Popular practices in child care: mothers’ perceptions

Objective: to describe the perception of mothers about the use of popular child care practices in the home. Methods: qualitative research, performed with ten mothers of children up to two years old. Data were collected through interviews in a primary health care unit, which were recorded and submitted to content analysis. Results: three categories emerged from the analysis of the discourse: 1) Family roles in child care; 2) Popular practices as a family culture in child care; and 3) The belief in healing spells as a resource in popular practice. Conclusion: the use of popular practices remains strong in the social and cultural context of families, and is especially influenced by grandmothers. Thus, there is a need for instrumentation of the health team for the good use of these practices in favor of the promotion of child health and recognition of nursing in its professional practice. Descriptors: Child Care; Family; Medicine, Traditional; Nursing.


Introduction
Child care in the home context is permeated by beliefs, myths and customs resulting from family cultural tradition. The adoption of home-based measures in child care comes from the easy access to such therapies. In fact, child care consists in a range of beliefs shared by people in different groups. When care is provided concomitantly by a sum of people, the cultural volume expands even further because the shared understanding provides interpretations that guide the experiences of the family (1)(2) .
Madeleine Leininger's Cultural Care Theory postulates that nursing must resort to cultural know--ledge in order to promote care. Leininger's theory harmoniously associates care to direct it to nursing practices. In other words, it is necessary to recognize the existence of the professional care system, but also of the popular care system (3)(4) .
It is worth noting that nursing plays a very important role in child care because it promotes health education through educational activities aimed at the population and dissemination of knowledge. Because nurses are professionals who are close to the community, health education is an inherent part of their work.
To this end, nursing professionals must understand the profile of the public that is being approached and its level of understanding so that popular knowledge and the local cultural influences have space in the negotiation of the practice of the care (4) . Given the above, the following question arises: Are popular practices in child care at the home context used?
The knowledge of these characteristics can provide important subsidies for the performance of nurses, in the sense of taking the culture in which the individuals are inserted into account so as to provide quality nursing care. When it comes to child care, this cultural influence becomes even more evident. It is essential to know the socio-cultural context of the mothers and identify their knowledge and care practices so that their beliefs and customs may be included in the health care practice.
Thus, the present study aimed to describe the perception of mothers about the use of popular child care practices at the home.

Methods
The qualitative approach was adopted in this research, which was carried out in a unit where the Family Health Strategy is implemented, located in the municipality of Irati, Paraná, Brazil. This municipality has 19 active Basic Health Units, and five of these units work with the Family Health Strategy.
The study included women who had children in the age range from zero to 24 months and who were enrolled in the family health program of the Family Health Strategy. The women were randomly selected. The choice of this age group was due to the greater exposure of these children to care permeated by cultural values (4) . The inclusion criteria were mothers aged 18 years and over, who resided in the municipality studied, and who accepted the invitation to participate in the study. There were no criteria for exclusion of the participants. Ten mothers participated in the study. This sample size followed the principle of data saturation (5) , which occurs when the statements do not add any new information.
Data were collected between September and October 2017. Mothers were approached by one of the researchers after the nursing consultation, initially explaining the research, and then providing the Informed Consent Term for signing in a private place in the basic health unit.
Open questions were used in the semi-structured interview, based on the following guiding questions: What do you understand by care? What are the traditional customs that your family uses in the care of your child? How have the use of healing prayers and/ or healing spells influenced the care of your child? The interviews lasted on average 40 minutes and were recorded upon permission of the interviewees.
After that, the speeches were heard and transcribed verbatim using the Word® text editor softwa-re. Then, the statements were submitted to Minayo's thematic analysis for organization of thematic categories (6) . The anonymity and secrecy of the identity of each participant were preserved. They were identified by the letter M (mother) followed by a number corresponding to the order of participation in the interviews.
The thematic analysis proposed by Minayo seeks to highlight the importance of communication through fundamental themes that are addressed in the course of the research, with statements on the subject analyzed. It also aims to discover the nuclei of meaning that make up the communications whose speech is meaningful to reach the objective of the study (6) .
The study respected the formal requirements of Resolution 466/12 of the National Health Council, considering the regulatory norms of research involving human beings, and was approved by the Research Ethics Committee of the State University of the Midwest, according to Opinion nº 2,225,146.

Results
Among the ten mothers participating in the study, the age range was between 21 and 44 years, and the majority had incomplete elementary education, low monthly family income, and was married and primiparae.
After the analysis of the speeches, three categories were created: Family roles in child care; Popular practices as a family culture in child care; and The belief in healing spells as a resource in popular practice.

