ASTRACT The increasing survival of children with sickle cell disease (SCD) in Brazil highlights the urgent need for structured health care transition (HCT) programs, yet no evidence-based models are currently implemented. This study was grounded in the principle that understanding the organizational context is essential for designing tailored and effective HCT strategies. The objective was to identify key contextual barriers and facilitators that may influence the implementation of pediatric-to-adult HCT for SCD at two major Brazilian referral centers, one in São Paulo and one in Rio de Janeiro. A contextual assessment was conducted using a Strengths, Weaknesses, Opportunities, and Threats (SWOT) matrix and the Context Assessment for Community Health (COACH) survey. Sixty healthcare professionals participated (36 physicians, 6 nurses, 18 other professionals). The SWOT results revealed substantial structural constraints at both centers, including limited staffing, resource shortages, insufficient financial autonomy, and fragmented care handoffs, in addition to high patients’ unpreparedness for transition. COACH findings indicated similar challenges across institutions without substantial differences in overall organizational readiness between both organizations. Notable facilitators were identified, including highly committed teams, strong intrinsic motivation among professionals, and institutional leadership support for developing standardized HCT protocols. The study concluded that for HCT implementation, two essential priorities must be targeted: enhancing patient and family education to strengthen self-management skills and establishing structured, consistent communication processes between pediatric and adult teams. Addressing these factors is critical for the successful implementation of structured HCT to ensure care continuity and improve health outcomes for youth with SCD in Brazil.
Vilela et al. (Mon,) studied this question.