual aspects of the experience, discovering
the common and the unusual for the purpose of
negotiating the sub-themes decoded from the
generating theme. The theme is summarized in
the fifth section and then validated.
People are used in the photo voice to document
their health and work realities.19 It is described
that as participants engage in a group process of
critical reflection, they can advocate changes in
their communities, using images and stories to
communicate with local policy decision-makers.19-
21
There were weekly meetings, totaling seven
meetings, in the months of April and May 2016,
with a minimum duration of one and a maximum
of three hours, in the computer lab of the school,
private place reserved for the research on days
and times previously scheduled.
It was clarified, in the first meeting, about the
project, agreeing the days and times of the other
meetings and the activities to be carried out in
each one. A digital photographic camera (Sony-
DSC-W690 / R) and training on the operation, care
and manipulation of the equipment by the
researchers were received in the second, by each
participant. The participants were divided into
three groups: three adolescents and two
adolescents with three adolescents to perform the
photographic records from the QGD: "For you,
what factors influence your health and the health
of the community where they live? " The
neighborhood was visited by adolescents,
recording images that responded to QGD in two
afternoons (two hours a day).
The images recorded by each participant in a
notebook were downloaded, where a folder titled
"fotografia" was created with sub-folders for each
adolescent containing the date of the
registrations.
The projection (Epson Powerlite Projector S18)
of the whiteboard images was given in the fifth,
sixth and seventh meetings, and the adolescents
were encouraged to report the motivation of the
recording of each image. After the individual
presentations, the group discussion where
repeated photos were excluded and which had the
same motivation, resulting in a bank with 136
images. During the individual presentations and
group discussion, the researcher and research aids
were key words and, at the end of each meeting,
these words were sent to the group for the
validation of the textual contents produced. The
meetings were recorded.
In order to classify, order and systematize the
empirical material (captured images and
narratives), the Content Analysis (CA) path, which
refers to the study of both the contents in the
language figures, ellipses, between lines, and the
manifestos.22 In this study, the cut was chosen
according to the Thematic Analysis (themes),
which led to the use of sentences, sentences or
paragraphs as analysis units (AU). Thus, the
thematic analysis was developed through the
following steps: a) pre-analysis; b) exploitation of
the material; c) treatment of results and
interpretation. Frames were drawn up with the AU
in common, applying the theoretical framework
adopted, obtaining two themes: "Social situation
in which one lives: images of social reality" and
"From naive to critical conscience: the voice of
adolescents".
After the analysis movement, a final meeting
was held with the participants where the final
material was presented, discussed and validated
by the group.
The research was approved by the Research
Ethics Committee of the University Center of the
North of Espírito Santo under number
49172415.6.0000.5063. The statements of the
participants with fictitious names, followed by
age, were identified in order to guarantee
confidentiality and privacy.
Social situation in which one lives: images
of social reality
It was revealed in the images captured by the
ten adolescents that it is common to find
RESULTS
Marim TD, Partelli ANM. Social determinants in health from the...
J Nurs UFPE on line. 2019;13:e239114
https://doi.org/10.5205/1981-8963.2019.239114
reservoirs, such as disposable cups, tires, open
water box and sink with standing water on the
streets and on the grounds of the community
where they live (Figure 1A). Garbage and rubble
were found lying in the middle of the street and
on the ground (Figure 1B). It is added that there is
the presence of animals such as the horse that
appears in a photograph surrounded by wire,
which is near the BR 101, a place where there is a
lot of cars, and the apparently ill dog, wandering
in the middle of the street (Figure 1C).
Images of food and beverages found in the
market, bakery and bar (Figure 1 D), which are
part of their daily life, as well as alcoholic
beverages and cigarettes (Figure 1 E) were also
brought to the adolescents. The Basic Health Unit
(UBS) and pharmacy were registered as health
care facilities (Figure 1 F) and toys, sandfield, lan
house computers and books found in the school
library as places of leisure and education ( Figure
1G).
A) Reservoirs found in the streets and in terrains with still water.
Cup Tire Open water box Sink
B) Accumulation of trash and rubble in the streets and on the land.
Trash on the street Terrain with rubble Trash and Rubble in the streets
C) Presence of animals in the community.
Horse Dog
D) Food and beverages available in the community.
In the supermarket Bread in the bakery Salty snacks at the bar Drinks in the supermarket
E) Alcoholic beverages and cigarettes.
Beer in the supermarket Cigarettes in the bar
F) Health care facilities.
