Abstract

This study aimed to understand the use of technosociality in the daily lives of the Family Health Strategy clients during the COVID-19 pandemic for care and health promotion. This holistic, qualitative, multiple case study based on the Comprehensive Everyday Life Sociology was conducted with 61 clients from three Brazilian municipalities, two in Minas Gerais and one in Santa Catarina. The sources of evidence were the open-ended individual interview and field notes. We adopted thematic content analysis to analyze data. The use of virtual social networks and health technologies for care, monitoring, prevention of risks and conditions, health promotion, and access to information is found in clients’ daily lives. We highlight the importance of support and solidarity networks. The infodemic and misinformation about COVID-19 denote uncertainty about the veracity of information and concern about mental health. We should pay close attention to using technologies and social networks for health promotion, enabling strategies to enhance their use and minimize the indicated harms.

Key words:
Technology; Internet; Family Health Strategy; Social network; Health promotion

Introduction

Postmodernity has transformed the modus operandi of living, being, and acting, bringing new demands. Formed on a paradox that relates the archaic and the technological, this relationship enables new connection types between the tribes¹1 Maffesoli M. O tempo retorna: formas elementares da pós-modernidade. 1ª ed. Rio de Janeiro: Forense Universitária; 2012.. This technology-mediated interaction can be defined as technosociality²2 Maffesoli M. A ordem das coisas: Pensar a pós-modernidade. Rio de Janeiro: Forense; 2016.. In this sense, using technology and social networks is a new social behavior polarized in benefits and harms. In this context, incorporating information and communication technologies (ICT) in health is a tool that can enhance health promotion and healthcare. Technological tools draw clients and professionals closer with swift procedures and remote health monitoring³3 Santos AF, Fonseca Sobrinho D, Araújo LL, Procópio CSD, Lopes ÉAS, Lima AMLD, Reis CMR, Abreu DMX, Jorge AO, Matta-Machado AT. Incorporação de tecnologias de informação e comunicação e qualidade na Atenção Básica em Saúde no Brasil. Cad Saude Publica 2017; 33(5):e00172815..

Online platforms progressively become a place that enables communication on health-related issues, which increasingly contributes to clients moving from passive to active care and health promotion agents. Communicating health information can eliminate misinformation-related gaps to achieve greater integration promoted by mobile devices⁴4 Nittas V, Lun P, Ehrler F, Puhan MA, Mutsch M. Electronic patient-generated health data to facilitate disease prevention and health promotion: Scoping review. J Med Internet Res 2019; 21(10):e13320..

Although social media facilitate the circulation and communication of health information, the growth of technologies and social networks during the COVID-19 pandemic brought another reality: the infodemic and the circulation of fake news. The infodemic is characterized by an excess of information that hinders access to reliable sources of knowledge. The swift circulation of information and the elevated reach of reputable news can positively impact the promotion and recovery of health and the prevention of risks and illnesses, but this same agility and quick reach are ammunition for spreading fake news and misinformation, which were and are the primary challenge for the continuity of care for COVID-19 and other diseases⁵5 Garcia LP, Duarte E. Infodemia: excesso de quantidade em detrimento da qualidade das informações sobre a COVID-19. Epidemiol Serv Saude 2020; 29(4):e2020186..

Given the above, it becomes relevant to understand technosociality in the daily lives of people and households. We justify that this study approaches the indication of the Sustainable Development Goals when addressing the use of technologies and virtual social networks to promote the health and well-being of clients and their households, which corroborates the precision of equal access to the Internet and its tools to consider the universal use of information and communication technologies to ensure a healthy life for all⁶6 Organização das Nações Unidas (ONU). Objetivos de desenvolvimento sustentável [Internet]. 2022 [acessado 2022 abr 2]. Disponível em: https://odsbrasil.gov.br/.
https://odsbrasil.gov.br... .

Thus, the question is: what are the implications of using virtual social networks and health technologies in self-care production by Family Health Strategy (ESF) clients and their households? What are the strategies for good communication and preventing the spread of fake news adopted by ESF clients? The present study aimed to understand technosociality in the daily lives of ESF clients and their households during the COVID-19 pandemic for care and health promotion.

