0017/2025 - Metas SMART do ChatGPT para práticas colaborativas na Global Strategy to Accelerate the Elimination of Cervical Cancer
SMART Goals of ChatGPT for collaborative practices in the Global Strategy to Accelerate the Elimination of Cervical Cancer
Autor:
• Antonio Jorge Silva Correa Júnior - Correa Júnior, A.J.S - <juniorjorge_94@hotmail.com>ORCID: https://orcid.org/0000-0003-1665-1521
Coautor(es):
• Mary Elizabeth de Santana - Santana, M.E - <marybete@ufpa.br>ORCID: https://orcid.org/0000-0002-3629-8932
• Jeferson Santos Araújo - Araújo, J.S - <jeferson.araujo@uffs.edu.br>
ORCID: https://orcid.org/0000-0003-3311-8446
• Pedro Emílio Gomes Prates - Prates, P.E.G - <pedropratesmoreno@usp.br>
ORCID: https://orcid.org/0000-0002-4920-7649
• Marília de Fátima Vieira de Oliveira - Oliveira, M.F.V - <mariliafvo@ufpa.br>
ORCID: https://orcid.org/0000-0003-4303-9434
• Camila Maria Silva Paraizo-Horvath - Paraizo-Horvath, C.M.S - <camilaparaizo@usp.br>
ORCID: https://orcid.org/0000-0002-3574-7361
• Jaime Alonso Caravaca-Morera - Caravaca-Morera, J.A - <jacamorera@gmail.com>
ORCID: https://orcid.org/0000-0002-6647-217X
• Helena Megumi Sonobe - Sonobe, H.M - <megumi@eerp.usp.br>
ORCID: https://orcid.org/0000-0003-3722-0835
Resumo:
O câncer de colo uterino tem aumentado significativamente nas Américas, impulsionado por fatores socioeconômicos, vulnerabilidade e ausência de ações que considerem os determinantes sociais em saúde. Identificar práticas colaborativas interprofissionais pode fortalecer o cuidado a essas mulheres. Este estudo analisa as práticas colaborativas na política "Global strategy to accelerate the elimination of cervical cancer as a public health problem" utilizando os critérios SMART gerados pelo ChatGPT. Trata-se de um estudo qualitativo e exploratório, com análise documental. O ChatGPT gerou critérios Específicos, Mensuráveis, Atingíveis, Relevantes e Temporizados (SMART) a partir do documento da OMS, analisados pelo método de análise indutiva de conteúdo em três etapas, conforme Bardin. Foram identificadas cinco categorias principais: metas mensuráveis, monitoramento assistencial, tecnologia como aliada, alinhamento com os Objetivos de Desenvolvimento Sustentável, e práticas colaborativas para expansão educacional. Conclui-se que as metas SMART indicam o cumprimento de ações de rastreio, diagnóstico e tratamento até 2030, conforme a OMS, especialmente em países subdesenvolvidos, em consonância com os Objetivos do Desenvolvimento Sustentável.Palavras-chave:
Neoplasias do Colo do Útero, Política de Saúde, Objetivos Organizacionais, Inovações Tecnológicas, Papilomavírus HumanoAbstract:
Cervical cancer has significantly increased in the Americas, driven by socioeconomic factors, vulnerability, and the lack of actions that consider social determinants of health. Identifying interprofessional collaborative practices can strengthen the care provided to these women. This study analyzes collaborative practices within the "Global strategy to accelerate the elimination of cervical cancer as a public health problem" policy, using SMART criteria generated by ChatGPT. This is a qualitative and exploratory study with document analysis. ChatGPT generated Specific, Measurable, Achievable, Relevant, and Time-bound (SMART) criteria based on the WHO document, which were analyzed using Bardin's three-stage inductive content analysis method. Five main categories were identified: measurable goals, care monitoring, technology as an ally, alignment with the Sustainable Development Goals, and collaborative practices for educational expansion. It is concluded that the SMART goals indicate the achievement of screening, diagnosis, and treatment actions by 2030, as outlined by the WHO, particularly in developing and underdeveloped countries, in line with the Sustainable Development Goals.Keywords:
Cervical Neoplasms, Health Policy, Organizational Objectives, Technological Innovations, Human PapillomavirusConteúdo:
Acessar Revista no ScieloOutros idiomas:
SMART Goals of ChatGPT for collaborative practices in the Global Strategy to Accelerate the Elimination of Cervical Cancer
Resumo (abstract):
