Ana Claudia Figueiro1, Sydia Rosana de Araújo Oliveira2, Zulmira Hartz3, Yves Couturier4, Jocelyne Bernier5, Maria do Socorro Machado Freire6, Isabella Samico7, Maria Guadalupe Medina8, Ronice Franco de Sa6, Louise Potvin9. 1. Escola Nacional de Saude Publica/Fiocruz, Rua Leopoldo Bulhões 1480, sala 611, Manguinhos, Rio de Janeiro, Rio de Janeiro, 21041-210, Brazil. anaclaudiafigueiro@gmail.com. 2. Fiocruz-PE, Av. Moraes Rego, s/n, Campus da UFPE-Cidade Universitária, Recife, Pernambuco, 50670-420, Brazil. 3. Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Rua da Junqueira 100, 1349-008, Lisbon, Portugal. 4. Centre de recherche sur le vieillissement, Centre de santé et des services sociaux, Institut universitaire de gériatrie, Sherbrooke 1036, rue Belvédère Sud, Sherbrooke, QC, J1H 4C4, Canada. 5. Chaire de recherche Approches communautaires et inégalités de santé, University of Montreal, 7101 Av du Parc, Montréal, QC, H3N 1X9, Canada. 6. Nucleo de Saude Publica/UFPE, Avenida Professor Moraes Rego s/nº, Hospital das Clínicas, Bloco E, 4º andar, Cidade Universitária, Recife, Pernambuco, 50670-901, Brazil. 7. Diretoria de Ensino e Pesquisa/IMIP, Rua dos Coelhos, 300 Boa Vista, Recife, Pernambuco, 50070-550, Brazil. 8. Instituto de Saúde Coletiva/Universidade Federal da Bahia, Rua Basílio da Gama, s/n-Canela, Salvador, Bahia, 40110-040, Brazil. 9. Medecine sociale et préventive, ESPUM, Université de Montréal, 7101 avenue du Parc, local 3028, Montréal, QC, H3N 1X9, Canada.
Abstract
OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: The CEC provides a tool to analyze and represent intersectoral internvetions' complex and dynamic evolution.
OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: The CEC provides a tool to analyze and represent intersectoral internvetions' complex and dynamic evolution.
Entities:
Keywords:
Actor network theory; Critical event; Health promotion; Innovative interventions