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Enfermería Global

versión On-line ISSN 1695-6141

Enferm. glob. vol.19 no.59 Murcia jul. 2020  Epub 10-Ago-2020

https://dx.doi.org/10.6018/eglobal.411311 

Reviews

Factors related to the resilience of adolescents in contexts of social vulnerability: integrative review

Isabel Cristina Sibalde Vanderley1  , Merenciana de Albuquerque Sibalde Vanderley2  , Alef Diôgo da Silva Santana3  , Fabio Scorsolini-Comin4  , Waldemar Brandão Neto5  , Estela Maria Leite Meirelles Monteiro6 

1 Enfermera. Alumna de Maestría del Programa de Posgraduación en Enfermería. Universidad Federal de Pernambuco. Recife-PE, Brasil. E-mail: belvanderley@hotmail.com

2 Estudiante del Curso de Pedagogía. Centro de Educación. Universidad Federal de Pernambuco. Recife-PE, Brasil.

3 Enfermero. Alumno de Maestría del Programa de Posgraduación en Enfermería. Universidad Federal de Pernambuco. Recife-PE, Brasil.

4 Doctor en Psicología. Profesor del Departamento de Enfermería Psiquiátrica y Ciencias Humanas. Escuela de Enfermería de Ribeirão Preto. Universidad de São Paulo. São Paulo-SP, Brasil.

5 Doctor en Salud del Niño y del Adolescente. Profesor Adjunto de la Facultad de Enfermería Nossa Senhora das Graças de la Universidad de Pernambuco. Recife-PE, Brasil.

6 Doctora en Enfermería. Profesora Adjunta del Departamento de Enfermería y miembro permanente del Programa de Posgraduación en Enfermería. Universidade Federal de Pernambuco. Recife-PE, Brasil.

ABSTRACT:

Introduction:

Resilience can be understood as a process of persistence and overcoming against experienced weaknesses. Adolescents in contexts of social vulnerability find obstacles in the development of their resilience, which impair the visibility of coping/answer strategies for the adversities of everyday life.

Objective:

To analyze the scientific evidence available in the literature on the factors related to the resilience of adolescents in contexts of social vulnerability.

Method:

Integrative review of articles published in Portuguese, English or Spanish, from 2014 to 2018, in libraries/databases Medline/Pubmed, Scopus, LILACS, Web of Science, IBECS, Cochrane, BDENF, CINAHL and PsycINFO. The following descriptors were used "Psychological Resilience", "Social Vulnerability", "Adolescent" and "Adolescent Health", resulting in 17 articles. The guiding question was: what are the factors related to the resilience of adolescents in contexts of social vulnerability? Results: Five classes emerged, depicting the factors that contribute to resilience in adolescents in situation of social vulnerability, namely: aspirations for the future, risk factors, institutional barriers, exposure and social support.

Conclusion:

The factors that strengthen resilience are the social support provided by family, friends, teachers, cultural and religious aspects, and risk factors are violence, substance abuse, lack of security and precarious institutional support. The understanding of resilience and specificities that outline the health conditions of adolescents in situation of social vulnerability must be considered to reorient interdisciplinary and intersectoral actions to promote the health of this population group.

Key words: Psychological Resilience; Social Vulnerability; Adolescent; Adolescent Health; Protective Factors; Community Health Nursing

INTRODUCTION

Adolescence is a phase of life characterized as a transition between childhood and adulthood, marked by a complexity of changes in biopsychosocial development1. Adolescents, faced with the changes experienced, are more susceptible to situations of social vulnerability that increase the challenges to be overcome in their course of life. Social vulnerability refers to all aspects of adversity related to the context in which the individual is inserted, characterized by socioeconomic, racial / ethnic, religious and gender factors. The situation of vulnerability denotes individual or group paths that can trigger undesirable factors or weaken the individual's development. The human being's ability to recognize and face situations resulting from social vulnerability, as inherent components of life, is conceptualized as resilience2.

