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PURPOSE: In response to the rise in suicidal behaviour and the strategies to address it, community actions represent a comprehensive approach to the factors influencing this situation. The aim of this study was to analyse the influence of mutual support on the recovery of individuals who experienced suicidal behaviour and attended community mental health groups. METHODS: A qualitative study was conducted in 2023. Focus groups were used as a data collection technique, followed by thematic analysis. Participants were selected based on convenience from mutual support groups registered with the Ministry of Health of Colombia. RESULTS: Two main themes were identified in the thematic analysis. The first theme, "Own Reasons Through Others," was composed of categories such as "What Others See in Me" and "The Importance of Being in the Same Boat." The second theme was titled "The Community as a Space for Suicide Prevention," with categories including "Human Rights for Recovery" and "What We Can Achieve Together." CONCLUSIONS: Pluralism, understood as the integration of diverse perspectives, is crucial for addressing complex phenomena such as mental health and community interventions. The study demonstrates how mutual aid groups and their members can generate collective and policy actions effective for managing suicidal behaviour.

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BACKGROUND: Malaria burden remains high in some Peruvian regions, especially in the Northeast Amazon rainforest state of Loreto and the tropical coastal state of Tumbes. Novel non-invasive diagnostic tools for malaria are being developed, and formative research in malaria-endemic areas with community members and health professionals who would potentially use these devices is vital for this process. This study aimed to examine the acceptability and feasibility of four new non-invasive malaria diagnostic tools in development in two regions of Peru with significant malaria burden. METHODS: The research team conducted focus group discussions and key informant interviews in Spanish to assess acceptability and ascertain questions and concerns regarding the non-invasive diagnostic tools. Focus group discussions included a range of community members (pregnant women, parents), professionals (health, education), and community leaders in Loreto. Vector control authorities and health professionals from Loreto, Tumbes, and Lima participated as key informants. RESULTS: Participants were initially enthusiastic about all non-invasive diagnostic tools. However, as discussions proceeded, high enthusiasm remained for two devices that were easy to use, acceptable for the communities they were intended for, feasible to carry in remote areas, and did not require new supplies nor generate waste: the skin scan and the skin odour test. The breath and saliva tests were considered less hygienic. They were less acceptable to community members and health professionals due to concerns of disease transmission and other environmental and cultural concerns. Health professionals felt the finger scan test and the skin odour test would help triage community members in endemic sites and would be valuable in remote regions with difficult access to health facilities or laboratories. CONCLUSIONS: Novel non-invasive malaria diagnostic tools can be valuable in malaria-endemic settings. As manufacturers evaluate the efficacy and effectiveness of these non-invasive diagnostic tools, international recommendations should be created to ensure their agile integration into national malaria programmes.

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This study aimed to understand the facilitators, barriers, and strategies for the use of food intake markers by primary health care (PHC) professionals. The responses of 235 healthcare health care professionals to an electronic questionnaire were used to develop a script for virtually conducted focus groups. In 10 focus groups, 34 professionals from healthcare and management positions from all Brazilian macroregions were included, and the transcripts were thematically analyzed. Healthcare professionals and managers emphasized the need for infrastructure to properly use the markers, pointing to the lack of equipment and connection instabilities as the main barriers. Managers highlighted the possibility of its use by any professional as a facilitator, whereas healthcare professionals positively indicated the structure of the markers. However, participants mentioned the lack of awareness about their importance as a barrier. Despite its slowness, the accessibility of the platforms to register the markers emerged as a facilitator, as did its conditionality with public policies, especially when linked to financial incentives. The focus groups allowed the exchange of strategies, such as continuing education, training for typists, ways to use markers in health care spaces, and expansion of data dissemination. Investment in infrastructure, professional training, and collaboration between PHC teams, with the sharing of strategies, configured crucial factors to strengthen the use of food intake markers.

Este estudo buscou compreender facilitadores, barreiras e estratégias para o uso de marcadores do consumo alimentar por profissionais da atenção primária à saúde (APS). As respostas de 235 profissionais de saúde a um questionário eletrônico foram utilizadas para desenvolver um roteiro para grupos focais realizados virtualmente. Em 10 grupos focais, 34 profissionais de cargos assistenciais e gestão de todas as macrorregiões brasileiras foram incluídos e as transcrições das gravações foram analisadas tematicamente. Profissionais da assistência e gestores enfatizaram a necessidade de infraestrutura para o uso adequado dos marcadores, apontando falta de equipamentos e instabilidade na conexão como principais barreiras. Gestores destacaram a possibilidade de uso por qualquer profissional como facilitadora, ao passo que profissionais da assistência assinalaram positivamente a estrutura dos marcadores, mas a falta de sensibilização sobre sua importância foi mencionada como barreira pelos participantes. Apesar da lentidão, a acessibilidade das plataformas para registro dos marcadores foi apontada como facilidade, assim como a condicionalidade com políticas públicas, especialmente quando vinculadas a incentivos financeiros. Os grupos focais permitiram trocas de estratégias, como educação permanente, treinamentos para digitadores, formas de uso dos marcadores nos espaços de assistência à saúde e ampliação da divulgação dos dados. Investir em infraestrutura, qualificação profissional e colaboração entre equipes da APS, com compartilhamento de estratégias, foram fatores cruciais para fortalecer o uso dos marcadores do consumo alimentar.