Drugstore Health Unit G) Leisure and education.
Toys Sand field Computers in the lan house Books in the library
Figure 1. Mosaic of community images captured by adolescents. São Mateus, (ES), Brazil, 2016.
In the images recorded by the adolescents, they
identified their reality, difficulties and limiting
situations regarding their way of life and the social
relations that influence their health and the
community where they are inserted.
Marim TD, Partelli ANM. Social determinants in health from the...
J Nurs UFPE on line. 2019;13:e239114
https://doi.org/10.5205/1981-8963.2019.239114
● From naive to critical consciousness: the
voice of adolescents
Throughout the various reservoirs with
accumulated water, health damages can be
brought about as diseases caused by mosquitoes
and other microorganisms.
[...]when it rains, the water falls inside the tire
and can cause dengue, chicungunha,
Zika and several other diseases. (Sara, 12 years)
[...]can bring many diseases, be focus for dengue
and bacteria. (Erica, 12 years old, Gil, 12 years
old)
[...]it harms the health because it brings
diseases caused by the mosquito, like dengue and
chicungunha because there it has water. (Ygor,
age 12, Beatriz, 12 years old)
They are denounced by the images of garbage
and rubble thrown in the street, habits of the
people resident in the place, as well as the
precarious maintenance of the cleaning by the
public organs. People's lives are affected by
garbage and debris and can cause illness and
injury. It turns out that villagers have a habit of
putting garbage in front of their homes or playing
in vacant lots without worrying about smell,
annoyance with neighbors and days of garbage
collection, and it is up to the person who
generated the garbage to put it in protected
reservoir and take it to the street, close to public
pick-up time, but according to adolescents, public
collection is inefficient or unrealized.
It is forbidden to throw rubble, but someone
threw it! It damages health [...] it does not help
to have a clean house, with a vacant lot on the
side that can bring disease. And nobody does
anything! (Sara, 12 years old)
[...]people wait for the trash car to pass and
then throw the trash in the middle of the street!
[...] the population is wrong because they threw
trash on the floor and not the trash can. (Rita,
age 12, Roger, 13 years old)
[...]it looks like the garbage truck never goes by!
[...] Several foods thrown away, and there are
many people who need it! (Guto, 12 years old)
[...]you risk cutting the foot with the rubble.
They could play inside a barrel [...], people play
in the middle of the street! [...] the garbage is
around the houses as if it were a garbage dump.
It's rubbish, rubbish here! (Guto, 12 years old,
Rita, 12 years old, Gil, 12 years old, Ygor, 12
years old)
Adolescents have been shown to be concerned
about finding abandoned animals or places they
think are inappropriate, as well as mentioning that
the dog appears to have disease and can transmit
it.
The dog has his leg "naked" and can bring disease
in the hair [...]. (Gil, 12 years old)
The dog can transmit diseases. The horse is good
for us to ride, but where he is, it is a very bad
place and he can die because there is no place
for him to stay! (Guto, 12 years old, Gil, 12
years old, Beatriz, 12 years old)
Disponibilizam-se os alimentos no mercado,
padaria e bares da comunidade e estes fazem
parte do consumo: arroz, feijão, sal, açúcar, além
de pães. Percebe-se que os adolescentes têm
conhecimento de que os salgadinhos (aperitivos) e
pães recheados, assim como o refrigerante,
trazem prejuízos à saúde, apesar de serem
saborosos. Identificaram-se, pelos participantes,
os aspectos positivos e negativos dos alimentos.
Verificou-se que eles conhecem parcialmente os
prejuízos causados pela má alimentação e que o
baixo nível econômico da comunidade e o menor
custo de alimentos nutricionalmente inadequados
ricos em açúcares, gorduras e sal favorecem o seu
consumo.
Rice, beans, sugar and salt are part of my diet.
(Gil, 12 years old)
Beans are good for our health [...] have iron and
vitamins. (Beatriz, 12 years old)
Bread is tasty, but has coverage, too much sugar
that causes diabetes. [...] It's very tasty. If it
hurts, I do not care! (Rita, age 12, Ygor, age 12)
O chips não é bom pra saúde porque tem muita
gordura e engorda. É puro isopor! (Silvia, 12
anos; Gil, 12 anos)
O refrigerante pode ser bom ou ruim para a
saúde. É bom porque a gente bebe e ruim porque
engorda. [...] iogurte, suco e água mineral são
bons para a saúde! Iogurte tem vitaminas e a
água mineral é uma coisa boa porque é uma coisa
que a gente bebe e não ter açúcar, sal, essas
coisas assim. (Guto, 12 anos; Gil, 12 anos)
In relation to alcoholic beverages, alcohol was
associated with chronic health effects such as
cirrhosis of the liver by adolescents, which also
related the consumption of alcoholic beverage to
the vehicular direction and the risk of accidents
with death.
