Medical and Lay Health Service Providers' Contributions to HIV-Prevention Research in Brazil's Countrywide Family Health Strategy

Background: While the integration of lay health service providers (LHSP) into interprofessional health teams has been recommended by policymakers globally, there is limited research on how medical and LHSP contribute to and participate in health research. This paper helps to narrow the gap in examining the involvement of community health agents (CHAs), nurses, and physicians in Brazil’s Family Health Strategy in HIV prevention research. The paper reports on involvement in specific phases of the research cycle and uses a brand-new reliable and valid instrument to examine participants’ efficacy and perceptions (e.g., ethics) about health and public health research.

Methods: This study employs community-engaged principles and practices; research partners from the U.S. and Brazil designed its aims and methods and disseminated the findings. Cross-sectional data were collected from 169CHAs, 62 nurses, and 31 physicians in two municipalities. Using an integrated framework of social-cognitive theories and theory of planned behavior, a reliable, valid instrument was developed. Based on principal components analysis (PCA) using Oblimin rotation (delta = 0), and assessment of Cronbach α, we developed two scales - perceptions of the research process (eight-item composite; Cronbach α = 0.779) and research self-efficacy (six-item composite with Cronbach α = 0.690). Oblimin rotation showed two factors had a weak negative correlation (r = - 0.081). We summarized descriptive frequencies of demographics, job context, and involvement in research activities. To test differences in research efficacy and perceptions of research process, ANOVA F-tests were performed.

Results: Majority of CHAs (n = 85; 51%) and nurses (n = 27; 44%) identified as pardo (mixed race); most physicians identified as white (n = 18; 58%). CHAs (n = 141; 83%) and nurses (n = 58; 94%) were predominantly female; most physicians were males (n = 16; 52%). Most respondents had been employed by Brazil’s FHS for a short time (1–5 years). Results indicate that CHAs have greater mistrust than nurses and doctors in the research process, and were not involved in substantive aspects of research (specification of aims, data collection, analysis, dissemination). Nurses recruited participants for research studies, and had greater willingness than CHAs to learn about, participate in, and implement research initiatives. Physicians developed survey instruments and disseminated research.

 

Implications: To the authors’ knowledge, this the only study that offers a reliable and valid scale to study attitudes and perceptions of providers on interprofessional health teams to examine their perceptions about research. The scale offered excellent reliability, and we recommend that it be tested in other areas of Brazil and other middle-income countries with larger samples of LHSP. Our study suggests the need for ongoing training in research processes and methods among LHSP to promote greater research participation to help them address the social determinants of health. Our findings also suggest that researchers ought to engage providers in all phases of the research cycle so that research is relevant to community priorities, and instrumental in addressing social justice issues affecting the community’s well-being.