Experiences of adult men in criminal proceedings for domestic violence regarding self-care and health: a qualitative study

Fernanda Araújo Valle Matheus¹, Andrey Ferreira da Silva², Selton Diniz dos Santos³, Nadirlene Pereira Gomes⁴, Anderson Reis de Sousa⁵, Júlia Renata Fernandes de Magalhães⁶

^1,3State University of Feira de Santana. Feira de Santana (BA), Brazil. ²Federal University of Alagoas. Arapiraca (AL), Brazil. ^4,5Federal University of Bahia. Salvador (BA), Brazil. ⁶State University of Bahia. Guanambi (BA), Brazil.

Introduction

Men's health care and care delivery have been discussed in public policies, whether due to the low demand for health services by men, the need to encourage them to adopt health-promoting behaviors by rethinking constructions and patterns of masculinity, or the high morbidity and mortality rate from preventable conditions, which are mostly the result of external causes, with a significant impact on violence.¹

National health actions addressing this phenomenon include the creation of the National Policy for Comprehensive Men's Health Care (PNAISH) in 2008. This policy aims to achieve gender equality in health by bringing these users closer together and encouraging their participation in health actions. This policy constitutes a socio-historical and political milestone in Latin America, being the first with this focus, incorporating the concept of gender.² The implementation of this policy established the definition of priority areas for action, grouped into thematic areas, which include: access and care; diseases prevalent in the male population; sexual and reproductive health; parenting and care; Health promotion and prevention of violence and accidents.²

Despite the creation of the policy and its structuring into priority areas, there is a gap in men's access to health services, evidenced by the lower male life expectancy than female life expectancy, resulting in a high incidence of male illness.³ These data are influenced by the presence, in the social construction of men, of identity markers that govern male behavior, such as strength, dominance, and virility. These are identified as elements that allow us to understand men's resistance¹ to recognizing their health needs, which can result in violence, especially within the conjugal relationship.⁴

Given this scenario, some men, especially those experiencing situations of conjugal violence as perpetrators, underestimate the illness or do not seek these health services for fear of being reported and facing legal and police sanctions.⁵ Regardless of the interface with conjugal violence, it is emergency situations that generally increase men's demand for health services, precisely when they need it. medium- and high-complexity care or intensive care, which explains the higher morbidity and mortality rates among this population¹ and the need for preventive and health promotion actions, including those related to the recognition of abusive relationships within the marital sphere that directly or indirectly impact their health and quality of life. Some studies have reported that the perpetration of domestic violence by men is strongly associated with sociocultural, historical, and psychosocial factors. Key factors include male socialization based on norms of virility, control, and domination, as well as prior exposure to domestic violence in childhood.³

Given this context, the social importance of PNAISH is understood, as is the urgency of understanding male discourses and behaviors and their relationship with health. This understanding can deconstruct issues that lead to illness and involvement in harmful situations, such as neglect of health and/or the implications of domestic or urban violence. This involves awareness-raising strategies and access to Primary Health Care (PHC) for this population.² Considering the importance of male involvement in domestic violence prevention actions that favor recognition of both perpetrators and victims, as well as the implications of this violence for individual, family, and collective health and quality of life, the study addresses the following research questions: What are the experiences of adult men in criminal proceedings for domestic violence regarding self-care and health? What are the interfaces with the PNAISH priority axes? Based on this policy, which addresses issues related to men's health in the Brazilian context, the objective of the study was defined as: to describe the experiences of adult men in criminal proceedings for domestic violence regarding self-care and health, and their interrelationships with the priority axes of the PNAISH.

Method

This is a qualitative, action-research study, understood as empirically based social research whose proposal is articulated with an action aimed at preventing, minimizing, and/or resolving a specific problem of collective interest. It is composed of the following phases: diagnosis, action planning, action execution, evaluation, and data analysis.⁶ It is noteworthy that the focus of this article refers to the action-research phase related to the execution of actions.

The study is a project in partnership with the First and Second Courts of Justice for Peace in the Home of the municipality of Salvador, Bahia, Brazil, in collaboration with public schools, departments, and health units in the PHC system. In these locations, Reflective Groups (RG) were held with men in criminal proceedings for domestic violence, complying with Law No. 11,340,^7-8 which recommends in its article 45 the participation of men in reeducation groups. The term "Reflective Groups" refers to a constructivist method used to actively and reflectively construct and produce theoretical and practical knowledge, enabling dialogue, the circulation of discourse, and the production of collective discourse.⁸ This technique, commonly used in health education activities, was used to actively and reflectively construct and produce theoretical and practical knowledge, promoting dialogic exchange. During the GR, two facilitators with training in the health field participated, both doctoral students studying the topic and fully trained to conduct the activity. This favored the process of welcoming participants and contributed to the creation of an environment conducive to sharing experiences.