Cervical cancer has significantly increased in the Americas, driven by socioeconomic factors, vulnerability, and the lack of actions that consider social determinants of health. Identifying interprofessional collaborative practices can strengthen the care provided to these women. This study analyzes collaborative practices within the "Global strategy to accelerate the elimination of cervical cancer as a public health problem" policy, using SMART criteria generated by ChatGPT. This is a qualitative and exploratory study with document analysis. ChatGPT generated Specific, Measurable, Achievable, Relevant, and Time-bound (SMART) criteria based on the WHO document, which were analyzed using Bardin's three-stage inductive content analysis method. Five main categories were identified: measurable goals, care monitoring, technology as an ally, alignment with the Sustainable Development Goals, and collaborative practices for educational expansion. It is concluded that the SMART goals indicate the achievement of screening, diagnosis, and treatment actions by 2030, as outlined by the WHO, particularly in developing and underdeveloped countries, in line with the Sustainable Development Goals.Palavras-chave (keywords):
Cervical Neoplasms, Health Policy, Organizational Objectives, Technological Innovations, Human PapillomavirusLer versão inglês (english version)
Conteúdo (article):
IntroductionIn the Americas, cervical cancer cases are expected to exceed 51,500 by 2030,
according to projections by the World Health Organization (WHO). In Brazil, estimates for
the three-year period of 2023-2025 indicate around 17,000 new cases, with an estimated
incidence rate of 15.38 cases per 100,000 women 1 .
ChatGPT, an Artificial Intelligence (AI) tool, has been increasingly used by doctors,
nurses and educators to access vast areas of knowledge and generate responses based on
specific patterns 2 . With the constant evolution of technologies, health professionals face the
challenge of integrating these innovations into care models, without losing sight of the
importance of emotional presence and clinical assessment, which are crucial for planning and
coordinating patient care 3 . Thus, although AI can support routine tasks, it does not replace the
core of health professions.
ChatGPT 3.5 uses the Transformer architecture, in contrast to Recurrent Neural
Networks (RNN), formulating responses based on patterns in which it was trained 4 . Although
ChatGPT can contribute significantly to data collection and the generation of methodological
insights, it is not a valid author, but rather a tool, similar to data analysis software 5 . In the
context of health care, command prompts need to be carefully formulated to encourage the
display of interprofessional collaborative practices 3 .
Interprofessional collaborative practices, unlike isolated approaches, promote the value
of the encounter between users and health teams, creating an ecology of specialized
knowledges that contributes to the resolution of health problems. These practices encourage
social participation and comprehensiveness, encompassing clinical and non-clinical aspects,
and permeate areas such as diagnosis, surveillance, communication and health management 6,7 .
For the benefits of interprofessional education and collaborative practices to be
effective, bachelor\'s degree curricula in health have been reformulated to incorporate systemic
and complex practices, moving away from the traditional fragmentation 8 . Evidence suggests
that collaborative practice reduces health complications, mortality, length and number of
hospitalizations, costs, professional turnover, medical errors, in addition to increasing
satisfaction with services, promoting treatment, and improving the diagnosis and treatment of
psychiatric illnesses 7 .
Hence, the research question is: How are collaborative practices employed by
professionals and users in the context of the WHO Global Strategy to Accelerate the
Elimination of Cervical Cancer? Therefore, the objective is to analyze which collaborative
practices are included in the Global Strategy to Accelerate the Elimination of Cervical Cancer
as a Public Health Problem policy, using the insights offered by the SMART criteria generated
by ChatGPT.
Methods
Study type
This is a qualitative exploratory approach, using the analysis of a document available
online. Documentary analysis 9 involves assembling conceptual elements, performing the
“mining” of concepts. The data source comprised the document "Global strategy to accelerate
the elimination of cervical cancer as a public health problem" (Figure 1), consisting of 52
pages and released on November 17, 2020 10 .
The exploratory research aims to gather preliminary information about a given object,
mapping its manifestations 11 . The immaterial nature of some documents stands out, especially
when highlighting the value that certain institutional records acquire when they deal with
social phenomena, incorporating relevant historical and cultural terms. With a qualitative
approach, documentary research is considered primary when the sources have not been
submitted to statistical analysis methods or previous interpretations. The authors also
emphasize the importance of new interpretations maintaining the integrity of the document,
preserving its originality 12 .
