Implementation of evidence-based health care using action research: An emancipatory approach.

The aim of the study is to discuss the emancipatory approach to action research as an appropriate methodology for workers' meaningful implementation of evidence-based health care. Implementation of evidence-based health care using action research is well supported by the literature. There are various approaches to action research, and they are coherent with the objectives and methods elected to develop the investigation. It is not clear which approach of action research is responsible for meaningful worker engagement in changing praxis. This is a discussion paper based on our experiences and supported by literature on collective health. Health care is defined as a social praxis, dependent upon the capitalist mode of production in which health workers engage themselves in a labour process that has negative (as alienation) as well as positive (as creativity) meanings. Emancipatory changes of social praxis through implementation of evidence-based health care require that participants understand the positive and negative meanings of their work and engage health workers in a conscious and intentional collaborative educational process. Implementation of evidence-based health care through emancipatory action research is capable of overcoming alienation and changing social practice through a participatory meaningful process of knowledge translation.

An Evidence-Based Approach to Scoping Reviews.

OBJECTIVE: Scoping reviews are used to assess the extent of a body of literature on a particular topic, and often to ensure that further research in that area is a beneficial addition to world knowledge. The aim of this paper reports upon the development of a methodology for scoping reviews based upon the Arksey and O'Malley framework, the Levac, Colquhoun, and O'Brien, and the Joanna Briggs Institute methods of evidence synthesis. METHODS: A working group consisting of members of the Joanna Briggs collaborating organizations met to discuss the proposed framework for the methodology and develop a draft for the scoping review methodology based on the Arksey and O'Malley framework and the work of Levac et al. This was followed by a workshop attended by other members of the organizations consisting of 30 international researchers to discuss the proposed methodology. Further refinement of the methodology was undertaken as a result of the feedback received from the workshop. RESULTS: The development of the methodology focused on five stages of the protocol and review development. These were identifying the research question by clarifying and linking the purpose and research question, identifying the relevant studies using a three-step literature search in order to balance feasibility with breadth and comprehensiveness, careful selection of the studies to using a team approach, charting the data and collating the results to identify the implications of the study findings for policy, practice, or research. LINKING EVIDENCE TO ACTION: The current methodology recommends including both quantitative and qualitative research, as well as evidence from economic and expert opinion sources to answer questions of effectiveness, appropriateness, meaningfulness and feasibility of health practices and delivery methods. The proposed framework has the potential to provide options when faced with complex concepts or broad research questions.

Emancipatory action research with young schoolchildren: experience report. / Pesquisa-ação emancipatória com jovens escolares: relato de experiência.

OBJECTIVE: To report an emancipatory action research experience and discuss its potentialities as a way to problematise the realities of the young participants. The aim of the action research was to create a drug awareness media programme. METHOD: Experience report of emancipatory action research with 13 young students of a public school, in São Paulo, from February to September 2014. Research was conducted by means of 13 workshops in five stages: exploratory; topic outline; theoretical and practical orientation; expression of new knowledge; and preparation and validation of scripts. RESULTS: It became clear that problematization, which is inherent to the action research method, allowed the young students to seize the discussion process as a right to critically reflect on the relationship between capitalism and drug use. CONCLUSIONS: The research enabled an emancipatory educational process and the construction of educational drug awareness media programmes, based on the way of life of young people who live in the outskirts of the city.

Practices in primary health care oriented toward the harmful consumption of drugs.

Objective To analyze the practices of primary care focused on the harmful consumption of drugs. Method This is a qualitative study, developed with a dialectical-critical approach. Data collection was carried out through semi-structured interviews with 10 employees of a basic health unit (UBS). Results The demands are not accepted, and if they go beyond the barriers shaped by the historical absence of health care practices for drug users and moralistic and preconceived ideologies, they are not reinterpreted as health needs; practices that meet these demands and go beyond the barriers are poor; the functionalist approach, which explains drug use as a disease and considers drug users as deviants, supports the few existing practices. Conclusion primary health care is mistakenly focused on addiction; it lacks structural elements of the production process in health and internal dynamics of the working processes that would foster the development of collective practices.

[Integrative review: concepts and methods used in nursing]. / Revisão integrativa: conceitos e métodos utilizados na enfermagem.

