Evaluation of health technology implementation in the Brazilian public health system: a systematic review

CONTEXT: The implementation of technologies in the Unified Health System (SUS) faces significant challenges in Brazil due to the diversity of contexts, the specificities of the technologies, and resource limitations. This study aimed to identify and critically describe the theoretical models and strategies adopted, as well as the outcomes most frequently reported in SUS implementation studies. METHODS: The primary research question was: “How are health technologies implemented within the SUS context, and what outcomes are evaluated?”. A systematic literature search was conducted, followed by independent reviewers’ screening and selection of articles. Studies published up to April 2024 that described the implementation process within the SUS and reported at least one of the following outcomes were included: acceptability, adoption, adequacy, feasibility, fidelity, penetration, implementation cost, and sustainability. Non-original studies or those published in languages other than Portuguese, English, or Spanish were excluded. RESULTS: A total of 45 studies were included, most of which were conducted in the Southeast region (53.0%) and focused on evaluating the implementation of good health practice processes (42.0%), with an emphasis on the perspectives of health professionals. Consolidated implementation frameworks were employed in 60% of the studies, with the framework from the Australian organization Joanna Briggs Institute (JBI) being the most frequently applied (17 studies), followed by the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework (RE-AIM) used in seven studies, and the Consolidated Framework for Implementation Research (CFIR) in three studies. Among the outcomes of interest, adequacy was the most frequently analyzed (66.7%), followed by penetration (24.4%) and fidelity (20.0%). In contrast, the outcomes of implementation cost (4.4%) and sustainability (4.4%) were the least explored. CONCLUSIONS: This study highlights the variability in the models and methods used to evaluate the implementation of health technologies in the SUS. The absence of standardized approaches underscores the need for consistent guidelines to guide the implementation process. Future studies should prioritize outcomes that capture the impact of implementation strategies within universal health systems, such as the SUS.