Methods

This holistic, qualitative, multiple-case study⁷7 Yin RK. Estudo de Caso: Planejamento e Métodos. Porto Alegre: Bookman editora; 2015. was based on the Comprehensive Everyday Life Sociology theoretical framework⁸8 Maffesoli M. O Conhecimento Comum - Introdução à Sociologia Compreensiva. Porto Alegre: SULINA; 2010.. The holistic, qualitative, multiple-case study is a recent, in-depth, and meaningful empirical investigation of an everyday object. It is developed from the research proposal, its implications, theoretical propositions, data collection and analysis, and discussion⁷7 Yin RK. Estudo de Caso: Planejamento e Métodos. Porto Alegre: Bookman editora; 2015..

The underlying theoretical framework of this study was based on the Comprehensive Everyday Life Sociology to analyze technosociality, establishing a balance between reason and emotion; that is, a sensitive reason⁸8 Maffesoli M. O Conhecimento Comum - Introdução à Sociologia Compreensiva. Porto Alegre: SULINA; 2010..

The research setting encompassed three Brazilian municipalities, one in the state of Santa Catarina (SC) and two in the state of Minas Gerais (MG), corresponding, respectively, to cases 1, 2, and 3. One hundred sixteen people were approached. Thirty-seven did not respond to the remote approach contact, and 18 refused to participate in this research, leaving out 61 participants. Fifty-three were ESF clients, and eight were clients of an Elderly Health Reference Center, as per the inclusion criteria of being 18 or older and answering for themselves. People with a condition that hindered their verbalization were excluded.

The sources of evidence were the individual open-ended interview, with a semi-structured roadmap of questions to characterize the participants and 13 questions to analyze further the research object, along with field notes used to record data collection methodological and theoretical information. Data were collected from April to October 2021.

Respondents for cases 1 and 2 were collected remotely due to the need for preventive measures because of the red and purple wave classification of the COVID-19 pandemic. The initial contact was made with the head of the ESF teams for indication and initial approach of the clients and invitation to participate in this research using electronic means, such as email or WhatsApp. Up to five attempts were made to contact the clients; many have yet to respond on the first contact. The ICF was sent through the Google Forms platform, with an appropriate place for the invitees to express their acceptance and enter their data. All interviews were recorded on the Google Meet platform after client consent. The snowball sampling technique was adopted in cases 1 and 2, which uses referral networks in which participating people are asked to indicate other people until data saturation is reached⁹9 Baldin N, Munhoz EMB. Educação ambiental comunitária: uma experiência com a técnica de pesquisa snowball (bola de neve). Rev Eletr Mestr Edu Ambient 2011; 27:46-60..

Case 3 data were collected in person. The ESF units were stipulated through a random draw. The order of this draw was respected until data saturation, reaching six ESF units and eight teams, to which clients participating in this study are registered and monitored. The participants were those present on the day of data collection at the ESF units, observing the inclusion and exclusion criteria. The interviews were held in a private room, strictly observing the SARS-CoV-2 control and dissemination measures, and were audio-recorded following participants’ consent. The ICF was drafted in two copies and read to the participants before the beginning of the interviews, besides granting enough time so that the invitees could express their free and informed will to participate in the research, formalized by signing both copies.

An alphanumeric codename (E1, E2, E3) was used to ensure the participants’ anonymity. The description of the studied population’s characteristics is shown in Figure 1.

Data analysis was outlined by semantic criteria grounded on the Thematic Content Analysis technique¹⁰10 Bardin L. Análise de conteúdo. 1ª ed. Lisboa: Edições 70; 2011., observing the analytical cross-case synthesis technique. Three thematic categories originated from the analysis, and this article discusses the category of “Virtual social networks and health technologies in the daily lives of clients and households: care and health promotion”.

The Research Ethics Committee of the Federal University of São João del-Rei approved the study under Opinion No. 4.538.343. Resolution No. 466, of December 12, 2012, of the National Health Council, and Resolution No. 510, of April 7, 2016, were observed. The recommendations of the Consolidated criteria for Reporting Qualitative research (COREQ) were considered.

Results

The results presented in two subcategories denote possibilities for using virtual social networks and health technologies for care and health promotion in the daily lives of clients and households monitored by the ESF teams in different settings, despite the infodemic and misinformation about COVID-19.

