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Abstract The management of water involves complex issues related to just allocation and sustainability. While integrated approaches incorporating diverse stakeholders have emerged as the dominant global framework for 21st-century challenges, policymakers face difficulties in assessing stakeholder participation and integration. This study generated primary data from a survey and interviews and used social network analysis to reveal and map the dynamics of interaction among ten groups holding stakes in the water resources of the Açu Lake State Park, a Brazilian coastal estuary. The results indicate that stakeholder group interaction was concentrated within two distinct clusters, such that high interaction correlated positively with political power, while those most dependent on the resources were characterized by limited decision-making influence and low interaction with other groups. These results offer insight for the equitable and sustainable governance of water resources and the assessment of participation and interaction among stakeholder groups.

Resumen: La subjetividad de multitud de dimensiones que inciden en la salud requiere abordajes sistémicos, diseños de estudios que integren datos de salud poblacionales y las narrativas de la población, así como abordajes metodológicos específicos que permitan capturar la evidencia procedente de procesos sociales y comunitarios. El uso de metodologías participativas en los diagnósticos de salud urbana es clave para capturar las diferentes perspectivas y conocimientos del contexto local, contribuyendo a un análisis más completo de la realidad. Esta nota metodológica expone el desarrollo del proceso participativo realizado como parte del diagnóstico de salud de Bilbao: la identificación de agentes participantes y criterios de selección, la invitación a participar y las dinámicas desarrolladas. Compartir experiencias que hayan incorporado procesos participativos es necesario para favorecer su desarrollo metodológico, y así, impulsar su práctica. Abstract: The subjectivity of a multitude of dimensions that affect health requires systemic approaches, study designs that integrate population health data and the narratives of the population, as well as specific methodological approaches that allow the capture of evidence from social and community processes. The use of participatory methodologies in urban health diagnoses is key to capturing the different perspectives and knowledge of the local context, contributing to a more complete analysis of reality. This methodological note presents the development of the participatory process carried out as part of the Bilbao health diagnosis; the identification of participating agents and selection criteria, the invitation to participate and the dynamics developed. Sharing experiences that have incorporated participatory processes is necessary to foster its methodological development, and thus, to promote it practice.

Objective. To present the results of a stakeholder analysis used to construct a map of the actors involved in the delib­eration of a proposal to increase the tax on sugar-sweetened beverages (SSB) in Mexico from 10 to 20 percent per liter. Materials and methods. A literature review and in­terviews to key actors were implemented. The analysis of the actors’ power and position was made using Policymaker. Results. There was concern for the obesity epidemic among all stakeholders, but little consensus on the way to solve it. Researchers and non-governmental organizations (NGO) support an increase in the tax on SSB, while government officials and industry representatives oppose this measure. Conclusion. Supporters of an increase to the tax on SSB need to build a coalition in order to force government officials to support this policy and successfully confront the soda industry, which has a solid opposing strategy and enormous financial resources to influence public opinion and congressmen.

Objective. To identify how countries have positioned themselves to fight against all forms of malnutrition. Methods. Qualitative, exploratory, and descriptive study of the statements of 91 out of the 127 (71.7%) countries that issued declarations in the Second International Conference on Nutrition. Results. According to the analysis of the official statements from the Conference, countries still responded to nutrition issues in a traditional way. Food systems were part of the narrative and mentioned as part of the problem and solution, but little thought was given to their determinants. Conclusions. The Decade of Action on Nutrition is spurred on by the urgent need to coordinate global endeavors in the fight against malnutrition and could aggregate efforts in prioritizing actions to address the determinants rather than the biological outcomes of malnutrition–which requires commitments–; and strengthening the countries’ ability to implement robust regulatory measures. These measures could be empowered through efforts across different levels, making use of multilateral spaces, and through strengthening civil society participation, including developing better mechanisms for the recognition and control of conflicts of interest across different political spaces.

