35

Research aM nagement Committee as

strategic device for a mental eh alth
implementation research
Comitê eG stor da Pesquisa como dispositivo estratégico para uma
pesquisa de implementação em saúde mental

ABSTRACT The objectives of this study were to identify and analyze the contributions of the
Research Management Committee for access to outcomes related to implementation, in a
research conducted in the mental health field. It is a qualitative study that adopted as a meth -
odological resource the accomplishment of a focus group and the data collection of the minutes
of the meetings held yb the Committee. yB means of the study, it was possible to identify that
the Research Management Committee favored the participation of the interested parties in
several aspects of the research; made possible the evaluation and monitoring of the meaning
and feasibility of the research in the field of study, from the perspective of those who live the
experience of daily work and care; and favored access to some outcomes of implementation
research in a continuous and more meaningful way for those who would eb nefit from it. In this
sense, the researchers and agencies involved in this type of study are suggested to adopt this
tool as a possibility to make the research a more dialogic and potentially transformative process.

K EY WO RDS Methods. Health evaluation. Program evaluation.

RESU M O

PALAV R AS- C H AVE

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36 Treichel CAS, Silva MC, Presotto RF, Onocko-Campos RT

Introduction outcomes; and user-related outcomes. Each of

these consists of a series of items that should
Among the main advances in the study of be scored in the evaluation process. It is em-
public policies, the global growth of implemen- phasized, here, items related to the first con-
tation research1 stands out. As the final stage struct: acceptability; adoption; adequacy; costs;
of a series of events related to translational viability; penetration; and sustainability3,5.
science, this type of research corresponds to The literature recommends that these
the scientific study of the many processes that items should be accessed through mixed
guide the translation of public policies into methods that consider both quantita-
actions or effective changes in the practice tive and qualitative approach elements 6.
of individuals or organizations2. Additionally, there is the need for making
The scope of this particular type of re- access to the items a cross-cutting process,
search considers many aspects of implemen- since, in addition to some items requiring
tation, including the factors affecting it, its evaluation at various stages of implementa-
results, at individual and collective levels, tion, some of them will interact with each
and also the establishment of strategies for other and change over time5. These changes
promoting the sustainability of the proposal need to be noticeable to the leaders of the
and its wide use. Thus, it is summarized process, who must also establish strategies
that the intention of this type of research to provide feedback to both implementing
is to understand how interventions work in agencies, workers and users to encourage
‘real-world’ scenarios1,3. learning and the incorporation of change5.
In this sense, the context in which inter- In this sense, the research delineation
ventions take place plays a central role in ‘Innovative strategies to qualify the mental
implementation research. Since its focus health network in a medium-sized city of
is on bringing to light contextual elements São Paulo: an implementation research’
that drive intervention to success or failure sought to include, as a cross-sectional com-
rather than trying to control context condi- ponent of the study, a Research Management
tions or remove their influence, implemen- Committee (RMC).
tation research seeks to understand and The aforementioned research concerns a
work with the actual conditions of context1. partnership between the city hall of a medium-
It is emphasized that working with the sized municipality in the state of São Paulo
context implies, as well, working with the and a public health and mental health research
actors that shape it. In addition to the mac- laboratory at a public university in the same
ropolitical, economic and legal aspects, it is state. This is an ongoing research, funded by
noteworthy that, especially at local levels, the Department of Science and Technology
the role played by governments, workers of the Ministry of Health, through Public
and users, as well as how they interact, make notice MS-SCTIE-Decit/CNPq nº 12/2018,
them responsible for shaping the institu- whose general objective is to execute and
tional environment, which may function evaluate the impact of device implementation
both as facilitator and as a barrier to the im- of network integration in the qualification of
plementation of policies and interventions4. mental health care in the municipality.
Considering the abovementioned as- It is noteworthy that, currently, one of the
sumptions, Proctor et al. (2011)5 proposed most critical issues in research on mental
a theoretical model to guide the practice of health services is the distance between what is
implementation research in order to score recognized as good community mental health
their outcomes at different levels: outcomes care practices and the reality that is experi-
related to implementation; service-related enced in these services by workers and users2.

