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                <text>10.1177/1558689806298224  https://www.semanticscholar.org/paper/Toward-a-Definition-of-Mixed-Methods-Research-Johnson-Onwuegbuzie/d5a3b8645e784997171d03ca6e8269404e956259</text>
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                <text>Mixed Methods Research: A Research Paradigm Whose Time Has Come</text>
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                <text>&lt;p&gt;The purposes of this article are to position mixed methods research (mixed research is a synonym) as the natural complement to traditional qualitative and quantitative research, to present pragmatism as offering an attractive philosophical partner for mixed methods research, and to provide a framework for designing and conducting mixed methods research. In doing this, we briefly review the paradigm “wars” and incompatibility thesis, we show some commonalities between quantitative and qualitative research, we explain the tenets of pragmatism, we explain the fundamental principle of mixed research and how to apply it, we provide specific sets of designs for the two major types of mixed methods research (mixed-model designs and mixed-method designs), and, finally, we explain mixed methods research as following (recursively) an eight-step process. A key feature of mixed methods research is its methodological pluralism or eclecticism, which frequently results in superior research (compared to monomethod research). Mixed methods research will be successful as more investigators study and help advance its concepts and as they regularly practice it.&lt;/p&gt;</text>
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                <text>10.3102/0013189X033007014 https://sites.uci.edu/socscihonors/files/2017/09/Mixed_Methods_Research.pdf</text>
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                  <text>Combinação de métodos QUAN &amp; QUAL com integração de dados e/ou resultados, utilizando-se de mais de um método, metodologia, abordagem, visão de mundo ou paradigma e a integração dos resultados desses diferentes componentes.</text>
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                <text>Mayo NE, Asano M, Pamela Barbic S.  When is a research question not a research question?. Journal of rehabilitation medicine. 2013;45(6): 513-518.</text>
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                <text>&lt;p&gt;Objectives: It has been argued that mixed methods research can be useful in nursing and health science because of the complexity of the phenomena studied. However, the integration of qualitative and quantitative approaches continues to be one of much debate and there is a need for a rigorous framework for designing and interpreting mixed methods research. This paper explores the analytical approaches (i.e. parallel, concurrent or sequential) used in mixed methods studies within healthcare and exemplifies the use of triangulation as a methodological metaphor for drawing inferences from qualitative and quantitative findings originating from such analyses. Design: This review of the literature used systematic principles in searching CINAHL, Medline and PsycINFO for healthcare research studies which employed a mixed methods approach and were published in the English language between January 1999 and September 2009. Results: In total, 168 studies were included in the results. Most studies originated in the United States of America (USA), the United Kingdom (UK) and Canada. The analytic approach most widely used was parallel data analysis. A number of studies used sequential data analysis; far fewer studies employed concurrent data analysis. Very few of these studies clearly articulated the purpose for using a mixed methods design. The use of the methodological metaphor of triangulation on convergent, complementary, and divergent results from mixed methods studies is exemplified and an example of developing theory from such data is provided. Conclusion: A trend for conducting parallel data analysis on quantitative and qualitative data in mixed methods healthcare research has been identified in the studies included in this review. Using triangulation as a methodological metaphor can facilitate the integration of qualitative and quantitative findings, help researchers to clarify their theoretical propositions and the basis of their results. This can offer a better understanding of the links between theory and empirical findings, challenge theoretical assumptions and develop new theory.&lt;/p&gt;</text>
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                <text>10.1016/j.ijnurstu.2010.10.005 https://www.sciencedirect.com/science/article/pii/S0020748910003639?via%3Dihub</text>
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                  <text>Combinação de métodos QUAN &amp; QUAL com integração de dados e/ou resultados, utilizando-se de mais de um método, metodologia, abordagem, visão de mundo ou paradigma e a integração dos resultados desses diferentes componentes.</text>
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                <text>When is a Research Question Not a Research Question?</text>