Background: Science integrity initiatives require specific recommendations for randomised clinical trials (RCT)., Objective: To prepare a set of statements for RCT integrity through an international multi-stakeholder consensus., Methods: The consensus was developed via multi-country multidisciplinary stakeholder group composition and engagement; evidence synthesis of 55 systematic reviews concerning RCT integrity; anonymised two-round modified Delphi survey with consensus threshold based on the average percent of majority opinions; and, a final consensus development meeting., Results: There were 30 stakeholders representing 15 countries from 5 continents including trialists, ethicists, methodologists, statisticians, consumer representative, industry representative, systematic reviewers, funding body panel members, regulatory experts, authors, journal editors, peer-reviewers and advisors for resolving integrity concerns. Delphi survey response rate was 86.7% (26/30 stakeholders). There were 111 statements (73 stakeholder-provided, 46 systematic review-generated, 8 supported by both) in the initial long list, with 8 additional statements provided during the consensus rounds. Through consensus the final set consolidated 81 statements (49 stakeholder-provided, 41 systematic review-generated, 9 supported by both). The entire RCT life cycle was covered by the set of statements including general aspects (n=6), design and approval (n=11), conduct and monitoring (n=19), reporting of protocols and findings (n=20), post-publication concerns (n=12), and future research and development (n=13)., Conclusion: Implementation of this multi-stakeholder consensus statement is expected to enhance RCT integrity., (Copyright © 2024. Publicado por Elsevier España, S.L.U.)

Abstract: Multi-stakeholder processes - as a necessary part in the development of public policies - can provide diverse perspectives to inform and to improve food security policy-making. Iran’s National Food Assistance Program (NFAP) is one of the major welfare programs in Iran that reduces food insecutiry to low-income households. This study aimed to identify and to categorize actual and potential stakeholders in NFAP using the stakeholder salience model. According to Mitchell’s theory, stakeholders’ attributes (power, legitimacy, and urgency) were assessed based on the nature of their interactions, roles, and level of engagement. Results revealed a number of significant but marginalized stakeholders, including Iranian Ministry of Health (office of community nutrition improvement), academia, center for food and nutrition research, target group, charities, and international organizations, who have not received any targeted organizational attention and priority to their claims. The unbalanced attention provided to some stakeholder groups characterized as “definitive” and “dominant” and ignoring some important ones will jeopardize long-term viability and undermine support for the program with inevitable declines in legitimacy. Understanding the change in the stakeholders’ characteristics is the main variable to determine the allocation of organizational resources in response to different and rising stakeholders’ demands and possibly the projects outcomes. This will facilitate and enhance the possibility of knowledge exchange and learning, and greater trust among stakeholders during the food and nutrition policy-making process.

RESUMO A incorporação dos diferentes interessados ao processo avaliativo é estratégica para facilitar a compreensão da avaliação e a apropriação de seus resultados. Este artigo se propõe a descrever e analisar criticamente a participação dos atores (stakeholders) no processo de avaliação, utilizando a pesquisa avaliativa do Projeto de Formação e Melhoria da Qualidade de Rede de Atenção à Saúde (Projeto QualiSUS-Rede). Para isto, foram tomadas como base as memórias das reuniões de trabalho, das oficinas de alinhamento conceitual e de validação dos Modelos Lógicos dos seminários realizados, assim como dos relatórios elaborados no período de agosto de 2012 a dezembro de 2015. A abordagem colaborativa envolveu inúmeros desafios, englobando 15 projetos, com distintos níveis de abrangência e complexidade, e com diversos stakeholders, com diferentes tipos e níveis de colaboração, o que condicionou os limites e as possibilidades de participação. Esta experiência gerou a adaptação do Modelo de Avaliação Colaborativa de Rodriguez-Campos e Rincones-Gomez (2013). A abordagem colaborativa exige por parte dos avaliadores um exercício de flexibilização e de ajuste às distintas particularidades e aos contextos locais, sem perder de vista o alinhamento às teorias da intervenção e ao modelo teórico da avaliação.

