Uso da evidência qualitativa para informar decisões no Brasil e na região da América LatinaI

Autores

  • Jorge Barreto Fundação Oswaldo Cruz (Fiocruz), Brasília, Brasil.
  • Simon Lewin  Centre for Informed Health Choices and Division of Health Services

DOI:

https://doi.org/10.52753/bis.2019.v20.34469

Resumo

O interesse em como fortalecer o uso de evidências de pesquisa em processos de tomada de decisão teve um rápido crescimen-to em muitos cenários. A formulação de políticas informadas por evidências tornou-se amplamente institucionalizada no setor da saúde e também vem sendo implementada em muitas outras áre-as de política social. A evidência qualitativa – dados empíricos extraídos de pesquisa que utiliza métodos qualitativos de coleta e análise de dados – pode desempenhar um papel crítico na formu-lação de políticas informadas por evidências porque esse tipo de evidência pode capturar as opiniões e as experiências daqueles afetados por uma intervenção ou opção. A evidência qualitativa também tem o potencial de humanizar os processos de tomada de decisão, e pode ajudar a garantir que as intervenções e as opções selecionadas para abordar problemas de saúde e sociais sejam bem aceitas pelos atores, viáveis de serem implementadas e não piorem iniquidades ou acesso a direitos. Este artigo discute acer-ca da evidência qualitativa e como pode ser usada para informar decisões, especialmente no contexto brasileiro. Apresentamos di-versos estudos de caso que mostram como a evidência qualitativa pode informar o desenvolvimento de políticas para questões-cha-ve dos sistemas de saúde. Então, discutimos sobre o que precisa ser feito no Brasil e na região para fortalecer o uso da evidência qualitativa na tomada de decisão.

 

Downloads

Não há dados estatísticos.

Biografia do Autor

Simon Lewin,  Centre for Informed Health Choices and Division of Health Services

 Centre for Informed Health Choices and Division of Health Services, Norwegian Institute of Public Health, Oslo, Noruega; Health Systems Research Unit, South African Medical Research Cou-ncil, Cidade do Cabo, África do Sul; Cochrane Effective Practice and Organisation of Care (EPOC), Norwegian Institute of Public Health, Oslo, Noruega.

