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Table 2 Main words, type of contribution, opinion and excerpts per class - classes 1 to 5

From: Public engagement in health technology assessment in Brazil: the case of the public consultation on National Clinical Guidelines for Care in Normal Birth

CLASS 1: 389 ST (35.99%) – Mandatory presence of an obstetrician during childbirth in hospital settings
Main Words TS in the class X2 Contributor and opinion Illustrative excerpt 1 - Absolute score
297.86
Illustrative excerpt 2 - Absolute score
269.35
Illustrative excerpt 3 - Absolute score
254.81
Illustrative excerpt 4 - Absolute score
222.17
Illustrative excerpt 5 - Absolute score
215.72
 complication 42 97.67 family member,
caregiver, health_professional
highly_inadequate
inadequate
fair
“childbirth should be performed by an obstetrician in a hospital setting to ensure the safety of mother and baby. Barriers for implementation are complications arising with no doctor to take responsibility” “an obstetrician should always be present during childbirth. Barriers to implementation are that even uncomplicated births should always take place in a hospital setting with a team that is qualified to deal with any complication that might arise” “obstetric nurses and midwives cannot take responsibility for complications during childbirth and there should always be an obstetrician present responsible for monitoring labor because complications are usually unexpected and require immediate medical attention” “but suggesting that these people are more qualified than doctors or that young mothers who could give birth in a properly equipped setting should be subjected to risks and complications that cannot be dealt with at home by a legally accountable professional is absurd. Who will take legal responsibility for the consequences to mother and child if the necessary measures are not taken in the event of a complication?” “because only doctors have the necessary technical training to deal with possible complications that might arise even in normal or uncomplicated births”
 medical_obstetrician 59 70.24
 no 134 52.55
 mother 31 81.58
 childbirth 107 53.23
 see 24 85.71
 risck 33 73.33
 hospital_setting 21 87.5
 stay 17 94.44
 study 21 80.77
 possible 22 78.57
 even 35 66.04
 pediatrician 13 92.86
 complications 14 87.5
 patient 37 61.67
Class 2: 339 ST (31.36%) – barriers and facilitators for guideline implementation
Main Words TS in the class X2 Contributor and opinion Illustrative excerpt 1 - Absolute score
1103.04
Illustrative excerpt 2 - Absolute score
1082.77
Illustrative excerpt 3 - Absolute score
1050.61
Illustrative excerpt 4 - Absolute score
1043.00
Illustrative excerpt 5 - Absolute score
1027.64
 implementation 264 323.74 Patient
Very good
“barriers for implementation include resistance from the federal government and facilitators are training health professionals who provide care during childbirth especially doctors who largely follow a protocol of cesarean section deliveries and unnecessary interventions” “barriers for implementation are the structure of the health system and the professionals involved as well as the lack of humanized care and facilitators are training and changing medical and hospital protocols” “barriers for implementation include the poor facilities at hospitals, the lack of human resources and materials as well as an overburdened national health system. Facilitators are awareness among health professionals and greater collaboration from management” “barriers for implementation are resistance to change on the part of health professionals lack of financial support for maternity hospitals and the municipal care model and facilitators include increasing professional training particularly obstetric nurses” “barriers for implementation include political disinterest and facilitators are training dissemination and awareness among patients, family members and health professionals about the need for change”
 barrier 193 299.63
 facilitator 160 186.21
 lack 70 95.83
 resistance 28 58.84
 professional 103 43.61
 doctor 66 39.37
 willing 16 31.6
 institution 17 30.34
 policy 13 28.8
 national_health_system 19 28.67
 care 27 26.96
 nurse 25 25.09
 training 14 23.78
 offer 15 22.97
Class 3: 135 ST (12.49%) – Use of evidence-based practices by health professionals
Main Words TS in the class X2 Contributor and opinion Illustrative excerpt 1 - Absolute score
271.88
Illustrative excerpt 2 - Absolute score
243.52
Illustrative excerpt 3 - Absolute score
204.00
Illustrative excerpt 4 - Absolute score
202.82
Illustrative excerpt 5 - Absolute score
181.88
 scientific_evidence 22 54.9 patient
other
patient_groups_organizations_or_associations
Very good