Este estudio pretende identificar los facilitadores, las barreras y las estrategias para el uso de marcadores de consumo de alimentos por parte de los profesionales de la atención primaria de salud (APS). Las respuestas de 235 profesionales de la salud a un cuestionario electrónico se utilizaron para desarrollar un guion para los grupos focales que se realizaron virtualmente. En 10 grupos focales, se incluyeron a 34 profesionales de puestos de atención y gestión de todas las macrorregiones brasileñas, y las transcripciones se analizaron temáticamente. Los profesionales y gestores de la asistencia enfatizaron la necesidad de una infraestructura para el uso adecuado de los marcadores, señalando como principales barreras la falta de equipos y la inestabilidad en la conexión. Los gerentes destacaron la posibilidad de uso por parte de cualquier profesional como facilitador, mientras que los profesionales de la atención señalaron positivamente la estructura de los marcadores, pero la falta de conciencia sobre su importancia fue mencionada como una barrera por los participantes. A pesar de la lentitud, se señaló como fácil la accesibilidad a las plataformas de registro de los marcadores, así como la condicionalidad con las políticas públicas, especialmente cuando se vinculan a incentivos financieros. Los grupos focales permitieron intercambiar estrategias, como la educación permanente, la capacitación de digitadores, las formas de uso de marcadores en los espacios de atención a la salud y la ampliación de la difusión de datos. La inversión en infraestructura, la calificación profesional y la colaboración entre los equipos de APS, con el intercambio de estrategias, fueron factores cruciales para fortalecer el uso de marcadores de consumo de alimentos.

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Hispanic populations are disproportionately impacted by HPV-associated cancers. An HPV vaccine is available that protects against 90% of HPV-associated cancers. Understanding the factors associated with HPV vaccine uptake, including identifying whom individuals trust to recommend the HPV vaccine, is an important step toward developing public health interventions for promoting the HPV vaccine among Hispanic people. The purpose of this pilot study was to use a qualitative approach to identify trustworthy messengers to disseminate HPV vaccine information among Mexican American (MA) parents of children of 11-17 years of age. Three 90 min pilot focus groups with three to five participants in each group were conducted. The inclusion criteria included being 18 years of age or older, residing in El Paso, TX, identifying as MA, speaking English, and being a parent of a child between the ages of 11 and 17. Focus groups were conducted with 15 predominately female participants (Mage = 38.46, SD = 5.73; Female = 93.3%). A reoccurring theme throughout all three focus groups was that pediatricians, registered nurses, and pharmacists were identified as the most trusted sources of information. Findings from this study have implications for designing public health interventions that leverage pediatricians, registered nurses, and pharmacists to promote the HPV vaccine among parents.

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OBJECTIVE: The study aims to describe the violence perceived by transvestigender people in Brazil, linking it to primary healthcare. METHODS: Fourteen transvestigender people in Brazil were interviewed through 2 focus groups and 8 interviews, conducted between December 2021 and April 2022. Data analysis was performed using a phenomenological-hermeneutic approach. RESULTS: The statements were categorized into the following themes: "the unintentional nature of violence", "violence in health services" and "the family as a producer of violence". These categories show that the phenomenon of violence extends beyond intentional acts directed at a person, as originally conceptualized by the World Health Organization. CONCLUSION: The transvestigender population experiences both intentional and unintentional violence, which impacts their physical and emotional well-being. Primary healthcare can serve as an ally in addressing these forms of violence by ensuring comprehensive care.

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The Homeless Population (HP) has grown exponentially in the last decade, causing different challenges for the Brazilian Unified Health System, especially during the COVID-19 pandemic. A cross-sectional, descriptive, and exploratory study, with triangulated quantitative and qualitative methods, was conducted from 2020 to 2022, exploring care practices geared to the HP in Belo Horizonte. The quantitative stage adopted official datasets from the health and social assistance secretariats, and 48 semi-structured interviews and four focus groups were conducted in the qualitative stage, totaling 86 participants. The results point to the need for implementing a polyarchic and multidisciplinary Healthcare Network (RAS-PSR) with intersectoral support, guided care territorialization and longitudinality integrated with information systems to address the complex approach and based on the logic of the expanded clinic. Updating HP records in health systems and qualifying services is needed to achieve RAS-PSR efficacy. Understanding the dynamics of actions developed or broadened by the municipality and lessons learned locally can assist the development of effective social care and health policies that can be upscaled to the national level.

