The target of the intervention was Conitec, Brazil’s National Committee for Health Technology Incorporation, the body that advises on which technologies enter the unified public health system known as SUS. Conitec’s public consultations are a formal channel through which patients and citizens can voice their perspectives before reimbursement and coverage decisions are made. International bodies, including the International Network of Agencies for Health Technology Assessment, treat such participation as essential to legitimate, equitable, patient-centered policy. Yet the researchers found that meaningful engagement was constrained by three intertwined barriers: low health literacy, reliance on technical language in consultation materials, and a shortage of accessible educational content that would explain what health technology assessment, or HTA, actually is. The team framed these barriers as a structural weakness, because a learning health system, one that continuously improves by cycling evidence into practice, requires an informed public as a core enabling condition rather than an optional courtesy.

To address the problem, the researchers turned to knowledge translation, the discipline concerned with moving evidence from those who produce it to those who need to use it. They organized their project around the knowledge-to-action framework, a widely used model that treats implementation as a structured process rather than a single act of communication. The framework guided the work through seven phases between 2022 and 2025, beginning with the identification of priority topics and ending with the deployment and evaluation of the finished products. Crucially, the team did not decide on its own what the public needed to learn. Their first substantive step was a needs assessment survey of patient and civil society representatives, the people with the most direct stake in HTA decisions and the clearest sense of what their communities find opaque.

That survey, completed by sixteen participants, generated five thematic areas that became the backbone of the curriculum. From these, the team built ten educational video modules, each adapted from technical HTA content into plain language. The adaptation process was deliberately conservative in its epistemics: content was developed by researchers, reviewed internally by HTA specialists, and then subjected to a structured pilot evaluation with a prespecified acceptability threshold of 70 percent across five domains, including clarity, relevance, and usefulness. Setting a numeric threshold in advance matters, because it converted what is often a vague aspiration, making content comprehensible, into a testable criterion. The pilot collected 430 responses, and the acceptance rates across the five domains ranged from 75 to 97 percent, clearing the bar in every case.

The most scientifically interesting part of the study is what happened next. User feedback did not simply confirm the content; it reshaped it. Respondents’ comments directly triggered revisions, including the addition of Brazilian Sign Language interpretation, the creation of a glossary, and adjustments to the format of the materials. In other words, the intervention was built on a feedback loop in which the intended audience functioned as a source of validation and improvement rather than a passive recipient. This iterative design mirrors the logic of the learning health systems the project is meant to support: the educational platform itself learned from its users between iterations. The authors present this cycle of development, evaluation, and revision as the operational core of their knowledge translation approach, distinguishing it from one-off awareness campaigns that produce content once and hope it lands.

The delivery infrastructure consisted of two complementary channels. The first was a free, gamified virtual learning environment hosting the animated videos and interactive activities, an architecture chosen to lower the motivational cost of learning about an unfamiliar technical field. The second was a multichannel digital outreach strategy spanning social media platforms. The virtual learning environment recorded 4,355 accesses over the study period, with module completion rates ranging from 11.1 to 42.9 percent. Those completion figures are candidly reported and fall well short of universal engagement, a reminder that access to an educational resource is not the same as sustained use of it. Even so, several thousand citizens engaged with material that previously existed in no public form at all, and every piece of content remained freely accessible after the project’s funding ended, extending its useful life beyond the grant period.

The social media results, by contrast, show how sharply audience growth can respond to investment. The project’s Instagram account grew by 1,200 percent, from 576 to 7,514 followers, following a paid promotional campaign, with individual reels reaching as many as 47,000 views. LinkedIn accumulated 1,778 followers, and the project’s YouTube channel drew more than 5,000 views. The contrast between organic and paid reach is itself a finding with policy implications: in competitive digital ecosystems, technically valuable public-interest content does not automatically find its audience. For health agencies and research institutes operating in low- and middle-income countries, the lesson is that dissemination budgets are not decorative extras but structural components of participation infrastructure. A consultation process can only be as inclusive as the number of people who know it exists and understand what is being asked of them.

The study was conducted under Brazilian regulatory standards for human subjects research, approved by the Research Ethics Committee of the National Institute of Cardiology, with informed consent obtained from all participants, and it was funded by Brazil’s National Council for Scientific and Technological Development with no funder involvement in design, analysis, or publication decisions. These procedural details reinforce the study’s central claim, which is deliberately modest and replicable at once. The authors do not claim that the project transformed Conitec’s consultations or measured a downstream change in actual public submissions. What they demonstrate is feasibility and acceptability: that a knowledge-translation-informed intervention can be built, tested against prespecified criteria, refined through documented user feedback, and distributed at scale within a public institution’s constraints. Acceptance rates of 75 to 97 percent across 430 evaluators, combined with a twelvefold social media expansion, constitute measurable evidence on both counts.

The broader significance lies in the argument the data are marshaled to support. Patient and public participation in HTA is frequently endorsed in principle and underdelivered in practice, particularly in low- and middle-income countries where consultation infrastructure tends to be thin. The Participa SUS-ATS results suggest a concrete, transferable template: survey the affected community, adapt technical content into validated plain-language modules, deploy through a free gamified platform alongside targeted digital outreach, and build revision cycles from user feedback into the design from the start. Because the knowledge-to-action framework is generic and the materials are openly accessible, the model could be adapted by other national HTA agencies without starting from zero. If participation is indeed a structural enabling condition for learning health systems, then the unglamorous work of making a committee’s work comprehensible, one animated video and one glossary at a time, may turn out to be among the most consequential investments a health system can make. The Brazilian team has provided the first carefully documented demonstration that this work is feasible, acceptable to its audience, and capable of finding that audience when given the means.

Subject of Research: Knowledge translation intervention to strengthen patient and public participation in health technology assessment in Brazil

Article Title: Operationalizing knowledge translation to strengthen patient and public participation in health technology assessment: a multicomponent intervention to support enabling environments for learning health systems in Brazil

Article References: Braga, A., Dias, Q., Spada, D., Evangelista, J. R., Correia, M., & Santos, M. (2026). Operationalizing knowledge translation to strengthen patient and public participation in health technology assessment: a multicomponent intervention to support enabling environments for learning health systems in Brazil. Health Research Policy and Systems. https://doi.org/10.1186/s12961-026-01530-0

Image Credits: AI Generated

DOI: 10.1186/s12961-026-01530-0

Keywords: knowledge translation, health technology assessment, patient participation, public engagement, learning health systems, Brazil, Conitec, health literacy, capacity building, health policy, virtual learning environment, low- and middle-income countries