“caring for women during and after childbirth identifying high-risk cases and referring when needed our inclusion is vital to reduce maternal and infant mortality rates in the country as well as unnecessary cesarean deliveries and better informing the population to achieve optimum results” “facilitators for implementation include open discussions for the community about best practices based on current scientific evidence to raise awareness in multidisciplinary teams regarding care during childbirth” “barriers for implementation include the current culture of providing obstetric care that blatantly disregards and disrespects the latest scientific evidence in the field” “I think it’s vital that health professionals are always up to date and trained based on scientific evidence communicating with patients and their families” “there is no established protocol each professional does what they feel they have learned regardless of scientific evidence training human resources based on the best scientific evidence in the field”
 culture 9 43.39
 based 11 43.09
 general 8 42.09
 community 5 35.2
 social 8 32.59
 population 15 32.13
 health 15 29.01
 good 11 28.91
 health_units 4 28.13
 residence 4 28.13
 extreme 4 28.13
 education 4 28.13
 empowerment 4 28.13
 women’s_health 5 27.71   
Class 4: 159 ST (14.71%) – Progression of childbirth and women’s rights
Main Words TS in the class X2 Contributor and opinion Illustrative excerpt 1 - Absolute score
983.99
Illustrative excerpt 2 - Absolute score
725.68
Illustrative excerpt 3 - Absolute score
717.03
Illustrative excerpt 4 - Absolute score
697.51
Illustrative excerpt 5 - Absolute score
604.55
 labor 58 152.28 stakeholder
company
Good
“item 105 page 230 if the active the stage of is not progressing the atmosphere in the delivery room should be considered and the wishes of the mother respected” “we understand that pain relief during childbirth when needed and properly applied can favor labor progression and a healthy vaginal birth contributing to reducing unnecessary and harmful interventions such as cesarean sections” “there is also a need to improve training given reports of professionals administering pain relief in a way that prevents the mother from moving and compromises” “this prevents the argument that women should undergo elective cesarean sections to prevent insufficient care during childbirth if they go into labor at home and on days when healthcare teams may not be at optimal” “we feel that every woman has the right to know and understand the physiological progression of labor as well as the risks and possible benefits of interventions during the process”
 progress 21 124.19
 women 77 118.82
 progression 17 92.77
 relate 13 76.3
 lack 15 63.62
 pain 13 62.78
 want 13 62.78
 right 32 62.2
 pharmacological 10 58.53
 suspect 12 57
 pain_relief_childbirth 20 54.46
 relief 9 52.63
 diagnosis 9 52.63
 respect 20 51.92
Class 5: 59 ST (5.46%) – Mobilization to promote the guidelines
Main Words TS in the class X2 Contributor and opinion Illustrative excerpt 1 - Absolute score
2128.05
Illustrative excerpt 2 - Absolute score
2060.41
Illustrative excerpt 3 - Absolute score
1429.79
Trecho ilustrativo 4 - Escore absoluto 1429.43 Illustrative excerpt 5 - Absolute score
1171.47
 scope 22 389 other
stakeholder
very good
good
“the research group: maternity_women_and_child_health_uff_cnpq feels that implementing these guidelines will help ensure that the labor and delivery process is an instrument for strengthening sexual and reproductive rights within the health policies of the public and private health systems” “csm_cofen feels that implementing these guidelines will help ensure that the labor and delivery process is an instrument for strengthening sexual and reproductive rights within the health policies of the public and private health systems” “we feel that adopting this care model will not require significant structural changes to the Brazilian health system and that similar initiatives exist within the Stork Network” “promote the guidelines as a guiding instrument for childbirth within public and private health services and include them at state and municipal level” “we feel that the process of compiling national guidelines based on broad debate and the involvement of different stakeholders favors a democratic society and more equitable better-quality care”
 understand 26 262.59
 research group_maternity_women_and_child_health_uff_cnpq 9 157.21
 instrument 11 146.94
 initiative 11 146.94
 state 11 146.94
 described 10 142.62
 municipal 11 135.81
 implementation 15 134.69
 large 17 121.71
 chart 7 105.13
 Brazilian_health_system 6 104.51
 require 6 104.51
 protection 6 104.51
 structural 6 104.51
  1. Source: Elaborated by the authors