A População em Situação de Rua (PSR) apresentou um crescimento exponencial na última década acarretando diferentes desafios para o Sistema Único de Saúde, especialmente durante a pandemia de COVID-19. Estudo transversal, descritivo e exploratório, com triangulação de métodos quantitativos e qualitativos, de 2020 a 2022, que explorou as práticas de cuidado no município de Belo Horizonte voltadas à PSR. Na etapa quantitativa utilizou-se bancos oficiais das secretarias de saúde e assistência social, e na etapa qualitativa foram realizadas 48 entrevistas semiestruturadas e 4 grupos focais, totalizando 86 participantes. Os resultados apontam para a necessidade de uma Rede de Atenção à Saúde (RAS PSR) poliárquica e multiprofissional, com apoio intersetorial, orientada pela territorialização e longitudinalidade do cuidado, integrada aos sistemas de informação, visando a complexidade da abordagem e pautada na lógica da clínica ampliada. A atualização cadastral da PSR nos sistemas de saúde e qualificação dos serviços são cruciais para a eficácia da RAS PSR. Compreender a dinâmica das ações implementadas e/ou ampliadas no município e lições aprendidas localmente possibilita auxiliar na elaboração de políticas de cuidado efetivas.

La Población Sin Hogar (PSH) ha mostrado un crecimiento exponencial en la última década, provocando diferentes desafíos para el Sistema Único de Salud brasileño, especialmente durante la pandemia de COVID-19. Se ha implementado un estudio transversal, descriptivo y exploratorio con triangulación de métodos cuantitativos y cualitativos de 2020 a 2022, que exploró las prácticas de atención en la ciudad de Belo Horizonte dirigidas a la PSH. En la etapa cuantitativa se utilizaron bancos oficiales de las secretarías de salud y asistencia social, y se realizaron 48 entrevistas semiestructuradas y cuatro grupos focales en la etapa cualitativa, totalizando 86 participantes. Los resultados apuntan a la necesidad de una Red de Atención de Salud (RAS-PSR) poliárquica y multiprofesional, con apoyo intersectorial, orientada por la territorialización y longitudinalidad de la atención, integrada con sistemas de información, apuntando a la complejidad del abordaje y basada en la lógica de la clínica expandida. La actualización de los registros de la PSH en los sistemas de salud y los servicios de calificación son cruciales para la eficacia de la RAS-PSR. Comprender la dinámica de las acciones implementadas y/o ampliadas en el municipio y las lecciones aprendidas localmente permite coadyuvar en el desarrollo de políticas de cuidado efectivas y escalables a nivel nacional.

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This article describes the construction and validation of an instruction manual geared toward nutritional care (NC) for people with severe obesity in the Brazilian Unified Health System (SUS). In the production of this instruction manual, a broad literature review was conducted for the identification and discussion of topics to be treated. The content and appearance validity were conducted according to the Delphi technique and to focus groups, respectively, with evaluators who were nutritionists and practitioners, from different regions of Brazil. According to the Delphi technique, the instruction attributes and their content as a whole were properly and sufficiently evaluated according to values obtained for the Content Validity Index (CVI > 0.8). In the focus groups, the saturation of content was reached. Furthermore, discussions considering the reality of SUS were conducted and subsequently incorporated into the instructions in order to adequate the final version of the instructions to SUS professionals' needs. In conclusion, the instruction manual produced to fill the gap regarding nutritional care for people with severe obesity presents an adequate content in terms of both quality and topics of interest (content validation), and is applicable within the reality of SUS nutritionists (appearance validity).

O artigo descreve a construção e a validação de um instrutivo destinado ao cuidado nutricional de pessoas com obesidade grave no Sistema Único de Saúde (SUS). Na construção do instrutivo, uma ampla revisão de literatura foi realizada para identificação e discussão dos tópicos a serem abordados. As validações de conteúdo e aparente se deram mediante técnica Delphi e grupos focais, respectivamente, com juízes nutricionistas especialistas e práticos de todas as regiões do Brasil. De acordo com a técnica Delphi, os atributos do instrutivo e seu conteúdo como um todo foram avaliados como adequadamente e suficientemente abordados, mediante valores obtidos para o índice de validade de conteúdo (IVC > 0,8). Nos grupos focais, atingiu-se a saturação de conteúdo. Além disso, discussões alinhadas com a realidade do SUS foram conduzidas e, posteriormente, incorporadas ao instrutivo, para adequar a versão final às necessidades dos profissionais do SUS. Em conclusão, o instrutivo construído para preencher uma lacuna sobre o cuidado nutricional da pessoa com obesidade grave apresenta conteúdo adequado em qualidade e tópicos de interesse (validação de conteúdo), aplicável dentro da realidade do(s) nutricionistas do SUS (validade aparente).