Family roles in child care
The birth of a baby mobilizes the whole family around its health care. When asked about the care given to the child, most mothers cited measures related to food and hygiene issues. Considering the importance of these two issues, as regards the growth and development of this new being within the family, the participants revealed the following testimonies:

Popular practices as a family culture in child care
Considering the possibility of children's exposure to the care provided by their families, the use of beliefs and spells demonstrated the influence of previously practiced customs, even outweighing professional guidelines: I do what my mother teaches me to do, everything... the way I take care of her is the way my mother taught me, how to use the picão, the teas when she has colic, these things (M1). There are spells that my family does, such as giving the child a fright, when he has hiccups, those things that they did to me when I was a child, and that they now do with my son (M5). I always ask my mother to "take out the fright", not necessarily in person, my grandmother used to do that, and passed it to my mother, she is the one who does it now... she prays pouring coal into the water, it helps a lot.
There are days when he is very scared, and she does that, and he gets a lot better, has less tantrums (M6). I did what the nurse taught me, use alcohol with a cotton swab right there on the little navel, and I also wrapped it. She said it was not necessary, on the day of the first consultation she took the wrap off, but my mother-in-law told me it was necessary, otherwise it would be swollen, so I left it (M10).
In the perception of one of the mothers, this influence results mainly from the lack of experience in caring for the child: The following report was also observed: She stayed under the light there in the hospital only for two days; after she left, she did not have it anymore, but I bathed her with bean broth.
We add one big spoon in the water for each day of life, and bathe the child for one day, to avoid that the yellowish aspect come back... if that aspect returned, we had to bathe the child in the tea of picão root, to avoid the aspect from returning (M7).

The belief in healing spells as a resource in popular practice
The importance of the belief in healing spells was perceived in the testimonies as first instance. As the family is adept to the use of healing spells, the mother also believes that the healers are important and influential for the care of her child. In one of the testimonies, it was seen that the belief in healing prayers, besides spells, led to the cure of diseases.