UNLABELLED: Integrative review (IR) has an international reputation in nursing research and evidence-based practice. This IR aimed at identifying and analyzing the concepts and methods recommended to undertaking IR in nursing. Nine information resources,including electronic databases and grey literature were searched. Seventeen studies were included. The results indicate that: primary studies were mostly from USA; it is possible to have several research questions or hypotheses and include primary studies in the review from different theoretical and methodological approaches; it is a type of review that can go beyond the analysis and synthesis of findings from primary studies allowing exploiting other research dimensions, and that presents potentialities for the development of new theories and new problems for research. CONCLUSION: IR is understood as a very complex type of review and it is expected to be developed using standardized and systematic methods to ensure the required rigor of scientific research and therefore the legitimacy of the established evidence.

[Marxism as a theoretical and methodological framework in collective health: implications for systematic review and synthesis of evidence]. / Marxismo como referencial teórico-metodológico em saúde coletiva: implicações para a revisão sistemática e síntese de evidências.

In this study, we discuss the integration in systematic reviews of research developed from a Marxist perspective of knowledge production and their results as evidence in healthcare. The study objectives are to review the assumptions of dialectical and historical materialism (DHM) and discuss the implications of dialectics for a literature review and the synthesis of evidence. DHM is a powerful framework for knowledge generation and transformation of policies and practices in healthcare. It assumes that social contradictions underlie the health-disease process, the fundamental theoretical construction in the field of collective health. Currently, we observe a considerable influence of the critical paradigm, of Marxist origin, in the construction of knowledge in health. Studies based on this critical paradigm incorporate complex methods, which are inherent to the guidelines of dialect, to identify the object and arrive at results that constitute evidence in healthcare. Systematic reviews should address the methodological difficulties associated with entirely integrating these results to healthcare.

Response to college students' mental health needs: a rapid review.

OBJECTIVE: To present strategic options to support the adoption of mental health strengthening policies for university students in the field of health, to be implemented by university institutions. METHODS: Rapid review, without period delimitation, with searches carried out from May to June 2020, in 21 sources of bibliographic data, including gray literature. The following keywords were used: mental health, students and university. The selection process prioritized systematic reviews of mental health interventions for university students in health care courses, and also considered other types of review and relevant primary studies. RESULTS: Forty-five studies were included: 34 systematic reviews, an evidence synthesis, an overview, a scope review, three narrative reviews, three experience reports and two opinion articles. The evidence from these studies supported the development of four options: 1) to establish and support policies to strengthen the mental health of students in health care courses; 2) to integrate mental health care programs, expand their offer and facilitate access by students; 3) to promote educational programs and communication strategies related to contemporary psychic suffering and its confrontation, so that students can get to know the services and resources and identify strengthening practices; 4) to continuously monitor and assess the mental health needs of students in health care courses. CONCLUSIONS: The options are challenging and require universities to establish institutional commissions to implement a policy to strengthen the mental health of university students in the health area, with the ability to recognize the different health needs, including manifestations of psychic suffering ; to integrate the university's internal actions with each other and with the services of the Unified Health System; to implement and monitor the actions that make up the mental health policy.

[Systematic review of theories: a tool to evaluate and analyze selected studies]. / Revisão sistemática de teorias: uma ferramenta para avaliação e análise de trabalhos selecionados.

The objective of this study is to report on the experience of constructing and using an instrument to collect and analyze theoretical-methodological references of studies, in systematic literature reviews. The goal is for researchers to have available an instrument that is appropriate for evaluating the studies that present their theoretical foundations, and for health professionals to have access to the theoretical explanations for study results and their applications in the practice of health care. The dissociation of theory from practice may lead to a lack of motivation at the work site and practices of repeating procedures without any awareness of the underlying concepts that base the interpretation of a health-disease phenomenon. Therefore we call on researchers to conduct reviews on the theoretical foundations of certain health-disease phenomena and we propose questions related to the inclusion criteria, critical appreciation and data extraction to be addressed in instruments.

Representations of everyday life: a proposal for capturing social values from the Marxist perspective of knowledge production. / Representações cotidianas: uma proposta de apreensão de valores sociais na vertente marxista de produção do conhecimento.

