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Barreto, J. ., & Lewin, S. . (2020). Uso da evidência qualitativa para informar decisões no Brasil e na região da América LatinaI. Boletim Do Instituto De Saúde - BIS, 20(2), 23–36. https://doi.org/10.52753/bis.2019.v20.34469
Resumen
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.
Citas
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4. Pantoja T, Barreto J, Panisset U: Improving public health and health systems through evidence informed policy in the Americas. Bmj 2018; 362(k2469 ).
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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.
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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).
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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
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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
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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.
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Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0.
Derechos de autor 2019 Jorge Barreto, Simon Lewin
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