Figure 1. Cover of the World Health Organization Global Strategy.
Operating reference
SMART goals are characterized by being broad and derived from Goal-setting theory,
which argues that goal-setting is essential for evaluating performance and meeting
expectations. Thus, goals outline a long-term path, being qualitative in their conception and
comprehensive in their scope, differing from more restricted, hierarchical and quantitative
objectives. The criteria of the SMART acronym are: Specific – defines goals for a specific
context; Measurable – facilitates the measurement of progress over time; Attainable –
assesses how long it will take for the goals to be achieved; Relevant – the goals must be
relevant to be achieved by third parties; and Time-bound – establishes a deadline for
achieving the goals 13 .
The goal-setting theory also classifies goals according to specific concepts: power and
compliance goals (to establish control), economic goals and cultural goals (to satisfy the
needs of the parties involved). Moreover, the goals are hierarchized into consumer goals,
goals related to the good or service, performance goals and secondary goals 14 .
Conceptual framework and reference
According to the document “Framework for Action in Interprofessional Education and
Collaborative Practice”, overcoming fragmented health systems requires a system that values
interprofessional and intersectoral collaboration at all levels, which optimizes and strengthens
the workers’ skills, allowing matrix support and an expanded clinical practice 7 . Achieving the
ideal of Universal Health requires addressing more than just conceptual issues, including the
need for training, reorientation of care flows, leadership in technology, increased community-
based research, and decision-making that considers regional goals 15 .
Data Collection
The excerpts were intentionally selected as described in (Table 1), and the translation
was carried out by ChatGPT. Data collection involved the delimitation of topics, covering
chapters and subchapters of the policy, with the exclusion of chapters 3 and 4, which
presented predominantly numerical data.
Table 1. Excerpts from the Global strategy to accelerate the elimination of cervical cancer as
a public health problem.
Source: prepared by the authors.
The translated verbatims were grouped into a large Microsoft Word file, and reinserted
into ChatGPT 3.5 in parts, this time, to obtain SMART criteria.
Data analysis method and dynamics: ChatGPT 3.5 stage
Following methodological rigor, two data analysis stages were designed (Figure 2).
The first stage involved the analysis of verbatims translated by ChatGPT 3.5 and the tool was
sensitized to have the SMART reference as output standards.
Figure 2. Data analysis flow.
Source: prepared by the authors.
The use of ChatGPT has been highlighted by offering information on healthy
lifestyles, decrease in risk factors for chronic diseases, vaccination and types of vaccines
available for different diseases, in addition to providing simple recommendations on the
screening and early detection of diseases. The tool also demonstrates sensitivity in discussions
about how environmental and vulnerability factors, such as lack of access to health care,
impact communities and individuals. ChatGPT provides information on types of health
programs and services needed by people with certain conditions, including eligibility criteria
and costs associated with these services. The literature indicates that, even for the use of AI,
there are reliability standards, and it is essential to explore the thought structures of this tool
and manage them through regulatory bodies 16,17 .
In the analysis carried out via ChatGPT 3.5, for each selected excerpt of the document,
SMART criteria were requested using the following command: "Recommend SMART criteria
for interprofessional collaborative practices considering this excerpt: [“X”]." The tool
generated criteria, defining deadlines and goals according to its Transformer technology,
which absorbs information available online. To ensure the transparency of this process, a first
set containing the translations and a second set containing the recommended goals were made
available as supplementary material.
Data analysis method and dynamics: human stage
The analysis of the criteria recommended by the tool was carried out using the content
analysis method in three stages: Pre-analysis, Exploration of the material, and Inference and
interpretation 18,19 , without the aid of software and with manual coding performed by two
authors with experience in qualitative research. In the pre-analysis, we sought, through a
skimming reading, to observe the relationships between the excerpts, noting them and
checking them against the objectives of the study, in addition to grouping similar goals. The
SMART recommendations for each excerpt were organized in individual Microsoft Word files
(one file for each letter of the acronym), allowing skimming reading and checking in the first
stage of Bardin 18 .
In the exploration of the material, coding started with the identification of latent and
semantic codes, carried out by the researchers, with the correspondence of recording units,
joining all the documents in a single matrix file. The latent codes originate from the
interpretation of what is said in verbatim, while semantic codes are more "direct", referring to
the word or expression with greater emphasis 20 .
