Análise dos determinantes da implementação do MonitoraSB em equipes de saúde bucal da atenção primária à saúde

Abstract

With the aim of investigating the association between the individual characteristics of professionals and the organizational readiness for change (ORC) of Oral Health Teams (eSB) concerning their work processes, an exploratory study was conducted. This study took place during the initial alignment phase of the implementation of MonitoraSB, an innovation for monitoring oral health services in Primary Health Care, across 13 municipalities in Minas Gerais, encompassing 86 eSB. The internal implementation context was assessed at the eSB level, considering both the work processes and ORC. The work processes were evaluated through a structured self assessment questionnaire completed by an eSB professional. All eSB professionals participated by responding to the organizational Readiness for Implementing Change Brazil (ORIC-Br) instrument to assess ORC, as well as questions related to their individual and professional characteristics. ORC was analyzed through the constructs of efficacy and commitment. A latent class analysis grouped the teams according to their work processes, and associations were investigated using the chi-square test. A total of 89.56% (n=163) of the professionals responded to the individual questionnaire and the ORIC-Br, while 87.05% (n=74) of the teams completed the work process self assessment instrument. The teams were classified as having either elementary (49.63%) or consolidated (50.36%) work processes, both of which showed high ORC scores. The majority of professionals were female, aged between 30 and 50 years, most of them with postgraduate degrees, dentists, and permanent staff, with an average work experience of 9.08 years. The median total score for organizational Readiness for Change was 51 points, with an interquartile range (IQR) of 11 (21-55); the median score for efficacy was 27 (IQR: 6; 13-30) and for commitment was 8 (IQR: 5; 8-25). The percentage of eSB with consolidated work processes was higher among eSB with a greater proportion of contracted professionals. Approximately half of the eSB had consolidated work processes, and these teams scored higher in efficacy in the ORC assessment (p<0.05), demonstrating greater confidence in the teams’ ability to implement changes. In the context of the implementation research, technical products such as the Strategy Booklet and the MonitoraSB Implementation Guide were developed. The determinants of implementation interact with each other and with the process, potentially influencing the implementation of MonitoraSB. The ORIC-Br proved to be an effective and valid tool for assessing ORC. Based on these findings, it will be possible to monitor whether ORC is maintained and whether changes in the teams’ work processes will be facilitated by the implementation of MonitoraSB. The technical products developed serve as support tools for the implementation of MonitoraSB. The quality of records and the use of digital resources in care, surveillance, and health management are essential to enable monitoring and evaluation through health indicators. In this context, the Educa e-SUS APS courses promote the continuing education of professionals in digital health.