ABSTRACT OBJECTIVE The study aims to characterize and discuss the processes of patient and public involvement (PPI) in the Brazilian Health Regulatory Agency (Anvisa), the National Committee for Health Technology Incorporation (Conitec), and the National Agency for Supplementary Health (ANS) in Brazil. METHODS This is an exploratory, descriptive, and comparative study, conducted by analyzing the public documents and regulation of the three institutions. RESULTS The mechanisms for PPI included public consultations, public hearings, participation in advisory committees, and health technology evaluation requests. Anvisa conducted 187 public consultations between 1999 and 2018, gathering 10,699 contributions. In total, 76 (41%) public consultations did not present information about the contributions received. Conitec carried out 234 public consultations and received 53,174 contributions between 2011 and 2018. It was identified that 70 (23%) recommendations from Conitec did not go through public consultation, and 26 (8%) recommendations changed after public consultation. Recommendation changes seemed to have occurred especially in cases with a greater number of contributions in the public consultation process. ANS conducted eight public consultations regarding the list of health procedures and events covered by health insurances between 2000 and 2018, and it received 31,498 contributions. For three public consultations, there was no information about the number of contributions received. CONCLUSIONS There are regulatory advances and institutional activity supporting PPI in highly technical decision-making processes in Brazil, although heterogeneously among the analyzed institutions. The power of PPI to influence health technology deliberative processes still requires in-depth studies, including the characterization of stakeholders and the legitimacy of decisions.

Objective: to identify and analyze the concepts of the realist evaluation and the methodologies recommended for its development in the health area. Method: an integrative review, which included theoretical and methodological studies published in the following databases: COCHRANE Library, EVIPNet, Health Systems Evidence, LILACS, PDQ-Evidence, PubMed, Rx for Change, and SciELO, in addition to Teses-CAPES and Google Scholar, for the gray literature. The mediation category underlay the analysis. Results: 19 references were included, published between 1997 and 2018. It is an innovative proposal to direct the process of evaluating health programs, interventions, and/or policies, with the democratic participation of the parties involved, such as users, workers, managers and researchers; it proposes to elaborate theories about what works, for whom, in what context, and how. The mediation category indicated the need for these theories not to be restricted to the micro-context, but to incorporate the elements of the social macro-structure to which they are connected. Conclusion: It is indicated that the realist evaluation is to be conducted in 21 stages. It takes into account qualitative and procedural methods, which makes it powerful for understanding human and social relationships in the context analyzed. Theories that come from evaluating the functioning of the programs analyzed have greater explanatory chances if they are built by reference to the social totality.

Raptors provide ecosystem services to African rural communities by: (1) preying on rodents, (2) regulating harmful snake populations, (3) shaping cultural beliefs, and (4) being part of tourist attractions. Peasant farmers, however, connect them with poultry depletion, telepathic omens, and traditional witchcraft. Consequently, raptors suffer human–induced persecution. Using a qualitative content analysis technique, we investigated the interaction between farmers and raptors in areas adjoining the Chembe Bird Sanctuary. Our results unravel negative perceptions, attitudes and practices that could threaten the extinction of five raptors in the study area. We propose the use of transformative cognitive measures (e.g., raising stakeholder awareness, ensuring stringent law enforcement for raptors and protecting their habitat, and strengthening relational social capital) and physical measures (e.g., providing appropriate fencing and poultry breeding of high resilient phenotypes) to improve the co–existence between farmers and raptors.

Este trabalho discute os desafios que se colocam à sociedade contemporânea no âmbito do combate à vulnerabilidade social, realça a importância da abordagem holística dos problemas socioambientais através da integração transversal e simultânea das dimensões social, ambiental e económica da sustentabilidade e exorta para a necessidade do uso combinado de métodos qualitativos e quantitativos como forma de compreender o fenômenos ambientais e sociais e implementar programas de intervenção sustentáveis.This article discusses challenges concerning contemporary society with respect to social vulnerability. The role of holistic approach to face socio-environmental problems by integration of the sustainability dimensions is also addressed. Finally, an approach that combines qualitative and quantitative methods is recommended as the appropriate way to understand socio-environmental processes, and perform sustainable programmes.

