title: Implementation of Brazil's "family health strategy": factors associated with community health workers', nurses', and physicians' delivery of drug use services.
abstract: BACKGROUND
  Brazil's "family health strategy" (ESF), provides primary care, mostly to individuals in impoverished communities through teams of physicians, nurses, and community health workers (CHWs). ESF workers are called upon to offer drug use services (e.g., referrals, counseling) as drug use represents an urgent public health crisis. New federal initiatives are being implemented to build capacity in this workforce to deliver drug use services, yet little is known about whether ESF workers are providing drug use services already. Guided by social cognitive theory, this study examines factors associated with ESF workers' provision of drug use services.
  
  
  METHODS
  Cross-sectional surveys were collected from 262 ESF workers (168 CHWs, 62 nurses, and 32 physicians) in Mesquita, Rio de Janeiro State and Santa Luzia, Minas Gerais State.
  
  
  METHODS
  provision of drug-use services.
  
  
  METHODS
  capacity to engage in evidence-based practice (EBP), resource constraints, peer support, knowledge of EBP, and job title. Logistic regression was used to determine relative influence of each predictor upon the outcome.
  
  
  RESULTS
  Thirty-nine percent reported providing drug use services. Younger workers, CHWs, workers with knowledge about EBP and workers that report peer support were more likely to offer drug use services. Workers that reported resource constraints and more capacity to implement EBP were less likely to offer drug use services.
  
  
  CONCLUSIONS
  ESF workers require education in locating, assessing and evaluating the latest research. Mentorship from physicians and peer support through team meetings may enhance workers' delivery of drug use services, across professional disciplines. Educational initiatives aimed at ESF teams should consider these factors as potentially enhancing implementation of drug use services. Building ESF workers' capacity to collaborate across disciplines and to gain access to tools for providing assessment and treatment of drug use issues may improve uptake of new initiatives.
authors.affiliation: HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 722 West 168th Street, Room 307, New York, NY 10032, United States. Electronic address: ay2117@columbia.edu.
authors.forename: Anya Y
authors.initials: AY
authors.lastname: Spector
authors.affiliation: Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY 10027, United States.
authors.forename: Rogério M
authors.initials: RM
authors.lastname: Pinto
authors.affiliation: Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY 10027, United States.
authors.forename: Rahbel
authors.initials: R
authors.lastname: Rahman
authors.affiliation: Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY 10027, United States.
authors.forename: Aline
authors.initials: A
authors.lastname: da Fonseca
mesh_terms: D000328:Adult; D000368:Aged; D001938:Brazil; D003150:Community Health Workers / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000379:methods* / Q000706:statistics & numerical data; D005192:Family Health; D005260:Female; D019538:Health Care Surveys; D006291:Health Policy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009726:Nurses / Q000706:statistics & numerical data; D010821:Physicians, Family / Q000706:statistics & numerical data; D016730:Program Development; D019966:Substance-Related Disorders / Q000628:therapy*; D055815:Young Adult
keywords: Brazil family health strategy; Community drug use services; Transdisciplinary collaboration