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 Research Management Committee as strategic device for a mental health implementation research 37

In this sense, the field of mental health is a participation in planning, implementation

particularly fertile ground for the expansion and in project evaluation.
of implementation research, which today is It is noteworthy that this methodology
one of the main advances in the study of public has already been used in the participatory
policies at the global level2,3. elaboration of indicators for mental health
One of the main highlights of implemen- evaluation10 and has favored important ad-
tation researches is that the outcomes pro- vances in order to give greater depth to the
posed in this type of study are particularly participation of workers in the research
useful in identifying when an intervention process. Another important record of its use
does not achieve the expected success, was in a research that sought to implement
whether this is because it was ineffective the use of instruments capable of qualifying
in the new scenario (intervention failure) the use of psychiatric drugs among users of
or if a good intervention was implemented community mental health services11. In this
incorrectly (failed implementation)5. experience, it was also found a significant
Thus, conducting an Implementation increase in the scope of the participatory
Research in the context of network inte- process, since, in addition to workers, users
gration devices can be useful in helping of services were also included in the process.
to shed light on one of the most important In the research that originated the present
gaps in mental health care in the Country: study, the RMC includes researchers linked
the persistence of a number of deadlocks to the educational institution, local manag-
and challenges for effectiveness of matrix ers and workers, allocated to the mental
support as a network articulation mecha- health services of the municipality, as well
nism, even after a decade of its incorpora- as members of the municipal management
tion in health networks7. directly involved in the coordination of
It is noteworthy that, although shared8 or mental health services.
collaborative9 proposals, similar to matrix Linked to the educational institution are:
support, are consolidated around the world the research coordinator, physician, doctor
as a good practice in mental health care in in public health; and three doctoral students
Brazil, the success of these arrangements still in public health, one nurse, one psychologist
bumps into problems that can be related to and one occupational therapist. To these,
the implementation process. A recent litera- it’s their duty to provide the methodologi-
ture review7 showed aspects such as: lack of cal operationalization of research and the
clear delineations for the practice of matrix- relationship with the development agency.
based strategies; deficiency in the training and The members of the RMC linked to the
qualification of professionals; and absence municipal government, appointed by the
of institutionalized spaces, with systematic municipal health department through an
meetings of professionals to discuss cases and internal selection process, are five psycholo-
joint evaluation of the progress of activities. gists and two nurses, as follows: two coordi-
The adoption of the RMC, in turn, was nators of Specialized Care, two coordinators
based on the understanding that this would of the Psychosocial Care Centers of the mu-
be a useful tool in monitoring the outcomes nicipality (one of the type II and one type
proposed for implementation research. The Alcohol and Drugs – AD), two workers from
assumption was that aspects such as con- the Central Specialties Ambulatory and one
stant assessments of the context and inter- worker from the Child Care Center (which
ested parties engagement needed to access provides mental health care to children and
outcomes would be favored by this tool as adolescents). To these, they have the role
it is a strategy for fostering stakeholder of evaluating and giving feedback on the

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38 Treichel CAS, Silva MC, Presotto RF, Onocko-Campos RT

