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A presente tese resultou do estudo realizado com o propósito da obtenção do grau de doutor em enfermagem, na Universidade Católica Portuguesa. Incide sobre a saúde dos adolescentes em contextos de pobreza urbana, mais precisamente, na periferia urbana da cidade de Lisboa, nos concelhos da Amadora e Sintra. Este estudo foi impulsionado por um conjunto de fatores, sendo que, o fundamental, foi poder contribuir para uma reflexão sobre os modos de erradicar a pobreza infantil e as desigualdades desvelando o mistério da saúde (unraveling the mistery of health), como proposto por Aaron Antonovsky na sua Teoria Salutogénica e, por vários autores, dedicados ao estudo da Resiliência. O estudo parte de um problema de investigação, a saber, a saúde dos adolescentes em contextos de pobreza. Deste problema resultou a questão central da investigação: Por que razão adolescentes que vivem em situação de pobreza, escolhem ter um estilo de vida promotor de saúde, apesar das circunstâncias adversas que rodeiam as suas vidas? A questão de investigação formulada deu origem a objetivos, a saber, identificar o estilo de vida de adolescentes que vivem em contextos de pobreza; analisar a relação que existe entre auto-eficácia, locus de controlo, sentido de coerência e resiliência de adolescentes que vivem em contextos de pobreza e um estilo de vida promotor de saúde; analisar a relação que existe entre fatores de ordem individual e fatores de ordem contextual que enformam e reproduzem os estilos de vida individuais; analisar, na perspetiva de adolescentes que vivem em contextos de pobreza, a relação que existe entre a experiência de ser pobre e um estilo de vida promotor de saúde. Para estes objetivos recorreu-se a um desenho de métodos mistos com uma estratégia sequencial: QUAN→qual de tipo exploratório-descritivo e explicativo. Na componente quantitativa utilizaram-se inquéritos por questionário e participaram 270 adolescentes. Na componente suplementar recorreu-se à entrevista semi-estruturada a 10 adolescentes. A tese inclui um enquadramento teórico do estudo (Parte I), onde se identifica o conhecimento atual na área da pobreza, pobreza infantil, desigualdades em saúde, políticas saudáveis e resiliência de adolescentes em contextos de pobreza. Ancoramo-nos em Amartya Sen quanto à equidade em saúde e, em, Antonovsky, Bronfenbrenner, Dahlgren, Whitehead e Pender na ligação de um estilo de vida promotor de saúde a um contexto social determinado. A parte II é dedicada à Investigação Empírica. Nesta parte reportamos a Metodologia (Capítulo I), a Apresentação de Resultados (Capítulo II) e a Discussão de Resultados (Capítulo III). A parte III é dedicada às Conclusões Gerais, Implicações e Sugestões. Como principais resultados relevamos: 1) a saúde dos pobres pior que a dos não-pobres 2) a construção do processo de resiliência dos adolescentes em contextos de pobreza urbana, faz-se no diálogo entre: a pertença a um nível socioeconómico baixo e a vivência de episódios de adversidade; os fatores individuais - valores favoráveis de sentido de coerência, auto-eficácia e resiliência - e, fatores contextuais, como famílias acolhedoras e de suporte, existência de pessoas significativas e a participação em atividades promotoras da saúde e bem-estar. O crescimento espiritual e as relações interpessoais são os comportamentos de saúde mais relacionados com um estilo de vida promotor de saúde no grupo dos pobres e dos não-pobres, quando associados aos fatores individuais e contextuais, evidenciando o grupo dos não-pobres valores igualmente favoráveis na nutrição, gestão do stress e atividade física. Nos dois grupos, o comportamento de saúde menos favorável foi a responsabilidade.