During the GR, eight health education activities were conducted, addressing the following themes: the influence of the family on the formation of the "self"; the social construction of gender inequality; masculinities and the formation of the "new man"; men's health and the encouragement of self-care; Perception of violent behavior and peaceful conflict resolution.⁷

Forty-six men were referred by the aforementioned violence courts. Of these, 44 participated in the study, as they met the inclusion criteria: being charged with domestic violence and having participated in the RG meeting entitled: "Men's Health and the Encouragement of Self-Care." Two men were excluded because they did not present psycho-emotional conditions, as assessed by a psychologist affiliated with the aforementioned courts. Five cycles were conducted: the first, second, and fifth cycles consisted of nine men; the third cycle, 14 men; and the fourth, three men, totaling 44 men.

Participants were instructed on the ethical principles contained in Resolutions No. 466/12 and No. 510/2016 and signed the Informed Consent Form (ICF). The study was approved by the Research Ethics Committee (CEP) of the Federal University of Bahia (UFBA) under opinion number 6.603.953.

Data collection took place during a health education activity entitled "Men's Health and the Encouragement of Self-Care," which aimed to raise awareness of diseases/conditions to which the male population is vulnerable due to "being a man" and to encourage self-care. During this activity, the men participated in a human board game designed based on the theoretical frameworks recommended by the National Institute of Health (PNAISH).

For each framework, the facilitator posed guiding questions to encourage participants to share "whatever came to mind," with a view to deepening the topic and fostering potential discussion. The questions were: "Access and Reception" asked: "Do you regularly use health services? Tell us about your experience"; "Injuries and Chronic Conditions in the Male Population" asked: "How is your health and what have you done to take care of it?"; "Sexual and Reproductive Health" asked: "What is your opinion on condom use?"; "Fatherhood and Care" asked: "Do you have a child? If so, have you had the opportunity to accompany your wife to prenatal care? Tell us about your experience"; and "Prevention of Violence and Accidents" asked: "Have you ever been involved in an accident or violent situation? If so, tell us about it."

The health education activities lasted an average of 90 minutes and were recorded using a tape recorder and transcribed using a text editor. It is worth noting that data collection was interrupted due to the presence of repetitive information in the speeches, characterizing theoretical saturation of the data. ⁹ After the initial stages, the transcriptions were validated by the participants and, after their consent, the data were submitted to the systematization and analysis process. The research met the consolidation criteria of the Consolidated Criteria for Reporting Qualitative Research (COREQ).

Participants' responses were systematized based on the Collective Subject Discourse (CSD), as proposed by Lefevre and Lefevre¹⁰ through the following steps: 1) transcription of all statements resulting from the RG and interviews; 2) analysis of the collected verbal material, extracting the following methodological figures from each of the oral statements: Central Ideas (CI) and their respective Key Expressions (KE); 3) based on the CI and KE, the various summary discourses, called collective subject discourses, were organized. CI is an expression that allows us to translate the content expressed by the subjects in their statements. It therefore constitutes a concise and precise way of describing or revealing the meaning and theme of the key expressions in each of the oral statements.¹⁴ This step was carried out with the support of the NVIVO10 software, which facilitates the organization of qualitative data.

The data were organized deductively based on the priority axes of the National Policy for Comprehensive Men's Health Care (PNAISH), especially in relation to the priority axes defined by the policy in Brazil.¹

Results

Characterization

The study participants were predominantly Black, 35 (79.5%), with 42 (95.5%) in the adult age group (25 to 60 years old) and two (4.5%) elderly (> 60 years old). Regarding educational level, 20 (45.5%) had completed high school, followed by 10 (22.7%) with completed elementary school, and seven (15.9%) with higher education. Regarding marital status, the majority were single (26 (59.1%), followed by eight (18.2%) in a stable relationship, seven (15.9%), and two (4.5%) were divorced.

Understanding Male Discourse Related to Health

The collective discourse of men in the context of domestic violence allowed us to address their experiences related to the five axes of the PNAISH. Thus, the study was organized deductively according to the PNAISH axes, aiming to elucidate their occurrence in men's experiences regarding self-care and health, as well as socio-affective interactions.

Based on an understanding of the relationships between the self-perception of health among men experiencing domestic violence and the PNAISH priority axes, we sought to uncover the DCS, based on the recognition of the CIs surrounding the phenomenon, expressed in male discourse, in a theoretical interpretation process within the adopted framework (Chart 1). 