Different epistemological positions and areas of application contribute to the various concepts proposed for resilience; however, the concept of resilience is based on the persistence against the weaknesses experienced, with the visibility of strategies to overcome adversities and stressful events. It involves an intersubjective process triggered to achieve a response to a trauma situation, ensuring peculiarities that contribute to the development of the individual3.

The individual's resilient behavior can be developed through interactions between the various levels, integrating molecular, ecological and social aspects. These interactions include factors related to family, school, friendships and community, reflecting the context to which the individual belongs4.

Adolescents inserted in a vulnerable and socioeconomically unfavorable environment have risk factors and behaviors that can undermine their resilience. Among the aspects present in this vulnerable group are the poverty, the presence of violence and the abuse of psychoactive substances, factors that tend to impair the adolescents' mental health and hinder the development of their resilience5.

Nevertheless, the presence of protective factors can predict a good development from the point of view of resilience through individual and social mechanisms. The individual mechanisms are related to specific aspects to deal with adversities, such as the presence of self-efficacy and optimism about the future. Social relationships are essential in facing difficulties, with emphasis on the protective role of a social support network, which can be composed of family, friends, community and health professionals6. Adolescents in a context of social vulnerability may have their existing protective factors weakened, which hinders the development of their resilience.

Research development is important to understand how resilient development in adolescence varies over time and how the factors involved in this process are important for a greater understanding of the specificities of this age group4)(5. In addition, they can support relevant public policies and measures that can resolve the present adversities and the possible traumatic aspects experienced7. Understanding and promoting a critical-reflexive practice of the adolescents' perceptions and their relationship with the socio-community context is a major challenge for the professionals who serve this age group1.

Nursing plays a fundamental role in the care of adolescents with a focus on their protagonism, and can contribute to the recognition of risk and protective factors to the resilience and to the development of strategies that can strengthen a resilient and healthy attitude of adolescents inserted in a context of social vulnerability. Based on the above, the objective of the present study was to analyze the scientific evidence available in the literature on factors related to the resilience of adolescents in contexts of social vulnerability.

MATERIAL AND METHOD

The integrative literature review allows the synthesis of knowledge and the gathering of a set of significant evidences for the improvement of professional practice8. To conduct this review, the following steps were taken to better organize, describe and discuss the results: identification of the theme and the research problem; definition of inclusion and exclusion criteria; selection of studies; categorization of the studies found; analysis of results and synthesis of learned knowledge8.

The guiding question was developed with the aid of the PICo mnemonic strategy (P: adolescents; I: resilience). The PICo strategy aims to elucidate the meaning that an intervention, process, states, procedures or health conditions have for individuals in a non-clinical context9. Thus, the following guiding question was formulate: What are the factors related to the resilience of adolescents in contexts of social vulnerability?

The selection of studies was composed of articles obeying the following inclusion criteria: original articles, published between the years 2014 and 2018, in Portuguese, English and Spanish, with research on adolescents aged 10 to 19 years, according to the age group proposed by the WHO and that answer the guiding question of the review. The exclusion criteria established were productions such as theses, dissertations, editorials, book chapters, literature reviews and experience reports.

Data collection took place from July 16 to November 20, 2018 by two independent judges in the following libraries / databases: Medline/Pubmed, Scopus, LILACS (Latin American & Caribbean Health Sciences Literature), Web of Science, IBECS (Cumulative Index to Nursing & Allied Health Literature), Cochrane, BDENF (Nursing Database), CINAHL (Cumulative Index to Nursing & Allied Health Literature) and psycINFO. And in the English language of Medical Subject Headings (MeSH): Psychological Resilience, Social Vulnerability, Adolescent and Adolescent Health, with double and triple cross performed and combined with the descriptor Psychological Resilience with the Boolean AND. 8,587 publications were found.

