Building primary health care research in Eastern São Paulo, Brazil through a Canada-Brazil partnership
Amanda Marcinowska, Graduate student in Family Medicine and Primary Care, McGill University
Primary health care is broad in scope and has a vast number of potential areas to address through research. Limited resources for primary health care research in Brazil require careful consideration in the planning of research to make the most efficient use of existing resources.
Local health professionals and researchers of Santa Marcelina Primary Health Care, a network serving over one million people in Eastern São Paulo, held discussions with McGill researchers and established the need to identify relevant research priorities that could guide primary health care research in this area. Our McGill research team decided to explore this through a research study.
We proposed to work with the local community to establish research needs and priorities, recognizing the importance of first-hand knowledge and experience of local stakeholders. The involvement of these stakeholders early on and throughout the duration of this project allows them to help shape the study and be part of the decision-making regarding what future research will be conducted in Eastern São Paulo that can address the concerns of health professionals and administrators, and the needs of the communities they serve.
Our study involves over one-hundred local stakeholders with a wide range of expertise within primary health care. Engaging our diverse stakeholder group, including physicians, nurses, managers, medical directors, modality stakeholders, technical advisors, leaders, researchers and educators, as partners in research is essential to represent the diverse needs of primary health care and ensure we address the local needs.
Stakeholder meeting at Atenção Primária à Saúde Santa Marcelina in São Paulo, Brazil
Our research methodology includes the Delphi method, a group communication process which is facilitated by a researcher. In this process, participants are asked to complete a series of online surveys anonymously, allowing them to freely express their opinion without pressure to conform, which is important when setting research priorities. In each consecutive survey, participants have an opportunity to see the aggregated responses and opinions of other participants of the study in this matter, thus can reflect on this and make an informed decision on the importance of research areas.
Since the construction of the group response takes place over a series of questionnaire rounds, we believe it is important to engage participants throughout the lengthy iterative process to support them and keep them motivated.
Integrating greater stakeholder engagement into the Delphi method, through in-person meetings and frequent communications, makes our research process more engaging, builds trust, and demonstrates this study is a collaborative effort. The iterative, collaborative approach we established involves stakeholders sharing their knowledge, experiences, values, and judgement throughout the study from the initial planning of the study through informing data collection, and eventual dissemination and implementation of key findings.
Having our research team work directly with stakeholders in the initial stages of this process allowed us to better get to know each other and gain a better understanding of our Brazilian partners’ needs and desires.
In-person meetings and video conference calls provided important opportunities for everyone to communicate with one another, understand each other’s expectations and have them understand our motivations for conducting the study, which contributed to building a trusting relationship.
As a result, our Brazilian partners had an integral role in optimizing the scope and plan of the study.
We strived to foster a co-learning environment, where participants learned about the concept of our study, became familiar with our research approach, and received detailed information about our research method, while our McGill research team learned about their needs and desires, existing local challenges, and the particularities of primary health care in Brazil.
The stakeholders’ input in the initial stages of this participatory process enhanced various aspects of the study. They advised us on the unique features of the organizational structure of the community-based primary health care in Brazil, directed us to relevant reports, and informed us of their specific needs, which enriched our understanding of the local situation and led to defining the scope of the study. They provided feedback and suggestions on the study design, including proposing the main output of the study to be research questions representing the research priorities, instead of research topics, as this approach would provide greater direction for future research. Recommendations have also been made on how participants could be better prepared to complete the surveys (i.e. by providing in-person information sessions).
Following these recommendations, we set up a group meeting with the Delphi panel participants and conducted a research question training workshop, which allowed participants to gain knowledge and skills that can enable them to formulate research questions. These skills are useful in completing one part of our current study but also for planning and conducting their own research studies in the future.
Healthcare workers participating in the research question formulation workshop in São Paulo, Brazil
We modified the study according to the recommendations made by our partners. The information exchanges enabled us to create a research proposal that is relevant to the local context, which is of major importance for setting regional priorities for future research.
Reflecting upon local needs is very important when planning research. Including the voice of local stakeholders in the development of a research agenda is essential to increase its relevance and make the research process more equitable. Furthermore, attending to the needs and issues of the population under study is vital to the study’s success and uptake of findings.
We hope that the collaborative efforts of the research teams and participants throughout this study will lead to the development and implementation of a future research agenda. The mutually agreed upon top research priorities will create the road-map for conducting more in-depth studies that can benefit Brazil’s primary health care and disadvantaged communities.
About the author
Amanda Marcinowska is a graduate student in Family Medicine and Primary Care at McGill University, Department of Family Medicine, Faculty of Medicine. Amanda is a recipient of the Norman Bethune Award for Global Health and the Mary A. Metcalf International Travel Fund, which support research in underserved and resource-limited areas that can make an impact in global health. Prior to graduate studies, Amanda completed a BSc in Biology for Health Sciences and Psychology at the University of Toronto.