Chart 1 - Analysis of the relationships between men's narratives in the context of domestic violence and the PNAISH action axes. Salvador (BA), Brazil, 2024.

IC 1: Access and acceptance in health services - from the impediments imposed by the work and structures of Primary Care, to the search for solutions and experiences of lack of acceptance in medium-complexity care.	DSC: [...] I have difficulty getting to the health center near my home because it's open during my work hours. Furthermore, to schedule appointments, we have to wait in line early [...] Sometimes when I need to go to the health center, I've been treated well by the receptionists, but I haven't been able to get an appointment due to a lack of space. When I have a complaint, be it a sore throat or a headache, I go to the Emergency Care Unit (UPA), but I don't feel welcomed. [...] They tell me I shouldn't be there, that the UPA is for emergencies [...] but how can I wait 15 days to see a doctor if I have a sore throat at that moment? That's why I go to the UPA even if I don't get good treatment; at least I get care and medication. [...] I confess that I only seek health services when I have serious symptoms. (Adult men experiencing domestic violence)
IC 2: Sexual and Reproductive Health - from the stereotype of condom use and other issues related to sexuality to the experience of Sexually Transmitted Infections (STIs).	DSC: [...] I confess that I don't like using condoms because I can't maintain an erection. [...] I've been through some embarrassing situations because of this. [...] although health units and pharmacies provide condoms, I don't usually carry them in my pocket. [...] I use them because I've had itching and discharge on my penis after unprotected sex. [...] when I went for a consultation and saw that the doctor was a woman, I was embarrassed to tell her and decided to see a male professional, [...] who advised me to use a condom not only to prevent disease but also pregnancy. (Adult men experiencing domestic violence)
IC 3: Fatherhood and Care - from the estrangement of fatherhood to the inclusion of the partner in prenatal care and the awakening to childcare and self-care.	DSC: [...] during my first pregnancy, there was nothing like that. I almost never went along, and when I did go, they left me waiting outside. Even at my first daughter's appointment, they called the grandmother [...] when my ex-wife got pregnant with my second child and had prenatal care at the health unit near our home, I was called to go to an appointment with her. I thought it was strange, but I went with her, and there the nurse asked me to undergo several tests and receive some vaccinations [...] Furthermore, I listened to my son's heartbeat and learned things I should do after he was born, like changing his diaper, bathing him, and burping him. I was even invited to join a pregnancy group, but my job wouldn't allow it [...] I thought it was really cool, and whenever possible, I attended the appointments.
IC 4: Prevalent diseases in the male population - from predisposition related to poor lifestyle and health habits to the onset of Chronic Noncommunicable Diseases (NCDs).	DSC: [...] since I spend all day at work, I can't eat at regular times. [...] I eat fast food. I don't exercise; and I also smoke and drink a lot. Because of this, I ended up with high blood pressure and high blood sugar. Despite these problems, I can't be seen at the health center. [...] when I feel bad, I take medication to control my blood pressure. (Adult men experiencing domestic violence)
IC 5: Accident and Violence Prevention - from the history of violence in social life to the direct impacts on health and life support.	DSC: [...] I've been involved in several fights. I've fought with my wife at home because I disagreed with things she said; I've fought at bars because of my drinking. I argued during a soccer match because a boy tackled me violently. [...] I argued several times in traffic [...] I crashed my car due to recklessness. [...] I was hospitalized after a serious accident [...] I had a broken arm [...] several bruises. I almost died! (Adult men in the context of domestic violence)

 Discussion

The male discourse of men undergoing legal proceedings for domestic violence revealed their health-related experiences based on the dimensions of the National Health Plan (PNAISH), in the following areas: access and reception in health services, sexual and reproductive health, fatherhood and care, diseases prevalent in the male population, and accident and violence prevention.

In the "access and reception" area, the discourse highlighted difficulties in seeking health care in primary care settings, often justified by the fact that these services typically operate during work hours, revealing problems such as long lines and lack of appointment slots. Scientific literature indicates that the absence of males in primary care settings is related to structural factors, such as work-schedule conflicts,¹¹ and cultural factors, which associate health care practices with feminine attributes and/or focus these practices on promoting the health of other groups. Progress is needed to overcome this situation.¹²

The male discourse also reveals that they complain about difficulties in scheduling medical appointments. To improve men's experience accessing primary health care units, successful initiatives highlighted the stratification of individuals according to risk/vulnerability and support for self-care. These initiatives are directly related to the availability of continuing care and self-care appointments, group activities, group care, nursing procedures, exams, medications, and other services.¹³

