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The World Health Organization Global Hearts initiative (HEARTS) and technical package aim to improve the primary health care management of hypertension and other risk factors for cardiovascular disease at the population level. This study describes the first HEARTS implementation pilot project in Guatemala’s Ministry of Health (MOH) primary health care system. This pilot began in April 2022 in six primary health care facilities in three rural indigenous municipalities. The project consisted of HEARTS-aligned strategies adapted to enhance program sustainability in Guatemala. Outcomes were defined using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. The primary reach outcome was treatment count, defined as the absolute number of patients per month receiving medication treatment for hypertension. The primary effectiveness outcomes were mean systolic blood pressure (BP), mean diastolic BP, and proportion of patients with BP control (

This Special Report aims to outline the development process of the first National Clinical and Policy guidelines on Intimate Partner Violence and Sexual Violence in Trinidad and Tobago and to support the implementation of quality standards for survivors. The study used an implementation science approach to identify key evidence-based practice recommendations from guidance documents on health care for women who are subjected to violence and from relevant national legislation, policy, and practices. The process engaged stakeholders in discussions on the appropriateness, implementation, and use of these recommendations in the context of local health care delivery. Multidisciplinary teams of frontline health workers were consulted in groups in each of the five Regional Health Authorities. Interviews were held with senior government stakeholders responsible for health policy and with representatives of four civil society agencies. Participants provided recommendations to integrate quality standards into routine practice. These were incorporated into the guidelines, which include human rights principles and pathways of care for identifying violence, providing psychosocial and clinical care, safety planning, referrals, care during emergencies, and prevention of intimate partner violence and sexual violence. The guidelines were approved by the Ministry of Health of Trinidad and Tobago on 15 August 2022. Training of trainers has been undertaken to support implementation.

Objectives. This paper describes and analyzes embedded implementation research and the empirical processes of planning for utilization, strategies to promote utilization and the sustainability of utilization of results from research led by decision-makers in Latin America and the Caribbean. Methods. This qualitative, descriptive and interpretive study is based on the findings from semistructured interviews with members of teams working under the Embedding Research for the Sustainable Development Goals initiative (2018–2019) as well as their responses to a self-assessment follow-up questionnaire 1 year after the project was completed. Results. Altogether 13 teams from 11 countries participated in the Initiative. Nine teams had a core team composed of a decision-maker as the principal investigator assisted by a researcher as co-principal investigator. Four teams included more than one co-principal investigator; and in five teams, the originally assigned principal investigator was replaced. There was an interesting relationship between the expected utilization of research results, the utilization strategies, the sustainability of research uptake and the teams’ collaboration modalities. When decision-makers and co-principal investigators were active participants, the intention to use the results and strategies for utilization were clearly oriented to improve implementation. In teams with basically a formal collaboration between the two principals, plans for utilization were unclear or focused on producing academic knowledge. The participation of implementers below the rank of principal investigator decision-maker may be relevant. Conclusions. Embedded implementation research is an innovative tool that may foster the utilization of research and strengthen health programs and services. Considering the internal dynamics of such research teams will enhance planning and strategies for research utilization as well as the sustainability of practical and actionable findings.

ABSTRACT Objective: To structure a proposal for implementing and monitoring the nursing care protocol for the safety of adult patients with external ventricular drains. Method: Descriptive exploratory research based on Implementation Science, with intentional sampling. Carried out in a hospital complex in southern Brazil, between May and December 2022, in four stages: online questionnaire on knowledge of care for patients with external ventricular shunt for nurses; matrix of proposed indicators with key actors; self-instructional online course for nurses; synthesis of the existing protocol. Contextualized instructional design was used to develop the course. Results: Six nurses from the operating room and intensive care unit participated, identifying knowledge gaps, pointing out the need for specific training; four key actors in the neurosurgery service defined six indicators. An online course was created and made available on the platform of the institution with two modules, including eight videos. Protocol synthesis was adapted to the standards of the institution’s quality sector. Conclusion: A report regarding the implementation of the nursing care protocol for patients with external ventricular drains was delivered for the nurse who was the technical responsible. Future studies should evaluate the implementation and impacts it will generate. This model can be adapted by other institutions.

