Contextual and organizational pathways to the long-term effect of behavior change among participants in a health promotion program in primary health care in Brazil

Background: This study aimed to map and understand the organizational and contextual conditions and mechanisms that contribute to the long-term effect of the Vida Ativa Melhorando à Saúde (VAMOS) program.

Methods: A primary health care-based intervention implemented in 15 cities, with 16 groups. The sample included professionals and participants from the VAMOS program. The analysis adopted was multivalued qualitative comparative analysis. Representing the VAMOS program groups, 16 cases were considered. For this analysis, the outcome variable was the long-term effect observed after the intervention. The mechanisms were analyzed on the basis of identified and calibrated conditions.

Results: Seven conditions were identified. The lower impact of COVID-19 was necessary for long-term effect. Four mechanisms that led to the long-term effect of VAMOS were identified, where the one with greater consistency and coverage had less external incentive, impact of COVID-19, and content execution, accompanied by greater relative priority, primary health care professionals’ self-efficacy, process execution, and maintenance intention. A tracing process identified the conditions that least varied for the long-term effect were relative priority and execution of the content.

Conclusions: Considering several organizational aspects, the greatest variation between the mechanisms for intervention long-term effect were linked to the program management and the implementation process.