Introduction

On a large scale, men have experienced an unprecedented experience that transformed the universe as a result of the impacts caused by COVID-19, declared a pandemic on March 11, 2020.¹ Faced with the scenario of uncertainties, significant social and environmental disruptions, the subjects were mobilized to promote new physiological and psychosocial adaptive modes.² Because it is a highly transmissible disease, health authorities established collective social distancing as a priority measure for the containment of the virus, however, this measure precipitated the rupture of socio-affective networks, financial balance and changes in human productive capacity, which abruptly began to experience anticipatory grief. As a result, routines were redesigned, others established and the various commitments, especially labor, began to be developed remotely on a large scale.³

Until November 2021, in Brazil, there were nineteen million people with confirmed diagnoses and a total of 608,671 deaths resulting from COVID-19,⁴ a study carried out in a Brazilian state showed that the case fatality rate was only among men 2.71%, while among women, 1.48%.⁵ This same scenario is observed in other countries and has challenged researchers and policymakers to understand the reasons why the cisgender male audience has been more affected.⁶

Despite evidence that showed different modulations of the immune response between men and women,^7,8 understanding the higher rates of infections among men presupposes the social dimension in which the experience of illness reflects the intersections of other elements, which impact on health behaviors causing greater male vulnerability to contamination by COVID-19, which can be modified requiring goals for care.^9,10

In addition, the fact that the complications of COVID-19 have repercussions on the bioenergetic dysfunction of men, evident in post-Covid-19 disabling syndromes,^6,7 aroused our interest in proposing adaptive care of nurses, for which we chose as a theoretical reference the Roy's Adaptation Model (RAM),² as it enables the achievement of interventional specificities in the production of care for men, according to its adaptive modes, which interact with the adaptive regulatory and cognition subsystems to face the improbabilities experienced by men during the pandemic.^2,10-12 Thus, this article was guided by the following research question: How has the COVID-19 pandemic produced/mobilized the emergence of adaptive modes among adult men? Its objective was: to understand the ways in which adult men adapt to the COVID-19 pandemic, based on the model proposed by Callista Roy.

Methods

This is a qualitative research structured in the light of the theoretical framework of Roy's Adaptation Model (RAM), which aims to maintain a preserved state of health amidst the changes that have taken place, with full appreciation of people who face new imposed challenges such as the health crisis^2,13 This study has a multicenter character and is part of a matrix project of national scope, for which the virtual environment (Web Survey) was used to develop data collection, through a semi-structured and self-administered form, available on the Google Forms^® platform, whose answer took about 20 minutes and contained closed and open questions related to sociodemographic, work, health conditions and the phenomenon of interest to the investigation, in the form of the following questions: How have you been experiencing the COVID-19 pandemic? What have you been doing to face the COVID-19 pandemic?

The data collection instrument was submitted to internal validation (pilot test) by two PhD researchers, a special PhD student and two regular PhD graduate students, and externally by a group of 25 participants (seeds) chosen convenience for being available to participate in the research in all its phases. Data were collected between June and September 2020 with a sample of 45 men over 18 years of age, who met the inclusion criteria: consider themselves men, be an adult and reside in Brazil in the context of the pandemic; those participants who found on international trips during this period were excluded.

The research team was composed of four researchers (men) and two researchers (women), with experience in the research area, working in teaching, research and service during data collection, without contact and/or direct link with the participants who maintained all technical rigor and scientific required in qualitative research, obtaining the study design according to the COREQ recommendations. To identify possible participants, the strategy of consecutive recruitment of men was adopted using the Snowball technique,¹⁴ in which a group of the first 25 participants who responded to the invitation, called “seeds”, were accessed and later shared the hyperlink for other men.

The approach and recruitment took place through social networks such as Facebook®, Instagram®, WhatsApp®, Grindr® and Scruff®. Dating apps were selected because they had a high concentration of male users, so informal messages were sent asking if they were interested in answering the form, and when the answer was productive, the hyperlink was sent. In the social media of the project, inviting layouts related to the research were disclosed.

The process of theoretical exhaustion^15,16 took place from the interruption of data collection because they were no longer inferred and because they did not bring new clarifications to the object of study investigated in the observed field. To preserve the anonymity of the participants, they were identified by the letter M and followed by randomly distributed Arabic numerals.

