Mapping inter-attribute relationships in Brazilian primary healthcare: a combined social network analysis approach
1
Faculty of Medicine, Federal University of Goiás, Goiânia, Brazil
2
School of Economics, Federal University of Minas Gerais, Belo Horizonte, Brazil
3
Institute of Mathematics and Statistics, Federal University of Goiás, Goiânia, Brazil
Popul. Med. 2026;8(Supplement Supplement 1):A1750
ABSTRACT
INTRODUCTION:
Understanding primary health care (PHC) as a complex adaptive system and the interdependence of its attributes in a dynamic context is crucial to develop better health systems. We aimed to estimate the inter-attribute relationships in primary healthcare according to age and occurrence of hospitalisation in Brazil.
METHODS:
s This cross-sectional, nationally representative household-based study used data from the 2019–2020 Brazilian National Health Survey. PHC attributes were measured with the Brazilian short version of the Primary Care Assessment Tool (PCATool). We adopted the commonly used cutoff score of 6.6 (scores ≥ 6.6 = strong PHC and scores < 6.6 = weak PHC). Network analysis was applied to assess the contribution of each item using centrality indices, clustering coefficients, and normalised accuracy.
RESULTS:
A total of 88,531 individuals were eligible for inclusion in the study. The overall mean PCATool score was 5.61 ± 1.23, with significantly higher scores observed in the strong PHC group (7.64 ± 1.35) compared with the weak PHC group (4.67 ± 1.20; p < 0.001). Items related to communication with health professionals showed the highest scores, whereas remote access to advice and patient feedback mechanisms received the lowest scores. By age group (<60 vs ≥60 years), items related to care coordination showed the highest node strength, with no significant differences in network structure between groups (p = 0.70). Among individuals hospitalised in the previous year, network structure comparison showed no significant differences (p = 0.55).
CONCLUSIONS:
PHC attributes in Brazil are highly interconnected, supporting the view of PHC as a complex adaptive system. Communication and care coordination emerged as central components, while remote access and patient feedback represented key weaknesses. The stability of network structures across age groups and hospitalisation status suggests consistent inter-attribute dynamics, highlighting the need to strengthen relational and coordination aspects to improve PHC performance.
Understanding primary health care (PHC) as a complex adaptive system and the interdependence of its attributes in a dynamic context is crucial to develop better health systems. We aimed to estimate the inter-attribute relationships in primary healthcare according to age and occurrence of hospitalisation in Brazil.
METHODS:
s This cross-sectional, nationally representative household-based study used data from the 2019–2020 Brazilian National Health Survey. PHC attributes were measured with the Brazilian short version of the Primary Care Assessment Tool (PCATool). We adopted the commonly used cutoff score of 6.6 (scores ≥ 6.6 = strong PHC and scores < 6.6 = weak PHC). Network analysis was applied to assess the contribution of each item using centrality indices, clustering coefficients, and normalised accuracy.
RESULTS:
A total of 88,531 individuals were eligible for inclusion in the study. The overall mean PCATool score was 5.61 ± 1.23, with significantly higher scores observed in the strong PHC group (7.64 ± 1.35) compared with the weak PHC group (4.67 ± 1.20; p < 0.001). Items related to communication with health professionals showed the highest scores, whereas remote access to advice and patient feedback mechanisms received the lowest scores. By age group (<60 vs ≥60 years), items related to care coordination showed the highest node strength, with no significant differences in network structure between groups (p = 0.70). Among individuals hospitalised in the previous year, network structure comparison showed no significant differences (p = 0.55).
CONCLUSIONS:
PHC attributes in Brazil are highly interconnected, supporting the view of PHC as a complex adaptive system. Communication and care coordination emerged as central components, while remote access and patient feedback represented key weaknesses. The stability of network structures across age groups and hospitalisation status suggests consistent inter-attribute dynamics, highlighting the need to strengthen relational and coordination aspects to improve PHC performance.
| eISSN: | 2654-1459 |
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