Ronice Franco de Sá

Bio: Ronice Franco de Sá is an academic researcher from Federal University of Pernambuco. The author has contributed to research in topics: Health promotion & Public policy. The author has an hindex of 7, co-authored 20 publications receiving 163 citations.

Análise da Intersetorialidade no Programa Saúde na Escola

Abstract: This research aimed to identify and analyze the process of cross-sectorialcooperation in the Health at Schools Program in a cityin Pernambuco state. Through semi-structured interviews this qualitative research addressed health care and education professionals in the first 20 schools that joined the PSE since its launch in the city. Data were analyzed using content analysis proposed by Bardin, associated with the computer program NVivo ®, as well as field diary also being used. The survey revealed that the biggest dilemma is to operate a necessarily cross-sectorial policy explained in an environment with actors that have previously established sectorial agendas and without sufficient space for the correct implementation of the policy, which leads to difficulty in reconciling institutional times of the various sectors and the sector involvement and commitment, preventing the sustainability of actions. Changes are being implemented, but what can be seen is the lack of training and continuing education, besides the lack of protocols to guide the development of cross-sectorial actions.

Processo de revisão da Política Nacional de Promoção da Saúde: múltiplos movimentos simultâneos

Abstract: Public policy can be understood as the translation of government proposals and the aspirations of society. Driven by the advances and challenges of social transformation, the need for the coordination of agendas and limited social participation in the drafting of the 2006 National Health Promotion Policy (PNPS), the Ministry of Health and the Thematic Group on Health Promotion/Abrasco proposed the PNPS review. This article describes the steps in that process. It involves policy analysis conducted by literature review and document analysis from the "internal triangulation" standpoint. The revision process adopted multiple approaches on data gathering (Regional Workshops and Health Councils, Intra/Intersectorial Delphi and Electronic Questionnaire). It also used heterogeneous sources of information, different local contexts (five regions of Brazil) and peer validation. The results were systematically ordered with the aid of an analytical matrix organized by objectives, principles, guidelines, themes and actions, resulting in a draft of the new PNPS. Lastly, a national seminar was organized in which the results of the process and a synthesis of the revised text were presented, making it possible to identify process gains and the next steps for the actors involved with the new PNPS.

Planos locais de promoção da saúde: intersetorialidade(s) construída(s) no território

Abstract: The article highlights the importance of considering the specificities of spaces/territories/ locations of individual and collective life in creating health promotion actions. It explores how this approach has conceptually consolidated respect for territoriality and territorial actions as a principle and an operational health promotion strategy. Based on the literature, the article also points to the need to envision the territory occupied as a locus to put intersetorialities into practice, giving a voice to people who live there, seek to and solve their complex problems, to existing and emerging social networks. It also presents a nationally and internationally validated strategy/method (Bamboo Method) for the development of local health promotion plans, which enables the prioritization of actions by listening to the people and to the managers.

A tool for exploring the dynamics of innovative interventions for public health: the critical event card.

Abstract: Public health interventions are increasingly represented as complex systems. Research tools for capturing the dynamic of interventions processes, however, are practically non-existent. This paper describes the development and proof of concept process of an analytical tool, the critical event card (CEC), which supports the representation and analysis of complex interventions’ evolution, based on critical events. Drawing on the actor-network theory (ANT), we developed and field-tested the tool using three innovative health interventions in northeastern Brazil. Interventions were aimed to promote health equity through intersectoral approaches; were engaged in participatory evaluation and linked to professional training programs. The CEC developing involve practitioners and researchers from projects. Proof of concept was based on document analysis, face-to-face interviews and focus groups. Analytical categories from CEC allow identifying and describing critical events as milestones in the evolution of complex interventions. Categories are (1) event description; (2) actants (human and non-human) involved; (3) interactions between actants; (4) mediations performed; (5) actions performed; (6) inscriptions produced; and (7) consequences for interventions. The CEC provides a tool to analyze and represent intersectoral internvetions’ complex and dynamic evolution.

Emergence Model of social and human capital and its application to the Healthy Municipalities project in Northeast Brazil

Abstract: SUMMARYWe developed the Emergence Model and introduced the concept of social and human capital into designing and evaluating the Healthy Cities/Municipalities project to ensure health promotion infrastructure. This model hypothesizes that through the interaction and utilization of the other forms of capital, namely financial, physical and natural, the emergence of collective action takes place in the community or municipal setting. Subsequently, collective action may influence health and quality of life determinants. Once health and quality of life improvements are achieved, the enhancement of the social, human and other capital may be brought about through positive feedback, and successive collective action is thereby facilitated. According to the model, practitioners and policy makers of the Healthy Cities/Municipalities project should primarily strengthen social and human capital.The model is currently applied to designing the Healthy Municipalities project implemented in rural areas of Northeast Brazil, where infrastructure and a supportive environment to facilitate collective action for control over health and health determinant have been considerably frail due to geographical, historical, social and cultural reasons. Various interventions have been conducted in the scope of the project to enhance social and human capital on three levels, namely the state, municipality and community. Through the capacity development of health promoters, obliging volunteers and so on, the project attempts to create the social mechanism that enables people to build healthy public policies through inter- and trans-sectoral collaboration as well as to address and resolve day-to-day issues using their potentialities.

