A construção de roteiros de entrevista a partir do referencial dos determinantes sociais da saúde: enfoque sobre a população jovem que vive em aglomerados subnormais / Preparation of interview scripts based on Social Determinants of Health: A focus on young adults living in subnormal clusters

Resumo Introdução A construção do roteiro de entrevista é uma etapa crucial para garantir o sucesso da pesquisa. Objetivo Descrever o processo de construção, validação e adaptação de instrumento voltado à pesquisa com população jovem que vive em aglomerados subnormais. Método A partir do referencial dos determinantes sociais da saúde e da temática da juventude foram elaboradas as versões iniciais de dois roteiros de entrevista, entre outubro e dezembro de 2017, para posterior validação e aplicação: um voltado para os jovens vivendo em aglomerados subnormais e outro para os trabalhadores da atenção básica. Posteriormente, foram realizados o pré-teste e a elaboração da versão final. Resultados A validação do conteúdo foi realizada por nove especialistas. Na avaliação geral do roteiro dos trabalhadores, o quesito com pior avaliação foi a abrangência do instrumento, e, na avaliação do formulário dos jovens, a ausência de itens foi mencionada por 44,4% dos juízes. Em ambos os roteiros, a compreensibilidade, a objetividade e a pertinência foram bem avaliadas. Os roteiros pós-validação foram aplicados a três trabalhadores e três jovens. Foram identificados problemas no ordenamento das questões e no encadeamento dos assuntos. Conclusão Os roteiros finais aproximaram a entrevista de uma proposta de maior diálogo entre pesquisador e participante.

Abstract Background The preparation of an interview script is a crucial step to ensure the success of a study. Objective Describe the process of construction, validation, and adaptation of an instrument aimed at surveying young adults living in subnormal clusters. Method Based on the Social Determinants of Health and the theme of youth, initial versions of two interview scripts were prepared between October and December 2017 for later validation and application: one aimed at young adults living in subnormal clusters and another at Primary Health Care (PHC) workers. After that, pretests were performed and the final versions were produced. Results Content validation was conducted by a group of nine specialist judges. Overall, instrument comprehensiveness received the worst evaluation in the script aimed at the PHC workers, whereas lack of necessary items was pointed out by 44.4% of the judges in the script aimed at the young adults. Both scripts were well assessed regarding comprehensibility, objectivity, and pertinence. After validation, the scripts were applied to three PHC workers and three young adults living in subnormal clusters. Problems with question order and theme chaining were identified. Conclusion The final scripts approached the interview to a proposal for greater dialogue between researcher and participant.

A práxis desenvolvida no âmbito do Conselho Municipal de Saúde em um município de São Paulo / The praxis developed in the Municipal Health Council in a large city in the state of São Paulo

RESUMO Os objetivos deste estudo foram caracterizar as modalidades de práxis desenvolvidas pelo Conselho Municipal de Saúde de Ribeirão Preto e investigar o exercício do papel do conselheiro enquanto membro participativo da gestão pública. Trata-se de um estudo descritivo com abordagem qualitativa, com coleta de dados em fontes primárias, por meio de questionários aplicado aos(às) conselheiros(as) de saúde, e secundárias, com análise das atas no período 2018-2019. Para análise dos dados, utilizaram-se a análise documental e o software IRaMuTeQ. Participaram deste estudo seis conselheiros, e foram analisadas 27 atas de reuniões. Embora o Conselho Municipal de Saúde se institua como espaço para o exercício do controle social, identificou-se falsificação de sua profecia inicial, uma vez que não houve entendimento do papel de conselheiros enquanto representante e sujeito político, observaram-se deliberações de baixo impacto, não houve estímulo da participação do cidadão, notou-se a utilização de um discurso técnico/científico como forma de estabelecer relações de subordinação, coerção de representantes pelo segmento governamental e uma participação pró-forma, reduzindo sua atuação à ocupação daquela cadeira. Entretanto, os Conselhos deveriam ser espaços ricos e potentes para a efetivação do Sistema Único de Saúde.

ABSTRACT This study aimed to characterize the praxis modalities developed by the Municipal Health Council of Ribeirão Preto and investigate the exercise of the role of the councilor as a participatory member of public management. It is characterized by a descriptive study with a qualitative approach with data col- lection and analysis from primary sources through questionnaires with a health counselor, and secondary sources, through analysis of the minutes in the period 2018-2019. For data analysis, we used a documentary analysis and the IRaMuTeQ software. Six counselors participated in this study and 27 minutes of meetings were analyzed. Although the Municipal Health Council is established as a space for the exercise of social control, falsification of its initial prophecy was identified, since there was no understanding of the role of counselors as a representative and political subject, low-impact deliberations were observed, there was no stimulus of citizen participation, the use of a technical/scientific discourse was noted as a way of establish- ing relationships of subordination, coercion of representatives by the governmental segment and a proforma participation, reducing their performance to the occupation of that chair. However, councils should be rich and powerful spaces for the implementation of the Unified Health System.

PRENACEL partner - use of short message service (SMS) to encourage male involvement in prenatal care: a cluster randomized trial.