Virtual social networks and health technologies in care and health promotion

In everyday life, even if clients say they do not know about health promotion, its notions are revealed in the clients’ voices:

When their understanding of health promotion was questioned, most participants answered: “Health promotion? I don’t know what to answer”. However, after clarification and another way of asking, “What do you understand about health promotion, and what do you do to promote health?”, most of the respondents responded by highlighting what they did to promote health, almost always emphasizing food, physical activity, and leisure.

The interviewed clients talk about the use of virtual social networks for care, prevention of risks and conditions, and health promotion:

The use of social networks was very much alive in the daily lives of people and households. Some participants used it to help disseminate health facility information. In turn, the health team used it to monitor patients diagnosed with COVID-19, per information from clients who had the disease or their relatives.

The use of technologies for care, monitoring, and health promotion in the daily lives of clients emerges from the results:

Promoting health through the use of applications becomes a reality in the daily lives of participants during pregnancy. Telemedicine was recognized as a facility with great potential for appointments and monitoring of COVID-19 cases and people with chronic conditions.

The use of health technologies for scheduling tests and accessing results becomes a frequent action in the clients’ voices:

Health technologies are also used by ESF clients to access medication:

The participants of this study talk about the use of WhatsApp for healthcare:

Clients talk about the impact of virtual social networks on access to information and health care:

The reports highlight the importance of support and solidarity networks in the pandemic context:

We take care. We do not believe everything we see [...] So, somehow, we know. We are on top of things and are warned [...] It is care provided by the people of our organization (religious organization). So, I’m well supported there. People care a lot, and I feel more protected (E3).

Infodemic and misinformation about COVID-19 and mental health care

Care in sharing news on social networks appears as a concern in the voice of respondents:

In the context of the high demand for news received daily, there is uncertainty about the veracity of the disseminated information:

Faced with the plethora of information available on the Internet, clients address the circulation of information about COVID-19 and mental health care:

Discussion

Given the results, one can infer the incredible impact of using health technologies and virtual social networks for health promotion, risk, illness prevention, health care and monitoring, access to information, and the importance of support networks in everyday life. Furthermore, using these technologies and social networks also interferes with the infodemic and misinformation about COVID-19 and mental health care.

Thus, understanding the clients’ view of health promotion in this study, despite the complex social determinants of health and their understanding, was vital as it showed that the singular notions of health promotion reflect, mainly, the incentive to good dietary practices and physical activity routine.

Health promotion consists of a vast network of strategies and actions, including public, private, individual, and collective resources to improve individuals’ life quality and condition¹¹11 Buss PM, Hartz ZMA, Pinto LF, Rocha CMF. Promoção da saúde e qualidade de vida: Uma perspectiva histórica ao longo dos últimos 40 anos (1980-2020). Cien Saude Colet 2020; 25(12):4723-4735.. Although the topic is challenging, the clients’ notions are part of the National Health Promotion Policy, which, among the priority themes to promote health, highlights the relevance of actions targeting adequate nutrition and physical activity, encouraging their incorporation into people’s lives, besides offering what is possible and accessible for each individual’s subjectivity, so that socioeconomic and inclusive issues are considered to guarantee human rights to all¹²12 Brasil. Ministério da Saúde (MS). Secretaria de Vigilância em Saúde. Secretaria de Atenção à Saúde. Política Nacional de Promoção da Saúde. Anexo I da Portaria de Consolidação nº 2, de 28 de setembro de 2017 [Internet]. Brasília: MS, 2018 [acessado 2022 abr 2]. Disponível em: https://bvsms.saude.gov.br/bvs/publicacoes/politica_nacional_promocao_saude.pdf..

Besides the scope of actions to be developed face-to-face with clients in the daily life of health services, technology and virtual social networks are essential tools to expand clients’ access to information, choose a healthier lifestyle that influences behaviors for health promotion and recovery, and prevent risks and illnesses. These tools gained even more prominence during the COVID-19 pandemic, as social distancing provided more significant contact with technologies and even the obligation to use them to access several services that started to be provided remotely. In this setting, technologies and, especially, applications are potential mechanisms for producing knowledge and democratizing access to scientific knowledge¹³13 Pereira LM, Leite PL, Torres FAF, Bezerra AM, Vieira CMA, Machado LDS, Silva MRF. Tecnologias educacionais para a promoção da saúde de adolescentes: evidências da literatura. Rev Enferm UFPE online. 2021; 15(1):e247457..