Systematic review of the Exploration, Preparation, Implementation, Sustainment (EPIS) framework

Abstract: Effective implementation of evidence-based practices (EBPs) remains a significant challenge. Numerous existing models and frameworks identify key factors and processes to facilitate implementation. However, there is a need to better understand how individual models and frameworks are applied in research projects, how they can support the implementation process, and how they might advance implementation science. This systematic review examines and describes the research application of a widely used implementation framework, the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. A systematic literature review was performed to identify and evaluate the use of the EPIS framework in implementation efforts. Citation searches in PubMed, Scopus, PsycINFO, ERIC, Web of Science, Social Sciences Index, and Google Scholar databases were undertaken. Data extraction included the objective, language, country, setting, sector, EBP, study design, methodology, level(s) of data collection, unit(s) of analysis, use of EPIS (i.e., purpose), implementation factors and processes, EPIS stages, implementation strategy, implementation outcomes, and overall depth of EPIS use (rated on a 1–5 scale). In total, 762 full-text articles were screened by four reviewers, resulting in inclusion of 67 articles, representing 49 unique research projects. All included projects were conducted in public sector settings. The majority of projects (73%) investigated the implementation of a specific EBP. The majority of projects (90%) examined inner context factors, 57% examined outer context factors, 37% examined innovation factors, and 31% bridging factors (i.e., factors that cross or link the outer system and inner organizational context). On average, projects measured EPIS factors across two of the EPIS phases (M = 2.02), with the most frequent phase being Implementation (73%). On average, the overall depth of EPIS inclusion was moderate (2.8 out of 5). This systematic review enumerated multiple settings and ways the EPIS framework has been applied in implementation research projects, and summarized promising characteristics and strengths of the framework, illustrated with examples. Recommendations for future use include more precise operationalization of factors, increased depth and breadth of application, development of aligned measures, and broadening of user networks. Additional resources supporting the operationalization of EPIS are available.

Promoción de la salud: concepciones, principios y operacionalización

Abstract: A partir del relevamiento bibliografico acerca de los antecedentes, concepciones y practicas de la promocion de salud, identificamos la laguna existente en su dimension metodologica, o sea, escasas experiencias que demuestren coherencia respecto al discurso de la promocion. El objetivo del estudio fue, entonces, describir la posible operacionalizacion de los siete principios que configuran las iniciativas en promocion de salud segun la definicion de la OMS (concepcion holistica, intersectorialidad, empoderamiento, participacion social, equidad, acciones multiestrategicas y sustentabilidad). Con base en datos secundarios y analisis documental, evaluamos cinco acciones de gestion publica en distintos sectores, a partir del banco de datos del Programa Gestion Publica y Ciudadania (EAPSP/FGV), identificando cada uno de los principios, sus limites, posibilidades y relevancia para la promocion. La investigacion posibilito concluir que los principios mencionados son suficientemente universalizables y operacionalizables, permitiendo su identificacion en iniciativas de distintas naturalezas y en las que el sector salud no tuvo papel preponderante. Una posible cuestion para futuros estudios es buscar que papel podria tener el sector salud en las politicas de promocion (segun la concepcion asumida en este estudio) para ejercer mayor impacto en las condiciones de vida cotidianas y los determinantes socioeconomicos y ambientales de la salud, segun la llamada "nueva promocion de salud".

Política Nacional de Promoção da Saúde (PNPS): capítulos de uma caminhada ainda em construção

Abstract: Health is a fundamental human right, according to the global commitment to the Universal Declaration of Human Rights. Health is a public good socially produced by and within social networks and disputes among subjects that seek to place certain interests and needs on the agenda of public policies. Health Promotion, as a set of strategies and forms of producing health, both individual and collective, aiming to meet the social needs of health and to assure better quality of life of the population, emerges intrinsically marked by tensions inherent to the defense of the right to health. The present article intends to detail a certain pathway of Health Promotion at SUS, telling the history of its affirmation as a National Policy and the possibilities that were produced therein to amplify the completeness of healthcare. The authors, totally involved in the preparation, implementation, and revision of the National Health Promotion Policy (PNPS), classified the journey into three chapters: (1) 1998/2004 – Embryo of a PNPS; (2) 2005/2013 – Birth, growth, and development of a PNPS; (3) 2013-2015 – Revision, expansion and dissemination of the PNPS. In addition to the narrative of a history, the cycle analysis of a policy, or balance of advancements, there is an attempt to restore contexts, texts, speeches, and tensions in the PNPS trajectory. The next chapters are still ongoing, and announce paths and possibilities on how to ensure that a Policy is kept alive.

O SUS e a Política Nacional de Promoção da Saúde: perspectiva resultados, avanços e desafios em tempos de crise

Abstract: Resumo O estudo analisa os avancos e desafios da implementacao da Politica Nacional de Promocao da Saude (PNPS) quanto as suas agendas prioritarias e aponta aspectos criticos para sua sustentabilidade em tempos de crises. Estudo de revisao narrativa, abrangendo estudos publicados e documentacao institucional. A PNPS foi aprovada em 2006 e revisada em 2014 e destaca a importância dos condicionantes e determinantes sociais da saude no processo saude-doenca e tem como pressupostos a intersetorialidade e a criacao de redes de corresponsabilidade que buscam a melhoria da qualidade de vida. Foram descritos avancos nas prioridades destacadas na PNPS, em programas e acoes de enfrentamento ao uso do tabaco e seus derivados; alimentacao adequada e saudavel; praticas corporais e atividades fisicas; promocao do desenvolvimento sustentavel; o enfrentamento do uso abusivo de alcool e outras drogas; a promocao da mobilidade segura e sustentavel; e a promocao da cultura da paz e de direitos humanos. Entretanto, os avancos da PNPS apresentados podem estar seriamente ameacados frente a grave crise politica, economica e institucional que abateu o pais, em especial os cortes orcamentarios para os proximos 20 anos, com a Emenda Constitucional 95, desenhando um cenario futuro de muitas incertezas.