Referências

1. Oliver K, Innvar S, Lorenc T, Woodman J, Thomas J: A systematic review of barriers to and facilitators of the use of evidence by policymakers. BMC Health Serv Res 2014; 14(2).
2. World Health Organization. World report on knowledge for better health. Geneva: WHO; 2004.
3. Lavis JN, Lomas J, Hamid M, Sewankambo NK: Asses-sing country-level efforts to link research to action. Bull World Health Organ. 2006; 84(8):620-628.
4. Pantoja T, Barreto J, Panisset U: Improving public health and health systems through evidence informed policy in the Americas. Bmj 2018; 362(k2469 ).
5. Oxman AD, Lavis JN, Lewin S, Fretheim A. SUPPORT To-ols for evidence-informed health Policymaking (STP) 1: What is evidence-informed policymaking? Health research policy and systems. BioMed Central 2009; 7 (1):S1.
6. Cook C, Nichols S, Webb J, Fuller R, Richards R. Simpli-fying the selection of evidence synthesis methods to inform environmental decisions: a guide for decision makers and scientists. Biological Conservation. 2017; 213(A):135-145.
7. Godfrey D, Brown C: How effective is the research and development ecosystem for England’s schools? London Re-view of Education. 2018; 16(1):136-151.
8. Stewart R. Using evidence in international development. In: Boaz A, Davies H, Fraser A, Nutley S, editors. What Works Now?: Evidence-Informed Policy and Practice. United Kingdom: Policy Press; 2019. paginação do capítulo
9. Glenton C, Lewin S, Gulmezoglu AM: Expanding the evi-dence base for global recommendations on health systems: strengths and challenges of the OptimizeMNH guidance pro-cess. Implement Sci. 2016; 11:98.
10. Glenton C, Lewin S, Norris SL. Using evidence from qua-litative research to develop WHO guidelines. In: WHO Hand-book for Guideline Development. 2nd edn. Edited by World Health Organization. Geneva: WHO; 2016.
11. Lewin S, Glenton C. Are we entering a new era for qua-litative research? Using qualitative evidence to support gui-dance and guideline development by the World Health Orga-nization. Int J Equity Health. 2018; 17(1):126.
12. Downe S, Finlayson K, Lawrie TA, Lewin S, Glenton C, Rosenbaum S, Barreix M, Tunçalp Ö: Qualitative Evidence Synthesis (QES) for guidelines: Paper 1 - Using qualitative evidence synthesis to inform guideline scope and develop qualitative findings statements. Health Research Policy and Systems. 2019; 17(76).
13. Glenton C, Lewin S, Lawrie TA, Barreix M, Downe S, Finlayson K, Tamrat T, Rosenbaum S, Tunçalp Ö: Qualitati-ve Evidence Synthesis (QES) for guidelines: Paper 3 - Using qualitative evidence syntheses to develop implementation considerations and inform implementation processes. Heal-th Research Policy and Systems. 2019; 17(74).
14. Lewin S, Booth A, Glenton C, Munthe-Kaas HM, Rashi-dian A, Wainwright M, Bohren MA, Tunçalp Ö, Colvin CJ, Gar-side R, et al. Applying GRADE-CERQual to qualitative eviden-ce synthesis findings: introduction to the series. Implemen-tation Science. 2018;13( 1):2.
15. Lewin S, Glenton C, Lawrie T, Downe S, Finlayson K, Rosenbaum S, Barriex M, Tuncalp Ö: Qualitative Evidence Synthesis (QES) for Guidelines: Paper 2 - Using qualitative evidence synthesis findings to inform evidence-to-decision frameworks and recommendations. Health Research Policy and Systems. 2019; 17(75).
16. Noyes J, Booth A, Cargo M, Flemming K, Garside R, Han-nes K, Harden A, Harris J, Lewin S, Pantoja T, et al. Cochra-ne Qualitative and Implementation Methods Group guidance series-paper 1: introduction. Journal of clinical epidemiolo-gy. 2018; 97:35-38.
17. Ministério da Saúde (BR). Comissão Nacional de Incor-poração de Tecnologias no Sistema Único de Saúde. Manu-al de elaboração de Diretrizes Clínicas irá preencher lacu-nas sobre as melhores práticas na elaboração de diretrizes em saúde CONITEC. 2016. Available at: http://conitec.gov. br/manual-de-elaboracao-de-diretrizes-clinicas-ira-preen-cher-lacunas-sobre-as-melhores-praticas-na-elaboracao-de-diretrizes-em-saude
18. Ministério da Saúde (BR), Secretaria de Ciência, Tec-nologia e Insumos Estratégicos, Gestão e Incorporação de Tecnologias em Saúde. Diretrizes metodológicas: elabora-ção de diretrizes clínicas. Brasília (DF); 2016. Available at: http://conitec.gov.br/images/Relatorios/2016/DiretrizMe-todologica.pdf.