The grouping of codes by each letter of the SMART acronym is depicted in (Figure
3). In the Inference and interpretation phase, the adopted theoretical framework and the
concepts of collaborative practices were used to name and give cohesion to the assertions. A
dataset on Figshare, containing relevant materials for the creation of codes, recording units
and categories, is available 21 .
Figure 3. Codes found in each letter of the SMART acronym.
Source: prepared by the authors.
Results
Subsequently, when proceeding with the human coding of the corpus offered by
ChatGPT, by induction, goal codes were grouped into five thematic categories according to
(Table 2).
Table 2. Determined codes distributed across thematic categories.
Source: prepared by the authors.
Category 1. Measurable: goals and percentages involved in the global strategy to
eliminate cervical cancer
There are goals to be achieved by 2024, 2025, 2028 and 2030; the elimination goal
should be achieved within the framework of the SDGs, 90% of the girls should be vaccinated
against the Human Papilloma Virus (HPV) by 2030 and there should be a reduction in cancer
incidence of 4 per 100,000 woman-years by 2030.
In 2024, conduct a comprehensive review of data systems and start
implementing improvements based on the results. By 2026, ensure that
at least 70% of health services related to cervical cancer are using
digital technologies. (Chapter 7, subchapter 7.1 and 7.2; Chapter 7,
subchapter 7.1 and 7.2).
By 2030, achieve the 90-70-90 goals globally for vaccination, screening
and treatment aligned with the UN Sustainable Development Goals.
Ensure that 90% of eligible girls are vaccinated against HPV, 70% of
women are screened for cervical cancer and 90% of women diagnosed
are treated by 2030. By 2030, ensure that all countries implement and
achieve the 90-70-90 goals. By the year [specify year, e.g. 2030],
achieve 90% coverage of treatment and palliative care. (Chapter 1;
Chapter 2; Chapter 3 – Chapter 5, subchapters 5.1 and 5.5; Chapter 6,
subchapter 6.1; Subchapter 6.6).
Achieve a reduction in cervical cancer incidence to less than 4 per
100,000 woman-years by 2030, 30% by 2030. (Chapter 1; Chapter 5,
subchapters 5.1 and 5.5).
Achieve at least 90% of HPV vaccination coverage for adolescent girls
aged 9–14 years by 2030. (Subchapter 6.2 and 6.3; Chapter 6,
subchapter 6.1).
Ensure that at least 70% of women over 30 years of age receive high-
performance screening by 2030. (Chapter 6, subchapter 6.1).
Ensure the integration of screening and treatment services for viral
hepatitis, cervical cancer and other sexually-transmitted infections into
HIV programs by 2028. (Chapter 2).
By 2025, ensure that at least 75% of the eligible girls are vaccinated
against HPV. By 2025, ensure that at least 80% of healthcare workers
are trained and equipped to provide cervical cancer-related counseling
and treatment. By 2025, transition to HPV testing as the primary
screening method in at least 50% of the countries. (Chapter 1;
Subchapters 6.2 and 6.3; Subchapters 6.4 and 6.5).
Category 2. Monitoring assistance actions and strengthening women\'s access to vaccines,
screening and treatment
Access and monitoring are two pillars of the WHO strategy and should be
implemented by the end of the decade. Vaccination coverage should be monitored annually.
By 2030, establish monitoring systems in all countries to track the
quality and coverage of HPV vaccination. Monitor progress toward
established goals annually and make adjustments as necessary.
(Chapter 6, subchapter 6.1; Subchapter 6.2 and 6.3).
Monitor and report annually on the number of women accessing
screening and treatment services, establishing performance indicators.
(Subchapter 6.4 and 6.5; Subchapter 6.6).
Continue to maintain and monitor incidence and mortality rates after
reaching the elimination threshold, ensuring the sustainability of
efforts. (Chapter 5, subchapter 5.1 and 5.5).
Set specific goals, milestones and indicators. (Chapter 9, subchapters
9.5, 9.6, 9.7 and 9.8; Chapter 9, subchapters 9.5, 9.6, 9.7 and 9.8).
Concerns about the network\'s capacity to promote access, monitoring and even
provide resources for its own line of care should be the subject of reflection.
Monitor the distribution and capacity of the health workforce, seeking a
more equitable distribution. (Chapter 7, subchapter 7.1 and 7.2).
Ensure a continuous and accessible supply of high-performance
screening tests. (Subchapter 6.4 and 6.5).