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                <text>&lt;p&gt;Research is undertaken to answer important questions yet often the question is poorly expressed and lacks information on the population, the exposure or intervention, the comparison, and the outcome. An optimal research question sets out what the investigator wants to know, not what the investigator might do, nor what the results of the study might ultimately contribute. Objective: The purpose of this paper is to estimate the extent to which rehabilitation scientists optimally define their research questions. Methods: A cross-sectional survey of the rehabilitation research articles published during 2008. Two raters independently rated each question according to pre-specified criteria; a third rater adjudicated all discrepant ratings. Results: The proportion of the 258 articles with a question formulated as methods or expected contribution and not as what knowledge was being sought was 65%; 30% of questions required reworking. The designs which most often had poorly formulated research questions were randomized trials, cross-sectional and measurement studies. Conclusion: Formulating the research question is not purely a semantic concern. When the question is poorly formulated, the design, analysis, sample size calculations, and presentation of results may not be optimal. The gap between research and clinical practice could be bridged by a clear, complete, and informative research question.&lt;/p&gt;</text>
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                <text>&lt;p&gt;A new form of literature review has emerged, Mixed Studies Review (MSR). These reviews include qualitative, quantitative and mixed methods studies. In the present paper, we examine MSRs in health sciences, and provide guidance on processes that should be included and reported. However, there are no valid and usable criteria for concomitantly appraising the methodological quality of the qualitative, quantitative and mixed methods studies. Objective: To propose criteria for concomitantly appraising the methodological quality of qualitative, quantitative and mixed methods studies or study components. Design: A three-step critical review was conducted. Data sources: 2322 references were identified in MEDLINE, and their titles and abstracts were screened; 149 potentially relevant references were selected and the full-text papers were examined; 59 MSRs were retained and scrutinized using a deductive–inductive qualitative thematic data analysis. This revealed three types of MSR: convenience, reproducible, and systematic. Review methods: Guided by a proposal, we conducted a qualitative thematic data analysis of the quality appraisal procedures used in the 17 systematic MSRs (SMSRs). Results: Of 17 SMSRs, 12 showed clear quality appraisal procedures with explicit criteria but no SMSR used valid checklists to concomitantly appraise qualitative, quantitative and mixed methods studies. In two SMSRs, criteria were developed following a specific procedure. Checklists usually contained more criteria than needed. In four SMSRs, a reliability assessment was described or mentioned. While criteria for quality appraisal were usually based on descriptors that require specific methodological expertise (e.g., appropriateness), no SMSR described the fit between reviewers’ expertise and appraised studies. Quality appraisal usually resulted in studies being ranked by methodological quality.&lt;/p&gt;</text>
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                <text>&lt;p&gt;Neste ensaio busca-se aprofundar a reflexão sobre o processo de análise na pesquisa qualitativa a partir de autores referenciais e da experiência da própria autora. O texto está organizado em forma de decálogo por meio do qual é tratado o tema processualmente. A hipótese é de que uma análise para ser fidedigna precisa conter os termos estruturantes da investigação qualitativa que são os verbos: compreender e interpretar; e os substantivos: experiência, vivência, senso comum e ação social. A seguir a proposta avança por 10 passos que se iniciam na construção científica do objeto pela sua colocação no âmbito do conhecimento nacional e internacional, na elaboração de instrumentos que tornem concretos os conceitos teóricos, na execução de um trabalho de campo que envolva empaticamente o investigador no uso de vários tipos de técnicas e abordagens, tornando-o um construtor de relações, de observações e de uma narrativa em perspectiva. Por fim, a autora trata da análise propriamente dita, mostrando como o objeto, que já vem pensado em todas as etapas anteriores, deve se tornar um construto de segunda ordem, em que predomine a lógica dos atores em sua diversidade e não apenas as suas falas, dentro de uma narrativa teorizada, contextualizada, concisa e clara.&lt;/p&gt;</text>
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                <text>A doença falciforme é uma das doenças hereditárias mais comuns no mundo. No estado de São Paulo, a incidência de doença falciforme é de um para quatro mil (1:4.000) nascidos vivos. Em situações de ausência ou diminuição da tensão de oxigênio, a HbS altera drasticamente a morfologia do eritrócito (forma de foice ou meia lua), causando vaso-oclusão e, consequentemente, isquemia, dor, necrose, disfunções, danos permanentes aos tecidos e órgãos, além de hemólise crônica. Devido às possíveis manifestações logo no primeiro ano de vida, é de suma importância o diagnóstico precoce na triagem neonatal. Dada sua complexidade, os cuidados globais à pessoa com doença falciforme são um grande desafio para gestores e profissionais de saúde ao envolver procedimentos que exigem uma rede de atenção regionalizada e integrada. Várias leis, decretos e portarias relacionadas à doença falciforme foram instituídos nos âmbitos federal, estadual