There is a growing interest in finding innovative approaches to the evaluation of complex interventions in public health. This methodological note presents the theory of change as a useful tool to facilitate both the planning and the evaluation of community health promotion interventions. A theory of change is a visual representation of how a programme or intervention works, in which its different components can be identified, together with how they relate to each other: what its objectives are, its expected results and through which actions they are expected to be achieved. It can be an applied research tool, developed using participatory approaches together with all relevant stakeholders, who can identify and jointly decide what to evaluate and how to., (Copyright © 2019 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

The purpose a call for papers on "History and health" at Salud Colectiva was to contribute to the development of a historical perspective on health-disease processes. We are therefore interested in calling on the perspectives of history and the social sciences to shed light on the fact that both the definition of health conditions as well as populations' possibilities for accessing essential healthcare services are the result of social processes in which knowledge, ideology, politics, and interests come into play - far from a simple reflection of objective biomedical conditions. This implies, on the one hand, that the definition of which of a population's health problems are to be attended to - as well as how, where, and who is responsible for them - is the result of relations among diverse actors (healthcare professionals, public officials, firms, users, among others), and these relations are not free of conflict. At the same time, these actors mobilize the institutional frameworks, professional knowhow, and economic interests that they represent. On the other hand, the unequal distribution of economic, symbolic, and cultural resources implies differential access to healthcare services, both for individuals and for social groups.

Public participation in research projects is an emerging area in Spain and Latin American countries. There are five types of projects according to the degree of involvement that the participants have in the processes: contributory, collaborative, co-created, contractual and independent. In order to promote public participation in health research teams, their practices and competencies need to be redefined. To this end, it may be useful to ask questions in the different phases of the research, as well as to develop strategies that include audiences that have fewer channels of participation in favour of favouring equity in health. This way of doing science allows gathering experience and expertise prioritizing and adapting the research to the needs of the population, which increases its transforming capacity and the social impact of its results., (Copyright © 2019 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To explore the perception of stakeholders on the implementation policy of the childhood protection subsystem "Chile Crece Contigo" in the Commune of Concepción, Chile., Materials and Methods: Qualitative study. Semi-structured interviews and a focus group were used as information gathering techniques. A theoretical sampling was carried out based on the representation of decision and power levels with regard to the implementation of Chile Crece Contigo in the Commune of Concepción. The data were analyzed with the ATLAS.ti 6.2 software., Results: The most notable achievements highlighted by interviewees were the high valuation of Chile Crece Contigo, along with the possibility of placing relevant subjects such as first childhood care into the agenda. On the contrary, taking advantage of benefits delivered by the program and the dissemination of the policy were deemed as not achieved. The main facilitator of the implementation was the commitment of the beneficiaries to Chile Crece Contigo, while the most important barrier identified was the contract modality of professionals. Finally, aspects to be improved included infrastructure of facilities, the Chile Crece Contigo network articulation and the funds to secure sustainability of the program over time., Conclusion: The implementation of Chile Crece Contigo in the Commune of Concepción has achieved high recognition in the community, however, it is still necessary to work on the achievement of aspects related to the articulation of the different stakeholders that make up the Chile Crece Contigo network, the diffusion of politics at all levels, and the best use of the benefits delivered to the population.

ABSTRACT Objectives: To reflect on the scope of the working process in nurse participation political activities as a possibility for expanding its performance. Methods: this is a reflective study, supported by the discursive elaboration on the nursing participation political activities and work process, structured through concepts, theoretical perspectives and practices based on the experiences described in references. Results: studies on this process demonstrate that nurses need sensitivity to understand the complexity of their social practice. Final Considerations: in their professional actions, nurses must mobilize political resources, making their knowledge, skills and attitudes available to their practices, aiming at power and improvement of conditions for the work of Nursing.