proposed operation, as well as communi- in this type of study, regarding the adoption
cating expectations, fears and suggestions of the tool in question.
of other workers regarding the services in
which they are allocated.
The operation of the RMC takes place Material and methods
through systematic meetings – monthly or
biweekly – in which representatives of the In this study, it was intended to identify the
services involved in the research process meet contributions of the RMC, both from the objec-
to reflect on the meanings and usefulness tive point of view, from the deliberations and
of research for the field, thus, deliberating adaptations operated by the Committee, and
on how it will be led. All participants can from the subjective point of view, from the
express themselves freely and are encouraged perceptions of its members. Therefore, a quali-
to share their impressions. The meetings last tative study was conducted, which adopted
approximately three hours and usually use the as a methodological resource the realization
following script: update on the progress of the of focus group and survey of data recorded in
research, with possible presentation of results the minutes of the meetings held by the RMC.
obtained since the last meeting; definition By the time of the focus group, four meet-
of meeting guidelines; discussion about the ings had already been held with the presence
topics under discussion, proposing directives of all members of the RMC, as well as three
for the follow-up of the work; and consensus previous meetings held with part of the team
and agreement on upcoming activities. at the project design stage. The characteriza-
In this study, the objectives were to iden- tion of RMC members can be seen in chart 1.
tify and analyze the contributions of the The meetings of the RMC were held monthly
RMC to access to implementation-related or bimonthly, depending on the period, and
outcomes in research conducted in the field were held at both the educational institution
of mental health. Therefore, it is expected to and the services to which the members were
provide information that can guide the deci- linked. All minutes of these meetings (seven)
sion of researchers and agencies involved were taken into account for this study.

Chart 1. Members of the Research Management Committee

Training Time in
Code Sex Age Education Origin Service
time Service
M1 F 39 Nursing 18 years Specialized Care Coordination 15 years
M2 M 32 Psychology 9 years Psychosocial Care Center II 6 years
M3 M 26 Psychology 9 months Outpatient Specialty Clinic 6 months
M4 F 35 Psychology 10 years Child Care Center 4 months
M5 M 66 Psychology 42 years AD Psychosocial Care Center 25 years
M6 M 32 Nursing 2 years Outpatient Specialty Clinic 4 months
M7 F 34 Psychology 10 years Specialized Care Coordination 2 months
M8 F 55 Medicine 33 years Educational institution 21 years
M9 M 26 Nursing 5 years Educational institution 2 years
M10 F 36 Occupational Therapy 16 years Educational institution 5 years
M11 M 36 Psychology 13 years Educational institution 12 years
Source: ‘Innovative strategies to qualify the mental health network in a medium-sized city of São Paulo: an implementation research’.

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 Research Management Committee as strategic device for a mental health implementation research 39

The focus group itself was conducted after of Campinas, following the Brazilian rules
the fifth meeting of the Committee and was and guidelines for research regulation in-
coordinated by a nurse, doctoral student in volving human subjects – Resolution of the
public health, and accompanied by a re- National Health Council nº 466/2012, in
porter/observer, psychologist, also doctoral addition to the provisions of the Declaration
student in public health, who took notes and of Helsinki.
assisted in conducting the group. Both the The analysis materials for this study were
coordinator and the reporter/observer were the transcription of the focus group audio
linked to the RMC through the educational and the registers, in minutes, of the previous
institution, where the session was held. meetings. It was decided to categorize the
The group was held in a room of adequate results according to the contributions of the
size and place, without noise or interference, RMC to explore each of the items that make
ensuring privacy and facilitating debate. All up the construction of outcomes related
members of the Committee were present, to implementation, namely: acceptability;
seated around a table, with no predefined adoption; adequacy; costs; feasibility; pen-
seats, so that everyone could have good eye etration; and sustainability5.
contact, being at equal distance from the For this categorization, the authors were
group coordinator. The session lasted approx- guided by the thematic categorical content
imately one hour and followed the following analysis model12. That is, the analysis was
script: (1) Opening; (2) Clarification on the conducted in stages, the first related to the
dynamics of the debate; (3) Establishment breakdown of the texts into units and cat-
of the setting; (4) Debate; (5) Synthesis of egories, and the second, related to the ana-
previous moments; and (6) Closing. lytical grouping through the organization of
For the debate, the coordinator used messages, from the predefined categories.
questions defined in a script built in con- In the second moment, each item was dis-
junction with the research coordinator. The cussed in order to establish a consensus
purpose of the questions was to bring out among the researchers as to its relevance
each member’s perceptions of their partici- in the proposed category.
pation in the RMC. They were encouraged to
respond individually and also interact with
each other in order to explore and clarify Results and discussions
individual and shared perspectives. The
session lasted approximately one hour and The increase in implementation researches
was recorded with the consent of the par- occurs at the moment when the recognition
ticipants, expressed by signing the Informed of evidences and experiences validated by re-
Consent Form (ICF). search results as qualifiers of construction and
To obtain the ICF, the participants were management of health policies13. Therefore, es-
informed about the study objectives and pecially in the Brazilian context, it is important
the right to give up participating at any to highlight the role of the university in provid-
time, as well as the guarantee of anonym- ing information that can guide decision-making
ity. In this sense, in the transcripts, the in the organization and practice of services14.
names of the participants were replaced The perspective that the interaction
by letters and numbers. It is noteworthy between research agents and health admin-
that the present study was submitted and istrators may contribute to better implement
approved, under opinion nº 3.065.312, by policies, favoring their effectiveness and/
the Ethics Committee of the Faculty of or performance, is recurrent in the litera-
Medical Sciences of the State University ture13-15. However, it should be taken into