When their needs are not met in primary health care, research participants revealed that, despite not feeling welcomed, they seek care at the emergency care unit (UPA) in an attempt to resolve less complex clinical problems, such as colds, sore throats, and headaches. Men often seek health services through outpatient and hospital care of medium and high complexity, reinforcing the inadequacy of primary care and health promotion and care, which contributes to the increase in male morbidity and mortality.¹⁴ In the "Sexual and Reproductive Health" section, men reported not using condoms during sexual intercourse, which is not related to a lack of access to the product, but rather to subjective, relational, and cultural factors. Among these factors, the perception of trust and exclusivity in the relationship, the belief that condom use reduces sexual pleasure, the desire to reaffirm masculinity through barrier-free sex, and a low perception of risk regarding STI infection or unplanned pregnancy stand out.¹⁵

Men's failure to use condoms is rooted in their interference with pleasure, the maintenance of virility, the length of the relationship, and the type of emotional-sexual bond with the other person. This is a consequence of the Christian religious moral construct that advocates the inseparability of marriage, trust, and fidelity, as highlighted in a study.¹⁶ Regarding the length of the relationship and the emotional-sexual bond, the ideal of love, monogamy, and fidelity are seen as protective factors against STIs.

In this sense, condom use can even test these ideals and raise questions within the relationship, compromising the safety and solidity of the bond.¹⁷ An international study found that condom use, within the context of marriage, can be interpreted as a lack of trust because it is considered an element of infidelity, catalyzing situations of psychological and sexual violence. ¹⁸ On the other hand, sexual and reproductive health issues continue to be women-centered practices, which reproduces the cultural and social construct that structures women's submission and repression in the face of power relations in the sexual realm, including in negotiations with their partners regarding condom use.¹⁶

Another important element concerns men seeking care when signs and symptoms of STIs already appear. The search for health services associated with the emergence of STI symptoms was evidenced in a Brazilian study of young men, who revealed that they only sought care when experiencing discomfort in the genital region that prevented them from having further sexual relations.¹⁸

The results also revealed that shame emerges as a feeling when the healthcare professional is female, even leading them to forgo care and seek a male provider. A national study found that body exposure and manipulation create uncomfortable situations in the professional-patient relationship for men, as men feel more comfortable interacting with doctors and nurses of the same sex, especially when it comes to genital complaints.¹⁶ Given this scenario, it is important to devise strategies that allow for better engagement with the male population within PHC. Also regarding the PNAISH, it is observed that male sexuality has been addressed infrequently, focusing on infertility, STIs, or issues related to the genitals, maintaining a stereotypical view of the male.¹

Regarding the "Fatherhood and Care" axis, the collective male discourse pointed to the perception of actions encouraging paternal care during prenatal care, as well as childcare and self-care, although it highlights previous experiences in which men were not directly monitored during prenatal care, even being asked to wait outside the office for their partners when they sought appointments. Another study indicated that, in the men's perception, the following barriers to male participation in prenatal care are: the understanding that maternal and child health concerns exclusively women, the fact that they are always on their work schedule, the understanding that consultation settings are uncomfortable and inhibiting, and the lack of support from health professionals.¹⁹

Despite the existing barriers to men's inclusion in prenatal care, scientific literature demonstrating the health benefits of male participation in prenatal care is scarce, highlighting the need to utilize this strategy as a source of engagement for men in health promotion and disease prevention activities.²⁰ Meanwhile, the National Partnership Program (PNAISH) established the "Fatherhood and Care" axis, emphasizing the importance of promoting male involvement in reproductive planning, conception, and child development.³

To address this issue more effectively, the Ministry of Health established the Prenatal Partner Strategy (EPNP) in 2016. This strategy aims, in addition to paternal involvement, to improve these men's access to health services.²¹ This strategy establishes men's participation in at least two prenatal appointments and educational activities; rapid testing and routine exams; updated vaccination records; approaches to topics geared toward men; and guidance on men's roles in pregnancy, prepartum, childbirth, the immediate postpartum period, and childcare.²¹

Some experiences are highlighted in the national literature as strategies for strengthening the EPNP. In Salvador, men are encouraged to participate in the EPNP during the Men's Saturday project, in which health units open once a month on Saturdays to promote care and increase male participation and attendance.²² Given this scenario, the need to expand successful experiences nationwide emerges, which is the main challenge of the PNAISH for the coming years.

In the "Diseases Prevalent in the Male Population" axis, the collective male discourse highlights the presence of modifiable risk factors, such as unhealthy diets, physical inactivity, excessive alcohol consumption, and smoking. These factors are present in men's daily lives, considering a routine with heavy workloads, a sedentary lifestyle, and the culture of alcohol and cigarette consumption for recreational purposes, due to their relaxing and socializing effects.²³ Therefore, this population is vulnerable to respiratory and cardiovascular diseases, changes in metabolic function, and cancers, generating significant social and health impacts on society.