ABSTRACT Objective: To identify the conditions that interfere with the implementation of the Advanced Access model in primary health care. Method: This is an implementation research that used the Consolidated Framework for Implementation Research (CFIR). The CFIR provides a classification of factors that affect the implementation of a technology and comprises five domains: characteristics of the intervention, external environment, internal environment, individuals, and process. The study setting included 13 Health Units in the southern region of the city of São Paulo-SP. 39 health professionals and 10 managers participated. Data was collected through semi-structured interviews. These were recorded and transcribed, and the text data was coded based on pre-established codes derived from the CFIR domains. Results: Four categories were found that impacted the implementation of the AA model in services: 1) Characteristics of the Advanced Access model that impacted implementation; 2) Organization of the health sector and the Advanced Access model; 3) Characteristics of the individuals involved in the innovation; and 4) The planning and leadership model for implementation. Final Considerations: The social, structural, and professional conditions in the municipality of São Paulo made it difficult to implement the AA model. The implementation research supported the process of improving access in the health units studied and provided evidence of what helped and what hindered the restructuring of the access model in these places.

This is the second part of the Brazilian S20 mental health report. The mental health working group is dedicated to leveraging scientific insights to foster innovation and propose actionable recommendations for implementation in Brazil and participating countries. In addressing the heightened mental health challenges in a post-pandemic world, strategies should encompass several key elements. This second part of the S20 Brazilian Mental Health Report will delve into some of these elements, including: the impact of climate change on mental health, the influence of environmental factors on neurodevelopmental disorders, the intersection of serious mental illness and precision psychiatry, the co-occurrence of physical and mental disorders, advancements in biomarkers for mental disorders, the use of digital health in mental health care, the implementation of interventional psychiatry, and the design of innovative mental health systems that integrate principles of innovation and human rights. Reassessing the treatment settings for psychiatric patients in general hospitals, where their mental health and physical needs are addressed, should be prioritized in mental health policy. As the S20 countries prepare for the future, we need principles that can advance innovation, uphold human rights, and strive for the highest standards in mental health care.

ABSTRACT OBJECTIVE To confirm the diagram of the program’s impact pathways and Estratégia Amamenta e Alimenta Brasil (EAAB - Brazilian Breastfeeding and Complementary Feeding Strategy) core functions, and to determine indicators for evaluating EAAB. METHODS This is a qualitative study within the field of implementation research. Data collection included two focus groups with EAAB implementers, document analysis, and literature review. The analysis included a review of the participants’ suggestions and two stages of reviewing the diagram and the names of the impact pathways and core functions. Questions for evaluating the EAAB were then constructed based on the confirmed diagram. The indicators of the RE-AIM framework (reach, effectiveness, adoption, implementation, maintenance) were adapted to the EAAB context. The evaluation questions were revised according to the RE-AIM domains and, finally, indicators were determined for each evaluation question. RESULTS This study advanced the analysis of EAAB implementation, defining 22 indicators for its monitoring and evaluation. Most of the indicators are already used in implementation, however, the analysis with the RE-AIM framework allowed the indicators to be updated to be more specific, measurable, and relevant to the desired objectives. CONCLUSION The results of the study support the pragmatic application of RE-AIM evaluation in health programs and encourage the planning of evaluation indicators for other child health and development programs in primary care.

ABSTRACT Objective Sexually transmitted infections (STIs) disproportionately affect transgender women and travestis (TGW), who often lack access to healthcare due to stigma and discrimination. We describe the approach and methodology of a study investigating the prevalence of syphilis, HIV, hepatitis A, B, and C, Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), and human papillomavirus (HPV) among TGW, as well as their knowledge and perceptions regarding syphilis, to better inform policies to curb STIs among this vulnerable population. Methods: TransOdara was a multicentric, cross-sectional study conducted among TGW in five capital cities from major Brazilian regions between December 2019 and July 2021. Self-identified transgender women and travestis aged >18 years were recruited using respondent-driven sampling after a qualitative formative phase, completed an interviewer-led questionnaire, were offered a physical examination, and were also asked to provide samples from multiple sites to detect various STIs, starting vaccination and treatment when indicated. Results: A total of 1,317 participants were recruited from the five study locations: Campo Grande (n=181, 13.7%), Manaus (n=340, 25.8%), Porto Alegre (n=192, 14.6%), Salvador (n=201, 15.3%), and São Paulo (n=403, 30.6%). The recruitment period varied at each study location due to logistic constraints imposed by the COVID-19 pandemic. Conclusion: Despite the enormous challenges posed by the co-occurrence of the COVID-19 pandemic and field work targeting a vulnerable, elusive, and scattered population, the TransOdara project has been effectively implemented. Caveats did not preclude 1,300 TGW from being interviewed and tested, amid a significant epidemic that disrupted health services and research projects in Brazil and worldwide.

