Implementação de ortodontia preventiva e interceptativa no município de Suzano-SP: um estudo de caso
Data
2023-04-20
Autores
Sugaya, Marisa de Freitas 
Orientadores
Fegadolli, Claudia
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: Este é um estudo sobre a implementação de novas práticas em odontologia no
Sistema Único de Saúde (SUS), em particular, sobre a iniciativa de implementação de
ortodontia preventiva e interceptativa (OPI) na atenção primária à saúde (APS) no município
de Suzano-São Paulo (SP). A iniciativa responde ao problema da maloclusão, condição de
elevada prevalência e impacto à saúde.
Objetivo: O estudo propõe analisar a implementação da ortodontia preventiva e interceptativa
no município de Suzano-SP.
Método: Tratou-se de um estudo de caso com métodos mistos apoiado no referencial teórico
metodológico da avaliação realista, que é um tipo de avaliação baseada na teoria do programa.
A principal fonte de dados foi um conjunto de entrevistas com cirurgiões-dentistas, gestores e
pesquisadores envolvidos na implementação. As entrevistas foram submetidas à análise
temática guiada pelas teorias iniciais do programa. A pergunta de pesquisa foi: ‘Como e por
que esta intervenção funcionou neste contexto?’. A produção de hipóteses iniciais (teorias do
programa) ocorreu com base na literatura, na análise documental e na experiência da
pesquisadora como coordenadora da área técnica de saúde bucal durante a implementação do
programa. As teorias iniciais foram testadas e refinadas por meio de triangulação com dados da
entrevista e descrição do caso.
Resultados: Os principais componentes da intervenção foram: compartilhamento de
informações de saúde bucal; espaços coletivos; e disponibilidade de apoio e de recursos para o
trabalho. Estes componentes interagiram com os fatores do contexto institucional e
características dos atores locais para ativar os seguintes mecanismos de mudança: reflexão e
maior compreensão sobre o problema; segurança; participação e responsabilização pela
mudança; e valorização do trabalhador. Três teorias de programa explicam como esses
mecanismos contribuíram sinergicamente para implementação da OPI na atenção primária em
Suzano-SP.
Conclusões: As teorias refinadas se reforçam mutuamente e têm elementos recorrentes, o que
sugere que o conjunto de estratégias de implementação adotadas no caso descrito podem
contribuir sinergicamente para implementação de intervenções semelhantes.
Introduction: This is a study on the implementation of new dentistry practices in the Brazilian Public Health System (SUS). It is especifically about the implementation of preventive and interceptive orthodontics (OPI) in primary health care (APS) in the municipality of Suzano-São Paulo (SP) The aim of this initiative is to face the problem of malocclusion, condition of high prevalence and impact on health. Objective: The study proposes to analyze the implementation of preventive and interceptive orthodontics in the municipality of Suzano-SP. Method: This was a case study with mixed methods supported by the methodology of realistic evaluation, which is a type of evaluation based on program theory. The main source of data was a set of interviews with dentists, managers and researchers involved in the implementation. The interviews underwent the thematic analysis guided by the initial theories of the program. The research question was: 'How and why did this intervention work in this context?' The production of initial hypotheses (program theories) occurred based on the literature, document analysis and experience of the researcher as coordinator of the technical area of oral health during the implementation of the program. Initial theories were tested and refined by triangulation with interview data and description of the case. Results: The main components of the intervention were: sharing of oral health information; collective spaces; and availability of support and resources for work. These components interacted with the factors of the institutional context and characteristics of local actors to activate the following mechanisms of change: reflection and greater understanding of the problem; security; participation and feeling responsible for change; and valorization of the worker. Three program theories explain how these mechanisms contributed synergically to the implementation of preventive and interceptive orthodontics in primary care in Suzano. Conclusions: Refined theories are mutually reinforced and have recurring elements, suggesting that the set of implementation strategies adopted in the case described can contribute synergically to the implementation of similar interventions.
Introduction: This is a study on the implementation of new dentistry practices in the Brazilian Public Health System (SUS). It is especifically about the implementation of preventive and interceptive orthodontics (OPI) in primary health care (APS) in the municipality of Suzano-São Paulo (SP) The aim of this initiative is to face the problem of malocclusion, condition of high prevalence and impact on health. Objective: The study proposes to analyze the implementation of preventive and interceptive orthodontics in the municipality of Suzano-SP. Method: This was a case study with mixed methods supported by the methodology of realistic evaluation, which is a type of evaluation based on program theory. The main source of data was a set of interviews with dentists, managers and researchers involved in the implementation. The interviews underwent the thematic analysis guided by the initial theories of the program. The research question was: 'How and why did this intervention work in this context?' The production of initial hypotheses (program theories) occurred based on the literature, document analysis and experience of the researcher as coordinator of the technical area of oral health during the implementation of the program. Initial theories were tested and refined by triangulation with interview data and description of the case. Results: The main components of the intervention were: sharing of oral health information; collective spaces; and availability of support and resources for work. These components interacted with the factors of the institutional context and characteristics of local actors to activate the following mechanisms of change: reflection and greater understanding of the problem; security; participation and feeling responsible for change; and valorization of the worker. Three program theories explain how these mechanisms contributed synergically to the implementation of preventive and interceptive orthodontics in primary care in Suzano. Conclusions: Refined theories are mutually reinforced and have recurring elements, suggesting that the set of implementation strategies adopted in the case described can contribute synergically to the implementation of similar interventions.
Descrição
Citação
SUGAYA, Marisa de Freitas. Implementação de ortodontia preventiva e interceptativa no município de Suzano-SP: um estudo de caso. 2023. 117 f. Dissertação (Mestrado Profissional em Saúde da Família (ProfSaúde)) - Instituto de Saúde e Sociedade, Universidade Federal de São Paulo, Santos, 2023.