NCDs account for more than half of all deaths in Brazil and worldwide. In 2019, 730,000 men and women died in Brazil. When analyzed by sex, 56.1% occurred prematurely in the male population.²⁴ Some studies have shown that circulatory system diseases are among the first and third leading causes of death in men. ²⁹ Deaths from diabetes increased 70% globally between 2000 and 2019, with an 80% increase in male morbidity and mortality.²⁵

This scenario has raised concerns among government officials, leading them to develop the Strategic Action Plan to Combat NCDs in Brazil, 2021-2030, to prevent NCD risk factors and promote population health, aiming to reduce health inequalities.²⁴ Despite this, the very cultural construction of male invulnerability encourages exposure to risks and reduced health care.

The study highlights barriers to accessing these services, hindering the monitoring of these diseases and leading this population to adopt measures such as self-medication. In addition to the sociocultural issues already highlighted, it is worth noting the historical data, highlighted in the literature, that reinforces this population's lack of access to health services. This data is justified not only by employment issues but also by the notion that care delivery focuses on women and children.²⁵

To mitigate this problem, strategies were created that align with the precepts of the National Primary Care Policy and the National Health Plan (PNAISH). In May 2019, Ordinance No. 930 created the "Saúde na Hora" (Health on the Spot) program, targeting users of the Unified Health System (SUS) treated in primary care settings. The program aims to expand access to services by extending opening hours and encouraging men to attend these alternative times.²⁶ Despite this, only 1,987 (5%) of the country's health centers participate in the program, in 387 (7%) municipalities. Of this total, 900 of them began operating with extended hours, with the states with the highest number of participants in the program being: São Paulo, with 407 health units, and Minas Gerais, with 288.²⁷ In this context, even after 15 years of implementation of PNAISH, as well as successful experiences, the need to expand these actions and other actions in other regions of the country is reinforced, especially for those whose indicators focused on men's health reinforce greater vulnerability to this problem.

In the "Prevention of Violence and Accidents" axis, the collective male discourse reveals that research participants' discourse is based on violence in domestic spaces, leisure activities, and traffic, with violent behavior occurring due to divergent opinions and disagreements, exacerbated in some situations by alcohol use. Experiences of violence in men's daily lives are often associated with an attempt to maintain power, an element that is part of the social construct of being a man. However, the immutability of these behaviors makes them vulnerable to external causes, generating impacts not only on the health of the male population, but also on social ones.⁸

External causes of morbidity and mortality were the main causes of death among men between 2009 and 2018, being more prevalent among young, single adults with low levels of education.²⁵ Overall mortality among the Brazilian population in the aforementioned period totaled 3,596,434 deaths. Of this number, 67.9% (n = 2,442,915) were male.²⁵ In this scenario, the main causes of death were assaults, traffic accidents, and accidental injuries, followed by intentional self-harm.

Given this vulnerability to external causes, hospital admissions among men are high, placing a strain on health services and significantly increasing public spending. Male hospitalizations due to external causes totaled 59,468,451 between 2009 and 2018, with the 20-59 age group accounting for 34.8% of this total (n = 20,693,695).²⁶ This context directly impacts public spending by the Unified Health System (SUS), which spent approximately R$7,082,295,712.35 between 2009 and 2018. Of this amount, 78.3% of the expenditures, equivalent to R$5,546,172,615.70, were on men victims of external causes.²⁶

It is important to highlight that alcohol consumption is generally present in situations involving violence, especially those that occur in the domestic environment. Many situations in which disagreements arise are influenced by alcohol use, which is corroborated by a study conducted in Latin American cities, including Salvador and Rio de Janeiro, revealing that 68% of men who committed assaults consumed alcohol before assaulting their partners.²⁷

The reckless practice of drinking alcohol before driving was also highlighted in the statements of the research participants, resulting in extreme situations such as car accidents, leading to the need for hospital intervention due to the severity of the incident. The Institute of Applied Economic Research (IPEA) revealed that, from 2009 to 2018, 250,790 deaths occurred in male motor vehicle accidents, representing 28.5% of mortality from external causes. It estimated that the annual cost to Brazilian society from traffic accidents is approximately R$50 billion.²⁸

The number of hospitalizations and deaths among males from external causes remained high, even 15 years after the implementation of the National Health Program (PNAISH) nationwide. There is an urgent need to reorganize services and improve the quality of care, especially regarding reception as a technical-assistance approach that entails changes in the professional/user relationship. This approach must be adopted at all stages of health service delivery, starting from the first contact with the patient, involving listening, attention, valuing complaints, identifying needs that can be met, humanized treatment, and recognizing the user as an active participant in their health-disease process.¹⁷

Such evidence reinforces the need for greater interventions that foster discussions on gender, the various types of masculinities, and health indicators related to men's health. Therefore, it is essential to include the dimension of masculinities, understood as plural, in the strategy for reviewing, reformulating, and implementing health policies in Brazil. Furthermore, professionals must be constantly trained to incorporate gender issues into health actions, as well as their connection to transversality, equity, and comprehensiveness.