Objectives. To validate the implementation drivers scale among first-level mental health care professionals in Colombia. The scale is designed as a tool to guide the implementation of strategies that effectively reduce gaps in mental health care. Methods. The Active Implementation Framework was adopted, which is a widely used model for measuring implementation. The participants included 380 individuals (55.56% men) – 349 health personnel trained in the Mental Health Gap Action Programme (mhGAP) and 31 territorial personnel in charge of planning mental health strategies at the territorial level in Colombia. To assess the critical dimensions of mhGAP implementation, we developed a scale of 18 items based on the active implementation framework. We conducted content validity assessments and exploratory factor analysis to evaluate the scale. We used the Organizational Readiness for Knowledge Translation scale as a comparative standard. Results. The implementation drivers scale identified four dimensions: system enablers for implementation, accessibility of the strategy, adaptability and acceptability, and strategy training and supervision. These dimensions had Cronbach alpha values of 0.914, 0.868, 0.927, and 0.725, respectively, indicating high internal consistency. In addition, all dimensions demonstrated adequate correlation with the Organizational Readiness for Knowledge Translation scale. Conclusion. The implementation drivers scale effectively determines the adaptability and implementation of various components of mental health programs, particularly those focusing on community-based approaches and primary care settings. As such, this scale can contribute to the more effective implementation of strategies outlined by global and local political frameworks, thus improving mental health care.

ABSTRACT The COVID-19 pandemic generated a large volume of scientific productions with different quality levels. The speed with which knowledge was produced and shared worldwide imposed on health management the challenge of seeking ways to identify the best available evidence to support its decisions. In response to this challenge, the Department of Science and Technology of the Brazilian Ministry of Health started offering a service to produce and provide scientific knowledge addressing priority public health issues in the pandemic scenario. Drug treatments, non-pharmacological measures, testing, reinfection and immunological response, immunization, pathophysiology, post-COVID syndrome and adverse events are among the topics covered. In this article, we discuss the strengths and lessons learned, as well as the challenges and perspectives that present a real example of how to offer the best scientific evidence in a timely manner in order to assist the decision-making process during a public health emergency.

ABSTRACT Objectives: to present the theoretical model, logic model, and the analysis and judgment matrix of the Fall TIPS Brazil Program. Methods: a qualitative, participatory research approach, in the form of an evaluability study, encompassing the phases (1) problem analysis; (2) program design, development, and adaptation to the Brazilian context; (3) program dissemination. Data were collected through document analysis and workshops. Results: through document analysis, workshops with stakeholders from the participating institution, and validation with key informants, it was possible to identify the program’s objectives, expected outcomes, and the target audience. This allowed the construction of theoretical and logic models and, through evaluative questions, the identification of indicators for the evaluation of the Fall TIPS Brazil Program. Final Considerations: this study has provided insights into the Fall TIPS program, the topic of hospital fall prevention, and the proposed models and indicators can be employed in the implementation and future evaluative processes of the program.

Objective: To describe the experience of elaborating the Primary Care Nursing Protocol and the management of Basic Health Units in Rio Branco -- Acre. Methods: This is an experience report on the elaboration of a Protocol, a powerful instrument for implementing improvements and managing Basic Health Units. The preparation of the protocol was carried out in stages: Stage 1: Composition of the Committee; Stage 2: Research and Construction; Stage 3: Public Consultation; Step 4: Completion of Construction. Results: A protocol drafting committee was set up. The implementation of improvements in the assistance provided to the population during the project execution period was observed. Ahead of the management of Basic Health Units, it was possible to experience the Primary Health Care scenario closely, (financing, composition of teams and attributes), to know the managerial and political capacity for the organization of health care, as well as to implement related improvements. clinic management and clinical guidelines. Conclusion: The elaboration and implementation of a Primary Care Nursing Protocol adds not only knowledge to practice, it envisions more professional appreciation, which makes it possible to break a barrier centered on the medical figure, by attributing a relevant and conquered role to nursing, with protocols services capable of meeting the existing demands in the Units. In addition to allowing the strengthening, technical and scientific visibility and the expansion of people's access to PHC as a significant and decisive part of nursing. [ABSTRACT FROM AUTHOR]

Copyright of Retos: Nuevas Perspectivas de Educación Física, Deporte y Recreación is the property of Federacion Espanola de Asociaciones de Docentes de Educacion Fisica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective. To understand how replacement of decision-makers (DMs) serving as principal investigators (PI) or co-PIs on research teams may affect the feasibility and value of embedded implementation research (EIR) used to improve health policies, programs, and services in Latin America and the Caribbean. Methods. This was a descriptive qualitative study based on 39 semistructured interviews with 13 embedded research teams selected by financing agencies to explore team composition, interaction among members, and research results. Interviews were conducted at three points during the study period from September 2018 to November 2019; data were analyzed from 2020 to 2021. Results. Research teams were found to be operating in one of three situations: (i) permanent core team (no change) with either active DM or inactive DM participation; (ii) replacement of DM–PI or co-PI that did not affect EIR research; and (iii) replacement of DM–PI that affected EIR. Conclusions. To ensure EIR continuity and stability, research teams should include high-level DMs together with more technical staff performing essential implementation activities. This structure could improve collaboration among professional researchers and ensure greater embeddedness of EIR to strengthen the health system.