We propose from the Marxist perspective of the construction of knowledge, a theoretical and methodological framework for understanding social values by capturing everyday representations. We assume that scientific research brings together different dimensions: epistemological, theoretical and methodological that consistently to the other instances, proposes a set of operating procedures and techniques for capturing and analyzing the reality under study in order to expose the investigated object. The study of values reveals the essentiality of the formation of judgments and choices, there are values that reflect the dominant ideology, spanning all social classes, but there are values that reflect class interests, these are not universal, they are formed in relationships and social activities. Basing on the Marxist theory of consciousness, representations are discursive formulations of everyday life - opinion or conviction - issued by subjects about their reality, being a coherent way of understanding and exposure social values: focus groups show is suitable for grasping opinions while interviews show potential to expose convictions.

The educative game as a sensitization strategy for the collection of data with adolescents.

UNLABELLED: The aim of this study was to understand and analyze the potential of a game as a sensitization strategy for the performance of focal groups with adolescents in investigations into values. Twenty nine groups were realized in 10 social institutions of the municipality of Santo André. The sample was composed of 209 adolescents of 15 to 19 years of age. The results indicated that the majority expressed themselves without difficulties, discussing each of the valorative expressions drawn during the game with resourcefulness, involvement and respect for differing opinions, as well as being a method to promote reflection and stimulate debate about social values. CONCLUSIONS: The game was adequate for the collection of data. The ludic character allowed the participation of adolescents in an intense, relaxed, enjoyable and interactive way, which facilitated the deepening of discussions on the topic. The evaluation also identified a strong motivation for adolescents to discuss social values.

[Teaching of education in undergraduate nursing courses]. / Ensino de educação nos cursos de graduação em enfermagem.

This study reviewed the literature on the health education subject and the impact on education in undergraduate nursing. Descriptors were selected in LILACS, PERIENF and BDENF bases. References were classified into four categories: education, care, scientific production and stricto sensu academic production. The results showed: the importance of educational issues in the nursing social practice, for what there is concern with the student and the teacher education; in spite of the effort in the undergraduation to prepare nurses for the educative actions, this is considered insufficient; the educative practices, in both teaching and care categories, are based on the biomedical model, with focus on preventive aspects.

Workers' occupational health surveillance systems in low- and middle-income countries: a scoping review protocol.

OBJECTIVE: The aim of this scoping review is to describe the characteristics of occupational surveillance systems available in low- and middle-income countries. INTRODUCTION: Well-established workers' health surveillance systems provide important data to guide public health decision-making. A previous review on occupational health surveillance systems in developed countries found that insufficient collection of information and resources affects the work of policymakers and researchers. Identifying the characteristics of existing systems in low- and middle-income countries can assist in decision-making in these countries. INCLUSION CRITERIA: This review will consider studies on occupational health surveillance systems used in both public and private health services in low- and middle-income countries, which describe, implement, analyze, or evaluate surveillance systems on workers' health and working conditions. METHODS: Primary studies, government documents, and other records focusing on information systems of occupational and work-related diseases, occupational accidents, or injuries, published in English, Portuguese, Spanish, or Italian will be retrieved from seven databases, including LILACS, Scopus, PubMed, CINAHL, and Embase, among others. Various sources of gray literature, such as low- and middle-income countries' government websites, will also be searched. After title and abstract screening, relevant articles will be analyzed in full. Data extracted will be presented in tables and narrative form to provide comprehensive information.

Realist evaluation for programs and services in the health area: an integrative review of the theoretical and methodological literature.

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.

[Work of young students of a public school: strengthening or weakening?]. / Trabalho de jovens estudantes de uma escola pública: fortalecimento ou desgaste?

The objective of this research was to recognize the strengthening and weakening potentials of young workers who study in a public school. It is a qualitative study that interviewed 19 students 16 to 20 years old of the nocturnal period. The main weakening potentials were: long hours of working, excess of responsibility, lack of stability and essentially manual, broken up and repetitive work. The few strengthening potentials were: socialization and satisfaction of social reproduction needs. The phenomenon of intergenerational regression was verified. The study of the binomial strengthening-weakening of the young denounces more negative than positive meaning of the concurrence work-study, that is closely related to the survival needs of the families. This process is potentially weakening, being able to cause health problems to the young.

Drug content in games for mobile devices. / Conteúdo sobre drogas em jogos para dispositivos móveis.

