Matriz de indicadores e ferramentas digitais para o monitoramento de saúde bucal na atenção primária: uma pesquisa de implementação

Abstract

MonitoraSB is a digital health innovation developed to strengthen the culture of monitoring and evaluation of oral health in Primary Health Care. It is operationalized through an indicator matrix and two digital tools: a dashboard and a calculator. Implementing innovations in public oral health services requires the involvement of all stakeholders to develop strategies that address local needs and overcome contextual implementation barriers. This study aims to identify facilitators and barriers to the adoption of MonitoraSB in oral health services, to present the collaborative development process, and to describe the implementation strategies and mechanisms of action. It combines quantitative and qualitative approaches grounded in implementation science, drawing on the following methodological frameworks: the Consolidated Framework for Implementation Research (CFIR), participatory implementation research, implementation outcomes, and expert recommendations for implementing change. The intervention involved incorporating MonitoraSB into the work processes of oral health teams in 13 municipalities in Minas Gerais, Brazil. The study presents findings from the initial alignment, diagnostic, and planning phase. The logic model included the following domains: external and internal contexts, innovation, individuals, strategies, mechanisms of action, and expected implementation outcomes. A total of 182 professionals from 86 oral health teams and 28 managers participated. Three remote focus groups with 29 local leaders assessed the acceptability, appropriateness, and feasibility of the implementation to predict the adoption of MonitoraSB. Structured self-administered instruments were used to analyze work processes and characterize oral health services. Content analysis and descriptive quantitative analysis were conducted. Facilitators and barriers were identified and assigned values according to their relative strength of impact. Strategies were developed by the research team to address the identified barriers. These strategies were evaluated by participants via electronic forms and finalized through four online consensus meetings between both parties. Key facilitators included partnerships with local leadership, the innovation’s potential to institutionalize, enhance, and optimize service monitoring and evaluation, its capacity to reveal data recording issues in SISAB, its contribution to improving management and care, and its compatibility with national policies and local practices. The main barriers included the prevailing biomedical model, the perception of evaluation as control or oversight, limited understanding of information systems, and the lack of a monitoring culture for using indicators in local planning. These barriers were organized into four thematic groups:1) developing interrelationships, 2) using evaluative and interactive strategies, 3) adapting and tailoring to the local context, and 4) training, educating, and engaging. Mechanisms of action were identified to achieve outcomes such as adoption, acceptability, appropriateness, feasibility, fidelity, penetration, and sustainability, in addition to impacts on work processes. The implementation was considered acceptable, appropriate, and feasible. The identification of barriers, the participatory approach, and the use of the logic model contributed to the development of contextualized, evidence-based, feasible, and sustainable implementation strategies. Participant engagement, educational activities, and continuous adaptation of strategies proved essential for overcoming barriers and strengthening the culture of monitoring and evaluation in oral health services within PHC.