This thesis is the result of a study that was made with the objective of obtaining the PhD degree in Nursing in the Universidade Católica Portuguesa. It is based on the adolescent’s health in contexts of urban poverty, more precisely, in the urban periphery of the city of Lisbon, in the municipalities of Amadora and Sintra. This study was leveraged through a set of factors, being that the fundamental one was being able to contribute to a reflection on the ways of eradicating child poverty and inequalities “unravelling the mystery of health” as it was proposed by Aaron Antonovsky in its Salutogenesis Theory, and also by various authors dedicated to the study of Resilience. The current study develops from a research problem – the health of adolescents in contexts of poverty. From this problem the main research question was defined namely, why adolescents that live in poverty choose to have a health promoting lifestyle, despite the adverse circumstances that characterize their lives? Through the analysis of this research question the following objectives were defined: to identify the lifestyle of the adolescents that live in a context of poverty; to analyze the relation that exists between auto- efficacy, locus of control, sense of coherence and resilience of adolescents that live in poverty contexts, and a health promoting lifestyle; to analyze the relation that exists between individual related factors and contextual related factors that give form and reproduce individual lifestyles; to analyze, through the perspective of adolescents that live in poverty contexts, the relation that exists between the experience of being poor and a health promoting lifestyle. For these objectives it was designed a mixed methods approach with a sequential strategy: QUAN→qual of exploratory-descriptive and explanatory type. In the quantitative component it was used surveys by questionnaire with the participation of 270 students. In the supplementary component it was used a semi-structured interview to 10 adolescents. The current PhD thesis, is structured around a theoretical analysis (Part I), in which it is identified the current state of the art on the research on poverty, child poverty, health inequalities, and health promoting policies and adolescent’s resilience in poverty contexts. This analysis is framed by Amartya Sen in what regards health equity, and also by Antonovsky, Bronfenbrenner, Dahlgren, Whitehead e Pender in what regards the connection between a health promoting lifestyle and a determined social context. Part II is centered around the Empirical Research, namely the Methodology (Chapter I), Presentation of Results (Chapter II), and Discussion and Results (Chapter III). Part III is related to the General Conclusions, Implications and Suggestions. The following main results were obtained: 1) the health of the poor is worse than the health of the non-poor; 2) the construction of the adolescent’sresilience process in contexts of urban poverty is made through the dialogue between: having a low socioeconomic status and living adverse situations; individual factors – favorable values of sense of coherence, auto-efficacy and resilience – and, contextual factors, as are foster and support families, the existence of significant others, and the participation in health promoting and wellbeing activities. The spiritual growth and interpersonal relations are the health behaviors which are more related with a health promoting lifestyle in the groups of the poor and non-poor, when related with individual and contextual factors, demonstrating the group of the non-poor equally favorable values in nutrition, stress management and physical activity. In the two groups the less favorable health behavior was the responsibility.
This thesis is the result of a study that was made with the objective of obtaining the PhD degree in Nursing in the Universidade Católica Portuguesa. It is based on the adolescent’s health in contexts of urban poverty, more precisely, in the urban periphery of the city of Lisbon, in the municipalities of Amadora and Sintra. This study was leveraged through a set of factors, being that the fundamental one was being able to contribute to a reflection on the ways of eradicating child poverty and inequalities “unravelling the mystery of health” as it was proposed by Aaron Antonovsky in its Salutogenesis Theory, and also by various authors dedicated to the study of Resilience. The current study develops from a research problem – the health of adolescents in contexts of poverty. From this problem the main research question was defined namely, why adolescents that live in poverty choose to have a health promoting lifestyle, despite the adverse circumstances that characterize their lives? Through the analysis of this research question the following objectives were defined: to identify the lifestyle of the adolescents that live in a context of poverty; to analyze the relation that exists between auto- efficacy, locus of control, sense of coherence and resilience of adolescents that live in poverty contexts, and a health promoting lifestyle; to analyze the relation that exists between individual related factors and contextual related factors that give form and reproduce individual lifestyles; to analyze, through the perspective of adolescents that live in poverty contexts, the relation that exists between the experience of being poor and a health promoting lifestyle. For these objectives it was designed a mixed methods approach with a sequential strategy: QUAN→qual of exploratory-descriptive and explanatory type. In the quantitative component it was used surveys by questionnaire with the participation of 270 students. In the supplementary component it was used a semi-structured interview to 10 adolescents. The current PhD thesis, is structured around a theoretical analysis (Part I), in which it is identified the current state of the art on the research on poverty, child poverty, health inequalities, and health promoting policies and adolescent’s resilience in poverty contexts. This analysis is framed by Amartya Sen in what regards health equity, and also by Antonovsky, Bronfenbrenner, Dahlgren, Whitehead e Pender in what regards the connection between a health promoting lifestyle and a determined social context. Part II is centered around the Empirical Research, namely the Methodology (Chapter I), Presentation of Results (Chapter II), and Discussion and Results (Chapter III). Part III is related to the General Conclusions, Implications and Suggestions. The following main results were obtained: 1) the health of the poor is worse than the health of the non-poor; 2) the construction of the adolescent’sresilience process in contexts of urban poverty is made through the dialogue between: having a low socioeconomic status and living adverse situations; individual factors – favorable values of sense of coherence, auto-efficacy and resilience – and, contextual factors, as are foster and support families, the existence of significant others, and the participation in health promoting and wellbeing activities. The spiritual growth and interpersonal relations are the health behaviors which are more related with a health promoting lifestyle in the groups of the poor and non-poor, when related with individual and contextual factors, demonstrating the group of the non-poor equally favorable values in nutrition, stress management and physical activity. In the two groups the less favorable health behavior was the responsibility.
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Keywords
Pobreza infantil Desigualdades Resiliência Promoção da saúde Child poverty Inequalities Resilience Health promotion