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40 Treichel CAS, Silva MC, Presotto RF, Onocko-Campos RT

account that the establishment of active However, it must be taken into account that,
and effective communication between such although a health intervention heavily relies
actors is still an important challenge. on a management that supports the proposal,
In this sense, the RMC is thought as a the success of implementation is not restricted
strategy that can contribute to reducing the to decision-making processes. Although the
distance between researchers and those who guarantee of an ethical-political framework
live the daily work and health care in the is essential to guide the production of health,
services studied. One of the Committee’s what effectively changes the indicators is the
main strengths is to promote a systematic practical engagement of those who develop
meeting between the team linked to the the day-to-day work of services.
research institution and the managers and It should be considered that, even if there
workers of the municipality. In these meet- is a managerial option for change, it will only
ings, the joint evaluation of the activities, be possible through its acceptability and
with presentation and discussion of the adoption among the care professionals, who
results raised so far, favors the appropria- are, in fact, those who execute the proposal.
tion of data immediately and intelligibly to The following statement illustrates a situa-
those who will use them to produce effective tion that warns of the institutionalization of
changes in the work organization. practices as a barrier to overcome and some-
Following, some of the contributions of thing that may undermine acceptability:
the RMC to the development of the research
are presented more specifically, from the There’s always the mapping of issues. But then,
items that make up the outcome assess- when you make a change proposal, the person
ment construct about the implementation kind of resents. ‘Oh, but I’ve been doing it for 30
proposed by Proctor et al. (2011)5, namely: years and you want me to change something that
acceptability; adoption; adequacy; costs; is working super well’. But, if it was working super
feasibility; penetration; and sustainability. well, she wouldn’t be taking it as a problem. So,
we have, still, this barrier of fear of change. You
Acceptability have to try, and if it doesn’t work, there’s no prob-
lem going back. (M1).
Acceptability is the perception among in-
terested parties of implementation – man- However, the action of the RMC as a
agers, workers, and users – that a particular proposal diffuser in the network, since its
treatment, service, practice, or innovation is planning, has been shown as a strategy to
acceptable, palatable, or satisfactory. Poor ac- promote the acceptability of the proposal
ceptability is a major barrier to the success of among the target population. Because they
an intervention. Its variation, however, is con- are understood as representatives to the
stant, and occurs according to the experience intervention team, RMC members act as
of the subjects, throughout the implementa- important field preparers in their home
tion process5. services, and this can significantly contrib-
From the point of view of municipal man- ute to the acceptability of the proposal, as
agement and services, the proposed imple- illustrated in the following statement:
mentation of network articulation devices
showed, from the outset, strong indications I’m already bumping into a lot of addictions [...]
of good acceptability. This aspect can be it’s complicated, right? We have to be open, be-
attributed to the fact that the proposal was cause even training will bring much that is not
based on a joint diagnosis, which effectively being done, or maybe it is not being done in the
involved actors from both spheres. right way. And then, my work with the team is:

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 Research Management Committee as strategic device for a mental health implementation research 41

‘Let’s open ourselves to criticism!’. I’m preparing team to articulate a partnership in the
for this, because I know a lot of things are going intervention.
to come up, and we’re going to have to restruc- Moreover, it is noteworthy that, although
ture ourselves somehow. (M2). in studies conducted in Australia, in the
state of New South Wales 13, most health
It is noteworthy that, while identifying managers had shown interest in contacting
and reporting the existence of points of low researchers to inform policy formulation
acceptability, the RMC points to strategies and management processes in Brazil, this is
that can assist in the promotion of this item, still a very rare move. Thus, it is necessary
such as, for example, by investing in indi- to recognize that the research that origi-
viduals who exert influence in the environ- nated this study is in a favorable context,
ments where they are inserted. but uncommon in the Country.
Regarding services, through the RMC,
[...] I see that there are leaders in ‘xxx’ and the it was possible, furthermore, to identify
people are very into it, there is availability for an articulation for the adoption that has
this change that we are talking about. It may been spreading through the points of the
be a little difficult to join the whole team, but I network, making the adoption process not
think we have leaders who will be able to help in only in the sense of management (workers),
this difficult process of changing addictions and but from a cross-sectional point of view,
behaviors and ways of welcoming, referrals and with greater involvement of professionals
counter-referrals. (M6). for the adoption of the intervention. The
speech below illustrates this phenomenon:
The above speech illustrates very well
how the RMC meets the suggestions of We haven’t begun executing, in fact, the concrete
Young, Mendizabal (2009) 16, who, among thing in the territory. But, at least, in the service
other things, synthesize that it is neces- where I am, we are already discussing these is-
sary to identify the main actors within the sues. We will empower and such, but what about
research context, as well as being able to our side? What are we doing with the referral
synthesize compelling and simple stories, of mental health in primary care? Are we doing
from the research results, to work effec- proper? Then, we sat down the other day and ar-
tively with all interested parties. gued, and said: ‘Let’s get better?’. (M2).

Adoption From the adoption point of view, the

meeting of the RMC to evaluate the activi-
Adoption is defined as the intention, initial de- ties was also an important moment for the
cision or action to employ an evidence-based group to establish a position of engagement
innovation or practice. This item, which is in the proposal, demonstrating, therefore,
measured from the perspective of workers and the tenacity of this item in the course of
managers, can also be termed as ‘absorption’5. the intervention.
It is noteworthy that, as in the case of
acceptability, because the construction of [...] With everyone who is here, we had a meet-
the proposal was based on a joint diagnosis, ing before, talked about whether there was really
the adoption of the proposal was always interest, because sometimes the person comes:
considered as very good. It is noteworthy ‘Because, then, I was indicated. What am I going
that, from the central management point of to do?!’. No, I think everyone here came because
view, there was an initiative of the munici- they really want to participate in the project, they
pal health secretary, to seek the research believe in the project and in this investment of

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42 Treichel CAS, Silva MC, Presotto RF, Onocko-Campos RT