Conclusion

Through the narratives of men facing criminal proceedings for domestic violence and participating in the GR, it was possible to highlight the collective discourse related to health regarding the five policy axes: access and reception; fatherhood and care; sexual and reproductive health; prevention of accidents and violence; and prevalent diseases. Although the GR are held with the aim of providing men with spaces to reflect on behaviors in marital relationships and their interface with health and quality of life, the male discourse reiterates the perpetuation of factors that impede access and accessibility, such as incompatible work schedules, poor lifestyle and health habits, which can lead to chronic diseases, the lack of condom use and greater vulnerability to STIs, the awakening to the exercise of fatherhood, and a history of violence in social relationships and in the repertoire of life. Although the study is limited by not delving into the barriers to health care, the barriers to ensuring the provision of men's health care in health services are well-known. Greater investment in strategies that encourage and promote access for men within PHC and the strengthening of the axes advocated by the National Health Plan (PNAISH) is essential. Regarding the implications for professional practice, it is urgent that professionals be able to comply with the focal men's health policy, its specificities, and scientific basis to guide decision-making and health care. It is crucial that public policymakers rethink access strategies and implement new actions that promote the connection and acceptance of men in PHC.

From this perspective, the study highlighted the importance of spaces for dialogue and self-reflection, based on health education initiatives for men, which can be carried out through GR, a low-cost method with high engagement potential. This strategy enables the identification of obstacles and pathways to improving access and support for the male population within the scope of PHC, and can be implemented in diverse contexts, such as prison situations, sexual, cultural, gender and/or ethnic diversity, LGBTQIAP+ population, indigenous people, quilombolas, among others.

Authors Contributions

Study conception: Fernanda Araújo Valle Matheus; Andrey Ferreira da Silva; Nadirlene Pereira Gomes; Júlia Renata Fernandes de Magalhães. Data collection: Fernanda Araújo Valle Matheus; Andrey Ferreira da Silva; Júlia Renata Fernandes de Magalhães. Data analysis and interpretation: Fernanda Araújo Valle Matheus; Andrey Ferreira da Silva; Júlia Renata Fernandes de Magalhães. Manuscript writing: Fernanda Araújo Valle Matheus; Andrey Ferreira da Silva; Selton Diniz dos Santos; Anderson Reis de Sousa; Júlia Renata Fernandes de Magalhães. Critical review of the manuscript: Selton Diniz dos Santos; Nadirlene Pereira Gomes; Anderson Reis de Sousa. Approval of the final version of the text: Fernanda Araújo Valle Matheus; Andrey Ferreira da Silva; Selton Diniz dos Santos; Nadirlene Pereira Gomes; Anderson Reis de Sousa; Júlia Renata Fernandes de Magalhães.

Conflict of interest

The authors declare no conflict of interest. 

Funding

Fundação de Amparo à Pesquisa do Estado da Bahia (FAPESB).

References

1. Shelswell R, Watson J. Investigating inequalities in men's health: a literature review [Internet]. Nurs Stand. 2023 [cited 2025 Apr 12];38(12):77-81. Available from: https://pubmed.ncbi.nlm.nih.gov/37718546/

2. Política Nacional de Atenção Integral à Saúde do Homem: Princípios e Diretrizes. Brasília: Ministério da Saúde; 2008 [cited 2024 July 13]. Available from: https://bvsms.saude.gov.br/bvs/publicacoes/politica_nacional_atencao_saude_homem.pdf

3. Brandão CC, Albuquerque FP, Takarabe JM, Soares IMSC, Salerno AAP, Celio CP, Magalhães RS, Lima JT, Almeida GS. Gestão federal da Política Nacional de Atenção Integral à Saúde do Homem: uma perspectiva histórico-crítica [Internet]. Interface. 2025 [cited 2025 Apr 17];29(Supl.1):e240378. DOI: https://doi.org/10.1590/interface.240378