By 2025, ensure that at least 80% of the target population has been
screened according to the established indicators. (Chapter 9, subchapter
9.5, 9.6, 9.7 and 9.8).
Establish an integrated, patient-centered referral network for diagnosis,
surgical, non-surgical treatment, and palliative care. (Subchapter 6.6).
By 2025, ensure that at least 80% of the target population has been
screened according to established indicators. Assess HPV vaccination
coverage, screening rate of the target population, positivity rate,
treatment rate, coverage rate indicator, incidence and age-specific
mortality of cervical cancer. (Chapter 9, subchapters 9.5, 9.6, 9.7, and
9.8; Chapter 9, subchapters 9.5, 9.6, 9.7, and 9.8).
Category 3. Technology and other innovations as allies in overcoming challenges and
fulfilling the global strategy
Technology and new systems need to adapt to local or even subnational realities, while
being uniformly implemented across multiple care points in the networks.
By the end of 2025, establish systems at local, subnational and national
levels to assess and continuously improve the quality of services.
(Chapter 7, subchapters 7.1 and 7.2).
Invest in research and development of new technologies and
innovations, such as artificial intelligence and telepathology platforms.
(Subchapter 6.2 and 6.3; Subchapter 6.6).
Promote the adoption of new innovations and technologies to improve
the efficiency of vaccine delivery. (Chapter 5, subchapters 5.1 and 5.5;
Subchapter 6.2 and 6.3; Chapter 7, subchapter 7.1 and 7.2).
Measure the efficiency of care models annually and adjust as necessary,
with information systems to track women\'s data at multiple points of
contact (Chapter 7, subchapters 7.1 and 7.2; Chapter 9, subchapters 9.5,
9.6, 9.7 and 9.8).
Another relevant and challenging point for the success of the initiative is the fight
against Fake News and stigmatization caused by cancer diagnosis.
Develop and implement national communication strategies based on
evidence to promote acceptance of HPV vaccination. Develop
awareness campaigns to fight cancer stigmatization. (Subchapter 6.2
and 6.3; Subchapter 6.6).
Fight against misinformation and address hesitancy related to the
vaccine. (Chapter 8, subchapter 8.2 and 8.3).
Category 4. Links to the Sustainable Development Goals and collaborations across
multiple public and private sectors
To implement collaborative practices, it is recognized that multiple sectors would be
involved in the global strategy, and the concept of Universal Coverage is brought to the fore
in contrast to the experience of the Unified Health System (SUS, Sistema Único de Saúde).
By the end of the sixth biennium of the strategy, evaluate the progress
and impact of the global strategy to eliminate cervical cancer. (Chapter
9, subchapters 9.5, 9.6, 9.7 and 9.8).
Promote the integration of cervical cancer with other global initiatives,
such as the Global Strategy for Women\'s, Children\'s and Adolescents\'
Health and the Political Declaration on HIV and AIDS. (Chapter 2).
Recognize the essence of multisectoral collaboration as a way to
mobilize resources, expertise and technology to achieve the health-
related Sustainable Development Goals. (Chapter 8, subchapters 8.2
and 8.3).
Highlight the importance of the global strategy to eliminate cervical
cancer in the context of the sustainable development goals and
universal health coverage. (Chapter 9, subchapters 9.5, 9.6, 9.7 and
9.8).
The private sector is widely mentioned in the strategy as a valuable contributor to
achieving the goals, which involve purchasing more HPV vaccines, reducing costs and
“strengthening” public services.
Develop partnerships with the industry to reduce the prices of products
and technologies related to cervical cancer. Establish interprofessional
teams to collaborate with the private sector to ensure continued supply
and affordable prices for HPV vaccines. Seek partnerships with private
sector providers and pharmaceutical industries to improve vaccine
availability and accessibility. (Chapter 5, subchapters 5.1 and 5.5;
Subchapter 6.2 and 6.3; Chapter 7, subchapters 7.1 and 7.2).
Foster partnerships between the public, private and NGO sectors.
(Subchapters 6.4 and 6.5; Subchapter 6.6).
By the end of 2025, ensure that at least 75% of the prevention and
treatment strategies are supported by multisectoral collaborations.
(Chapter 8, subchapters 8.2 and 8.3).
Create multisectoral platforms to increase HPV vaccination coverage,
with special focus on vulnerable populations. (Subchapter 6.2 and 6.3).
Focus on return of investment, ensuring significant economic and social
benefits. (Chapter 5, subchapters 5.1 and 5.5).