e municipal. O diagnóstico precoce e medidas de profilaxia de infecções na infância têm melhorado a expectativa de vida dos indivíduos com doença falciforme. No entanto, o período da adolescência é de grande vulnerabilidade, uma vez que os pacientes enfrentam os desafios do desenvolvimento físico e psicológico próprios dessa fase, assim como as mudanças no seu acompanhamento pelos serviços de atenção pediátrica para os de atenção a adultos. Estudos indicam que a transição da atenção pediátrica para a adulta ocorre de forma abrupta, sem um preparo prévio do adolescente e seus familiares, fato que dificulta a manutenção do tratamento. Essa síntese teve como objetivo levantar opções para lidar com essa fase de transição da atenção pediátrica para a adulta de maneira a garantir a continuidade do cuidado aos adolescentes com doença falciforme e reduzir o abandono ou resistência ao tratamento. Opções para enfrentar o problema: Constatou-se que são escassas as revisões sistemáticas sobre doença falciforme, particularmente com relação à população de adolescentes. Por isso, as buscas por opções para políticas de saúde foram realizadas também para estudos em doenças crônicas. Deve-se levar em consideração essas limitações quanto aos resultados e possibilidades de aplicação das opções propostas abaixo para o cuidado aos adolescentes com doença falciforme. Opção 1 ? Utilização de intervenções psicológicas para melhorar a adesão ao tratamento Opção 2 ? Implantação de programa de transição da atenção pediátrica para a de adultos Opção 3 ? Promoção do autocuidado em adolescentes Considerações gerais acerca das opções propostas: a implementação das opções deve levar em consideração que pacientes com doenças genéticas, em geral, têm como referência os serviços especializados em detrimento da atenção primária. Nesse sentido, pode haver dificuldade dos adolescentes com doença falciforme e suas famílias na criação de vínculo com os profissionais da atenção primária. Os profissionais da atenção primária precisam estar adequadamente capacitados para acolher, apoiar e orientar esses adolescentes e familiares. Os serviços de atenção a adultos necessitam de médicos hematologistas capacitados para atender pacientes com doença falciforme. O adequado funcionamento do sistema de referência e contrarreferência entre os serviços com graus variados de complexidade é de fundamental importância para alcançar a atenção integral aos adolescentes com doença falciforme. Em qualquer situação deve-se considerar as barreiras impostas pelo fenômeno do racismo institucional, em que as pessoas podem ser discriminadas e não ter seus direitos garantidos devido à sua cor, etnia ou cultura.&#13;
Assunto(s): Adolescente Anemia falciforme Brasil Política de Saúde</text>
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                <text>Avançando no uso de políticas e práticas de saúde informadas por evidências: a experiência de Piripiri-Piauí</text>
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                <text>Jorge Otávio Maia Barreto e Nathan Mendes Souza</text>
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                <text>Políticas informadas por evidências têm potencial de otimizar sistemas de saúde. O uso de evidências envolve definir problemas, identificar intervenções para enfrentá-los, avaliar a qualidade das evidências globais e locais e traduzi-las para os principais interessados considerando valores sociais e leis. O Brasil encoraja o uso de evidências na política de saúde e Piripiri, município de 61.840 habitantes, da região mais pobre do país, implementou o Núcleo de Evidências em Saúde (NEv) em 2010. São apresentados o desenvolvimento e os resultados preliminares do NEv, sua visão, composição, mandato e atividades. A experiência contou com o envolvimento da Rede para Políticas Informadas por Evidências, Centro Latino-americano e do Caribe de Informação em Ciências da Saúde, governos federal e municipal. A descentralização do financiamento e prestação de cuidados de saúde, a expansão do uso de evidências na gestão e o contexto político local explicariam o desenvolvimento da experiência, cujas atividades incluem a produção e a disseminação de sínteses de evidências e diálogos deliberativos com formadores de opinião, trabalhadores e usuários dos serviços de saúde. A iniciativa está sendo monitorada e avaliada e seus resultados podem se prestar à ampliação das ações no Brasil e exterior.</text>
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eficiente. Cada artigo desta série apresenta uma proposta de ferramenta que pode ser usada por aqueles envolvidos na busca e utilização de evidências de pesquisa para sustentar a elaboração de políticas de saúde baseadas em evidências. A série aborda quatro grandes áreas: 1. Apoio na elaboração de políticas baseadas em evidências; 2. Identificação das necessidades de evidências de pesquisa nas três etapas dos processos de formulação de políticas, ou seja, esclarecimento do problema, estruturação de opções, planejamento da execução; 3. Descoberta e avaliação das revisões sistemáticas e outros tipos de evidência para sustentação dessas etapas; e 4. Passagem da fase de evidências de pesquisa para a fase de decisões. Cada artigo começa com um, dois ou três cenários típicos relacionados ao tema. Estes cenários são projetados para ajudar os leitores a decidir sobre o nível de detalhamento que é relevante para eles na aplicação das ferramentas descritas. A maioria dos artigos desta série é estruturada utilizando um conjunto de perguntas que guia os leitores por meio das ferramentas propostas e mostra como desenvolver atividades para sustentar, de fato e com maior eficiência, a elaboração de políticas baseadas em evidências. Estas atividades incluem, por exemplo, o uso de evidências de pesquisa para esclarecer problemas, a avaliação da aplicabilidade das constatações de uma revisão sistemática sobre os efeitos das opções selecionadas para a resolução de problemas, a organização e o uso de diálogos da política para sustentar a elaboração de políticas baseadas em evidências e o planejamento da avaliação e monitoramento de políticas. Em vários artigos, o conjunto&#13;