To assist in the systematization of the data, the NVIVO12 Software was used. Data analysis followed the deductive perspective, guided by the theoretical/methodological proposal contemplated in Roy's four adaptive modes: 1) physiological-physical (physical and chemical processes of human activities in the face of adaptations); 2) group self-concept identity (psycho-spiritual integrity with the sense of being unity and its purpose in the universe); 3) role function (roles held in society and social integrity) and 4) interdependence (structural relationship of the solitary or collective being);^2,13 as well as by the Reflective Thematic Content Analysis proposed by Clark and Braun, in its six stages: rigorous reading and re-reading of data; creation of theoretical codes (nodes); derivation of emerging themes and subthemes; code grouping; search for relationships between the themes that emerged; naming of themes and development of the analysis synthesis corresponding to the object of investigation.¹⁷

The project was approved by the Research Ethics Committee of the Federal University of Bahia, under opinion number: 4,087,611 and CAAE: 32889420.9.0000.5531, according to resolutions 466/12 and 674/2022 and Circular Letter 2/2021, of the CNS, in addition to the general data protection law. The participants declared their consent to the Informed Consent Term (ICT) in the imagery modality. For the preservation of identity, codes were created for the participants, such as: M1 (Man 1), M2 to M45.

Results

Most of the individuals involved in this study identified themselves as heterosexual, cisgender, of mixed race/color, with a higher education level, with a mean salary income above five minimum wages, single, living in urban areas, living with family members, not elderly. Participants reported not having been affected by COVID-19 or having sequelae that could be attributed to the disease. They used both the Unified Health System and the private subsystem to access general health services and care. The empirical material was framed in four Thematic Analysis Categories (TAC) in convergence with RAM, namely: Physiological-physical mode and regulatory subsystem (TAC1), composed of 3 Thematic Cores (TC): changes in sleep pattern (TC1A), changes in dietary pattern (TC1B), and changes and adoption of measures to maintain physical activity (TC1C); Group self-concept identity mode (TAC2), with 01 TC: changes in the management of emotions (TC2A); Role function mode (TAC3), with 01 TC: improvement of self-knowledge, self-care and health care practices (TC3A); Change of interdependence (TAC4) with 4 TC: Changes in the dynamics of the marital relationship, in the performance of roles and in the exercise of paternity (TC4A), Improved strengthening of family ties (TC4B), Increased availability of time to study (TC4C), and excessive cell phone use (TC4D).

TC4D: Control over cell phone usage

throughout the day I have spent more time on my cell phone than necessary. The use has become excessive and I'm having trouble reducing the length of stay. Because of that I started to decrease the usage time, I removed the notifications and sound messages. M3.

with the pandemic I started to feel changes in my individual organization in relation to daily activities. Now I have been trying to control the consumption of content on my cell phone, I avoid using it at night and reducing the frequency of access on social networks. M5.

The experience of men in the COVID-19 pandemic mobilized the construction of adaptive modes according to RAM adapted based on the findings found, which can be seen in Figure 1, which represents a diagram of human adaptive systems in which there is a centralization of the coping process surrounded by four modes of adaptation that generated new behaviors.

Source: Adapted from Russian; Baumann; Velasco-Whetsell; Roy, 2020.²

Figure 1 Diagrammatic representation of human adaptive systems to the experience of adult men in the Covid-19 pandemic in Brazil, Salvador, BA, Brazil, 2020.  

Discussion

The analysis of male adaptation in the face of the COVID-19 pandemic made it possible to perceive that their ways were convergent, which made it possible to carry out the theoretical framework of RAM; however, they reserve symbolic spaces of the uniqueness of each subject in the face of the experience of the "new self" of the pandemic, which could be observed in the oscillations of health patterns in the physiological-physical mode and in the adaptation regulatory subsystem. New findings are evidenced, such as the openness of men to concern for a healthy adaptation and transition in the face of the numerous changes in their respective social and family contexts through attitudes that provide a healthier life in the face of the pandemic. Mental health stands out, stressing for self-care, in mobilizing adaptive modes and relating to the daily dynamism in which men reported accessing reliable sources of news about the pandemic and filtering the media excess of social networks; they also started integrative practices (meditation and physical activity) and therapeutic activities in male groups in a virtual environment to circumvent the psychosocial impacts.¹⁸ This means that men express alternatives in the face of the perception of their own vulnerability and the feelings of fragility that enhance the effective search for caring for themselves and for others. ^6,11,18

The cognitive-emotive and regulatory channels of RAM^2,13 in view of the findings of this study, were manifested from the perceptive processing of information, learning, judgment and emotion of the adaptive process issues that respond to the dynamics of facts through the neural, chemical and endocrine coping channels. This can be seen in the expressions of self-perception regarding the impacts suffered by men.¹⁸ Although some men have reported alternative measures of low adherence among the male population to deal with the process of coping and adaptation, such as meditation and yoga, others have highlighted the weaknesses in the sleep pattern, with emphasis on insomnia and changes in appetite, which included reduced and increased desire to eat. Thus, men with a higher level of education, economic and work and with greater ease of access to private health services may have a favorable adaptation to achieve balance even in the pandemic.¹⁸ Therefore, the link between sociodemographic conditions and effective adaptive forms it becomes more understandable.¹⁹