Category 5. Collaborative practices and potential for sociocultural congruent expansion
of the educational aspects of the global strategy
The collaborative practices are transversal to the planning of women\'s care network,
necessarily involving the strengthening of Primary Care.
Establish interprofessional teams in all countries to implement and
monitor actions related to prevention, screening, treatment, awareness
campaigns, HPV vaccination and education about cervical cancer.
Comprising physicians, nurses, health educators. (Chapter 1; Chapter
2; Chapter 5, subchapter 5.1 and 5.5; Chapter 6, subchapter 6.1).
Implement single-visit screening and treatment approaches whenever
possible and appropriate. (Subchapter 6.4 and 6.5).
Implement a primary health care approach and education and training
programs for the health workforce that integrate all aspects of cervical
cancer. (Subchapter 6.6; Chapter 7, subchapter 7.1 and 7.2).
Create culturally-sensitive awareness campaigns in low-income
communities, encouraging HPV vaccination and screening in low-
income and hard-to-reach areas. (Chapter 1).
Social, cultural and local aspects of the policy emerge as the leveraging factor for the
policy, and civil society needs to exercise social control over its goals.
Develop and implement culturally adapted awareness campaigns,
highlighting the importance of cervical cancer prevention and
treatment. (Chapter 2).
Ensure financial protection, especially for the most vulnerable
populations. (Chapter 7, subchapters 7.1 and 7.2).
Develop and implement national guidelines for the management of
cervical cancer adapted to the local context. (Subchapter 6.6).
Establish partnerships with civil society organizations and groups to
raise awareness and promote acceptance of vaccination and screening,
sensitizing communities with information and education campaigns.
(Chapter 6, subchapter 6.1; Subchapter 6.2 and 6.3).
Empower local communities, especially women, to support the
development and implementation. (Subchapter 6.4 and 6.5).
Professional training through workshops and seminars is addressed according to
ChatGPT recommendations, in addition to strengthening governance and local and
multisectoral coalitions.
Expand training for the health workforce, training health professionals
on updated guidelines and protocols for screening and treatment.
(Chapter 5, subchapter 5.1 and 5.5; Subchapter 6.2 and 6.3).
Implement ongoing training for health teams on the latest guidelines for
cervical cancer prevention, detection and treatment. (Chapter 1;
Chapter 7, subchapter 7.1 and 7.2).
Conduct workshops and seminars to facilitate the creation and
strengthening of multisectoral partnerships. (Chapter 8, subchapters 8.2
and 8.3).
Use digital platforms and influential leaders to promote effective
communication. (Chapter 8, subchapters 8.2 and 8.3).
Strengthen governance and accountability and establish partnerships
with local, national and international organizations. (Chapter 1;
Chapter 9, subchapters 9.5, 9.6, 9.7 and 9.8).
Prioritize actions that seek gender equality and reduction of inequality,
considering their direct association with prevalence and treatment.
(Chapter 2).
Engage with communities and groups at risk, such as women with HIV,
to ensure that prevention and treatment approaches are adapted.
(Chapter 6, subchapter 6.1)
Provide options such as self-collection to make screening services more
accessible and acceptable to women. (Subchapter 6.2 and 6.3).
Discussion
According to a global epidemiological analysis 22 , invasive cervical cancer is the first
neoplasm with the potential to be eradicated in the coming decades, provided that social
inequalities and sociocultural barriers are overcome. The establishment of regional
cooperation to reduce disparities, as revealed by this study, is emphasized. Primary Health
Care (PHC) is a privileged locus for cancer prevention and user monitoring. However,
realistically, many professionals still feel poorly trained and are unaware of policies for the
monitoring of cancer patients in PHC, which demands urgent activation of in-service
education 23 .
Intertwining this panorama with the framework of collaborative practice, it is observed
that this practice involves effective actions to respond to the users’ needs. It is, therefore, a
communicative, intersubjective and argumentative practice, which aims to fight the
asymmetries of social contradictions. New educational horizons are constructed, and a new
posture between professionals, users and policies is developed 24 . Consequently, collaborative
practices refer to the fulfillment of formalized teamwork actions, but transcend these actions,
based on four pillars: interaction and communication between members of the Network, so
that the goals are achieved; common objectives; shared responsibility; and innovations driven
by the incorporation of technology 25 .
Being guided by collaborative practices means facing the challenges of hierarchization.