the network. So, I think that’s what we’re going was after the project was submitted to the
to gain, through engagement, really, to take to evaluation of external experts, in order to
the teams. (M1). refine the study methodology. There was
an understanding, by the experts, that, for
logistical reasons, it would be interesting
Adequacy to restrict intervention to primary care ser-
vices that operate within the logic of the
Adequacy refers to the perception of the Family Health Strategy (FHS). However, the
interested parties that an innovation or evi- RMC pointed out that this change would
dence-based practice is appropriate to address be in the opposite direction of what the
a specific issue or problem. In some litera- municipal network workers understood as
tures, this item is treated as a component of ideal and expected. Considering the con-
acceptability, however, Proctor et al. (2011)5 flicts that a change in this direction could
advocate maintaining the distinction, since, cause, especially regarding the decrease
such intervention can be perceived as appro- in acceptability, it was decided to use only
priate, but not acceptable in a given context, the FHS services as places to monitor the
and vice versa. impact of the intervention, but with the
Measuring this item is especially useful inclusion of all primary care services in this
for recognizing barriers to implementation intervention.
with workers. Its measurement makes it This perspective concerns an essential
possible to identify whether there is align- feature of the involvement of the interested
ment of the proposal with what is under- parties in the research process: the depth of
stood by the workers as the institution’s participation. This is characterized by the
mission, or even with their skills, functions degree of intervention of the agents in the
and work expectations5. process of formulation, survey and analysis
One of the situations mediated by the of the procedures involved in the research17.
RMC that illustrates well its performance Deepening the participation of the actors
regarding this item occurred in the planning in the research processes, especially those in
phase of the intervention. Initially, there which they are the beneficiaries themselves,
was the perspective of the articulation of is to help the academy move increasingly
the network only from the Family Health from the prescriptive role to a place of joint
Support Centers (Nasf ), however, the RMC construction and ecology of knowledge.
identified that the municipal network de-
manded a more transversal action, which Costs
contemplated the promotion of articulation
actions with fronts both primary care and Costs relate to the budgetary impact of the
specialized services. The following state- implementation process. Its assessment should
ment illustrates a recap of this episode: take into account both the costs of the inter-
vention itself as well as the budget variance
I think it was a construction, since that first meet- relative to the implementation strategy used,
ing, where you asked: ‘What do you need?’ [...] and the costs of where the intervention will
We reached out and said: ‘I think there, The prob- be implemented. Measuring this item is par-
lem is way trickier than it seems. Maybe some- ticularly useful for conducting comparative
thing more global has to be done, then’. (M2). studies on the cost of different interventions
and implementation strategies5.
Another direction of the research evalu- Although access to this item is achieved
ated based on the perceptions of the RMC especially through very specific technical

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 Research Management Committee as strategic device for a mental health implementation research 43

tools, such as budget and management in guiding the methodological options of

reports, some nuances could be observed the intervention with regard to feasibility.
in the meetings of the RMC. Through the Regarding the training offered, for example,
group, it was possible to identify a culture the size and number of classes offered, as
of centralization of investments in services well as the determination of vacancies per
of greater quantitative appeal, which would service in each class, were aspects marked
be questioned from the intervention. by the RMC’s weightings. In this way, the
aim was to make training feasible, without
Certain segments don’t generate large numbers, there being detrimental missteps to the
so, you lose too much focus on that. It is not the service work process.
largest amount of care, it is not the largest popu-
lation of the municipality, but it is an area that Loyalty
requires a lot of attention and, without invest-
ment, it does not exist. So, we came out of this, The loyalty item is defined as the degree to
and today we are already discussing the issue of which an intervention has been implemented
investment, right? (M2). as prescribed in its original protocol or plan-
ning. It is effectively the extent to which: (1) an
Facing the above speech, it can be said intervention was adhered to between workers
that perhaps the RMC can also contribute and users; (2) there was coverage/availability
to the evaluation of this item, as regards of the intervention on the intended scenario;
the characterization of the health budget, and (3) the quality with which the intervention
as regards the allocation priority. Although protocol was adhered to by workers and users5.
it is a subjective datum, the perception of As this is a process commonly verified in
actors on how the budget pact is given can more advanced stages of the research, no
help in understanding the political game significant evidence of action of the RMC
that marks the implementation of health regarding this item has yet been found.
policies of the municipality. However, the results obtained through the
RMC for the other items give evidence that
Feasibility it will be a potent instrument, especially for
the evaluation of adherence by workers and
This item concerns the extent to which an users of the intervention protocol.
evidence-based innovation or practice can be
successfully performed or used within a given Penetration
scenario or organization. This is an item that
can be worked through both the implementa- It is defined as the integration of a practice
tion process and retrospectively to explain the within a service configuration and its sub-
success or failure of an initiative5. systems, and concerns one of the facets of
It is emphasized that, although there intervention institutionalization. In literature,
is a relationship between feasibility and there are records of the measurement of this
adequacy, the two items are conceptually item, both from the perspective of how many
distinct. This is because an intervention users eligible for the intervention/use of in-
may, for example, be appropriate for the novation went through it/used it and from the
configuration of a service – being compat- perspective of the proportion of workers who
ible with the mission of the service –, but used a given protocol, among those who were
may not be feasible, due to the need for trained to follow it5.
resources or training unavailable. It is noteworthy that, as discussed in the
So far, the RMC has played the key role topic related to adoption, the municipal