Este artículo describe la construcción y validación de una instrucción orientada a la atención nutricional de personas con obesidad severa en el Sistema Único de Salud (SUS) brasileño. Al construir la instrucción se realizó una amplia revisión de la literatura para identificar y discutir los temas a tratar. Las validaciones de contenido y aparente fueron realizadas mediante la técnica Delphi y grupos focales, respectivamente, con jueces expertos y prácticos nutricionistas de todas las regiones de Brasil. Según la técnica Delphi, se evaluaron los atributos de la instrucción y su contenido en su conjunto como adecuados y suficientemente abordados, con base en los valores obtenidos para el índice de validez de contenido (IVC > 0,8). Se alcanzó la saturación de contenidos en los grupos focales. Además, se realizaron discusiones alineadas con la realidad del SUS y posteriormente incorporadas a la instrucción, para adaptar la versión final de la instrucción a las necesidades de los profesionales del SUS. En conclusión, la instrucción creada para cubrir un vacío en el cuidado nutricional de personas con obesidad severa presenta contenidos adecuados en términos de calidad y temas de interés (validación de contenido) y aplicables dentro de la realidad de los nutricionistas del SUS (validez aparente).

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OBJECTIVE: to understand the perception of teachers and health professionals regarding the use of the Play Nicely Program for parents/caregivers in the prevention of violence against children. METHOD: a descriptive and exploratory qualitative study was conducted through three focus groups with twenty primary school teachers and primary health care professionals who implemented the Program for parents/caregivers in 2022. The data analysis was guided by French discourse analysis, interpreted through the lens of Urie Bronfenbrenner's theory. RESULTS: three categories emerged from the participants' perceptions: innovation and utility; theory applicability in practice; reinterpreting attitudes of austerity and impatience towards children; disciplining rather than punishing children: dilemmas and challenges. The testimonies highlighted that the Program is innovative, easily accessible, clear in language, and easy to apply in practice for parents/caregivers. CONCLUSION: the use of the Program added knowledge and fostered positive attitudes toward the development of the bioecological system in addressing and preventing violence against children.

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INTRODUCTION: Climate change is shaping adolescent and young people's (AYP) transitions to adulthood with significant and often compounding effects on their physical and mental health. The climate crisis is an intergenerational inequity, with the current generation of young people exposed to more climate events over their lifetime than any previous one. Despite this injustice, research and policy to date lacks AYP's perspectives and active engagement. METHODS: Participatory, youth co-led qualitative focus group discussions were held in Bangladesh, Guatemala and Nigeria in mid-2023. A total of 196 AYP ages 12-25 years participated. Open-ended questions elicited responses regarding AYP knowledge, experiences and perceptions of climate change. Using NVivo software, translated transcripts were coded to explore and synthesise key thematic areas. RESULTS: Respondents discussed varied climate exposures and associated health risks, for example, how flooding events were impeding access to sexual and reproductive health commodities. Acute climate events like flooding and cyclones increased perceived risk of early marriage and gender-based violence in Bangladesh and Guatemala. In Nigeria, respondents discussed health effects of extreme heat, and how droughts were shifting women into more traditionally male roles in agriculture and income-generating activities, increasing the perceived risk of household tensions and gender-based violence. Commonly reported themes included perceived climate impacts on sexual and reproductive health including early marriage or gender-based violence. Another common theme was anxiety about climate change, its effects on economic and food insecurity in communities and feeling hopeless, lacking agency and not feeling supported by local institutions, all linked with worse mental health. CONCLUSION: Our results summarise how AYP perceive climate change is affecting their physical and mental health, finding similarities and differences across these three settings. Our results can inform the development of policies and programmes that directly address AYP needs in a way that is inclusive and responsive.

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This study explores the adaptation of a Positive Youth Development (PYD) programme for the Indigenous Quichua community in Guangaje, Ecuador, which faces chronic poverty and low educational attainment. In May, June 2023 we conducted focus groups with school teachers and indigenous community leaders, parents and middle school, high school and college students. We found a disconnect between students' aspirations for higher education and adults' emphasis on practical and vocational training. Findings highlight the need to strengthen youth internal assets and change adult perspectives to foster a supportive environment, empowering youth to be motivated and prioritise the long-term benefits of education beyond immediate economic challenges.