Methodological rigor was verified through the Critical Appraisal Skills Programme (CASP), which classifies the studies as: good methodological quality and reduced bias (category A - 6 to 10 points), and satisfactory methodological quality (category B - at least 5 points)10. The level of evidence was also assessed according to Stleter et al11 according to the following categorization: I - meta-analysis studies of multiple randomized controlled studies; level II - individual studies with experimental design; level III - quasi-experimental studies, time series or case-control; level IV - descriptive studies (non-experimental or qualitative approach); level V - case or experience reports; level VI - opinions of expert committees, including interpretations of information not based on research, regulatory or legal opinions.

The data processing used the interface software R for Multidimensional Analysis of Texts and Questionnaires (IRaMuTeQ, versão 0.7 alpha 2). The IRaMuTeq is a computerized program anchored to software R that allows different forms of statistical analysis on textual corpus. The corpus was composed of the synthesis of the articles included in the review. The program allows the realization of the Descending Hierarchical Classification (DHC), which considers the Text Segments (TS) of the study corpus and the registration of the contexts of the classes12.

RESULTS

From the search for studies through double and triple crosses, 8,587 articles were found in the databases used. According to the follow-up of the development stages of this review, 8,108 articles were excluded according to the reading of the titles and 360 articles were excluded after reading the abstracts because they were not in line with the theme or because they did not answer the guiding question. Then, the remaining 119 articles were read in full, resulting in 17 studies that demonstrated an affinity with the theme proposed in the present study (Figure 1).

Figure 1:  Flowchart of study selection, adapted from the Preferred Reporting Items for Systematic Review and Meta-Analyses - PRISMA13. Recife, Brasil, 2019. 

Of the 17 studies retrieved, all were found at evidence level IV, denoting quantitative and qualitative descriptive studies. All studies were developed from 2014 to 2018 and were presented in the English language. The studies were carried out in Russia, Australia, the United States (USA), India, South Africa, Spain, Mozambique, Uganda and Turkey. A summary of the articles is presented in Tables 1 and 2.

Table 1:  Description of studies selected for review according to author, year of publication, title of the article, method and level of evidence. Recife, Brasil, 2019. 

Authors / Year Title Method / Level of evidence
Ulturgasheva14, 2014 Attaining khinem: Challenges, coping strategies and resilience among Eveny adolescents in northeastern Siberia Qualitative descriptive study / IV
Hopkins et al15, 2014 Resilience amongst Australian Aboriginal Youth: An Ecological Analysis of Factors Associated with Psychosocial Functioning in High and Low Family Risk Contexts Cross-sectional study / IV
Rasmus et al16, 2014 "Where I have to learn the ways how to live:" Youth resilience in a Yup'ik village in Alaska Qualitative descriptive study / IV
Narayanan17, 2015 Predictors of resilience among adolescents of low socio-economic status in India Cross-sectional study / IV
Ernestus; Prelow18, 2015 Patterns of risk and resilience in African American and Latino youth Cohort study / IV
Chapin19, 2015 Mexican-American Boys' Positive Outcomes and Resilience: Importance of Social Support and Individual Attributes Qualitative descriptive study / IV
Mosavel et al20, 2015 South African, urban youth narratives: resilience within community Qualitative descriptive study / IV
Hills et al21, 2016 The lived experiences of street children in Durban, South Africa: Violence, substance use, and resilience Qualitative descriptive study / IV
Moreno et al22, 2016 Characterization of Vulnerable and Resilient Spanish Adolescents in Their Developmental Contexts Cross-sectional study / IV
Theron23, 2016 Toward a Culturally and Contextually Sensitive Understanding of Resilience: Privileging the Voices of Black, South African Young People Qualitative descriptive study / IV
Aitcheson et al24, 2017 Resilience in Palestinian Adolescents Living in Gaza Cross-sectional study / IV
Hiller et al25, 2017 Post-trauma coping in the context of significant adversity: a qualitative study of young people living in an urban township in South Africa Qualitative descriptive study / IV
Namy et al.26, 2017 Gender, violence and resilience among Ugandan adolescents Cross-sectional study / IV
Bulut et al27, 2018 Living in difficult conditions: an analysis of the factors associated with resilience in youth of a disadvantaged city Cross-sectional study / IV
Taylor et al28, 2018 Effortful Control as a Mediator Between Contextual Stressors and Adjustment in Midwestern Latino Youth Cross-sectional study / IV
Herbst et al.29, 2018 "They Were Going to Kill Me": Resilience in Unaccompanied Immigrant Minors Qualitative descriptive study / IV
Theron; Rensburg30, 2018 Resilience over time: Learning from school-attending adolescents living in conditions of structural inequality Qualitative descriptive study / IV