19. Ministério da Saúde (BR). Comissão Nacional de Incor-poração de Tecnologias no Sistema Único de Saúde. Diretriz Nacional de Assistência ao Parto Normal. Protocolo. Brasi-lia (DF); 2016. Available at: http://conitec.gov.br/images/Consultas/2016/Relatorio_Diretriz-PartoNormal_CP.pdf.
20. Lewin S, Glenton C, Munthe-Kaas H, Carlsen B, Colvin CJ, Gulmezoglu M, Noyes J, Booth A, Garside R, Rashidian
A. Using qualitative evidence in decision making for health and social interventions: an approach to assess confiden-ce in findings from qualitative evidence syntheses (GRADE--CERQual). PLoS Med. 2015; 12(10):e1001895.
21. Glenton C, Lewin S, Norris S. Usando evidências de pesquisa qualitativa para desenvolver diretrizes da OMS. In: WHO Handbook for Guideline Development. 2nd edn. Edi-ted by World Health Organization. Geneva: WHO; 2016. Dis-ponível em: https://www.who.int/publications/guidelines/WHO_Handbook-for-Guideline-Develoment-Chapter-15_Por-tuguese.pdf
22. Lewin S, Glenton C, Munte-Kaas H, Carlsen B, Colvin C, Gülmezoglu M, Noyes J, Booth A, Garside R, Rashidian A: Uso de Evidência Qualitativa em Decisões para Intervenções So-ciais e em Saúde: Uma Abordagem para Avaliar a Confiança em Achados de Sínteses de Evidências Qualitativas (GRA-DE-CERQual). PLOS Medicine 2015; 12(10):e1001985. Dis-ponível em: http://bit.do/e1001983SPt
23. Green J, Thorogood N: Qualitative methods for health research, Fourth edn. London: Sage; 2018.
24. Alonso-Coello P, Schünemann H, Moberg J, Brignardello-Petersen R, Akl E, Davoli M, Treweek S. GRADE Evidence to Decision (EtD) frameworks: 1. A systematic and transparent approach to making well-informed healthcare choices: 1. In-troduction. Bmj 2015.
25. Moberg J, Oxman AD, Rosenbaum S, Schunemann HJ, Guyatt G, Flottorp S, Glenton C, Lewin S, Morelli A, Rada G et al: The GRADE Evidence to Decision (EtD) framework for health system and public health decisions. Health research policy and systems. BioMed Central. 2018; 16(1):45.
26. Lavis JN, Oxman AD, Grimshaw J, Johansen M, Boyko JA, Lewin S, Fretheim A: SUPPORT Tools for evidence-in-formed health Policymaking (STP) 7: Finding systematic re-views. Health research policy and systems. BioMed Cen-tral. 2009; 7 (1):S7.
27. Booth A, Noyes J, Flemming K, Gerhardus A, Wahlster P, Van Der Wilt GJ, Mozygemba K, Refolo P, Sacchini D, Tum-mers M, et al. Guidance on choosing qualitative evidence synthesis methods for use in health technology assess-ments of complex interventions. In. Available from: http://www.integrate-hta.eu/downloads/ 2016.
28. Ring N, Jepson R, Ritchie K. Methods of synthesizing qualitative research studies for health technology assess-ment. International journal of technology assessment in he-alth care. 2011; 27(4):384-390.
29. Magic Evidence Ecosystem Fondation. The Evidence Ecosystem: Personalised e Health Solutions. 2019 [Acces-sed 10 July 2019]. In. Available from: http://magicproject. org/research-and-tools/the-evidence-ecosystem/.
30. Shepherd JP. How to achieve more effective ser-vices: the evidence ecosystem. In. Cardiff. UK: What Works Network. Cardiff University; 2014. Available at:http://www.scie-socialcareonline.org.uk/how-to-achie-ve-more-effective-services-the-evidence-ecosystem/r/a11G0000006z7vXIAQ.
31. Molino CG, Romano-Lieber NS, Ribeiro E, de Melo DO. Non-Communicable Disease Clinical Practice Guidelines in Brazil: A Systematic Assessment of Methodological Quality and Transparency. PLoS One. 2016; 11(11):e0166367.
32. Ministério da Saúde (BR), Secretaria de Atenção à Saúde. Departamento de Atenção Básica Estratégias pa-ra o cuidado da pessoa com doença crônica: hipertensão arterial sistêmica. Brasília (DF);2013. Available at http://bvsms.saude.gov.br/bvs/publicacoes/estrategias_cuida-do_pessoa_doenca_cronica.pdf.
33. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, Schunemann HJ, Group GW: GRADE: an emerging consensus on rating quality of evidence and streng-th of recommendations. BMJ. 2008; 336(7650):924-926.
34. Khatib R, Schwalm JD, Yusuf S, Haynes RB, McKee M, Khan M, Nieuwlaat R: Patient and healthcare provider bar-riers to hypertension awareness, treatment and follow up: a systematic review and meta-analysis of qualitative and quantitative studies. PLoS One. 2014; 9(1):e84238.