In general, alterations in sleep patterns, in the irregularity between sleeping and waking up, are risk factors for mental health disorders in all human beings, regardless of gender, which reflect a decline in the capacity for intellectual and cognitive function performance.²⁰ The relationship between men reporting problems in the sleep-wake cycle goes beyond the neurochemical mechanism, as the difficulty in sleeping, waking up and maintaining a desirable quality of sleep, establishes an interface with the excessive feeling of worry that is favorable for insomnia²⁰ due to confinement and the home office, which promoted the adaptive/regulatory mode by awakening a stimulus to its execution to preserve some immunological/emotional activities in men.²¹⁾

However, an intersection between altered sleep patterns, mood/behavior changes and acute mental disorders, such as the tension/stress/nervousness triad, panic crisis, demotivation and depression, can already be observed. Depression, in turn, is bidirectionally associated with insomnia and makes its treatment a complex clinical management item. It is noteworthy that insomnia causes more depression and both must be treated concomitantly.²⁰ This situation alerts to the needs triggered by the restrictions and disruptions in the socialization of men that can, in addition to favoring mental illness, make it difficult to access and adhere to psychosocial support programs.

In pandemic contexts, the problem can worsen and make the adaptation process even more complex, which will require nursing interventions anchored in the philosophical and cultural assumptions of RAM,^2,13 aimed at guidance on sleep hygiene, promotion of healthy eating with reduced consumption of alcohol, other drugs and caffeine, and greater control over access to electronic objects before going to bed, as excessive cell phone use without control over time was evidenced.^20,21

Changes in dietary patterns also emerged in this period and had negative impacts on men's health and quality of life. Such changes are related to mental health aspects and have repercussions on a dysfunctional diet in the face of the psycho-emotional responses mobilized in the pandemic, since the problem of sedentary lifestyle, permeated by physical inactivity, increased time in the sitting position and excessive food intake, raising the possibility that men developed morbidities from the group of Chronic Non-communicable Diseases (CNCDs).²²

Taking into account the behaviors and attitudes of men's practices, adaptive modes have shown to be ascending, and need to be better explored by multidisciplinary teams, in particular the nurses, with a view to achieving tangible goals of care with other groups of men, namely: acquisition of healthy eating habits; prevention of health problems; hygiene; meditative practices; behavioral management of emotions; strengthening of affective bonds; virtual interaction/communication; hope; self-efficacy; self-compassion and establishment of socio-affective networks.

In addition, the “mode of interdependence”, which involves the structure and development of the person as a unit or his collectivity, in a dimension of the cognitive-emotional coping subsystem,^2,13 was present in the experience of men, and may be related to the way they processed the individual adaptability that caused marital, family and paternity changes, and that for these reasons, they lack nursing interventions to support the adaptation of affective relationships between couples and different partnerships, aiming to promote a good relationship, non-violence and a culture of peace with a focus on family harmony and balance.^12,19 It is worth mentioning that with the advance of vaccination, the population acquired subsidies to face an installed international disaster and made men return, as far as possible, with its socializations in different groups, with nursing as a promoter of safety under a collective gaze, in different formats, using technology as a vehicle for communication and digital social interaction.^23,24

Regarding mid-range Nursing Theories, they are still poorly incorporated into care in the different complexities of health systems, which need to conform to the logic of complex adaptives, because when they are used, nursing theories create foundations that reformulate practices and protocols for the qualification of care, directing it to the specific demands of men during the pandemic and enabling the applicability of focal, contextual and residual stimuli belonging to Roy's model.^2,13

Regarding the limitations of the study, there was the possibility of biases in relation to the sample in view of the recruitment technique used, the inaccessibility of groups of men with low levels of digital literacy or with limited access to technological resources such as a smartphone and the lack of deepening of knowledge given the impossibility of establishing a dialogue with the participants. Such facts, according to RAM, can hamper the process of monitoring what is adaptable or not, and prevents generalization.

Finally, nurses can expand the scope of their actions, when contemplating the concept “nursing goal”² by mobilizing the promotion of adaptation of the four adaptive modes proposed by Callista Roy that named the analytical categories of this study, and for carrying out investigations at the regulatory and cognition levels, as they define the problem more accurately and support the decision on which care plan will achieve its expected results.

Conclusion

Faced with the emergence of the COVID-19 pandemic and its different consequences, men expressed ways of adapting to social interaction facilitated by digital connectivity, generating success in the cognitive subsystem. On the other hand, the group self-concept identity mode still remains in modulation and non-adaptation, especially in mental health, which has been altered, while physical health has been altered through a sedentary lifestyle, eating and sleeping patterns. The way of interdependence was manifested when exercising new behaviors, attitudes and practices that in general are directed to the management of emotions, self-knowledge, spirituality/transcendence and the strengthening of the construction of bonds through socio-affective networks. In addition, the need for adequacy and qualification of health care regarding the adaptation of men was identified, above all, the role that nursing has in providing analytical elements such as RAM, which allow the apprehension and subsidizing of interventions at the individual and collective levels that contribute to better assisting emerging demands.