Multicomponent programs to promote physical activity have shown promise to help adolescents to increase physical activity levels. Although evaluation of the intervention implementation process is important, information about this evaluation is rarely reported. This observational study aimed to evaluate the implementation of a 12-week physical activity intervention program for adolescents. The ActTeens program consists of three components: (1) structured physical activity sessions; (2) self-monitoring associated with daily goal setting; (3) healthy lifestyle messages (mHealth). The evaluation of the process was carried out through observations and self-reported information from the students. Fifty-one adolescents (37.5% girls) answered the questionnaire. Overall, the reach was 73.3%, retention rate 96.3%, and satisfaction with the intervention was high (score 5). The structured sessions presented high fidelity, and good acceptability among adolescents, with an average attendance rate of 93.7%. Participants rated the sessions as enjoyable and the teacher’s role as excellent. Adherence to self-monitoring (goal setting with a pedometer) was moderate and 57.8% of adolescents reported using the device daily. In addition, adolescents reported that the use of a pedometer increased their motivation to practice physical activity (72.4%). Satisfaction with the messages was considered low, with only 37.8% agreeing that the messages promoted the adoption of a healthy lifestyle. In conclusion, the structured sessions and the self-monitoring showed good acceptability among adolescents, and these strategies were considered relevant to promote a more physically active lifestyle. However, the component mHealth, when used as a single strategy, did not aid the adoption of healthy behavior.

ABSTRACT Objective: To map knowledge regarding Quality Improvement in the implementation science paradigm in graduate nursing education in professional programs. Method: This is a scoping review, conducted from October to December 2021, following the assumptions established by the Joanna Briggs Institute and the PRISMA-ScR protocol. Results: 18 studies were selected. Being, 7 articles (38.8%) about the implementation strategies and development of Quality Improvement projects for graduate nursing students. The included studies emphasize Quality Improvement as a methodological strategy capable of capturing a problem in practice, to be solved without losing scientific rigor, and emphasize the importance of obtaining Quality Improvement skills in professional programs. Conclusion: Implementation science and Quality Improvement projects advance professional programs to improve and develop quality health care.

Copyright of Interface - Comunicação, Saúde, Educação is the property of Fundacao UNI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: to analyze the implementation of care agreements developed in the CACTO program for mothers of children with Autism Spectrum Disorder., Method: exploratory, qualitative study, guided by Unitary Caring Science and the Implementation Science methodological framework, based on the Consolidated Conceptual Framework for Implementation Research. Conducted with 20 mothers of children with Autism Spectrum Disorder, between April 2023 and February 2024, during care meetings developed in a non-governmental organization. For analysis, deductive thematic content analysis was used., Results: the agreements were categorized into three dimensions of human existence: body-mind-soul. The health needs of mothers determined the implementation of the agreements, such as: difficulties in body acceptance, sedentary lifestyle, lack of awareness of their own potential, insufficient self-care, unresolved past conflicts, self-blame, family conflicts, signs and symptoms of overload and fragility in the relationship with God. The lack of time and oppressive relationships were barriers, while motivation and spirituality served as strengths for the mothers in applying the agreement device., Final Considerations: in-depth dialogue and the leading role of the mothers were decisive in the implementation of the agreements. Professional caregivers play a fundamental role in epistemological development while triggering innovative care in the health field.

ABSTRACT Objectives: to report the implementation and maintenance of an evidence-based Standard Operating Procedure for surgical counting performed at a teaching hospital. Methods: a report of a project to implement evidence for surgical counting, carried out at a university hospital in December 2017, and the subsequent cycles for better performance of the implemented organizational document and maintenance of better results until March 2022. Results: the report is divided into implementation project presentation and four other cycles after implementation, related to maintenance of improvements. It was possible to prepare a Standard Operating Procedure for Surgical Count, train the nursing team, carry out educational intervention for surgical teams. Final Considerations: there was an improvement in complying with the standardized procedure at the first moment and worsening in the period related to the pandemic. New efforts began again, including a self-instructive online course combined with first-time strategies.

