Estudo de viabilidade e implementação da plataforma web gestação segura na atenção primária de saúde: uma pesquisa formativa utilizando a estrutura Consolidated Framework for Implementation Research (CFIR)

Abstract

he maternal mortality ratio is an important and relevant indicator of the quality of life and health of women during their reproductive years. It is estimated that in Brazil in 2020 the maternal mortality ratio (MMR) was 72 per 100,000 live births, according to data from the Mortality Information System (SIM). The World Health Organization (WHO) aims to reduce this indicator to less than 70 deaths per 100,000 live births by 2030. This thesis describes the development and evaluation of the web platform "Safe Pregnancy," conceived as a rule-based expert system designed to automate the classification of gestational risk and the referral of pregnant women between different levels of healthcare. Methods: The study adopts a hybrid type III design, combining clinical and implementation evaluation, along with pre-implementation formative research based on the Consolidated Framework for Implementation Research (CFIR), which guides the analysis of five domains and constructs related to the implementation of health interventions. Objectives: To evaluate the feasibility of implementing the platform in prenatal care pathways in two primary health care units in the municipality of Três Rios, Rio de Janeiro, Brazil, considering dimensions such as usability, acceptability, organizational context, and the identification of barriers and facilitators. Care indicators related to referrals of pregnant women between health units were also analyzed. Results: It was evidenced that, in 2021, the local mortality rate reached 100 deaths per 100,000 live births, accompanied by a high proportion of incorrect and incomplete referrals (66%) in the municipality of Três Rios. Before the intervention, a pre-test applied to health professionals revealed significant insecurity among them regarding gestational risk assessment (40%), prenatal care training (20%), and information recording (40%). Despite this, there was high acceptance of the use of health technologies (92%). Context analysis by CFIR indicated a higher concentration of barriers in the external configuration domain (45%), while individual characteristics had less impact (15%). In the health managers' assessment, the intervention characteristics domain obtained (37.5%) barriers. After the platform's implementation, a substantial improvement was observed in the accuracy of gestational risk classification and in the perception of professional training, reaching 92% adequacy. The platform's usability measurement was considered satisfactory, with a score of 80 points on the System Usability Scale. A comparative study of referrals within the healthcare network between the primary health care unit (PHCU) that used the platform and the PHCU that participated in phase 1 of the study showed 100% correct referrals, contrasting with the PHCU that did not participate in the study, which maintained high rates of incorrect and incomplete referrals (64.7%). Conclusion: the "Safe Pregnancy" web platform demonstrated effectiveness as a clinical decision support tool, contributing to the improvement of prenatal care. Despite persistent structural and contextual barriers, technology has proven capable of improving care processes, reinforcing its potential for expansion in healthcare networks and offering insights for future interventions and research in the field.