BACKGROUND: The partner has an important role when he participates of the prenatal care as showed in the positive results relate to the mother and the child health. For this reason it is an important strategy to bring future fathers closer to health services and to improve their link with paternity. AIM: To evaluate whether the implementation of SMS technology, through the PRENACEL program for the partner as a health education program, is a useful supplement to the standard prenatal monitoring. METHODS: A parallel cluster randomized trial was carried out, with the clusters representing primary care health units. The 20 health units with the largest number of pregnant women in 2013 were selected for the study. There was a balance of the health units according to the size of the affiliated population and the vulnerability situation and these were allocated in intervention and control health units by the randomization. The partners of the pregnant women who started prenatal care prior to the 20th week of gestation were the study population of the intervention group. The participants received periodic short text messages via mobile phone with information about the pregnancy and birth. In the control group units the partners, together with the women, received the standard prenatal care. RESULTS: One hundred eighty-six partners were interviewed, 62 from the PRENACEL group, 73 from the intervention group that did not opt ​​for PRENACEL and 51 from the control group. A profile with a mean age of 30 years was found and the majority of respondents (51.3%) declared themselves as brown race/color. The interviewees presented a mean of 9.3 years of study. The majority of the men (95.2%) cohabited with their partner and 63.7% were classified as socioeconomic class C. The adherence to the PRENACEL program was 53.4%. In relation to the individual results, there was a greater participation of the PRENACEL partners in the prenatal consultations, as well as a greater presence of them accompanying the woman at the moment of the childbirth when compared to the other groups. CONCLUSION: The study showed that a health education strategy using communication technology seems to be a useful prenatal care supplement; the intervention had a good acceptability and has a promising role in men's involvement in prenatal, labour and postpartum care of their partners. TRIAL REGISTRATION: Clinical trial registry: RBR-54zf73, U1111-1163-7761.

Towards a Clinical Trial Protocol to Evaluate Health Information Systems: Evaluation of a Computerized System for Monitoring Tuberculosis from a Patient Perspective in Brazil.

Assessment of health information systems consider different aspects of the system itself. They focus or on the professional who will use the software or on its usability or on the software engineering metrics or on financial and managerial issues. The existent approaches are very resources consuming, disconnected, and not standardized. As the software becomes more critical in the health organizations and in patients, becoming used as a medical device or a medicine, there is an urgency to identify tools and methods that can be applied in the development process. The present work is one of the steps of a broader study to identify standardized protocols to evaluate the health information systems as medicines and medical devices are evaluated by clinical trials. The goal of the present work was to evaluate the effect of the introduction of an information system for monitoring tuberculosis treatment (SISTB) in a Brazilian municipality from the patients' perspective. The Patient Satisfaction Questionnaire and the Hospital Consumer Assessment of Healthcare Providers and Systems were answered by the patients before and after the SISTB introduction, for comparison. Patients from an outpatient clinic, formed the control group, that is, at this site was not implanted the SISTB. Descriptive statistics and mixed effects model were used for data analysis. Eighty-eight interviews were conducted in the study. The questionnaire's results presented better averages after the system introduction but were not considered statistically significant. Therefore, it was not possible to associate system implantation with improved patient satisfaction. The HIS evaluation need be complete, the technical and managerial evaluation, the safety, the impact on the professionals and direct and/or indirect impact on patients are important. Developing the right tools and methods that can evaluate the software in its entirety, from the beginning of the development cycle with a normalized scale, are needed.

Aspectos da gestão que influenciam o processo de planejamento municipal e regional do Sistema Único de Saúde / Aspects of management that influence the process of municipal and regional planning of the Unified Health System

Modelo do estudo: Estudo descritivo, transversal, com abordagem qualitativa. Objetivos do estudo: descrever e analisar a opinião de gestores e técnicos do setor saúde sobre os instrumentos e os recursos que integram o processo de planejamento no Sistema Único de Saúde. Metodologia: foram entrevistados 26 participantes, entre gestores e técnicos dos municípios e do estado que compõem o Departamento Regional Saúde XIII. Para análise dos dados, utilizou-se a Análise de Conteúdo em sua vertente temática. Resultados: o espaço de planejamento e cogestão regional, conhecido como Colegiado de Gestão Regional, se mostrou potente para a troca de experiências, mas apresentou fragilidades em relação a falta de coesão pelos diferentes níveis de conhecimento dos gestores e condições financeiras diversas entre os municípios. Notouse que a permanência dos gestores nos cargos foi positiva, desde que acompanhada por práticas de educação permanente. Por fim, a construção e a execução do planejamento tiveram como grandes barreiras o subfinanciamento e a judicialização na saúde, levando alguns municípios a escolha de políticas indutoras do nível federal e a terceirização da contratação de recursos humanos. Conclusão: O Colegiado de Gestores Regional apresentou grande potencial e poderia colaborar com a diminuição de retrocessos, a cada descontinuidade política, no processo de planejamento municipal e regional se fosse dado maior enfoque à coordenação federativa e ao aporte técnico do estado. (AU)

Study model: Descriptive, cross-sectional study with a qualitative approach. Objectives of the study: to describe and analyze the opinion of managers and technicians of the health sector on the instruments and resources that integrate the planning process in Unified Health System. Methodology: 26 participants were interviewed, among managers and technicians from the municipalities and the state that make up the Regional Health Department XIII. To analyze the data, we used Content Analysis in its thematic aspect. Results: The regional planning and co-management space, known as the Regional Management Collegiate, proven to be influential for the exchange of experiences, but it showed weaknesses about the lack of cohesion due to the different levels of managerial knowledge and diverse financial conditions among the municipalities. It was noticed that the permanence of the managers in the positions was positive, as long as accompanied by practices of permanent education. Finally, the construction and execution of the planning had as main barriers the underfinancing and the judicialization in health, leading some municipalities to choose policies to induce the federal level and outsourcing the hiring of human resources. Conclusion: The Collegiate of Regional Managers presented great potential and could collaborate with the reduction of setbacks, with each political discontinuity, in the process of municipal and regional planning if the greater focus given to federative coordination and state technical contribution (AU)