The Silences Framework: Metodologia Para Pesquisas De Temas Sensíveis E Perspectivas Marginalizadas Na Saúde

Abstract

Objective: to describe the experience of applying of The Silences Framework to underpin health research investigating Tuberculosis/ HIV/AIDS coinfection.Method: the Silences Framework originally developed following a study exploring the decisions and silences surrounding black Caribbean men living in England, discussing the themes 'sexual health' and 'ethnicity'. Following this study, a conceptual theory for research on sensitive issues and health care of marginalized populations was developed called 'Screaming Silences', which forms the foundation of The Silences Framework. 'Screaming Silences' define research areas and experiences that are poorly studied, little understood or silenced.Results: the Silences Framework supports researchers in revealing "silences" in the subjects they study -as such, results may reflect how beliefs, values, and experiences of some groups influence their health. This framework provides the application of four complementary stages: working the silences, hearing silences, voicing silences and working with the silences. The analysis occurs cyclically and can be repeated as long as the silences inherent in a study are not revealed. Conclusion: this article presentsThe Silences Framework and the application of the notion of "sounds of silence", mapping an antiessentialist theoretical framework for its use in sensitive research in health and nursing areas, being a reference for other researchers in studies involving marginalized populations. DESCRIPTORS:Inequalities in health. Methods. Nursing. Coinfection. Research. Tuberculosis. Acquired immunodeficiency syndrome. THE SILENCES FRAMEWORK: METODOLOGIA PARA PESQUISAS DE TEMAS SENSÍVEIS E PERSPECTIVAS MARGINALIZADAS NA SAÚDE RESUMOObjetivo: descrever a utilização da metodologia The Silences Framework em uma pesquisa na área da saúde, envolvendo a temática da coinfecção tuberculose/HIV/aids.Método: a metodologia foi originalmente utilizada para estudar decisões e silêncios de homens negros do Caribe que viviam na Inglaterra, problematizando-se os temas 'saúde sexual' e 'etnicidade' e resultando em uma teoria para a pesquisa de questões sensíveis e de cuidados de saúde de populações marginalizadas. The Silences Framework define áreas de pesquisa e experiências que são pouco estudadas, compreendidas ou silenciadas.Resultados: os "silêncios" podem refletir aspectos não compartilhados sobre como crenças, valores e experiências de alguns grupos influenciam sua saúde. Esse referencial prevê a aplicação de quatro estágios complementares: trabalhando os silêncios, ouvindo os silêncios, dando voz aos silêncios e trabalhando com os silêncios. A análise ocorre de modo cíclico e pode ser repetida enquanto os silêncios não forem desvelados.Conclusão: este artigo apresenta a noção de "sons do silêncio", mapeando um quadro teórico antiessencialista para sua utilização em pesquisas sensíveis na area da saúde e da enfermagem, podendo ser referência para outros investigadores em estudos envolvendo populações marginalizadas. DESCRITORES: THE SILENCES...

Coinfecção tuberculose/HIV/aids em Porto Alegre, RS - invisibilidade e silenciamento dos grupos mais afetados

“…The research was developed through the methodology of The Sound of Silence, in four different stages (3)(4)(5)(6)(7) . In the first, a literature review was carried out to delimit the research object.…”

“…Data analysis (fourth stage) followed the guidelines proposed in the theoretical framework of The Sound of Silence methodology (3)(4)(5)(6)(7) . The interviews were transcribed and read with the desire to find units of analysis (words or phrases) that could be grouped into common units, referring to the objective of analyzing how belonging to certain social groups contributed to constituting the vulnerabilities associated with TB/HIV/AIDS coinfection.…”

“…In order to understand how and why, in the context of tuberculosis and AIDS, certain people are sicker than others, the study has incorporated the referential of the determinants of the health and disease process in the analysis, to examine environmental, behavioral, cultural and social factors related to vulnerability to these diseases (3)(4) .…”

“…In 2016, in Porto Alegre, to contribute to the knowledge of these themes, a study was developed to analyze social processes that silence the voices of certain groups affected by coinfection (3) . Porto Alegre is the second Brazilian capital with the highest incidence of TB, the first in HIV/ AIDS incidence, and the highest proportion of coinfection in the country, with 25% of cases of TB diagnosed in people living with HIV (1) .…”

Silenced Knowing: An Intersectional Framework for Exploring Black Women's Health and Diasporic Identities

“…The Silences Framework has been used in a range of empirical studies, which centralize previously hidden or marginalized aspects of human experience in specific contexts that are deemed "sensitive." These have included studies of experiences of health provision for newly released offenders (Eshareturi et al, 2015;Eshareturi et al, 2014), exploration of HIV stigma within Black Sub-Saharan African communities residing in the UK (Nyashanu and Serrant, 2016), living with comorbidities of HIV and Tuberculosis in Brazil (Rossetto et al, 2018) and the recovery experiences of young adults following proximal fracture of the femur following a low velocity fall (Janes et al, 2018) with further studies currently underway.…”