Discussion
The fact that this article presents information only from a small municipality, which generally favors the imposition of cultural influence, as well as the focus of the study directed only to popular beliefs in child care, imply limitations to the study, preventing the generalization of the data. Further investigation in other municipalities, of medium and large size, is recommended to verify if this predominance of popular beliefs persist despite scientific knowledge. Further studies with other population groups are necessary to identify the existence of popular beliefs also among other clienteles.
The influence of sociocultural characteristics on the perceptions about the health-disease process should be explored in the community under a careful perspective of cultural and behavioral singularities of the population. When popular knowledge and the presence of folk healers are so strong, the implementation of actions can be considered a challenging task for health professionals, especially the nurse. It is up to these professionals to understand the way of thinking and acting of individuals before their problems and health care, associating such popular knowledge with scientific information, in order to facilitate their care practice.
The results of the present study corroborate with other investigations that emphasize the use of popular knowledge by families and the belief in healers as a primary care resource when it comes to child care. Because the use of these strategies brings numerous benefits, experienced by family traditions in former times, there is a feeling of satisfaction and increased confidence to enjoy these practices with their children (7)(8) .
These cultural practices full of symbols, meaning, tenderness and affection can express the perception of health and illness during motherhood, as well as social roles that are defined as a consequence of the experience of giving birth (9) . Such practices passed on from generation to generation impose difficulties for the nursing team finds to provide due care, thus generating conflicts with families (10) .
In the caregiver's conception, the promotion of care for good child development involves cultural practices that are impregnated in the way of carrying out care, combining a series of scientific care measures with popular practices that are still used in all phases of the evolutionary cycle of children (4) .
Given the above, a sense of responsibility of the family for the health care of its members in the different phases of the life cycle is clear, understanding that the health-disease process of the individual must be attended professionally through family responsibility. Thus, the family plays a prominent role in primary health care and in the care of its members.
Despite all technological advancement, popular resources are credible because they often respond to the population's expectations. It was observed that most mothers used old home-based measures already tested by the community to solve the problems they faced on a daily basis (11) . Sometimes, the use of popular practices overrides scientific knowledge in child health care (9) , and this can be considered harmful to child care.
Cultural and family values, coupled with a vulnerable socioeconomic situation, lead families to learn and resort to these resources as the first form of treatment of health problems in the daily care of children. In a research carried out in a riverside community in Amazonas, the results indicated that popular practices such as the use of medicinal plants are widely spread in the treatment of diseases as a result of the difficult access to health services by this type of community; thus, this resource is held as first choice in the treatment of children affected by pathologies (8) .
Another very strong cultural factor in the study is the presence of the folk healers, because their knowledge often opposes to the guidelines provided by health professionals. They are people with great in-fluence in the community where they live as holders of popular knowledge. They are known as people of great faith and with a greater connection with the divine plan, which is why they can identify diseases and treatments. Their knowledge is passed on from generation to generation, and the belief in their power, coupled with the belief in healing through a Supreme Being, strengthens their standing before the community.
The strength of healers in the community has been solidified on a two-fold belief: the trust of individuals in the healers and in the power of their prayers; and the faith of the healer in God, which ensures that their requests will be accepted. Some authors explain that such belief is a form of faith, and believing in the sayings, in the everyday life, means to incorporate this thought (12) .
Because they are placed between the traditional medicine and the religious space, healers deal with the real and practical problems of people's daily life. For this reason, their presence promotes strength and confidence to the community. People turn to them because they trust their skills and their knowledge about home medicine (8,13).
Before such a reality, it is possible to infer the importance of popular practices and healers as a significant link between the population and the formal health system. This shows that the existence of these elements is not limited to distant, isolated places and to the lack of formal health care, but it is rather a cultural phenomenon that has always existed and which will hardly disappear, especially when it comes to child care (14) .
In view of all the popular practices and the belief in healers, there is a lack of guidance to mothers with respect to the process of child growth and development, as well as to actions in case of the emergence of pathologies. In this context, it is up to health professionals to improve the methods used by the society in which they are inserted, seeking to respect the presented beliefs and offer a mutual exchange of knowledge. This content should be addressed in all health education opportunities, especially in nursing consultations.
Child health care is still in the process of construction, as it is health care in general, in a network model to favor family inclusion and comprehensive care. Care can be developed by health professionals and by the community in general. This practice implies the exchange of technical and scientific knowledge, as well as the exchange of experiences and sharing of information among all involved in the action (15) .
Thus, nurse take on an important role in assisting the population, as they promote health education activities, health promotion and prevention actions, fulfilling their duty of guiding the population and disseminating knowledge. Health professionals must pay attention to the fact that, when arriving at a certain place, it is necessary to value the local culture and the common knowledge of the people in order to achieve the desired success in their health education actions (9) .
In this context, the Cultural Care Theory developed by nurse and anthropologist Madelaine Leininger can be used creatively with individuals, groups and/or families. According to this theory, it is recommended that nursing improves health care by taking cultural diversity, and not merely the disease, into account in its actions (16) .
Nursing consultations become opportune moments for families to present and clarify their doubts. Through childcare, nurses have the possibility to follow-up the growth and development of the children, evaluating the care applied to these new beings, with the possibility of exchanging experiences (16) .
In a study carried out in Ceará, the authors presented a protocol to be used in childcare. This was a guiding tool for nurses that systematized and standardized care. The results pointed out that the application of a protocol can fill the gaps in childcare, allowing a holistic and systematized assistance during childcare consultations (17) .
Therefore, knowing the experiences of mothers about the care provided to their children is extremely important for nurses to direct the dialogue, and to make it possible to improve the knowledge of families, through health education, enabling the establishment of new forms of care where the beliefs and cultures experienced by them are taken into account (9) .
The dialogue between the two universes, namely, popular and scientific knowledge, proves to be an essential practice for health promotion in primary health care. The consideration of cultural beliefs and family practices favors the perception of user as co--responsible in their therapeutic process, besides facilitating the approach between health professionals and clients (18)(19) . It is, in fact, critical to know the cultural context, beliefs, rituals and way of life of users and their families in order to establish an innovative approach to caring (18)(19) .
It is noteworthy that the relationship between mothers/families and nurses is placed in the national and international literature as an essential piece to strengthening the mother-baby bond. This is so because these professionals are trained to promote assistance and encourage parental involvement in child care, facilitating the reciprocity, the sense of responsibility, and the adequacy of maternal responses to the child. Therefore, mothers who receive support from nurses are more likely to build a positive and healthy relationship with their child (8,20) .

Conclusion
The study showed that the use of popular practices, including the role of healers, remains strong in the social and cultural context of families, mainly influenced by grandmothers. There is, therefore, a need for instrumentation of the health team to make good use of these practices in favor of child health promotion and recognition of nursing in its professional practice.