4. Oliveira E de, Couto MT, Separavich MAA, Luiz O do C. Contribuição da interseccionalidade na compreensão da saúde-doença-cuidado de homens jovens em contextos de pobreza urbana [Internet]. 2020 [cited 2025 Jan 20];24: e180736. DOI: https://doi.org/10.1590/Interface.180736

5. Calcia MA, Bedi S, Howard LM, Lempp H, Oram S. Healthcare experiences of perpetrators of domestic violence and abuse: a systematic review and meta-synthesis [Internet]. BMJ Open. 2021 [cited 2025 Jan 25];11(5):e043183. DOI: https://doi.org/10.1136/bmjopen-2020-043183

6. Leite AL, Lemos D da C. Utilização da pesquisa-ação no campo das ciências sociais aplicadas [Internet]. REAd Rev eletrôn adm. 2022 [cited 2025 Apr 17];28(1):64–91. DOI: https://doi.org/10.1590/1413-2311.345.114473

7. Estrela FM, Gomes NP, Pereira Á, Paixão GP do N, Silva AF da, Sousa AR de. Social technology to prevent intimate partner violence: the VID@ Group in actions with men [Internet]. Rev Esc Enferm USP. 2020 [cited 2025 Jan 25];54:e03545. DOI: https://doi.org/10.1590/S1980-220X2018040803545

8. Lei n. 11.340, de 7 de agosto de 2006. Diário Oficial da União [Internet]. 2006 [cited 2024 July 14]. Available from: https://www.planalto.gov.br/ccivil_03/_ato2004-2006/2006/lei/l11340.htm

9. Naeem M, Ozuem W, Howell K, Ranfagni S. Demystification and Actualisation of Data Saturation in Qualitative Research Through Thematic Analysis [Internet]. International Journal of Qualitative Methods. 2024 [cited 2025 Apr 12];23. DOI: https://doi.org/10.1177/16094069241229777

10. Leite AL, Lemos DC. Utilização da pesquisa-ação no campo das ciências sociais aplicadas [Internet]. Rev. eletrôn. adm. 2022 [cited 2024 Sept 15];28(1):64-91. DOI: https://doi.org/10.1590/1413-2311.345.114473

11. Mokua SN, Ombogo L, Mathu D, Otambo P, Nyandieka L, Onteri SN, Mbuka SJ, Kariuki J, Ahmed I, Wanjihia V, Mutai J, Bukania Z. "For a man to go to hospital, then that would be his last option": A qualitative study exploring men's experiences, perceptions and healthcare needs in the implementation of Universal Health Coverage in Kenya [Internet]. PLOS Glob Public Health. 2024 [cited 2025 Apr 12];4(5):e0002925. DOI: https://doi.org/10.1371/journal.pgph.0002925

12. Garcia LHC, Cardoso N de O, Bernardi CMC do N. Autocuidado e Adoecimento dos Homens: Uma Revisão Integrativa Nacional [Internet]. Psicol. Saúde. 2019 [cited 2025 Jan 25];11(3):19-33. DOI: https://doi.org/10.20435/pssa.v11i3.933

13. Bacelar G da S, Aguiar RS. Estratégias utilizadas na atenção primária para inclusão do homem nas ações de saúde: uma revisão integrativa [Internet]. Saud Coletiv (Barueri). 2021 [cited 2025 Apr 6];11(68):7349-62. DOI: https://doi.org/10.36489/saudecoletiva.2021v11i68p7349-7362

14. Mashilo NJ, Oladimeji KE, Gumede S, Lalla-Edward ST. Access to Health Care and Use of Health Care Services Among Males in Africa: Protocol for a Scoping Review [Internet]. JMIR Res Protoc. 2025 [cited 2025 Apr 12];14:e52351. DOI: https://doi.org/10.2196/52351

15. Borges ALV, Duarte LS, Cabral C da S, Lay AAR, Viana OA, Fujimori E. Uso de preservativo masculino e dupla proteção por homens adolescentes no Brasil [Internet]. salud pública. 2021 [cited 2025 Jan 25];55:109. DOI: https://doi.org/10.11606/s1518-8787.2021055003298

16. Guimarães DA, Oliveira VC de P, Silva LC da, Oliveira CAM de, Lima RA, Gama CAP da. Dificuldades de utilização do preservativo masculino entre homens e mulheres: uma experiência de rodas de conversa [Internet]. Estud. Psicol. 2020 [cited 2025 Jan 25];24(1):21-31. DOI: https://doi.org/10.22491/1678-4669.20190003