Beer and cachaça are bad because it can cause
cirrhosis. Several people drink and drive, will
something happen? (Beatriz, 12 years old)
If you drink, you can not drive because it can
cause death. (Lucas, 12 years old)
The consumption of beer by an adolescent was
identified, although the consumption and
commercialization of alcoholic beverages for
children under 18 years in Brazil.
Beer G is good! Not good for health, is it? But it's
too good! Cachaça is not good! (Guto, 12 years
old)
It is noted, in relation to cigarette smoking,
that adolescents are aware of the damages caused
and cite the disease in the lung as the main
problem caused by their use.
The cigarette is not good for health, it is bad for
the lung. (Gil, 12 years old)
Adolescents were identified by the BHU and the
pharmacy as the neighborhood's health access
points. According to them, UBS is able to access
condoms, medication and medical consultation. It
Marim TD, Partelli ANM. Social determinants in health from the...
J Nurs UFPE on line. 2019;13:e239114
https://doi.org/10.5205/1981-8963.2019.239114
is called attention to the search for the health
service still be driven by the disease and
associated factors. The benefits of the drug were
reported for treatment, while criticizing it as a
drug.
People will treat the body at the health clinic.
Get medicine and preservative. (Sara, age 12,
Roger, 13)
The bad thing about the drug is that it sucks and
we bought it at the drugstore. Good is good for
people, not to die and take care of diseases.
(Ygor, age 12, Silvia, age 12, Erica, age 12, Rita,
age 12)
It has been demonstrated, when it comes to the
forms of leisure, the use of ball, computer of the
lan house and the sand field. It is noted, however,
that some associated leisure in the field with the
possibility of acquiring diseases, due to the easy
access of abandoned animals in the neighborhood.
The education in the lines was valued, relating
the study with the entrance in the labor market.
The library books were cited as a door to the
acquisition of knowledge by reading and the
computer, as well as fun, is used as an instrument
for acquiring knowledge and a means of
interaction between people.
Playing ball is good! Because people run, jump,
crouch, get up. (Roger, 13 years old)
The sand field is good and bad. It's good because
people have fun! Bad because the dog needs it in
there and can cause ringworm in the foot (in the
field). (Rita, 12 years old)
The computer serves to know things. It's good to
mess around on the internet and communicate
with people via Facebook [...] (Roger, 13).
Education is good! Because if you do not study,
you can not get a job. (Ygor, 12 years old)
Library where we can read. Reading, we learn
more. (Silvia, 12 years old)
According to the study, the determinants of
health were analyzed according to the
adolescents' perspective. Images and narratives
that correspond to the low social level of life were
brought by the participants. In relation to the
social situation in which they live, the
photographic record shows the various deficiencies
in the neighborhood, such as: standing water in
several reservoirs exposed by residents; litter and
debris in the streets and on land; presence of
abandoned animals on the streets and on land and
places that relate to health, education and
leisure. The food and beverages that are present
in the daily life of the community were also
brought. It was observed, when adolescents were
given voice, that they reflected on the impact of
social determinants on their lives and the
community. This data collection strategy is built in
and by the community, where it was possible to
expose the world view of the adolescent and the
critical opinion in the place where they are
inserted.23
Têm-se demonstrado, pelo desenvolvimento e
implementação de estratégias de coleta de dados,
como a foto voz, que combina membros da
comunidade e pesquisadores, resultados positivos,
pois os adolescentes são agentes de mudanças de
suas próprias vidas e capazes de refletir com a
comunidade pontos fortes e preocupações com o
futuro.24 Tornam-se, dessa forma, protagonistas
para a avaliação de questões que envolvem a
saúde pública.
