Family Health Support Center: reflection on its development through realist evaluation

Silva, Jonatan Willian Sobral Barros da; Silva, Jaslene Carlos da; Oliveira, Sydia Rosana de Araujo

doi:10.1590/0103-1104202012402

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ORIGINAL ARTICLE • Saúde debate 44 (124) • Jan-Mar 2020 • https://doi.org/10.1590/0103-1104202012402 copy

Family Health Support Center: reflection on its development through realist evaluation

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

This study aims to assess the development of a Family Health Support Center (Nasf) team in the city of Recife, Pernambuco, Brazil. This is a qualitative study based on realist evaluation. Identification and analysis of the contexts, mechanisms and results were carried out by an Nasf team. The research was initiated by the formulation of the initial theory of intervention based on documentary research and workshops with program informants. Next, focus groups were formed with professionals from a Family Health Team (FHT) receiving support and users from the area, as well as semi-structured interviews with program managers at district and municipal level. Thirteen contexts, seven mechanisms and four results were identified, which together produced six Context-Mechanism-Outcomes (CMOs). Evaluation of the Nasf team revealed a dual profile that combines technical-pedagogical features with clinical ones relating to care. This duality produces results that, together, generate higher resolution Primary Care (PC). On some occasions, however, an outpatient-centered approach can be seen to emerge in its work with PC and the users in the locality. Identification of elements and the interactions among them is fundamental for ensuring sustainability and replication of this intervention throughout Brazil.

KEYWORDS
Health evaluation; Health care evaluation mechanisms; Primary Health Care

Category	Definition	Operationalization
Context	Real conditions in which programs are introduced for the operation of the mechanisms.	Social, environmental, economic and biological conditions of the territory, users and workers of Nasf and FHT in which the Nasf program is implemented.
Mechanism	Ways in which the components or any set of them bring about changes resulting from the program. The logic of a program intervention, the ways in which the resources offered permeate the change.	Logic of one or the whole set of Nasf interventions/actions with the objective of bringing about behavioral change in the territory covered by the USF and the eSF professionals.
Result	Intended and unintended consequences of programs resulting from the activation of different mechanisms in different contexts.	Consequences and effects found to be caused by the Nasf implantation process in the referenced eSF team and users in the territory.
Context-Mechanism-Outcome (CMO)	Models that indicate the relationship between the different contexts associated with the program mechanisms that bring about changes in behavioral or behavioral regularities as a result of the program.	Chains of the interrelation of the contexts presented, the mechanisms chosen by the implementing agents and the results found for the Nasf program at the USF and in the territory covered.

	Context	Mechanism	Result
CMO1	Training, skills and experience in collective health of Nasf team members(C1)	Strengthening of care, promotion and prevention actions in PC(M2)	Improved qualityof referrals (R1)
	Horizontal management with training and knowledge for managing Nasf (C2)
	Link between eSF and eNasf (C3)	Matrix support for FHT/PC team professionals (M1)
	NASF team referral professional for the FHT(C4)	Integration between health care levels for comprehensive user care (M3)
CMO2	Training, skills and experience in collective health of eNasf professionals (C1)	Matrix support for FHT/PC team professionals (M1)	Clinical expansion in PC (R2)
	Horizontal management with training and knowledge for managing Nasf (C2)
	Physical structure of the Basic Health Unit (BHU)and available inputs (C5)
	The Nasf team professional referred to the FHT (C4)
	The Nasf headquarters at FHTBHU (C6)	Strengthening of care, promotion and prevention actions in PC (M2)
	Relationships and links between eNasf professionals (C7)
CMO3	Link between eSF and eNasf (C3)	Strengthening self-care among users (M4)	Clinical expansion in PC (R2)
	Training, skills and experience in collective health of eNasf professionals (C1)
	Recognition of users by eNasf (C8)
CMO4	Training, skills and experience in collective health of eNasf professionals (C1)	Strengthening cross-sector actions (M5)	Clinical expansion in PC (R2)
	The Nasf team professional referred to the FHT.The Nasf headquarters at FHT (C4)
	The Nasf headquarters at FHT (C6)BHU
	Relationships and links between Nasf team professionals (C7)	Integration of health care levels for comprehensive user care (M3)
	Links between FHT and Nasf team(C3)
CMO5	Physical structure of the UBS and available inputs (C5)	Strengthening of care, promotion and prevention actions in PC(M2)	Organization of the PC work process and territory needs (R3)
	Link between eSF and eNasf (C3)
	Organization of the eSF (C9)
	ENasf headquarters at eSF UBS (C6))	Joint planning of AB actions (M6)
	ENasf reference professional for the eSF (C4)	Joint planning of AB actions (M6)
CMO6	Lack of understanding of the role of Nasf (C10)	Reproduction of the clinical-care aspect in PC (M7)	Increased out patient profile (R4)
	Employment relationship and workload of Nasf team (C11)
	Health care network disconnected from other levels of care (C12)
	Turnover of eSF professionals (C13)

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[1] Collaborators

Silva JWSB (0000-0002-5640-8481)^* * Orcid (Open Researcher and Contributor ID). and Oliveira SRA (0000-0002-6349-2917)^* * Orcid (Open Researcher and Contributor ID). contributed to the conception, planning, analysis and interpretation of data; a critical review of the content; and approval of the final version of the manuscript. Silva JC (0000-0002-1210-9121)^* * Orcid (Open Researcher and Contributor ID). contributed to the critical review of the content and approval of the final version.