Abstract Objective: to evaluate the use of a renal health application by kidney transplant recipients. Method: a retrospective, observational study with a sample composed of individuals registered in the kidney transplant section of the application from July of 2018 to April of 2021. Demographic data, data entry, time of use, weight, blood pressure, blood glucose, creatinine, medication schedules, appointments, and tests were the variables collected. Descriptive analysis of the data was performed. Results: eight hundred and twenty-three downloads of the application were identified, and 12.3% of those were registered as kidney transplant recipients, the majority from southeastern Brazil (44.9%), 36±11 years old, and female (59.1%). Of the sample, 35.1% entered information such as creatinine (62%), weight (58.2%), and blood pressure (51.8%). Most used the application for one day (63.3%) and 13.9% for more than one hundred days. Those who used it for more than one day (36.7%) recorded weight (69%), medication intake (65.5%) and creatinine (62%), and scheduled appointments (69%). Conclusion: the kidney transplant recipient section of the Renal Health application generated interest in the young population, but showed low adherence throughout the assessed months. These results offer a relevant perspective on the implementation of mHealth technologies in kidney transplantation.

Objective. To describe trends in timing of ART initiation for newly diagnosed people living with HIV before and after Haiti adopted its Test and Start policy for universal HIV antiretroviral therapy (ART) in July 2016, and to explore predictors of timely ART initiation for both newly and previously diagnosed people living with HIV following Test and Start adoption. Methods. This retrospective cohort study explored timing of ART initiation among 147 900 patients diagnosed with HIV at 94 ART clinics in 20042018 using secondary electronic medical record data. The study used survival analysis methods to assess time trends and risk factors for ART initiation. Results. Timely uptake of ART expanded with Test and Start, such that same-day ART initiation rates increased from 3.7% to 45.0%. However, only 11.0% of previously diagnosed patients initiated ART after Test and Start. In adjusted analyses among newly diagnosed people living with HIV, factors negatively associated with timely ART initiation included being a pediatric patient aged 014 years (HR = 0.23, p > 0.001), being male (HR = 0.92, p = 0.03), being 50+ years (HR = 0.87, p = 0.03), being underweight (HR = 0.79, p > 0.001), and having WHO stage 3 (HR = 0.73, p > 0.001) or stage 4 disease (HR = 0.49, p > 0.001). Variation in timely ART initiation by geographic department and health facility was observed. Conclusions. Haiti has made substantial progress in scaling up Test and Start, but further work is needed to enroll previously diagnosed patients and to ensure rapid ART in key patient subgroups. Further research is needed on facility and geographic factors and on strategies for improving timely ART initiation among vulnerable subgroups.

This article describes the main models for embedding research and the successful experiences and challenges faced in joint work by researchers and decisionmakers who participated in the Embedding Research for the Sustainable Development Goals (ER-SDG) initiative, and the experience of the Technical Support Center. In June 2018, funding was granted to 13 pre-selected research projects from 11 middle- and low-income countries in Latin America and the Caribbean (Argentina, Bolivia, Brazil, Colombia, Dominican Republic, Ecuador, Guatemala, Guyana, Haiti, Paraguay, and Peru). The projects focused on the system-, policy-, or programlevel changes required to improve health and build on the joint work of researchers and decisionmakers, with a view to bringing together evidence production and decision-making in health systems and services. The Technical Support Center supported and guided the production of quality results useful for decision-making. This experience confirmed the value of initiatives such as ER-SDG in consolidating bridges between research on the implementation of health policies, programs, and systems, and the officials responsible for operating health-related programs, services, and interventions. It highlighted the importance of both respecting and taking advantage of each context–and the specific arrangements and patterns in the relationships between researchers and decisionmakers–through incentives for embedded research.

Objective. To identify potential barriers to the implementation of the National Childbirth Guidelines in Brazil based on the best available global evidence. Method. A rapid review of evidence was performed in six databases in March/April 2019. Secondary studies published in English, Spanish, or Portuguese with a focus on barriers of any nature relating to the implementation of the Guidelines were retrieved. Results. Twenty-three documents (21 reviews and two practice guides) were included in the review. The barriers identified were grouped into 52 meaning categories and then reorganized into nine thematic clusters: delivery and childbirth care model, human resource management, knowledge and beliefs, gender relations, health care service management, attitudes and behaviors, communication, socioeconomic conditions, and political interests. Conclusions. The results show that combined approaches may be required to address different barriers to the implementation of the Guidelines. For successful implementation, it is essential to engage health care leaders, professionals, and users in the effort to change the delivery and childbirth care model. Also necessary is the development of intersectoral initiatives to improve the socioeconomic conditions of women and families and to curtail gender inequalities.