It is added, in this way, to reflect their daily
life, that adolescents internalize knowledge and
values that are building their own ways of
perceiving the world and being in it. Health
professionals12 must therefore be aware of the
fact that these young people need to be
considered active subjects in a constant process of
construction and transformation of themselves and
of their social relations, since it is through this
construction that the adolescent becomes an
autonomous subject within the health process.25
It is believed that health education in a
dialogical, critical and creative way is an
increasingly current, necessary and effective
strategy of health care, since, for the Unified
Health System (UHS), health education is a set of
practices with the potential to stimulate the
autonomy of the people, from the incorporation of
educational actions in the daily life of the health
services.13,26
It is recognized by the users of the Family
Health Strategy that there are educational actions
permeated by listening and dialogue. In practice,
however, there are still educational actions
centered on the hegemonic medical model,
focusing on specific themes for certain population
groups and with emphasis on the transmission of
knowledge, not valuing the socio-historical
context where the user is inserted and the
repercussions for their health.27
It is emphasized that caring is to promote the
autonomy of the subject and his family and, for
this, it is necessary to overcome the current
hegemonic model and to re-signify the care, the
way of caring, jointly constructing strategies to
promote health as a form of care between the
teenager who is cared for and the professionals
involved.4
It is considered the work with groups, such as
the one carried out in this research through SCM, a
care technology to be used by nurses in their
practice, in the scope of Collective Health. In
these dialogic spaces, the valuation of the
different knowledges and the possibility of
intervening creatively in the health-illness process
of each person are favored. The advantages of the
group's realization in facilitating the collective
construction of knowledge through reflection on
DISCUSSION
Marim TD, Partelli ANM. Social determinants in health from the...
J Nurs UFPE on line. 2019;13:e239114
https://doi.org/10.5205/1981-8963.2019.239114
the reality experienced by its components, and
the vertical relationship between the nurse and
the patient are broken, and facilitate the
expression of the needs and expectations.28
It is necessary that each individual seeks to
increase the degree of consciousness within the
problems of his time and space, seeking in the
dialogue a foundation within his values, seeking
equality, autonomy, respect for difference. It is
shown in this sense by Paulo Freire that the more
man seeks knowledge before the world, the more
he will be challenged to seek answers through
dialogue. Freirian pedagogy, because it is dialectic
and dialogical, is also considered critical and
creative, since it challenges man in overcoming
modernity, in order to construct new elements to
conceive human life in society, in a way
democratic and liberating, making stories and
transforming cultures.17,29
It is noticed that when adolescents were given
voice, they were identified that they identified
the social determinants and reflected how they
influence their lives and the community, this, by
the valorization of popular knowledge and
problematization according to the perspective of
Paulo Freire, enabling the adolescents to act in
the transformation of their reality, increasing the
capacity to make decisions and, consequently, to
soften future vulnerabilities.
Alternatives for health education should be
sought by health professionals, since the
repetition of information from professionals
outside the community life context does not
achieve the desired efficacy. By means of
experience, listening and dialogue, new truths can
be consolidated, concepts, practices and
behaviors can be consolidated in search of a
healthier life.
The study was limited, in this first phase, to the
photographic record and the discussion of the
findings with adolescents. The next step is to
continue the research with the socialization of
findings in the community by exposing
photographs recorded at the school and at the
neighborhood health unit. Another limitation is
related to the applicability of the study
methodology by health professionals due to the
high cost for the acquisition of the cameras by the
health services, however, this factor can be
overcome with the use, for example, of the
photographic camera present in the devices
mobile technology, since it is an increasingly
accessible technology for the popular classes.
One can contribute, through the bank of images
and narratives produced in the research, to the
development of educational materials such as
comic books, games and films. It is also stated,
through this research, that the nurse must include
the adolescent in the planning and development of
health actions through participative
methodologies, where knowledge of community
health needs becomes a continuous exchange and,
for this reason, In this way, the professional knows
where to act to develop health promotion actions
in the community that are really effective.
Foundation for Research and Innovation of
Espírito Santo - FAPES (Term of Grant: 890/2015).
To adolescents who participated in the study
and their relatives who authorized the
participation of adolescents.
1. Ministério da Saúde (BR), Conselho Nacional
de Saúde. Lei nº 8.080 de 19 de setembro de 1990.
Dispõe sobre as condições para a promoção,
proteção e recuperação da saúde, a organização e
o funcionamento dos serviços correspondentes e
dá outras providências [Internet]. Brasília:
Ministério da Saúde;1990 [cited 2018 Dec 02].
Available from:
http://conselho.saude.gov.br/legislacao/lei8080_
190990.htm
2. Silva KL, Sena RR, Akerman Marco, Belga SMM,
Rodrigues AT. lIntersectoriality, social and
environmental determinants and health
promotion. Ciênc Saúde Coletiva. 2014
Nov;19(11):4361-70. Doi:
http://dx.doi.org/10.1590/1413-
812320141911.10042014
3. Garbois JA, Sodré F, Dalbello-Araujo M. Social
determinants of health: the “social” in question.