These practices are a safe bet even in scenarios with scarce resources, as they promote
dialogue between managers and teams, although they depend on well-defined programmatic
actions. Other factors that influence the success of collaborative practices include:
interprofessional communication, user-centered care, clarification of roles, team dynamics,
conflict resolution, and collaborative leadership 26 .
The Sustainable Development Goals (SDGs) meet the demands of populations such as
women, children, and vulnerable groups, but they are not just a list of numerous goals without
articulation. The health sector is planning to create Sustainable Territories, where governance
microsocial mechanisms favor the implementation of intersectional and intersectoral
strategies. These strategies, combined with health work categories, seek to formulate
sustainable care that meets local and social determinants, as well as the SMART goals of this
study 27 .
It is important to note that collaborative practices do not solve all the problems of Public
Health. Insufficient supplies, work overload and deficient infrastructure require interventions
such as social control and evidence-based protocols, which have an impact on the
improvement of services 28 .
Regarding the various references to the private sector in the strategy, it is believed that
the concept of Universal Health Coverage, which influences this policy, foresees a focus on
financing through a combination of funds and a limited and targeted set of services, differing
from the experience of the SUS in Brazil 29 . These aspects are particularly dramatic in the
Brazilian context, where the “third sector” often manages state health services with a
businesslike approach, setting a precedent for the private appropriation of SUS resources and
instrumentalizing them to generate profit 30 .
There is a consensus that the third sector, encouraged by the ruling class, has promoted
a “disguised privatization” of universal systems, diverting the focus from the assumptions of
social security and more holistic health and care arrangements, at least in Brazil. The
implementation of collaborative policies and practices faces significant challenges when
confronted with the context of specific fiscal adjustments and restrictive liberal economic
policies in relation to the budget 31 . However, the Collaborative Practice must be seen in all its
potential. More than a guide to direct conduct, it is a movement to confront neoliberal
domination, an emancipatory movement that, emerging from the microsocial context, creates
lines of action and inventiveness that challenge the mechanistic status quo, replacing, to a
certain extent, capitalist subjectivism by collaborative ways of being 32 .
Micro and macropolitical contexts must be considered, as collaborative practices do not
occur in a vacuum. The use of electronic health records (EHRs) allows access to a variety of
user information through a click or keyword search. Telehealth and telemedicine, which
became popular after the COVID-19 pandemic, are increasingly used for online patient
monitoring and guidance, especially in remote areas or areas with difficult access. Wearable
technology, such as smartwatches and fitness trackers, also offers important real-time
indicators for patient monitoring 3 .
The established goals must be used by managers and coordinators, such as the Tripartite
Management Commission in Brazil. To achieve the strategy by 2030, it is crucial that
developing countries be prepared to ensure vaccination, and these criteria suggest the
centrality of technological innovations in overcoming obstacles, such as fighting fake news
about vaccines. Finally, the results indicate that culturally congruent care drives adaptations of
collaborative practices to increase adherence to this strategy, which requires multisectoral
partnerships and expanded continuing education.
The strengths of this article include the use of ChatGPT 3.5 as a generator of SMART
goals, the analysis of a policy established by the WHO using Public Health references, and
the disclosure of the possibilities and challenges for the implementation of measures to
mitigate cervical cancer. However, this documentary-qualitative study has limitations, such as
the lack of intertextuality with other WHO strategies and the lack of content validation of the
prompt used to obtain the SMART criteria matrix.
Final considerations
The analysis showed that the emerging goals and percentages indicate that, by 2030,
according to the WHO perspective, screening, diagnosis and treatment actions will be
underway, with emphasis on the 90-70-90 objective in relation to HPV vaccination, screening
and treatment.
Evidently, monitoring of these actions must be continuous, requiring the training of
active interprofessional networks to understand how the indicators of this disease interconnect
with the Sustainable Development Goals (SDGs). The provision of more devices to enhance
detection is a central recommendation, requiring governments to monitor and disseminate
indicators annually, in accordance with the SMART goals. Technology presents itself as an
ally in reducing inequalities in access, promoting the implementation of intelligent
information systems in peripheral countries. Collaboration, at least in theory, between the
organized civil society and the public and private sectors was the strategy that the WHO
adopted to ensure sustainable care and collaborative practices that give greater visibility to
social determinants in this line of care.
Availability of data and material
https://chat.openai.com/share/ad10f5cd-5147-447d-b7b9-f96692015758
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