OBJECTIVE: To analyze drug content in games for mobile devices. METHOD: An exploratory study implementing a qualitative approach. The collective health critical perspective was taken in relation to the ideology of prohibitionist education and the foundations of emancipatory education in the area of drugs. Games about drugs were selected in a virtual store based on inclusion and exclusion criteria. Content analysis was performed with the support of an interpretative model specific to digital games used to identify textual and procedural messages in games. RESULTS: Nineteen (19) games were analyzed. Most of them reiterate prohibitionist positions and play the role of transmitting prescriptive and normative information, assuming the objective of disciplining risk behaviors. This evident limitation demonstrates an important contradiction that games are strategies of contemporary language, with outdated and unscientific content. CONCLUSION: Despite the potential of virtual tools, the analyzed games are marked by intense simplification regarding the phenomenon of drug use and stimulate fast preprogrammed responses that do not go beyond memorization and conditioning. A need for scientific updates and incorporation of critical educational content persists in the area.

Fundamentos do processo de trabalho em terapia ocupacional: uma abordagem analítica a partir do diálogo entre Terapia Ocupacional Social e Saúde Coletiva Latino-Americana / Labor process foundations of occupational therapy: an analytical approach based on the dialogue between Social Occupational Therapy and Latin American Collective Health / Fundamentos del proceso de trabajo de la terapia ocupacional: una aproximación analítica basada en el dialogo entre Terapia Social Ocupacional y Salud Colectiva Latinoamericana

Resumo Introdução Este artigo apresenta uma abordagem analítica da prática da terapia ocupacional baseada no materialismo histórico dialético, compreendendo que a prática profissional da terapia ocupacional é considerada trabalho no sistema capitalista, podendo ser analisada à luz da Teoria do Processo de Trabalho. Objetivo Propor uma abordagem analítica com o intuito de apoiar o desenvolvimento de práticas de terapia ocupacional emancipatórias, baseadas no diálogo entre a Terapia Ocupacional Social e a Saúde Coletiva Latino-Americana. Método Com base na pesquisa-ação emancipatória, foram realizadas dez oficinas com dez terapeutas ocupacionais visando à produção coletiva de conhecimento. Resultados A atividade humana foi identificada como objeto do processo de trabalho da terapia ocupacional, definida pela categoria trabalho em sua dimensão ontológica. A participação radical foi proposta como o produto intencionado deste processo, sendo entendida como a participação na luta por transformar elementos da determinação social das condições coletivas de trabalho e vida. Os sujeitos desse processo são os terapeutas ocupacionais e os indivíduos, grupos e/ou comunidades acompanhados, todos entendidos como seres sociais em parceria para a transformação social. São identificadas quatro ferramentas teórico-metodológicas: análise emancipatória de atividades humanas, proposição emancipatória de atividades humanas, operacionalização da participação radical e intervenções sobre o tecido social. Conclusão A terapia ocupacional como prática social oferece uma contribuição específica para o desenvolvimento de uma práxis revolucionária coletiva que, voltada para a realização de uma utopia concreta, poderá gerar os meios para produzir uma nova sociedade.

Abstract Introduction This paper presents an analytical approach to occupational therapy practice grounded in historical dialectical materialism. It understands occupational therapy professional practice as work within a capitalist system, and thus subject to analysis through the labor process theory. Objective To propose an analytical approach to occupational therapy practice aimed at supporting the development of an emancipatory practice framework based on the dialogue between Social Occupational Therapy and Latin American Collective Health. Method Utilizing emancipatory action research methodologies, this study conducted 10 workshops with 10 occupational therapists aimed at collective knowledge production. Results Human activity is identified as the object of occupational therapy working process, defined by the category work in its ontological dimension. Radical participation is set as the intended product of this process, which entails engaging in efforts to transform the social determination of collective living conditions. The individuals in this process include occupational therapists and the followed-up individuals, groups, and/or communities, all viewed as social beings collaborating toward social transformation. Four theoretical-methodological tools are identified: emancipatory analysis of human activities, emancipatory proposition of human activities, operationalization of radical participation, and interventions in the social fabric. Conclusion Occupational therapy, as a form of social practice, offers a specific contribution to the development of a collective revolutionary praxis. This praxis, aimed at realizing a concrete utopia, seeks to generate the means to create a new society.