Saúde soc. 2014 Oct/Dec;23(4):11-9. Doi:
http://dx.doi.org/10.1590/S0104-
12902014000400005
4. Lima FA, Galimbertti PA. Sentidos da
participação social na saúde para lideranças
comunitárias e profissionais da Estratégia Saúde da
Família do território de Vila União, em Sobral-CE.
Physis. 2016;26(1):157-75. Doi:
http://dx.doi.org/10.1590/S0103-
73312016000100010.
5. Partelli ANM, Cabral IE. Stories about alcohol
drinking in a quilombola Community: participatory
methodology for creatingvalidating A comic book
by adolescents. Texto contexto-enferm.
2017;26(4):1-12. Doi:
http://dx.doi.org/10.1590/0104-
07072017002820017
6. Correa Júnior AJS, Souza TCF, Sousa YM,
Polaro SHI, Santana ME, Silva SED, Carvalho JN.
Popular education in health, critical thinking and
the seven type of knowledge. J Nurs UFPE on line.
2018 Feb;12(2):537-45. Doi:
CONCLUSION
AKNOWLEDGEMENTS
REFERENCES
FUNDING
Marim TD, Partelli ANM. Social determinants in health from the...
J Nurs UFPE on line. 2019;13:e239114
https://doi.org/10.5205/1981-8963.2019.239114
https://doi.org/10.5205/1981-8963-
v12i2a231062p537-545-2018
7. Silva KL, Matos JAV, França BD. The
construction of permanent education in the
process of health work in the state of Minas
Gerais, Brazil. Esc Anna Nery Rev Enferm.
2017;21(4):1-8. Doi:
http://dx.doi.org/10.1590/2177-9465-ean-2017-
0060
8. Freire P. Pedagogia do oprimido. 49th ed. Rio
de Janeiro: Paz e Terra; 2007.
9. Ministério da Saúde (BR), Secretaria de
Atenção à Saúde, Departamento de Ações
Programáticas Estratégicas. Saúde do adolescente:
competências e habilidades [Internet]. Brasília:
Ministério da Saúde; 2008 [cited 2016 May 15].
Available from:
http://bvsms.saude.gov.br/bvs/publicacoes/saud
e_adolescente_competencias_habilidades.pdf
10. Ministério do Planejamento, Orçamento e
Gestão (BR), Instituto Brasileiro de Geografia e
Estatística. Censo 2010: população residente, por
situação do domicílio e sexo, segundo os grupos de
idade - Brasil – 2010 [Internet]. Rio de Janeiro:
IBGE; 2010 [cited 2016 May 13]. Available from:
http://www.ibge.gov.br/home/estatistica/popula
cao/censo2010/caracteristicas_da_populacao/tab
elas_pdf/tab1.pdf
11. Ministério da Saúde (BR), Secretaria de
Ciência, Tecnologia e Insumos Estratégicos,
Departamento de Ciência e Tecnologia. Agenda
nacional de prioridades de pesquisa em saúde
[Internet]. Brasília: Ministério da Saúde; 2008
[cited 2016 May 13]. Available from:
http://brasil.evipnet.org/wp-
content/uploads/2017/07/ANPPS.pdf
12. Oliveira MB, Cavalcante EGR, Oliveira DR,
Leite CEA, Machado MFAS. Health education as
practice of nurses in family health strategy. Rev
RENE. 2013;14(5):894-903. Doi:
http://dx.doi.org/10.15253/rev%20rene.v14i5.361
3
13. Coutinho VC, Dias AG. Curta SUS: the role of
the cinema and popular health education in
promoting Public Health. Rev Bras Pesq Saúde
[Internet]. 2016 Oct/Dec [cited 2017 Aug
03];18(4):46-54. Available from:
http://periodicos.ufes.br/RBPS/article/viewFile/1
6730/11560
14. Farre AGMC, Pinheiro PNC, Vieira NFC, Gubert
FA, Alves MDS, Monteiro EMLM. Adolescent health
promotion based on community-centered arts
education. Rev Bras Enferm. 2018
Jan/Feb;71(1):26-33. Doi:
http://dx.doi.org/10.1590/0034-7167-2016-0078
15. Hardy LJ, Hughes A, Hulen E, Figueroa A,
Evans C, Begay RC. Hiring the experts: best
practices for community-engaged research. Qual
Res. 2016 Oct;16(5):592-600. Doi:
10.1177/1468794115579474
16. Dias S, Gama A. Community-based
participatory research in public health: potentials
and challenges. Rev Panam Salud Pública. 2014
Feb;35(2):150-4. PMID: 24781097
17. Soratto J, Pires DEP, Cabral IE, Lazzari DD,
Witt RR, Sipriano CAS. A creative and sensitive
way to research. Rev Bras Enferm. 2014
Nov/Dec;67(6):994-9. Doi:
http://dx.doi.org/10.1590/0034-7167.2014670619
18. Ministério do Desenvolvimento Social e Agrário
(BR). Relatórios de Informações Sociais. [Internet].