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BACKGROUND: The widely implemented prevention program in Brazil, PROERD (a translated version of the DARE-kiR program), showed no evidence of effect in preventing drug use in a recent trial. The lack of cultural adaptation and instructors' deviations from the curriculum were identified as potential reasons for its ineffectiveness. This study aims to identify points of inadequacy of the PROERD program for the Brazilian culture, suggesting strategies for revising the curriculum to improve implementation. METHODS: We triangulated data obtained from three different groups of study participants: semi-structured interviews with the law enforcement officer who implemented the program, focus groups with students who participated in the program, and questionnaires completed by external experts in the prevention field who evaluated the program's manuals. Data was analyzed using thematic analysis based on the Ecological Validity Model theory, which encompasses three main axes: methodology, content, and language to identify the main points for cultural adaptation. RESULTS: Regarding the program's methodology, there is an excess of activities with little interactivity involving literacy skills that do not match Brazilian students' cognitive development and require equipment unavailable in Brazilian public schools. Regarding content, activities were considered appropriate for evidence-based prevention; however, there were some contradictions related to the drug content. The language presented in the program's manuals was considered inappropriate for the culture of Brazilian youth (vocabulary, examples, and images). CONCLUSIONS: In conclusion, this study strongly recommends revising the PROERD curriculum Caindo na Real, ensuring it will align with the international prevention standards and Brazilian Culture.

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Approaching families to discuss deceased organ donation authorisation is considered one of the central stages of the organ donation process. In many countries, specialist nurses lead the organ donation process, approach and support families. However, how these encounters occur is not yet fully understood. A constructivist grounded theory methodology was used to conceptualise the process of approaching families from the perspectives of healthcare professionals and families. Data collected included six months of observations across two large hospitals in Chile, documents, interviews and focus groups with 71 participants including healthcare professionals involved in the organ donation process, and bereaved families who were approached for organ donation conversations. The theory Reading the family was developed to explain the relational process of how nurse organ donor coordinators approach families to negotiate organ donation authorization. It explains the sophisticated and skilled process of accessing, assessing and managing family's emotions to negotiate organ donation authorization as a family unit. The theory has two dimensions, indirect and direct, which refers to when and how nurses read families emotions to lead organ donation conversations and support bereaved families' decision-making process. These dimensions critically depend on the clinicians set of beliefs and communication processes. Understanding the complexities of approaching families is essential for practice and policymaking, particularly when there is a trend towards individual decision-making instead of understanding organ donation as a family affair. Reading the family could be eventually applied in other contexts and situations that involve navigating difficult conversations, and therefore, further research is needed and suggested to assess the feasibility of its application.

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BACKGROUND: The use of urban green spaces differs by social characteristics, including gender, ethnicity, and socioeconomic position. We examined motives, means and prerequisites to visit green space of marginalised populations with high cardiometabolic risk in the Netherlands, namely women with a Turkish or South Asian Surinamese background residing in disadvantaged neighbourhoods. METHODS: We conducted six focus group discussions in two Dutch cities. The study was performed in collaboration with social workers from the local communities with similar ethnic backgrounds as the participants. A thematic analysis was carried out. RESULTS: Sixteen Turkish women and 30 South Asian Surinamese women participated. Motives, means and prerequisites that emerged covered four themes: social, personal, environmental characteristics and undertaking activities. Socializing was an important motive to visit green space. Personal motives mainly consisted of positive effects on mental and physical well-being. Activities undertaken in green space were often a means to socialize or improve well-being. Many environmental factors, including safety, aesthetics, and (sanitary) facilities, influenced motivation to visit green space. Except for environmental characteristics, motives, means and prerequisites largely overlapped between ethnic groups. There were notable interactions between the themes. CONCLUSION: Motives, means and prerequisites to visit green space of women with a Turkish or South Asian Surinamese background who live in disadvantaged neighborhoods span multiple interacting themes. Future studies examining the relationship between green space and health should consider interactions between motives, means, prerequisites and ethnicity. The possibility of expanding the multifunctionality of green spaces to provide marginalized populations with more equitable access and activities should be further explored.

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INTRODUCTION: In Argentina, the implementation of a national strategy to reduce the prevalence of noncommunicable diseases (NCDs) has been hampered by challenges at the provincial level. We aimed to design a new model of care for NCDs at the primary care level by conducting a multimodal system assessment and co-design of potential solutions in the province of Mendoza. METHODS: We carried out a mixed-methods study with 7 components: evaluation of patterns of care, patient focus groups, cross-sectional standardized population-based phone survey, an electronic cohort follow-up of patients with type 2 diabetes, in-depth interviews with stakeholders, a knowledge test for health care providers on chronic condition management, and a Delphi consensus to provide recommendations from stakeholders. RESULTS: Focus group and in-depth interviews revealed access to primary health care for NCDs was associated with problems with long waiting times and time-consuming procedures for referral to laboratory tests, hospital care, and provision of medication. Mental health care services were particularly limited. Survey respondents (N=1,190) were predominantly covered through public (41%) or social security sectors (54%); 41% fell in the lowest income group. Contact with the health system was high (5.7 annual visits), but 19.7% reported unmet health care needs. Public sector providers perceived they provided high-quality care despite insufficient material and human resources. Within the social security sector, the main challenge was insufficient staff, particularly affecting mental health care. Health care providers showed a higher percentage of correct answers to depression-related questions, but worse results were seen in hypertension and diabetes care. Actions supported by evidence and expert agreement were identified for implementation to guide future system changes. CONCLUSION: Our research highlights the potential for Argentina's primary care system to initiate transformative, system-level changes aimed at improving health outcomes. We propose an innovative methodological assessment and co-design for improving primary care.

