Saddi Fabiana da Cunha, Harris Matthew J, Coelho Germano Araújo, Pêgo Raquel Abrantes, Parreira Fernanda, Pereira Wellida, Santos Ana Karoline C, Almeida Heloany R, Costa Douglas S
Faculdade de Ciências Sociais, Universidade Federal de Goiás, Goiânia, Brasil.
Centre for Health Services Studies, University of Kent, Canterbury, U.K.
Cad Saude Publica. 2018 Oct 22;34(10):e00202417. doi: 10.1590/0102-311X00202417.
Although it is well known that a successful implementation depends on the front-liners' knowledge and participation, as well as on the organizational capacity of the institutions involved, we still know little about how front-line health workers have been involved in the implementation of the Brazilian National Program for Improving Access and Quality to Primary Care (PMAQ). This paper develops a contingent mixed-method approach to explore the perceptions of front-line health workers - managers, nurses, community health workers, and doctors - regarding the PMAQ (2nd round), and their evaluations concerning health unit organizational capacity. The research is guided by three relevant inter-related concepts from implementation theory: policy knowledge, participation, and organizational capacity. One hundred and twenty-seven health workers from 12 primary health care units in Goiânia, Goiás State, Brazil, answered semi-structured questionnaires, seeking to collect data on reasons for adherence, forms of participation, perceived impact (open-ended questions), and evaluation of organizational capacity (score between 0-10). Content analyses of qualitative data enabled us to categorize the variables "level of perceived impact of PMAQ" and "reasons for adhering to PMAQ". The calculation and aggregation of the means for the scores given for organizational capacity enabled us to classify distinct levels of organizational capacity. We finally integrated both variables (Perceived-Impact and Organizational-Capacity) through cross-tabulation and the narrative. Results show that nurses are the main type of professional participating. The low organizational capacity and little policy knowledge affected workers participation in and their perceptions of the PMAQ.
尽管众所周知，一项成功的实施工作取决于一线人员的知识和参与度，以及相关机构的组织能力，但我们对一线卫生工作者如何参与巴西国家初级保健改善获取与质量计划（PMAQ）的实施仍知之甚少。本文开发了一种权变混合方法，以探究一线卫生工作者——管理人员、护士、社区卫生工作者和医生——对PMAQ（第二轮）的看法，以及他们对卫生单位组织能力的评价。该研究以实施理论中的三个相关联的概念为指导：政策知识、参与度和组织能力。来自巴西戈亚斯州戈亚尼亚市12个初级卫生保健单位的127名卫生工作者回答了半结构化问卷，旨在收集关于依从原因、参与形式、感知影响（开放式问题）以及组织能力评价（0至10分）的数据。对定性数据的内容分析使我们能够对“PMAQ的感知影响水平”和“依从PMAQ的原因”这两个变量进行分类。对组织能力评分的均值计算和汇总使我们能够划分不同的组织能力水平。我们最终通过交叉制表和叙述将这两个变量（感知影响和组织能力）整合起来。结果表明，护士是参与的主要专业类型。组织能力低下和政策知识匮乏影响了工作人员对PMAQ的参与度及其看法。