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44 Treichel CAS, Silva MC, Presotto RF, Onocko-Campos RT

management initiative, of seeking research end, it will be much bigger. But it is already very
agents for the qualification of health man- big compared to what I had before joining here. I
agement and practice can strongly favor the think this is what has taught me most here: this
penetration of the planned intervention. integration, this possibility of breaking institu-
Therefore, this movement marks a process tionalized things. (M3).
of investment and prioritization of mental
health policy in the municipality. It is worth highlighting that, as illus-
This way, as it is a much-awaited moment, trated in the statements above, the RMC
the beginning of the research activities has also functioned as a thermometer, in the
was configured as a catalyst for neces- sense of reflecting, in the experience of its
sary changes in the context of the service members, the process of transformation that
network. Aspects that illustrate this perspec- is already happening in the daily routine
tive relate to evidence of the penetration of of services. This aspect also contributes to
the intervention that could be observed and the understanding of the impact of actions
reported by group members, from the first developed so far.
articulations, in order to gather data from
the health network. Sustainability

[...] We were already discussing there because It is defined as the extent to which a newly
people requested some data. Someone said, ‘Ah, implemented innovation or practice is main-
but there isn’t!’ So, how can we include this data tained or institutionalized within the ongoing
in the routine in order to systematize? (M2). and stable operations of a service or organiza-
tion. It is noteworthy that sustainability results
Apart from aspects observed in the can be related, conceptually and empirically,
network, it is noteworthy that the RMC is to the penetration item, especially from the
also located as an actor of change and new perspective that greater penetration can con-
ways of organizing services in this network. tribute to long-term sustainability5.
Aspects related to the penetration of the Within the organizational culture, sus-
intervention could be observed, even in tainability occurs through the political and
moments of self-assessment of the members, practical spheres, and is marked by three
regarding their participation in the RMC, stages, which determine institutionaliza-
as illustrated by the following statements: tion: (1) transition (the transition from a
single temporary funding event to perma-
So, I think the value is very much in fostering this nent funding); (2) repetitive reinforcement
discussion on mental health, that didn’t exist. cycle of the importance of the interven-
From zero to one hundred, we didn’t have it, and tion, through its inclusion in procedures
today, we put it on the agenda. (M2). and organizational behaviors; and (3) niche
saturation (the extent to which an interven-
Look, I’m very satisfied because, at first, we will tion is integrated into all subsystems of an
talk about the network, which, even, did not exist. organization)5.
And now, we begin to feel that, with this dialogue In the research in question, the RMC,
between managers and teams, this dialogue be- besides a strategy of articulation and par-
gins to exist and begins to understand this net- ticipation of the interested parties, was also
work. (M5). adopted as a strategy that promotes the sus-
tainability of the intervention. This interface
I think that, minimally, the project has already was thought, especially, in the perspective
reached its goal, right? Minimally because, in the of establishing a routine of reinforcement