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BACKGROUND: One of the most important pillars of action to achieve the elimination of trachoma and soil-transmitted helminth infections as a public health problem is the mass administration, at regular intervals, of azithromycin and anthielmintics, respectively, to a high proportion of the eligible population in endemic areas. OBJECTIVE: The objective of the study was to identify access barriers and facilitators for achieving coverage goals in the mass drugs administration, azithromycin and albendazole, in the department of Amazonas, Colombia. METHODOLOGY: Implementation research was used, combining three types of qualitative research methodologies to collect information about access barriers and facilitators already described; These were individual and group interviews, focus group discussions and face-to-face intercultural dialogues. We design, validate and apply different instruments with questions adapted to the context and role of the participants, and recorded and transcribed the sessions and analyzed them in qualitative analysis software. We used the Consolidated Framework for Implementation Research (CFIR) to complement the above instrument questions, to guide data analysis, and apply the Consolidated Criteria for Reporting Qualitative Research (COREQ). RESULTS: Records of 159 participants were included; 21 individual and 3 group interviews, 6 focus group discussions and 4 intercultural dialogues were carried out. 21 strong, 30 weak, 6 neutral barriers as well as 5 weak and 11 strong facilitators were identified. 62% of the strong barriers and 40% of the weak ones were concentrated in the "Outer Setting Domain". Only 16 facilitators were identified, 44% in the "Innovation" domain. CONCLUSIONS: Multiple political, administrative, geographical, logistical and cultural access barriers, as well as external and internal migration of the population, explain low coverage in mass administration of azithromycin and albendazole. It is necessary to review them individually to implement an improvement plan that also recognizes the identified facilitators.

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OBJECTIVE: To construct a matrix of interprofessional competencies produced in Multiprofessional Health Residencies in the interior of Rio Grande do Norte. METHOD: Qualitative study, with a deductive method for theorization and construction of the competency matrix. It was organized into three phases: theoretical, field and analytical phase. Developed in multi-professional residencies in the interior of northeastern Brazil, with a sample of 41 subjects: 30 students, 06 preceptors, 04 professors and 01 municipal health manager. Focus group and interview data collection techniques were used, carried out from November 2022 to August 2023. Deductive thematic analysis was applied. All ethical principles were respected. RESULTS: The matrix was organized on three levels of competencies: common, professional-guiding, and collaborative. It is demonstrated using a table that organizes the type of competency, the interviewees' speeches and the competencies identified in the study, guided by international literature. CONCLUSION: It was possible to construct the interprofessional competencies matrix. The matrix foresees a contemporary professional profile, demonstrating the need for improvements to professional reorientation from an interprofessional perspective to meet the demands of this new professional profile.

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OBJECTIVES: This study investigated how Brazilian young people perceive their role in promoting and supporting their peer community's mental health and well-being, and the conditions and contexts influencing their engagement. DESIGN: Co-produced qualitative study using in-depth interviews and focus groups with adolescents. The sessions were audio-recorded, transcribed and anonymised. Data were analysed using reflexive thematic analysis. SETTING: Data collection took place remotely across Brazil via audio or video calls conducted by a youth collaborator and a senior researcher. PARTICIPANTS: 46 Brazilian adolescents aged between 15 and 18 years old, recruited primarily via social media. RESULTS: Our analysis generated four overarching themes: (1) young people's sense of responsibility and motivation-many participants felt committed to promoting the mental health and well-being of their friends and community, while also critically emphasising responsibilities of and partnerships with adult stakeholders to make a meaningful difference; (2) strategies for promoting peer mental health-suggested strategies included peer-to-peer support, such as non-judgemental listening, and collective actions such as forming school groups; (3) intrapersonal barriers-key barriers to participation included a lack of necessary skills and self-efficacy; and (4) contextual barriers-young people reported feeling unheard, invalidated, and fearing judgement due to mental health stigma. CONCLUSION: These findings support an ecological view of youth participation in the promotion of mental health as dependent on intrapersonal, interpersonal and contextual factors. Realising young people's potential in advancing mental health in their communities requires fostering youth-adult partnerships, providing peer support training, and combating adultism and mental health stigma.