Table 2:  Summary of studies found on the resilience of adolescents in situations of social vulnerability. Recife, Brasil, 2019. 

Article Country Objectives
Ulturgasheva16 Russia To examine the strategies used to deal with difficult situations.
Hopkins et al17 Australia To evaluate predictors of positive psychosocial function for young people in contexts of high and low family risk.
Rasmus et al18 USA To describe youthful stressors and resilience strategies.
Narayanan19 India To examine predictors of resilience in adolescents with low socioeconomic status.
Ernestus; Prelow20 USA To identify subgroups of adolescents from low-income ethnic minorities and examine different outcomes after six years.
Chapin21 USA To analyze gender and cultural context to the resilience of adolescents.
Mosavel et al.22 South Africa To understand the challenges facing young South Africans and coping strategies.
Hills et al23 South Africa Qualitatively explore the experiences of young people living on the streets of Durban - South Africa.
Moreno et al24 Spain To characterize resilience and vulnerability in a sample of adolescents.
Theron25 South Africa To investigate how resilience processes characterize a positive adjustment in an economically disadvantaged context.
Aitcheson et al26 Mozambique To examine the prevalence of depression and anxiety and predictors of resilience in a group of adolescents.
Hiller et al27 South Africa To understand the support networks and coping strategies of young people in a context of significant adversities and risks.
Namy et al.28 Uganda To explore the dimensions of resilience and associations with experiences of violence among adolescents.
Bulut et al29 Turkey To assess the different dimensions of psychological resilience in youth.
Taylor et al30 USA To examine the effects of multicultural individual and family stressors of young Latinos.
Herbst et al. (31) USA To understand the experiences of unaccompanied young immigrant minors in the context of migration.
Theron; Rensburg(32) South Africa Investigate the resources that adolescents identify as promoting resilience.

In the analysis of articles using the Descending Hierarchical Classification (DHC), the corpus was divided into 267 Text Segments (TS), with 203 classified segments (76.03%). From this, five classes were established, according to the dendrogram (Figure 2). Each class was represented by the most significant words using X2 and p-value (<0.05), with their associations according to the classes.

Figure 2:  Dendrogram of the Descending Hierarchical Classification of the corpus on mechanisms used by adolescents to develop resilience in contexts of social vulnerability. Recife, Brasil, 2019. 

The dendrogram shows the corpus delimited according to the occurrence and co-occurrence of the most significant words, subsidizing the composition of the following classes: class 1 contributed with 17.2% of the ST's of the Elementary Context Units (ECU's) and was named as "Aspirations for the future". Class 2 represented 28.6% of the TS, being named as "Risk factors"; class 3, "Institutional barriers" represented 20.7% of the TS; class 4, "Exposure" represented 13.3% and finally, class 5 represented 20.2%, being called "Social support".

DISCUSSION

The factors related to the resilience of adolescents in contexts of social vulnerability run through the dimensions of the adolescent's life, configuring themselves as threatening or strengthening the resilience of young people. Individual attributes, family and social support and institutional aspects are factors that can contribute or hinder the resilient development of adolescents.

In class 1, Aspirations for the future, there was a focus on aspects related to the future that adolescents considered important. Success, employment, college and money are words that indicated aspirations for a promising future and that promote a change in the lives of these young people. In a qualitative study of Mexican adolescents living in the USA19, young people reported their desire to complete high school and enter a college to change the reality they experienced, aiming to get a good job and be a good provider for the family.