The WhatsApp application is an entertainment and communication technology that has become an essential ally in promoting health. It enables interaction with health units, scheduling appointments, delivering test results, and developing health education/support groups. Therefore, WhatsApp is a tool that allows health control, emergency measures, and information dissemination, hugely impacting the behavior of clients and households in a short time¹⁴14 Stringhini MLF, Chagas JS, Reis MJM, Brito PRT, Souza DS. Whatsapp como ferramenta de promoção da saúde com diabetes: relato de experiência. Rev UFG 2019; 19:1-15.. The present study corroborated these findings.

Given the pandemic, it was necessary to create new ways of producing health and enabling care by health professionals. Most countries have adopted strict lockdowns due to the high SARS-CoV-2 virus transmission rate, which has hindered physical contact and communication¹⁵15 Fagherazzi G, Goetzinger C, Rashid MA, Aguayo GA, Huiart L. Digital Health Strategies to Fight COVID-19 Worldwide: Challenges, Recommendations, and a Call for Papers. J Med Internet Res 2020; 22(6):e.19284.. The use of technologies emerges as an aid to the health system, highlighting the use of telemedicine/telehealth in its most different forms: online appointments; telemonitoring; sensors used as trackers that allow clients to avoid places with a higher infection risk; and Chatbots, offering recommendations. Moreover, telemedicine has other advantages, such as convenience, accessible health information, and low cost¹⁶16 Vidal-Alaball J, Acosta-Roja R, Pastor Hernández N, Sanchez Luque U, Morrison D, Narejos Pérez S, Perez-Llano J, Salvador Vèrges A, López Seguí F. Telemedicine in the face of the COVID-19 pandemic. Aten Primaria 2020; 52(6):418-422..

The benefits indicated by telehealth are significant and associated with a shorter diagnosis and treatment initiation time. It allows continuous patient monitoring without needing to be done entirely in person, assisting in managing medical resources and providing real-time access to information. An example of using health technologies to support the health system occurred in the Spanish region of Catalonia, with the implementation of a monitoring system in Primary Health Care to follow up on the patients’ symptoms through calls. The patients were (re)admitted to the hospital if it was detected that the patients’ conditions deteriorated. This intervention offered continuous and longitudinal care. Concomitantly, the medical prescription was sent to the clients’ electronic medical records for the electronic system of pharmacies, and the medications were offered to the patient¹⁶16 Vidal-Alaball J, Acosta-Roja R, Pastor Hernández N, Sanchez Luque U, Morrison D, Narejos Pérez S, Perez-Llano J, Salvador Vèrges A, López Seguí F. Telemedicine in the face of the COVID-19 pandemic. Aten Primaria 2020; 52(6):418-422..

The short-term impact on health is one of the benefits of using technologies in general. The tool configuring this speed was the online appointments/telehealth in the COVID-19 pandemic, which was pointed out in the present study. Although telehealth is still a significant challenge for the Brazilian reality, this tool shortens the geographical distance between patients and health professionals. It must guarantee the security of data generated online to support health care effectively, even physically distant¹⁷17 Catapan SC, Calvo MCM. Teleconsulta: uma revisão integrativa da interação médico- paciente mediada pela tecnologia. Rev Bras Educ Med 2020; 44(1):e003..

In this sense, other technological tools are developed for the same purpose, like the Registration and Monitoring System for Hypertensive and Diabetic Patients (HiperDia). HiperDia follows up and monitors clients with arterial hypertension or diabetes, improving the care provided by the health professionals, increasing treatment adherence, and following up on patients in secondary/tertiary prevention actions and against the disease(s)¹⁸18 Teixeira LM, Oliveira AG, Rosa DMA, Simão IP, Souza GO, Sousa JKA, Souza LC, Anjos RB, Sousa RF, Ferreira VL, Monteiro YC, Lima IOF. Utilização de recurso tecnológico para estratificação de risco cardiovascular em usuários do programa hiperdia: relato de experiência. Rev Eletr Acerv Saude 2019; 27(27):1-6..