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This study sought to explore the perspective of medical faculty on the mental health of their students. This qualitative study based on a focus group is part of a longitudinal research that studied the mental health of Brazilian students. One group was conducted with faculty employed at a medical school. Topics discussed covered the concept of mental health and medical education. Six professors participated in one group. The mental health of medical students is a construct that encompasses emotional aspects, ability to solve problems and multiple facets of a human being, according to the participants. Artistic practices, moments of socialization and leisure were perceived as stimulating students' good mental health. Excessive demands generate competitiveness and the teacher's expectation of the student's good performance based on their own experience can harm the student's mental health. Participants also highlighted that a pedagogical reformulation that makes sense for the student's learning process is necessary to update traditional curricula. Medical students' mental health is influenced by experiences and exchanges during the medical school, mainly between professor and student, understood as necessary and inherent to the process of becoming physician. The findings of this study show the need for curriculum changes in the medical education process and updating teacher training for good practices that reinforce good mental health.

Este estudio buscó explorar la perspectiva de los profesores de medicina sobre la salud mental de sus estudiantes. Este estudio cualitativo basado en un grupo focal es parte de una investigación longitudinal que estudió la salud mental de estudiantes brasileños. Un grupo se llevó a cabo con profesores empleados en una escuela de medicina. Los temas tratados abarcaron el concepto de salud mental y educación médica. Seis docentes participaron en un grupo. La salud mental de los estudiantes de medicina es un constructo que abarca aspectos emocionales, capacidad de resolución de problemas y múltiples facetas del ser humano, según los participantes. Las prácticas artísticas, los momentos de socialización y el ocio fueron percibidos como estimulantes de la buena salud mental de los estudiantes. Las exigencias excesivas generan competitividad y la expectativa del docente sobre el buen desempeño del estudiante basándose en su propia experiencia puede perjudicar la salud mental del estudiante. Los participantes también resaltaron que es necesaria una reformulación pedagógica que tenga sentido para el proceso de aprendizaje del estudiante para actualizar los currículos tradicionales. La salud mental de los estudiantes de medicina está influenciada por las experiencias y los intercambios durante la carrera de medicina, principalmente entre profesor y estudiante, entendidos como necesarios e inherentes al proceso de convertirse en médico. Los hallazgos de este estudio muestran la necesidad de cambios curriculares en el proceso de formación médica y de actualización de la formación docente hacia buenas prácticas que refuercen la buena salud mental.

Este estudo buscou explorar a perspectiva dos docentes de medicina sobre a saúde mental de seus alunos. Este estudo qualitativo baseado em grupo focal faz parte de uma pesquisa longitudinal que estudou a saúde mental de estudantes brasileiros. Um grupo foi conduzido com professores empregados em uma faculdade de medicina. Os temas discutidos abrangeram o conceito de saúde mental e educação médica. Seis professores participaram de um grupo. A saúde mental dos estudantes de medicina é um construto que engloba aspectos emocionais, capacidade de resolução de problemas e múltiplas facetas do ser humano, segundo os participantes. As práticas artísticas, os momentos de socialização e de lazer foram percebidos como estimuladores da boa saúde mental dos estudantes. Exigências excessivas geram competitividade e a expectativa do professor pelo bom desempenho do aluno com base na própria experiência pode prejudicar a saúde mental do aluno. Os participantes destacaram também que é necessária uma reformulação pedagógica que faça sentido para o processo de aprendizagem do aluno para atualizar os currículos tradicionais. A saúde mental dos estudantes de medicina é influenciada pelas experiências e trocas durante o curso de medicina, principalmente entre professor e aluno, entendidas como necessárias e inerentes ao processo de tornar-se médico. Os achados deste estudo mostram a necessidade de mudanças curriculares no processo de formação médica e de atualização da formação docente para boas práticas que reforcem a boa saúde mental.

RESUMO

Drugs have been consumed since ancient times, and their taboo has generated segregation and hindered the proper confrontation of harmful use. This study investigated the real and symbolic values of drug use for ill-housed people beyond pathologization, seeking to understand factors that hinder giving them up, even with intense losses and suffering. It also aimed to understand its implications for health care. This is a phenomenological qualitative research based on participant observation of ill-housed people care provided by the Street Clinic, interviews with ill-housed people and focus group with professionals from the Health Care Network in Rio de Janeiro city, Brazil, between March 2017 and July 2019. Results showed that "drug use" interacted with the research categories as follows: drugs are the main reason for living and staying on the streets; drugs motivate having financial activity; drugs cause abandonment of health treatment; drugs soothe and cause depression, suffering and hunger; drugs make them seek shelter and religion to "escape" using, but without adequate treatment hope leads to relapse and low self-esteem - which one want to get rid of, but few successes undermine hope. As expected, it is the reason for divergences among professionals regarding the type of care and support for ill-housed people. Given the results, how can we face abusive use that relieves hunger, loneliness, suffering and depression? How to take care of a use that generates hunger, depression, affective, health and self-esteem losses? A cyclical story told by people in situations of extreme vulnerability. Unveiling the symbolic plurality of drug use enables reflections and new ways of caring for ill-housed people.

