Table 2 Potentialities, barriers and solutions to promote the implementation of the EducaDor programme

Intervention characteristics

Stakeholders' perceptions of the quality and validity of evidence support the belief that the intervention will have desired outcomes and perception of the advantage of implementing the intervention and its adaptability to meet local needs

The interventions can be tested and can reverse the implementation if warranted

(1) Difficulty of implementation in primary healthcare

(2) Costs of the intervention and costs associated with implementation

(1) Implementation of interventions in the secondary level of healthcare

(2) Low-cost interventions, PPSUS resources, and implementation of interventions in partnership with universities^a through research and extension projects

Outer setting

The public health organisation recognizes the high prevalence of chronic pain among SUS users by the number of requests for physiotherapy based-care for chronic pain treatment regulated by the municipality

Also recognizes the evidence about the use of pain science education in chronic pain treatment, but this intervention is not yet available for SUS’s users in the municipality

With the COVID-19 pandemic, the public health organisation of Guarapuava city could identify that most SUS users have smartphones and the internet, which can become these online interventions possible to occur

There is a high network between public health organisations and the University (intervention providers)

(1) Currently, the public health organisation of Guarapuava city is not able to offer pain science education for SUS users in primary healthcare

(2) Although the SUS’s users have access to smartphones and the internet, the stakeholders identified that the SUS’s users change their telephone numbers frequently

(3) There is no pay-for-performance

(1) Implementation of the intervention in partnership with Unicentro, through the Clinical School of Physiotherapy, which is accredited to the secondary level of healthcare

(2) Explain the importance of maintaining the telephone number over time; request home visits from community health agents to update the register

(3) For the maintenance of the intervention after the study, we will request an increase in the number of service quotas to the Clinical School of Physiotherapy from the Health Department of the State of Paraná

Inner setting

The stakeholders agree that the intervention proposed is aligned with the norms, values and perceived risks and needs of the health policies

They shared the perception of the importance of implementing the intervention and an online programme fit with the existing workflows and system in the municipality's health department considering the social distance imposed by the COVID-19 pandemic and the in-person return of other repressed care during the period of the pandemic

Formal communication within the organisation for the referral of SUS’s users from primary healthcare to specialized healthcare (that is, to the secondary level of healthcare) is done through the information and technology system acquired by the municipal health department

(1) How to refer SUS users with chronic pain from primary healthcare to the EducaDor Programme

(2) Health professionals' lack of knowledge about the new intervention in the digital information and communication system

(1) Provide referral access to the intervention in the digital information and communication system

(2) Create a highlight on the intervention icon in the digital information and communication system, and insert video and explanatory text about the EducaDor programme; disseminate the video and text on the smartphones of health professionals in primary healthcare

Characteristics of individuals

The municipal health department organized study groups in various health thematic areas (eg, chronic diseases, elderly health, women's health, child and adolescent health, and others). Each study group is coordinated by a case manager, who organizes meetings with health agents, health professionals and municipal managers to discuss health cases and promote lectures to encourage continuing education. The study groups share about the health process in the respective primary healthcare unit, challenges and achievements. The case manager assists the team's engagement in strategic actions of municipal public health and represents a formal influence in the organisation on the attitudes and beliefs of colleagues about the interventions proposed for implementation. This relationship between public servants and managers can facilitate the relationship between them and SUS users, increasing the degree of commitment to public health

(1) Non-reference of SUS users with chronic pain to EducaDor programme due to lack of knowledge of health professionals about evidence-based practice

(1) Understand how evidence-based practice in primary healthcare is developed, specifically referring to EducaDor programme; explaining about pain science education and our programme to each case manager; participate in the study groups with the focus on chronic pain; disseminate the intervention to each primary healthcare unit leader

Process of implementation

Case managers and their study groups could facilitate the dissemination of adequate information at the various organisational levels of municipal public health and can assist in the process of implementing the EducaDor programme

(1) Lack of knowledge about pain science education on the part of physiotherapists who will be conducting physiotherapy-based care may discourage users from continuing the intervention

(1) Explain pain science education and our programme in-person to each physiotherapy centre accredited to the secondary level of healthcare