Objective. To identify barriers to the implementation of National Childbirth Guidelines in Brazil from the women’s perspective. Methods. A descriptive exploratory study was performed using a qualitative approach and an interpretive perspective. The hermeneutic unit of analysis was established based on the contribution of users to a public online consultation about the National Childbirth Guidelines in Brazil, performed in 2016 by the National Committee for Health Technology Incorporation into the Unified Health System (CONITEC). Content analysis techniques were used to examine the answers provided to the following specific question: “Considering your local reality, what would hinder the implementation of this protocol or guideline?” Results. Of 396 contributions recorded by CONITEC, 55 were included in the content analysis. The mean age of women was 31 years, with most self-declared as white (69%) and living in the Southeast of Brazil (56.3%). Coding revealed seven barrier categories, which were grouped into three families — barriers related to 1) professional training and culture (which highlighted the centrality of physicians, not women, in childbirth), 2) social culture (general population not well informed), and 3) political and management issues (little interest on the part of managers, lower physician compensation for vaginal childbirth vs. cesarian section, and poor hospital infrastructure). Conclusions. Aspects of professional training and culture, social culture, and political as well as management issues are critical points to be considered in future interventions aiming at overcoming or weakening the barriers to implementing childbirth recommendations in Brazil.

Introduction: The benefits of the application of therapeutic play (TP) in pediatrics are widely reported in the literature. Evidence supports its use in the care of hospitalized children with a positive impact on reducing anxiety and fear, not only for the child, but for her family members. This study sought to investigate the perception of professionals from a reference group for the application of TP (BrinquEinstein) in relation to its implementation in a pediatric hospital unit. Objectives: To understand how professionals who belong to the BrinquEinstein group evaluate the process of systematic implementation of TP in pediatric hospital units; outlining the facilitating factors and barriers for this implementation to occur from the perspective of these professionals. Method: Exploratory study, with a qualitative approach, developed in the pediatric and intensive care units of a general hospital, extraport, in the city of São Paulo. Professionals from different categories who work in these units and who belong to BrinquEinstein participated in the sample. Data were collected through individual semi-structured and audio-recorded interviews, being analyzed using the Inductive Thematic Analysis proposed by Braun & Clark. Results: From the analysis of the interviews, two themes emerged that represent the perspective of BrinquEinstein members about the TP implementation process: "experiencing a transforming process" and "establishing future perspectives". Conclusion: For the professionals interviewed, it is essential that the use of TP becomes a routine practice in the different contexts of child health care. Managers and institutions play a fundamental role in the implementation of this practice, in the identification of needs and in the search for solutions to make it a reality. [ABSTRACT FROM AUTHOR]

The present report describes the process and results obtained with a knowledge translation project developed in three stages to identify barriers to the Implementation of the National Guidelines for Normal Childbirth in Brazil, as well strategies for effective implementation. The Improving Programme Implementation through Embedded Research (iPIER) model and the Supporting Policy Relevant Reviews and Trials (SUPPORT) tools provided the methodological framework for the project. In the first stage, the quality of the Guidelines was evaluated and the barriers preventing implementation of the recommendations were identified through review of the global evidence and analysis of contributions obtained in a public consultation process. In the second stage, an evidence synthesis was used as the basis for a deliberative dialogue aimed at prioritizing the barriers identified. Finally, a second evidence synthesis was presented in a new deliberative dialogue to discuss six options to address the prioritized barriers: 1) promote the use of multifaceted interventions; 2) promote educational interventions for the adoption of guidelines; 3) perform audits and provide feedback to adjust professional practice; 4) use reminders to mediate the interaction between workers and service users; 5) enable patient-mediated interventions; and 6) engage opinion leaders to promote use of the Guidelines. The processes and results associated with each stage were documented and formulated to inform a review and update of the Guidelines and the development of an implementation plan for the recommendations. Effective implementation of the Guidelines is important for improving the care provided during labor and childbirth in Brazil.

Introduction: Evidence shows most patients are not recognised by their attending healthcare professionals as having palliative needs. This feasibility study aimed to aid healthcare professionals identify hospital patients with palliative needs. Material and Methods: Mixed-methods, cross-sectional, observational study. The patient inclusion criteria comprised: age over 18 years old, being mentally capable to give consent judged as such by participating healthcare professionals, and if unable, having a legal substitute to consent, having a diagnosis of an incurable, potentially life-threatening illness. Field notes were taken for reflexive purposes. Outcome measures included: Integrated Palliative Care Outcome scale, surprise question, phase of illness, referral request status, The Eastern Cooperative Oncology Group Performance Status and social needs assessment. An interim data collection period meeting assessed implementation outcomes in each context. A web-based survey was sent to all participating healthcare professionals at the end of data collection period to explore overall experiences of participation and implementation outcomes. Results: Forty-two departments in four hospitals were contacted. The study was presented in nine departments. The field notes were vital to understand the recruitment process and difficulties experienced: time constraints, fear of additional work, department dynamics and organisation, relationships between departments and need of training in palliative care and research. One department agreed to participate. There were six participating healthcare professionals and only 45 patients included. Three participating healthcare professionals responded to the web-based survey. Conclusion: There is an urgent need to provide generalist palliative care training to clinicians.