Desde a antiguidade, consome-se drogas e seu tabu promoveu segregações e inibiu o enfrentamento adequado do uso nocivo. Este trabalho objetivou descortinar valores reais e simbólicos do uso de drogas pela população em situação de rua para além da patologização, buscando entender fatores que dificultam sua renúncia, mesmo com perdas e sofrimentos intensos. Este estudo visou também compreender as implicações do uso para o cuidado de saúde. Esta é uma pesquisa qualitativa fenomenológica, envolvendo observação participante do atendimento da população em situação de rua pelo Consultório na Rua, entrevistas com população em situação de rua e grupo focal com profissionais da Rede de Atenção à Saúde, em território do Município do Rio de Janeiro, Brasil, entre março de 2017 a julho de 2019. Resultados mostraram que "uso de droga" teve interação com as categorias da pesquisa da seguinte forma: droga é o principal motivo para viver e manter-se na rua; motiva a ter atividade financeira; faz abandonar tratamento de saúde; aplaca e provoca depressão, sofrimento e fome; faz buscar abrigo e religião, para "fugir" das drogas mas sem o tratamento adequado, esperança transverte-se em recaída e baixa autoestima, da qual deseja livrar-se, no entanto, poucos êxitos minam a esperança. Correcionalmente, é motivo das divergências entre profissionais quanto ao tipo de cuidado e apoio para necessidades da população em situação de rua. Diante dos resultados, como enfrentar o uso abusivo que alivia fome, solidão, sofrimento e depressão? Como cuidar do uso que gera fome, depressão, perdas afetivas, de saúde e autoestima? Uma história cíclica contada por pessoas em situação de extrema vulnerabilidade. Evidenciar a pluralidade simbólica do uso de drogas possibilita reflexões e novas formas de cuidar da população em situação de rua.

Desde la antigüedad las drogas se consumen y su tabú ha promovido la segregación y ha inhibido el enfrentamiento adecuado del uso nocivo. El objetivo fue descubrir valores reales y simbólicos del consumo de drogas por parte de la población sin hogar más allá de la patologización, buscando comprender factores que dificultan la renuncia, incluso con pérdidas y sufrimiento intensos. También tuvo como objetivo comprender sus implicaciones para el cuidado de salud. Esta es una investigación cualitativa fenomenológica, que implica la observación participante de la atención de la población sin hogar por el Consultorio en la Calle, entrevista de la población sin hogar y grupo focal con profesionales de la Red de Atención a la Salud, en el territorio del municipio de Río de Janeiro, Brasil, entre marzo/2017 y julio/2019. Los resultados mostraron que el "consumo de drogas" interactuó con las categorías de investigación de la siguiente manera: las drogas son la principal razón para vivir y permanecer en la calle; que motivan tener una actividad financiera; que hacen que las personas abandonen el tratamiento de salud; que aplacan y provocan depresión, sufrimiento y hambre; que hacen que las personas busquen refugio y religión para "escapar" de las drogas, pero sin el tratamiento adecuado, la esperanza se convierte en recaída y baja autoestima, de la que quieren deshacerse, pero los pocos éxitos socavan la esperanza. Correccionalmente, es motivo de desacuerdos entre profesionales en cuanto al tipo de cuidado y apoyo a las necesidades de la población sin hogar. Ante los resultados, ¿cómo podemos afrontar el uso abusivo que alivia el hambre, la soledad, el sufrimiento y la depresión? ¿Cómo cuidar el consumo que genera hambre, depresión, pérdidas afectivas, de salud y autoestima? Una historia cíclica contada por personas en situación de extrema vulnerabilidad. Resaltar la pluralidad simbólica del uso de drogas posibilita reflexiones y nuevas formas de cuidar de la población sin hogar.

RESUMO

The rapid diagnosis of opportunistic infections (OIs) is critical for improving the health outcomes of people living with HIV/AIDS (PLWHA). This study aimed to describe the feasibility of implementing a package for the rapid diagnosis of tuberculosis, histoplasmosis, and cryptococcosis in patients with advanced HIV/AIDS disease in Porto Alegre, Brazil. The research involved two focus groups with health professionals, four in-depth interviews with healthcare managers, and twelve interviews with PLWHA. The corpus was analyzed using Descending Hierarchical Classification (DHC). The study found that the rapid test diagnosis intervention was generally well-received by patients and health professionals, improving diagnosis and treatment outcomes. However, it also identified several areas for improvement, including the need for expanded psychosocial support and enhanced coordination between health services. The findings have important implications for the development and implementation of policies and programs aimed at enhancing the diagnosis and treatment of OIs among PLWHA with advanced diseases. Further research should explore social determinants of HIV/AIDS mortality to offer valuable insights into improving prevention and treatment strategies. By prioritizing patient-centered care and improving coordination between health services, policymakers and health professionals can improve the health outcomes of PLWHA with advanced disease in Porto Alegre and other similar settings.