Acceptability, appropriateness, and feasibility of a digital innovation for monitoring public oral health services in Brazil - MonitoraSB: an implementation study

MonitoraSB is an innovative digital health initiative designed to support the monitoring and evaluation of oral health services in primary care within Brazil’s Unified Health System. It comprises a matrix of 54 validated indicators related to oral health care provision and management, operationalized through a digital dashboard. By integrating data from the primary health care information system, the dashboard generates timely performance indicators that reflect local health needs. By promoting the use of health data in daily practice, MonitoraSB may contribute to more effective, evidence-based service management. In implementation research, early assessment of implementation outcomes helps identify favorable and unfavorable conditions for adopting innovations in primary care work processes. These findings can inform strategies tailored to service realities. This study aimed to explore the acceptability, appropriateness, and feasibility of MonitoraSB and identify facilitators of and barriers to its adoption on the basis of the perceptions of oral health team professionals and managers. A qualitative study was conducted using theoretical framework of implementation science. Data were collected through three online focus groups with 29 professionals leading the implementation process across 13 municipalities in Minas Gerais, Brazil. The discussions were audio-recorded, transcribed, and analyzed using thematic content analysis. Three themes, 12 categories, and 14 subcategories emerged, revealing facilitators of and barriers to MonitoraSB adoption. Theme I – Determinants of Implementation – identified contextual factors affecting appropriateness and feasibility, such as the persistence of the biomedical model, a regulatory evaluation culture, monitoring focused on targets and financial transfers, and limited team engagement. Theme II – Strategies for Implementation – emphasized the importance of institutional support, training, and professional development to overcome barriers. Theme III – Potential Impacts in the Local Setting – highlighted contributions to improving evaluation, planning, management, teamwork, and social control in oral health services, reinforcing its acceptability and appropriateness. MonitoraSB was perceived as a feasible, appropriate, and acceptable innovation with the potential to improve oral health services. The study underscores the importance of institutionalizing evaluation, advancing digital health, and fostering critical technological training to support the adoption of innovations within the SUS.