Transdisciplinary Collaboration In Brazil's Unified Health System: Improving Evidence-Based Practice
Background: Transdisciplinary collaboration (TC) includes professional and paraprofessional practitioners providing myriad health services. TC is a promising collaboration method, reflecting theory of diffusion in that integration of intellectual and financial resources by professionals and paraprofessionals can improve access and delivery of research-informed services. Brazil’s model of TC is acknowledged worldwide for its inclusion of professionals and community health workers (CHWs) in transdisciplinary teams of primary care providers. This research aimed to test the extent to which TC improves research-informed practice and integration of public health services by CHWs, physicians and nurses in Brazil’s Unified Health System.
Methods: This study used a comprehensive survey developed from interviews with 30 CHWs and 20 physicians and nurses. Cross sectional data were collected from 168 CHWs, 62 nurses and 32 physicians (n = 262). We used structural equation modeling (SEM) to examine whether integration of CHWs’ experiential knowledge with physicians’ and nurses’ professional knowledge would improve research-informed practice. In addition, SEM was used to assess service integration and research-informed practice, all measured and operationalized as latent factors. Predictors included endorsement of team meetings, access and consultations with colleagues, familiarity with community and previous research experience.
Results: The majority of participants were CHWs (168; 64%); 62 (24%) nurses; and 32 (12%) physicians. The majority were females (214; 82%). The highest proportion of participants identified as “pardo” (123; 46%); 82 (31%) as white; and 54 (21%) as Black. The mean age was 34 (SD = 10); ranging from 20 to 70. Previous research shows that low usage of research in practice is relatively uniform across professions. This study also did not detect significant differences between practitioners; however, it suggested that transdisciplinary collaboration (TC) involving different practitioners improved research-informed practice – e.g., adherence to primary care doctors’ visits and medical regimens – and incorporation of different types of research-informed services. Practitioners’ familiarity with community and team meetings positively influenced research-informed practice and integration of primary care and public health services. More experienced practitioners reported more service integration and engagement in research-informed practice. Physicians, compared to CHWs, reported less integration. After accounting for all variables, research-informed practice and service integration were moderately correlated. This analysis also highlighted unique variables that positively influenced research-informed practice: on-the-job experience; familiarity with the community; endorsement of regular transdisciplinary meetings; and access to and consultations from colleagues.
Conclusions: Age and race of practitioners, TC and familiarity with the community are significant variables that should inform design and implementation of training for physicians, nurses and CHWs. Reflecting theory of diffusion, TC can be disseminated as an innovation across health systems and thus have a positive impact on practitioners’ use of research to guide practice. Practices, which facilitate service integration and research-informed services in Brazil, may be used in other countries.