Resumen Introducción Este artículo presenta una aproximación analítica a la práctica de la terapia ocupacional basada en el materialismo histórico dialéctico. Entiende la práctica profesional de terapia ocupacional como trabajo bajo el capitalismo y, como tal, puede ser analizada bajo la teoría del proceso de trabajo. Objetivo Proponer un enfoque analítico de la práctica de la terapia ocupacional con la intención de apoyar el desarrollo posterior de un marco para la práctica de la terapia ocupacional emancipadora basada en el dialogo entre la Terapia Ocupacional Social y la Salud Colectiva Latinoamericana. Método A partir de una investigación acción emancipadora, se realizaron 10 talleres con diez terapeutas ocupacionales con el objetivo de la producción colectiva de conocimiento. Resultados La actividad humana es identificada como objeto del proceso de trabajo de la terapia ocupacional, definida por la categoría trabajo en su dimensión ontológica. La participación radical se establece como el producto previsto del proceso, es decir, la participación en la lucha por los elementos transformadores de la determinación social de las condiciones de vida colectivas. Los sujetos del proceso de trabajo son los terapeutas ocupacionales y los individuos, grupos y/o comunidades acompañados, todos entendidos como seres sociales en colaboración para la transformación social. Se identifican cuatro herramientas teórico-metodológicas: análisis emancipatorio de las actividades humanas, propuesta emancipadora de las actividades humanas, operacionalización de la participación radical e intervenciones en el tejido social. Conclusión La terapia ocupacional como práctica social ofrece una contribución específica al desarrollo de una praxis revolucionaria colectiva que, dirigida a realizar una utopía concreta, puede generar los medios para producir una nueva sociedad.

Harm reduction: trends being disputed in health policies.

OBJECTIVE: to identify the underlying harm reduction trends in Brazilian drug policies. METHOD: The research, qualitative in nature, used in-depth interviews with experts in the field. The recorded and transcribed material was analyzed via the content analysis method. RESULTS: The analysis exposed the following conceptions: drug use is a disease, and its associated health practices should be treatment, rehabilitation and social reintegration. These conceptions deviate to some extent from the war on drugs approach, and support the adoption of harm-reduction practices, proposed by public health. Less expressively, critical conceptions which clearly distance themselves from the prohibitionist approach and from public health may be seen, in line with the perspective of collective health, for the implementation of emancipatory harm-reduction practices. FINAL CONSIDERATIONS: Harm-reduction conceptions and practices reveal the underlying conservative, liberal, and critical tendencies in Brazilian drug policies.

Realist review as a methodology for using evidence in health policies: an integrative review. / Revisão realista como metodologia para utilização de evidências em políticas de saúde: uma revisão integrativa.

OBJECTIVE: To identify and analyze the concepts of realist review and the recommended methodology for its development in the health area. METHOD: An integrative review which sought theoretical-methodological qualitative or quantitative studies through 11 data sources which analyzed or proposed theories and/or realist review methodology. RESULTS: Twenty-three (23) studies, mainly published in the United Kingdom, were included. The realist review aims at explaining what makes a complex policy, program, or intervention work, in which aspects, for whom, in what context, to what extent, and why, by constructing theory, decompressing the functioning mechanisms, complex policy contexts or programs which generate results. Such methodology relies on the involvement of stakeholders in the problem from the early stages of the review process. CONCLUSION: The realist review has the potential to provide relevant and applicable subsidies for researchers, workers, policy makers and health decision makers.

Emancipatory drug practices: building projects with Primary Healthcare workers. / Práticas emancipatórias na área de drogas: construção de projetos com trabalhadores da Atenção Primária à Saúde.

OBJECTIVE: To build projects for implementing emancipatory drug practices with Primary Healthcare workers. METHOD: An emancipatory action research based on historical-dialectical materialism developed at the Vila Prudente/Sapopemba Health Technical Supervision of the city of São Paulo with the participation of Primary Healthcare workers (care providers and management). RESULTS: Seventeen (17) health workers participated in sharing 13 workshops. The workshops discussed the following topics: the health needs of residents of the territories in which they operate; social dimension of drug use; limitations and contradictions of public healthcare policies and practices in the area of drugs; purpose of working in Primary Healthcare; and implementing drug evidence. Four intersectoral implementation projects were designed based on critical policy discussions. CONCLUSION: The emancipatory workshops enabled workers to position themselves in the health production process and capture the contradictions of this process, thereby strengthening their ability to develop and implement tools in response to health needs based on the social processes that involve the production, circulation and consumption of drugs.