de questões apresentadas oferece mais orientações gerais sobre como apoiar a elaboração de políticas baseadas em evidências. Em cada artigo são listados e descritos recursos de informações adicionais. A avaliação dos métodos de apoio à elaboração de&#13;
políticas de saúde baseadas em evidências é um campo em desenvolvimento e opiniões&#13;
construtivas sobre como melhorar a série são bem-vindas. </text>
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              <text>&lt;h3&gt;INTRODUÇÃO&lt;/h3&gt;
O uso do conhecimento científico para melhorar o desempenho dos sistemas de saúde tem sido preconizado entre os países-membros da Organização Mundial da Saúde (OMS)1,2, a qual, em 2003, estabeleceu que suas próprias diretrizes deveriam ser baseadas nas melhores evidências3. No mesmo sentido, a Agenda de Saúde para as Américas (2008-2017) da Organização Pan-Americana da Saúde (OPAS) incluiu a aplicação de evidências científicas no fortalecimento da capacidade institucional e da liderança intersetorial na saúde entre suas linhas de ação4. Apesar de evidências científicas serem consideradas um elemento importante para o desenvolvimento de políticas públicas de saúde, o uso sistemático dos resultados de pesquisas científicas por tomadores de decisão ainda é incipiente5,6. Dentre as barreiras ao uso de evidências, destacam-se a pouca comunicação e colaboração entre pesquisadores e tomadores de decisão, o que representa importante limitação à incorporação do conhecimento científico ao processo de formulação e de implementação das políticas de saúde7. As limitações do diálogo entre a gestão e a academia têm origem nas diferenças das atividades, dos interesses e da forma de inserção dos profissionais nos processos relacionados à formulação, implementação e avaliação de políticas públicas de saúde8. Uma revisão sistemática da literatura indicou grande variação (7,0-40,0%) no uso direto de evidências científicas por parte dos tomadores de decisão6. A superação das dificuldades dos tomadores de decisão em usar o conhecimento científico e do baixo nível de interação entre os diferentes atores requer estratégias que considerem processos de tradução e de disseminação do conhecimento, adaptados a diferentes contextos institucionais e sociais6. Quando a questão é a tradução do conhecimento, uma análise da mídia impressa em países de baixa e média renda (PBMR) demonstrou que os países latino-americanos apresentaram a segunda mais baixa divulgação de evidências de pesquisas em saúde no mundo, ficando atrás apenas de países do Oriente Médio9,10. O mesmo estudo também revelou que os PBMR apresentaram o menor número de artigos a respeito da promoção de diálogo sobre políticas, informados por evidências científicas10. Promover o uso sistemático das evidências científicas nos processos decisórios representa um importante desafio para políticas de saúde no Brasil e no mundo. Nesses cenários, o uso das melhores evidências científicas poderia melhorar a aplicação de recursos ao buscar maior eficiência e efetividade na promoção, prevenção e atenção à saúde11. O presente artigo busca investigar as estratégias para estimular o uso de evidências científicas no processo de tomada de decisão em saúde.</text>
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                <text>Estratégias para estimular o uso de evidências&#13;
científicas na tomada de decisão</text>
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                <text>&lt;p&gt;Um importante desafio para os sistemas de saúde é promover o uso sistemático do conhecimento em políticas públicas que busquem, ao mesmo tempo, melhorar a eficiência e as condições de saúde da população. O objetivo deste artigo foi identificar e discutir estratégias para estimular o uso de evidências científicas no processo de tomada de decisão em políticas de saúde. A busca de evidências científicas foi realizada nos repositórios da Biblioteca Virtual em Saúde, Health Systems Evidence e PubMed. A ferramenta SUPPORT (Supporting Policy Relevant Reviews and Trials) foi usada na construção desse panorama. Sete revisões sistemáticas apontaram quatro principais estratégias para estimular o uso de evidências na tomada de decisão: 1) produzir e disseminar sínteses de evidência com linguagem adaptada a diferentes públicos; 2) estimular o uso do jornalismo e de outras formas de comunicação para ampliar a disseminação do conhecimento científico; 3) utilizar plataforma virtual on-line para disseminação do conhecimento científico; 4) promover a interação entre pesquisadores e tomadores de decisão. Estratégias para estimular o uso de evidências científicas na tomada de decisão em saúde podem ser desenvolvidas de maneira sinérgica, mas é necessário considerar o contexto local e as implicações das estratégias para o sistema de saúde como um todo.&lt;/p&gt;</text>
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