By declaring the importance of support and solidarity networks in the COVID-19 pandemic, the present study identifies that increasingly postmodern values are emerging, fundamental values of exchange, sharing, and cultural and spiritual values overlooked in modernity¹⁹19 Maffesoli M. Pensar o (im)pensável: Instituto Ciência e Fé e PUCPRESS debatem a pandemia [Internet]. 2020 [acessado 2021 dez 16]. Disponível em: http://doi.org/10.7213/pensarimpensavel.001.
http://doi.org/10.7213/pensarimpensavel.... .

One study observed a positive relationship between internet use and improved diet quality, especially if the internet user was primarily responsible for preparing the family’s meals, corroborating the present study’s findings²⁰20 Ma E, Jin X. Does Internet Use Connect Us to a Healthy Diet? Evidence from Rural China. Nutrients 2022; 14:2630..

Given the above considerations, the power of technology for health and access to information is evident. Virtual social networks and applications obtain information about strategies that improve well-being and quality of life. However, the polarized use of technologies and social networks is remarkable. The association of technology and health is not only beneficial. The harm of this use is evidenced by the excessive amount of circulating information, its uncertainty and impact on mental health. These aspects were enhanced during the COVID-19 pandemic, as the globalized infodemic generated more uncertainty, increased the circulation of famous fake news, and distanced the population from accessing reliable content. In this context, technology can contribute to weakening science and medicine²¹21 Zanatta ET, Wanderley GPM, Branco IK, Pereira D, Kato LH, Maluf EMCP. Fake news: the impact of the internet on population health. Rev Assoc Med Bras 2021; 67(7):926-930..

Maffesoli¹1 Maffesoli M. O tempo retorna: formas elementares da pós-modernidade. 1ª ed. Rio de Janeiro: Forense Universitária; 2012. affirms that:

The spread of fake news is a potential aggravating factor for the mental health of individuals, especially during the COVID-19 pandemic. The infodemic is an adverse result of globality and access speed driven by the Internet. It contributes to risky behavior based on untruths²²22 Giordani RCF, Donasolo JPG; Ames VDB, Giordani RL. A ciência entre a infodemia e outras narrativas da pós-verdade: desafios em tempos de pandemia. Cien Saude Colet 2021; 26(7):2863-2872. and directly affects the mental quality of clients and households who, in an instability and social distancing situation, are bombarded with sensational news, which infers a more significant mental impact²³23 Faro A, Bahiano MA, Nakano TC, Reis C, Silva BFP, Vitti LS. COVID-19 e saúde mental: a emergência do cuidado. Estud Psico 2020; 37:e200074..

Final considerations

The association between technology and health in clients’ daily lives is a tremendous challenge of postmodernity and is becoming increasingly present in Primary Care. In the present study, its impact on the health and quality of life of clients can be evidenced in benefits and harms: if, on the one hand, technology favors access to some health resources, such as medication, test appointments, disease monitoring chronicles and teleconsultations, on the other hand, technology elitizes knowledge, favors the spread of fake news, impairs the socialization of individuals, and incites a virtual utopia that makes people sick. This duality triggers critical reflections and highlights the transitional moment of society between modern and postmodern values.

The benefits of technological contribution to health are undeniable since it allows streamlining procedures and appointments; access to contents that prevent risks and promote and restore health is easy; virtual social network tools shorten physical distances, enhance care, and facilitate access to information and distance follow-up, as denoted in this study. That is, technology has become a tool that supports healthcare quality and continuity.

However, while this easy access to technologies and virtual social networks promotes positive aspects, it generates uncertainty and insecurity in the daily lives of its clients, such as the infodemic, very evident in the COVID-19 pandemic, ratified in this work. The avalanche of news allows the quick circulation of untruths and socializes them and contributes to the mental illness of clients.

The limitation of this research is due to the purposeful sampling of ESF clients, representing a subgroup of the community. However, in multiple holistic-qualitative cases, purposeful sampling can represent groups with similar characteristics. Understanding technosociality in the daily life of ESF clients contributes to the health and nursing area by pointing out its strategic use for care and health promotion actions.

References

Publication Dates

History