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ABSTRACT The term knowledge translation has been used to describe the process of applying research results to the real world, in order to enhance the quality and effectiveness of health care and services. The aim of this article is to discuss the incorporation of knowledge translation in the Brazilian public health. The article addresses the basic activities of knowledge translation and lists challenges and perspectives in Brazilian scenario. Brazil began to move towards understanding the process of translating scientific knowledge into practice. Investing in pilot studies to adapt the so-called effective interventions to the Brazilian scenario may be an alternative. Increasing the qualification of Brazilian researchers in the design and evaluation of implementation studies is relevant to improve this field in the country.

This study aims to analyze the social representations of strategic actors involved in health care or management, on issues involving women, childbirth, and birth, seeking to identify and understand barriers to the implementation of the National Guidelines for Assistance to Normal Childbirth. A qualitative, descriptive, cross-sectional study was conducted, based on a word association test with 12 strategic actors. The words - Childbirth; Midwife; Birth; Obstetrician; Mother; Complication; Woman - were selected from a textual analysis of society's contributions to the Public Consultation of the Guidelines, supported by IRaMuTeQ software. The analysis of the word association test result was carried out in the structural approach of Social Representations, with the OpenEVOC and IRaMuTeQ software. Representations about childbirth associated with pain, the obstetrician as an obstructer and the stereotypes that mark the role of women and mothers in society were identified as potential barriers to implementation. Understanding these representations is important to highlight the conventions that underlie the attitudes and practices of professionals and users of services, enabling the definition of specific strategies for each group. [ABSTRACT FROM AUTHOR]

The objective was to analyze the perceptions of primary health care (PHC) workers about interprofessional collaboration from the perspective of implementation science. This is a qualitative study that used in-depth interview as a data production technique. Interviews were conducted with 15 workers (three community health agents, one nursing assistant, three nurses, three managers, three physicians, and two nursing technicians) from basic health units in the Municipality of São Bernardo do Campo, São Paulo State, Brazil. The interview plan was based on three domains of the Consolidated Framework for Implementation Research (CFIR). Thematic content analysis was used. In the interprofessional collaboration characteristics domain, respondents highlighted the complexity, and its possible influence, as to the implementation and sustainability of this practice. In the inner setting domain, factors that influence interprofessional collaboration were identified, namely: how the time allocated to formal communication/team meetings is used; social interactions between professionals; and leadership characteristics, such as feedback, autonomy and participation in decisions. In the individuals characteristics domain, participants noted interprofessional collaboration geared to quality of care and the need for integration between knowledge centers. Thus, measures to enhance the quality of communication, collective team building and leadership can contribute to improve interprofessional collaboration in PHC and leverage its impacts on health care.

Objective: describe the process of designing and implementing a care protocol for the first hour of life of premature newborns., Method: a participatory research study using an implementation science framework, the Consolidated Framework for Implementation Research (CFIR) was employed to determine drivers and facilitators of implementation success of the Golden Hour protocol for newborns at a large university hospital in southeastern Brazil. A multi-professional team, including first line providers and managers participated in six stages of quality improvement: situational diagnosis; protocol elaboration; training protocol implementation; barrier and facilitator assessment; and protocol monitoring and review. Qualitative and monitoring data collected across these six stages were analyzed using descriptive statistics and content analysis., Results: the institution's Golden Hour protocol was organized by the multi-professional team based on a collective and dialogical approach. The protocol prioritized the infant's cardiopulmonary stability, as well as prevention of hypothermia, hypoglycemia and infection. After four months of implementation, the care team was evaluated the protocol as a good quality intervention, necessary for the service, low-cost and not very complex. One suggested improvement recommended was to carry out refresher training to address staff turnover., Conclusion: implementation of the Golden Hour protocol introduced an appropriate and feasible neonatal care quality improvement process, which requires periodic refresher training to ensure greater adherence and better neonatal results.

