Integrated care that speaks the language of contexts: validation experiences of SCIROCCO in Bolivia, Chile, Colombia, Costa Rica and Mexico.

Background: Latin America faces marked health inequalities and segmented, fragmented health systems that hinder care coordination and continuity for people and communities. Advancing toward integrated care models is key to improving outcomes and experiences. Within this framework, IFIC LatAm promoted a study to analyze organizational maturity in Bolivia, Chile, Colombia, Costa Rica, and Mexico, using the Scaling Integrated Care in Context (SCIROCCO) tool. Since the tool has been used in Europe, and with guidance from psychometrics experts at the University of Costa Rica, a qualitative validation was conducted applying cognitive interviews to ensure understanding, relevance, and applicability in Latin American contexts.

 

Approach: It is a qualitative, exploratory and descriptive study implemented by country teams in Bolivia, Chile, Colombia, Costa Rica and Mexico under a harmonized protocol. The preparation phase has involved: establishing research teams; workshops to select the application context (national, regional or local) in each country; training on the SCIROCCO tool to gain in-depth familiarity; defining informant profiles at macro, meso and micro levels; and validating the tool through the cognitive interview technique.

 

This technique includes: (1) an in-country review, based on expert judgment, to adapt the tool to the study context; (2) a cross-country comparative review using results from each context; and (3) a pilot test to build informant profiles. This phase has also included a series of workshops, dialogue and reflection spaces, and the development of instruments for comparative analysis of each country’s health system, as well as structured exchanges among country teams to facilitate understanding of integrated care in each context and to reflect specificities in the revised versions of the SCIROCCO tool. It also included reflection and experience-sharing with the tool’s authors on the Latin American context, which further strengthened the research process in the region among participating teams.

 

Results: Five versions of the SCIROCCO tool were reviewed and adapted to the study contexts of Bolivia, Chile, Colombia, Costa Rica, and Mexico, considering the specificities of each health system. Lessons emerged regarding important differences among stakeholders and characteristics of health systems and services in each country at different levels, as well as their understandings of integrated, person- and community-centred care. The cognitive interview technique documented more clearly different ways of understanding and interpreting the dimensions, challenged concepts about health services that did not reflect participating countries’ realities, and translated them into national contexts. These differences and similarities among countries and with the original tool supported greater clarity and relevance in applying the instrument and improved understanding of maturity conditions for integrated care in the study settings.

 

Implications: The qualitative validation the SCIROCCO tool in Latin American contexts reduces ambiguities and ensures cultural relevance in applying the instrument. This step is crucial when transferring tools developed in external contexts to Latin American realities, as it improves understanding of the constructs and strengthens research results with greater practical usefulness for decision-making. In addition, the process generated inputs and methodological steps that standardize application and facilitate replication, so other stakeholders can guide validation in new Latin American settings.