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 Research Management Committee as strategic device for a mental health implementation research 45

of the intervention, through the continuing Because the girls at Caps said that they already
education activities that will be promoted by had some projects with the university, but that
the members of the RMC after the conclu- they missed, later, continuity. Because they did,
sion of the research, when it will become they felt used and then... you know? In that case,
a Permanent Education Committee (PEC). I thought: Look, here’s the project, there’s a term
In this sense, it is noteworthy that the of commitment, there’s RMC’. (M4).
inclusion of professionals directly linked to
the assistance of users in the composition of Both in the above speech and in other
the RMC, as well as a potent reorientation moments, it was possible to identify that the
of practices, may be an important sustain- members of the RMC stand as articulators of
ability strategy. Faced with the instability of the sustainability of the proposal, indicating
the Brazilian sanitary political context, his- that it is a tool that can contribute both to
torically associated with administrative dis- the access of this item and to its promotion.
continuity and the dilemmas, practices and
contradictions that arise in public admin- I think this aspect has to be created by us there. I
istration with each change of government think the project, it has a beginning, middle and
and change of leaders18, the perspective that end. And we have to take ownership of it, and we
top professionals are appropriate regarding have to strengthen ourselves to not keep these
good care practices may favor the continuity speeches of abandoned orphans. Because we
of such proposals, even in the face of pos- have to strengthen ourselves to continue, if not,
sible institutional disinterest. it makes no sense, right? (M1).
It was understood, furthermore, that,
after the experiences and training with the Therefore, as stated in the excerpts above,
research team, the workers that made up the it can be said that the RMC has been an
RMC would be able to sustain the group’s important mechanism for assigning meaning
functioning autonomously, replicating the to the workers’ implication so that, at the
training activities with the network workers end of the research, the actions triggered
who were covered by the intervention. It remain permanent, favoring, this way, the
is noteworthy that this perspective has articulated mental health care network.
been discussed with the municipal man-
agement since the planning of the project,
culminating in the signing of a term that, Conclusions
in addition to the release of professionals,
signed the commitment of management, Faced with the demand for implementation
to ensure budget means and availability research, to consider the context and its con-
for Committee maintenance after the field stituent individuals as key elements to under-
research team has left the field. stand the success or failure of interventions, as
This process was important, both to mo- well as the need to use strategies to evaluate
tivate the engagement of RMC members and the outcomes that are able to provide feedback,
to strengthen them in stimulating teams. while encouraging learning and adaptation,
It is emphasized that the performance of the RMC has proved to be a useful device for
interventions requires an important mobi- this field of research.
lization and reorganization of the teams, so Among the main contributions of the
that their discontinuity is often a source of RMC were: the promotion of the partici-
frustration. This situation is illustrated in pation of the interested parties in various
the following statement: aspects of the research, giving greater
depth to the participation of these actors;

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46 Treichel CAS, Silva MC, Presotto RF, Onocko-Campos RT

the possibility, from the perspective of this study the perspective that the evalua-
those who live the daily work and care, to tion process of the RMC activities took place
evaluate and monitor aspects such as the at an early stage of the research, and through
meaning and feasibility of research for the a single focus group. However, the memories
field of study; and the ability to have access retrieval of the group’s performance through
to implementation research outcomes on the minutes of the meetings enriched the
an ongoing and more meaningful basis for results, which were able to illustrate the
those who will benefit from it. contributions that this tool presented in
As for the outcomes of the Implementation the reported research, up to now.
Research worked on in this study, it should be
noted that the RMC constituted, in addition to
a tool of access to some of the items, one of its Collaborators
promotion strategies, especially with regard
to acceptability, adoption, penetration and Treichel CAS (0000-0002-0440-9108)*,
sustainability. In this sense, it is suggested to Silva MC (0000-0002-9574-7494)*, Presotto
the researchers and agencies involved in this RF (0000-0002-4240-6493)* and Onocko-
type of study to adopt this tool as a possibil- Campos RT (0000-0003-0469- 5447)* worked
ity to make the research a more dialogic and on the conception and design of the research,
potentially transformative process. analysis and interpretation of data, and writing
It is worth mentioning as a limitation of of the manuscript. s

*Orcid (Open Researcher

and Contributor ID).

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 Research Management Committee as strategic device for a mental health implementation research 47

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Conflict of interests: non-existent
Financial support: Department of Science and Technology
10. Furtado JP, Onocko-Campos RT, Moreira MIB, et (Ministry of Health)

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