Objective: To identify potential barriers to the implementation of the National Childbirth Guidelines in Brazil based on the best available global evidence., Method: A rapid review of evidence was performed in six databases in March/April 2019. Secondary studies published in English, Spanish, or Portuguese with a focus on barriers of any nature relating to the implementation of the Guidelines were retrieved., Results: Twenty-three documents (21 reviews and two practice guides) were included in the review. The barriers identified were grouped into 52 meaning categories and then reorganized into nine thematic clusters: delivery and childbirth care model, human resource management, knowledge and beliefs, gender relations, health care service management, attitudes and behaviors, communication, socioeconomic conditions, and political interests., Conclusions: The results show that combined approaches may be required to address different barriers to the implementation of the Guidelines. For successful implementation, it is essential to engage health care leaders, professionals, and users in the effort to change the delivery and childbirth care model. Also necessary is the development of intersectoral initiatives to improve the socioeconomic conditions of women and families and to curtail gender inequalities.

Objective: To identify barriers to the implementation of National Childbirth Guidelines in Brazil from the women's perspective., Method: A descriptive exploratory study was performed using a qualitative approach and an interpretive perspective. The hermeneutic unit of analysis was established based on the contribution of users to a public online consultation about the National Childbirth Guidelines in Brazil, performed in 2016 by the National Committee for Health Technology Incorporation into the Unified Health System (CONITEC). Content analysis techniques were used to examine the answers provided to the following specific question: "Considering your local reality, what would hinder the implementation of this protocol or guideline?", Results: Of 396 contributions recorded by CONITEC, 55 were included in the content analysis. The mean age of women was 31 years, with most self-declared as white (69%) and living in the Southeast of Brazil (56.3%). Coding revealed seven barrier categories, which were grouped into three families - barriers related to 1) professional training and culture (which highlighted the centrality of physicians, not women, in childbirth), 2) social culture (general population not well informed), and 3) political and management issues (little interest on the part of managers, lower physician compensation for vaginal childbirth vs. Caesarian section, and poor hospital infrastructure)., Conclusions: Aspects of professional training and culture, social culture, and political as well as management issues are critical points to be considered in future interventions aiming at overcoming or weakening the barriers to implementing childbirth recommendations in Brazil.

The present report describes the process and results obtained with a knowledge translation project developed in three stages to identify barriers to the National Childbirth Guidelines in Brazil as well strategies for effective implementation. The Improving Programme Implementation through Embedded Research (iPIER) model and the Supporting Policy Relevant Reviews and Trials (SUPPORT) tools provided the methodological framework for the project. In the first stage, the quality of the Guidelines was evaluated and the barriers preventing implementation of the recommendations were identified through review of the global evidence and analysis of contributions obtained in a public consultation process. In the second stage, an evidence synthesis was used as basis for a deliberative dialogue aimed at prioritizing the barriers identified. Finally, a second evidence synthesis was presented in a new deliberative dialogue to discuss six options to address the prioritized barriers: 1) promote the use of multifaceted interventions; 2) promote educational interventions for the adoption of guidelines; 3) perform audits and provide feedback to adjust professional practice; 4) use reminders to mediate the interaction between workers and service users; 5) enable patient-mediated interventions; and 6) engage opinion leaders to promote the use of guidelines. The processes and results associated with each stage were documented and formulated to inform a review and update of the Guidelines and the development of an implementation plan for the recommendations. An effective implementation of the Guidelines is relevant to improve the care provided during labor and childbirth in Brazil.

Objective: to determine the contents that must be included in the usual counseling to improve the adherence to antiretroviral therapy (ART) of HIV patients, according to their different levels of alcohol consumption, and to determine the validity of the Counseling Guide in improving the adherence to ART in patients who consume alcohol using Implementation Science., Method: this is an observational study with formative and validation phases. The formative phase defined the content, approach and structure of the counseling. Validation included focus groups with patients and nurses, trial process by an expert and a pilot test. The criteria evaluated based on Implementation Science were: intervention source, evidence strength and quality, relative advantage, and complexity. The following criteria were also evaluated: usefulness, practicality, acceptability, sustainability, effectiveness; content consistency and congruence; procedural compliance and difficulties, and time spent in counseling., Results: the strength of evidence of the counseling is High-IIA, with strong level of recommendation and presenting usefulness, practicality, acceptability, sustainability and effectiveness. Eight in 11 experts argued that the Guide is clear, consistent and congruent. Initial counseling takes around 24 minutes; and follow-up counseling, 21. The instruments of the Guide present reliability levels between good and high (0.65 ≥ alpha ≤ 0.92)., Conclusion: the Counseling Guide is valid to improve the adherence to antiretroviral therapy in patients who consume alcohol.