17. Exavery A, Kanté AM, Jackson E, Noronha J, Sikustahili G, Tani K, Mushi HP, Baynes C, Ramsey K, Hingora A, Phillips JF. Role of condom negotiation on condom use among women of reproductive age in three districts in Tanzania [Internet]. BMC Public Health. 2012 [cited 2025 Jan 25];12(1):1097. DOI: https://doi.org/10.1186/1471-2458-12-1097

18. Spindola T, Santana RSC, Antunes RF, Machado YY, Moraes PC de. A prevenção das infecções sexualmente transmissíveis nos roteiros sexuais de jovens: diferenças segundo o gênero [Internet]. Cien Saude Colet. 2021 [cited 2025 Jan 25];26(7):2683–92. DOI: https://doi.org/10.1590/1413-81232021267.08282021

19. Brito JGE de, Santos JMDJ, Barreiro M do SC, Dantas DDS, Leite AM, Mendes RB. Participação do companheiro da gestante nas consultas de pré-natal: prevalência e fatores associados [Internet]. Enferm. 2021 [cited 2025 Jan 25];26:e75169. DOI: https://doi.org/10.5380/ce.v26i0.75169

20. Walsh TB, Carpenter E, Costanzo MA, Howard L, Reynders R. Present as a partner and a parent: Mothers’ and fathers’ perspectives on father participation in prenatal care [Internet]. Infant Ment Health J. 2021 [cited 2025 Jan 25];42(3):386–99. DOI: https://doi.org/10.1002/imhj.21920

21. Guia do Pré-Natal do Parceiro para Profissionais de Saúde [Internet]. Brasília: Ministério da Saúde; 2023 [cited 2024 June 25]. Available from: https://bvsms.saude.gov.br/bvs/publicacoes/guia_pre_natal_profissionais_saude_1ed.pdf

22. Rodrigues JP, Amorim R da C, Carvalho RC de, Sousa AR de, Souza S de L, Almeida AM, Matheus FAV, Silva RS. Estratégia de implementação de ações em saúde dos homens: potencialidades e desafios da pesquisa-ação [Internet]. Texto Contexto - Enferm. 2023 [cited 2024 June 25];32:e20230187. DOI: https://doi.org/10.1590/1980-265X-TCE-2023-0187pt

23. Zhang M, Shi Y, Zhou B, Huang Z, Zhao Z, Li C, Zhang X, Guiyuan H, Peng K, Li X, Wang Y, Ezzati M, Wang L, Li Y. Prevalence, awareness, treatment, and control of hypertension in China, 2004-18: findings from six rounds of a national survey [Internet]. BMJ. 2023 [cited 2024 June 25];380:e071952. DOI: https://doi.org/10.1136/bmj-2022-071952

24. Plano de Ações Estratégicas para o Enfrentamento das Doenças Crônicas e Agravos não Transmissíveis no Brasil 2021-2030 [Internet]. Brasília: Ministério da Saúde; 2021 [cited 2024 July 15]. Available from: http://bvsms.saude.gov.br/bvs/publicacoes/plano_enfrentamento_doencas_cronicas_agravos_2021_2030.pdf

25. McGrath C, Kennedy MR, Gibson A, Musse S, Kosar Z, Dawson S. World Cafés as a participatory approach to understanding research agendas in primary care with underserved communities: reflections, challenges and lessons learned [Internet]. Research Involvement and Engagement. 2023 [cited 2024 July 15];9(1):101. DOI: https://doi.org/10.1186/s40900-023-00509-3

26. Mendonça F de F, Lima LD de, Pereira AMM, Martins CP. As mudanças na política de atenção primária e a (in)sustentabilidade da Estratégia Saúde da Família [Internet]. Saúde debate. 2023 [cited 2025 Apr 17];47(137):13–30. DOI: https://doi.org/10.1590/0103-1104202313701

27. Conselho Nacional de Secretarias municipais de Saúde. Saúde na Hora: apenas 7% dos municípios participam do programa [Internet]. Brasília: Ministério da Saúde; 2020 [cited 2024 July 15]. Available from: https://portal.conasems.org.br/orientacoes-tecnicas/noticias/5323_saude-na-hora-contra-coronavirus-horario-estendido-emergencial-da-aps

28. Gonçalves ET, Silva JJT da. Morbimortalidade masculina por causas externas no brasil: 2009-2018 [Internet]. Rev enferm UFPE on line. 2021 [cited 2024 July 15];15(2):e245680. DOI: https://doi.org/10.5205/1981-8963.2021.245680

Corresponding Author

Andrey Ferreira da Silva

E-mail: andrey.ferreira@arapiraca.ufal.br

The Author(s) 2026.  This work is licensed under Creative Commons Attribution 4.0 International. License text for use: https://creativecommons.org/licenses/by/4.0/deed.pt_BR