Brasília: Ministério do Desenvolvimento Social e
Agrário; 2017 [cited 2017 May 15]. Available from:
https://aplicacoes.mds.gov.br/sagi/RIv3/geral/in
dex.php
19. Cabral IE, Neves ET. Pesquisar com o método
criativo e sensível na enfermagem: fundamentos
teóricos e aplicabilidade. In: Lacerda RM,
Costenaro RGS, organizadores. Metodologia da
pesquisa para a enfermagem: da teoria à prática.
Porto Alegre: Moriá; 2016.
20. Fernandes CS, Ferreira F, Marques G. The use
of the Photovoice methodology to determine the
concept of family which nursing students have. Av
Enferm. 2018;36(1):59-68 Doi:
http://dx.doi.org/10.15446/av.enferm.v36n1.639
88
21. Nykiforuk CIJ, Vallianatos H, Nieuwendyk LM.
Photovoice as a Method for Revealing Community
Perceptions of the Built and Social Environment.
Int J Qual Methods. [Internet]. 2011 Jan [cited
2018 Dec 1];10(2):3–26 PMID: 27390573
22. Bardin L. Análise de conteúdo. Lisboa: Edições
70; 2011.
23. Freire P. Conscientização: teoria e prática da
libertação: uma introdução ao pensamento de
Paulo Freire. São Paulo: Cortez & Morales; 2017.
24. Brazg T, Bekemeier B, Spigner C, Huebner CE.
Our Community in Focus: The Use of Photovoice
for Youth-Driven Substance Abuse Assessment and
Health Promotion. Health Promot Pract. 2011
July;12(4):502-11. Doi:
10.1177/1524839909358659
25. Oliveira E, Soares CB, Batista LL. Everyday
representations of young people about peripheral
areas. Rev Bras Enferm. 2016 Nov/Dec;69(6):1082-
8. Doi: http://dx.doi.org/10.1590/0034-7167-
2016-0387
26. Queiroz MVO, Brito LMMC, Pennafort VPS,
Bezerra FSM. Sensitizing children with diabetes to
self-care: Contributions to educational practice.
Esc Anna Nery Rev Enferm. 2016
Apr/June;20(02):337-43. Doi:
http://dx.doi.org/10.5935/1414-8145.20160046
27. Couto TA, Santos FPA, Rodrigues VP, Vilela
ABA, Machado JC, Jesus AS. Health education
under perspective of family health teams users. J
Nurs UFPE. 2016 May;10(5):1606-14. Doi:
Marim TD, Partelli ANM. Social determinants in health from the...
J Nurs UFPE on line. 2019;13:e239114
https://doi.org/10.5205/1981-8963.2019.239114
https://doi.org/10.5205/1981-8963-
v10i5a11156p1606-1614-2016
28. Candaten AE, Germani ARM. Educação em
saúde: Uma proposta educativo-reflexiva na
formação do enfermeiro. Rev Enferm [Internet].
2012 [cited 2017 May 03];8(8):192-207. Available
frrom:
http://revistas.fw.uri.br/index.php/revistadeenfe
rmagem/article/view/486/887
29. Zitkoski JJ. Paulo Freire e a Educação. Belo
Horizonte: Autêntica; 2006.
Submission: 2018/12/04 Accepted: 2019/04/23 Publishing: 2019/06/16
Corresponding Address
Adriana Nunes Moraes Partelli.
Email: [email protected]
All the contents of this article is licensed under a Creative Commons Atribuição 4.0 Internacional
Copyright of Journal of Nursing UFPE / Revista de Enfermagem UFPE is the property of Revista de Enfermagem UFPE and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