Studies carried out in Australia13, USA17)(27 and South Africa18)(21 have shown that money and employment are important issues for reversing the situations of vulnerability to which young people are exposed and strengthening their resilience. In the studies with adolescents developed in the USA, the profile of young people refers to individuals who emigrated from their countries of origin in search of opportunities, reinforcing future aspirations to improve living conditions.

The hope of a promising future gives a purpose to the lives of young people and can become an ally in their resilience process. In a nefarious scenario, adolescents feed their desires and develop strategies that can favor a change in socioeconomic status, which, even in the presence of denial of rights, strengthen their optimism and facilitate the coping with the adversities experienced.

In most studies, school was a variable mentioned14)(15)(16)(17)(18)(19)(20)(22)(23)(25)(26)(27)(29)(30. Despite studies carried out in a Russian village14, the USA16 and India17 indicate the school environment as a stressor, mainly due to the practice of bullying, the school was reported in most studies as a protective factor for adolescents. For young people who are in a situation of vulnerability and of deprivation of rights, the school environment is conFigured as a space for social interaction and the promotion of well-being, with a great potential for changing social practices by contributing to the development of adolescents while being biopsychosocial and cultural, contributing to the their resilience process.

Class 2 (Risk factors) gave rise to all other classes and refers to words that are associated with psychosocial aspects that hinder the resilient development of adolescents. Some studies have highlighted the importance of the family as a protective factor against the risks present in the experienced context16)(18)(24. Although the family is often considered a strength for young people, studies indicate that a family mismatch can cause losses in the development of these adolescents' resilience24)(25)(28. Risk factors related to family mismatch15)(17)(18 and low socioeconomic status are aspects that characterize the situation of social vulnerability experienced by adolescents, as demonstrated in several studies that investigate this phenomenon.

The presence of a family base capable of providing favorable conditions for the adolescent's development can be a great collaborator in strengthening resilience. However, a context of social vulnerability can interfere with the family structure and disrupt the relationships between family members. In this context, healthy family relationships are essential, which, even under adverse conditions, are able to welcome and encourage adolescents to face the problems of life.

The contexts of poverty are evident in all studies in the present review, differing in levels and characteristics inherent to the research sites. Studies carried out in urban environments describe the challenges of adolescents within a context of marginalization and suppression of some types of resources. Studies developed in Russia14, Australia15 and the USA16 with adolescents who live in tribes and villages demarcated a scenario of scarcity of resources and reported the challenges faced by young people in facing adverse situations.

Two studies carried out in India17) and South Africa23 described a disadvantaged rural context and the youth's adaptation strategies to the present risk factors. The different panels reveal that social vulnerability is strictly linked to low socioeconomic development in different realities and resilience strategies vary according to the resources available in urban or rural settings.

A study conducted in Australia found the occurrence of racism as a risk factor for adolescents' resilience. Ethnic / racial issues involve situations of social vulnerability and constitute a barrier in the development of identity formation and self-esteem, affecting the resilient behavior of young people.

Class 3, named Institutional barriers, presents words that refer to the precariousness of government resources and investments to provide basic needs for adolescents. Four studies pointed out the lack of security as a stressor present in the daily lives of young people. In a study carried out in a Russian village14, the lack of security is reported to be constant in the lives of young people, requiring the improvement of strategies to circumvent these situations and guarantee their resilience and survival.

Three studies carried out in South Africa20)(21)(25 denounced the concern with the lack of security precarious housing conditions (or homelessness) and frequent demonstration of aggression / violence. In the USA29, in a study conducted with adolescent immigrants, the lack of basic resources such as security, food and housing was highlighted as motivations for their emigration. In an African study of adolescents living on the streets, young people reported constantly experiencing police violence.