35. Marshall IJ, Wolfe CD, McKevitt C: Lay perspectives on hypertension and drug adherence: systematic review of qua-litative research. Bmj. 2012; 345:e3953.
36. World Health Organization. WHO guideline: recommen-dations on digital interventions for health system strengthe-ning. Geneva: WHO; 2019.
37. Maldonado JM, Marques AB, Cruz A: Telemedicine: chal-lenges to dissemination in Brazil. Cad Saude Publica. 2016; 32(2):e00155615.
38. Machado F, Pinto de CarvalhoI M, Mataresi A, Mendon-ça E, CardosoI L, Yogi M, Rigato H, Salazar M. Utilização da telemedicina como estratégia de promoção de saúde em comunidades ribeirinhas da Amazônia: experiência de trabalho interdisciplinar, integrando as diretrizes do SUS. Ciência & Saúde Coletiva. 2010; 15(1):247-254.
39. Odendaal WA, Goudge J, Griffiths F, Tomlinson M, Le-on N, Daniels K: Healthcare workers’ perceptions and ex-perience on using mHealth technologies to deliver primary healthcare services: qualitative evidence synthesis (Proto-col). Cochrane Database of Systematic Reviews. 2015(11): CD011942.
40. Larson HJ, Jarrett C, Eckersberger E, Smith DM, Pa-terson P: Understanding vaccine hesitancy around vaccines and vaccination from a global perspective: a systematic review of published literature, 2007-2012. Vaccine. 2014; 32(19):2150-2159.
41. MacDonald NE, Sage Working Group on Vaccine Hesi-tancy: Vaccine hesitancy: Definition, scope and determi-nants. Vaccine. 2015; 33(34):4161-4164.
42. Poerschke de Quevedo J, Myrrena I, Moro Wieczorkie-vicz A, Invernizzi N: A política de vacinação contra o HPV no Brasil: a comunicação pública oficial e midiática face à emergência de controvérsias. Rev. Tecnologia e Sociedade. 2016; 12(24):1-26.
43. Kops N, Hohenberger G, Bessel M, Correia Horvath J, Domingues C, Kalume Maranhão A, Alves de Souza F, Ben-zaken A, Pereira G, Wendland E. Knowledge about HPV and vaccination among young adult men and women: Results of a national survey. Papillomavirus Res. 2019; 7:123-128.
44. Mendes Lobão W, Duarte FG, Burns JD, de Souza Te-les Santos CA, Chagas de Almeida MC, Reingold A, Duarte Moreira EJ. Low coverage of HPV vaccination in the national immunization programme in Brazil: Parental vaccine refusal or barriers in health-service based vaccine delivery? PLoS One. 2018; 13(11):e0206726.
45. Foss H, Oldervoll A, Fretheim A, Glenton C, Lewin S: Communication around HPV vaccination for adolescents in low- and middle-income countries: a systematic scoping overview of systematic reviews. Systematic Reviews. 2019; 8(190).
46. Oxman AD, Vandvik PO, Lavis JN, Fretheim A, Lewin S: SUPPORT Tools for evidence-informed health Policymaking (STP) 2: Improving how your organisation supports the use of research evidence to inform policymaking. Health rese-arch policy and systems. BioMed Central. 2009; 7 (1):S2.
47. Ongolo-Zogo P, Lavis JN, Tomson G, Sewankambo NK. Assessing the influence of knowledge translation platfor-ms on health system policy processes to achieve the he-alth millennium development goals in Cameroon and Ugan-da: a comparative case study. Health Policy Plan. 2018; 33(4):539-554.
48. Chalmers I, Glasziou P: Avoidable waste in the produc-tion and reporting of research evidence. Lancet. 2009; 374(9683):86-89.
49. Chalmers I, Glasziou P: Systematic reviews and resear-ch waste. Lancet. 2016; 387(10014):122-123.
50. Macleod MR, Michie S, Roberts I, Dirnagl U, Chalmers I, Ioannidis JP, Al-Shahi Salman R, Chan AW, Glasziou P: Bio-medical research: increasing value, reducing waste. Lancet. 2014; 383(9912):101-104.
51. Lewin S, Glenton C: Using evidence synthesis in the development of health systems guidance. In: Langlois EV, Daniels K, Akl E, editors. Evidence synthesis for health po-licy and systems: a methods reader. Geneva: WHO; 2018; 144-148
52. Carroll C: Qualitative evidence synthesis to improve im-plementation of clinical guidelines. Bmj. 2017; 356:j80.
53. Britten N, Garside R, Pope C, Frost J, Cooper C. Asking More of Qualitative Synthesis: A Response to Sally Thorne. Qualitative health research. 2017; 27(9):1370-1376.

Arquivos adicionais

Publicado

2020-12-31

Como Citar

Barreto, J. ., & Lewin, S. . (2020). Uso da evidência qualitativa para informar decisões no Brasil e na região da América LatinaI. BIS. Boletim Do Instituto De Saúde, 20(2), 23–36. https://doi.org/10.52753/bis.2019.v20.34469