The limited institutional support offered to adolescents undermines their resilient capacity and restrains their rights as citizens. It is important to reflect beyond the insufficient availability of resources, revealing limitations of services that should minimize the risks of young people and that end up becoming propagators of fear and constant insecurity in youth.

Regarding the studies carried out in South Africa20)(21, the adolescents' reports highlighted the occurrence of rape of girls. Sexual violence against female adolescents involves issues of gender and male domination, which brings out the ingrained machismo in society that is directed more strongly to individuals who are in a situation of social vulnerability and deprivation of rights.

Class 4 (Exposure) is very close to class 3 because it mentions other risk factors that adolescents are exposed to. The consumption of alcohol and other substances14)(15)(19)(20)(21)(22)(25)(27 has been described in several studies. Although substance use denotes a risk and exposure factor for young people in situations of social vulnerability, some situations are conFigured as a way to escape from coping with stressors21)(25.

In addition, young people are exposed to several situations that compromise their resilient development, such as: involvement with crime20)(21)(24)(27) and the presence of diseases18)(23)(27. Living in an unfavorable socio-economic context undermines the integrity of young people and puts not only their development at risk, but is also a threat to their lives. The debate about the involvement of young people in situations of social vulnerability with crime reinforces the urgency of intersectoral actions that promote fair and equal access to education and the labor market. Poverty condemns adolescents to live in precarious sanitary conditions that favor the onset of diseases, requiring public protection policies and effective health care for young people.

Finally, class 5, Social Support, refers to the resources available and used by adolescents to cope with stressful situations and the development of resilience. Identity and cultural practices have been described in several studies15)(16)(17)(21)(23)(24)(28)(29 and referred to the importance of the sense of identity arising from the socio-cultural context of adolescents, as a tool for coping with adversity. The different study contexts demonstrate a variety of cultures that are very significant in providing motivations for young people and that assist in their resilience process.

Another aspect mentioned in the studies is based on the faith and religion of young people20)(21)(23)(25)(29)(30, bringing beliefs as sources of hope for a better future and with less difficulties. Faith appears as a resource that helps young people to deal with difficult social contexts in which they live, keeping hope for an auspicious future.

In most studies, friendship was also cited as a support to face the difficult moments of adolescents' lives14)(15)(16)(19)(21)(22)(23)(25)(29)(30, as well as the support of the teacher19)(22)(23)(25)(30 and family relationships14)(16)(19)(23)(24)(25)(26)(29. The establishment of a support network provided by friends, family and teacher reinforces the importance of strengthening the resilient process of young people who live in contexts of social vulnerability.

Resilience encompasses all the continuously developed and renewed overcoming strategies that adolescents use to deal with a society often exclusionary. However, through the aforementioned supports of the social dimension of adolescents' lives, young people can seek and renew their sources of resilience, even in very vulnerable contexts.

CONCLUSION

The factors related to the resilience of adolescents in the context of social vulnerability involve all dimensions of the socio-cultural context to which they are inserted. The main factors that strengthen young people's resilience are the social support provided by family, friends, teachers and by cultural and religious aspects. Living in an unfavorable socioeconomic context helps adolescents face several risk and exposure factors, such as violence, substance abuse and lack of security, in addition to precarious institutional support.

Studies have shown that the resilience of adolescents in situations of social vulnerability is reflected in a proactive stance in facing challenges and in the search for their development, even under disadvantageous conditions. The understanding of resilience and the specifics that outline the health requirements of adolescents in situations of social vulnerability need to be considered to reorient intersectoral and interdisciplinary actions to promote the health of this population group, which represents the potential of a successful future.

Nursing needs to be in consensus with the literature produced, establishing its practice based on scientific evidence, to identify and evaluate the factors that can pose risks to the development of the adolescent population. As well as identifying existing resources and strategies that can be developed to respond to contexts of social vulnerability, enhancing the emergence of resilience as a protection and overcoming mechanism for healthy growth and development.

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Received: January 23, 2020; Accepted: February 17, 2020

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