Maternal, neonatal and infant mortality is still high globally, but worse in low-resourced countries such as Kenya. Progress in reducing maternal mortality in Kenya is slow, with an estimated maternal mortality ratio of 400 deaths per 100,000 live births. Similarly, the infant mortality rate is tabulated at 39 deaths per 1000 live births. Given the high prevalence of maternal and newborn mortality and morbidity in low-income countries such as Kenya, it is vital to maximize nurses’ and midwives’ capacity to contribute to the reduction of this burden of disease during the perinatal period. As the main healthcare providers in rural Kenyan facilities, nurses and midwives are best positioned to provide effective maternal, newborn, and infant health (MNH) services. They provide both health promotion and disease prevention care throughout pregnancy, labor and delivery, and the early postpartum period. One way of achieving this is through effective postpartum care, a period of perinatal care that is plagued with high rates of pregnancy-related complications. A significant amount of research has been conducted on improving MNH in developing and low- to middle-income countries. However, there is a paucity of literature examining the experiences of nurses and midwives providing postpartum care in these settings. As is evident in the existing literature, nurses’ and midwives’ experiences and perspectives have not been explored to the fullest. This study, therefore, was guided by critical theory and Foucault’s concepts of knowledge and power. Using focused ethnography (FE) as the research methodology, the study had four specific objectives: 1) To describe how the sociopolitical and cultural contexts of healthcare influence the provision of postpartum care by nurses and midwives; 2) To identify the facilitators influencing nurses’ and midwives’ ability to competently provide postpartum care; 3) To identify the barriers to nurses’ and midwives’ ability to competently provide postpartum care; and 4) To explicate nurses’ and midwives’ current knowledge regarding best practices in postpartum care. As consistent with FE methods, this study employed individual in-depth interviews and focus groups to obtain data. Thematic analysis based on Braun and Clarke (2006) was used to analyze data. Credibility, transferability, dependability, and confirmability were used to ensure the trustworthiness of the research process. The analysis of data generated six themes: 1) Provider-Client Relationships; 2) Fostering a Healthy Work Environment; 3) Barriers to Postpartum Care; 4) Transcending Adversity; 5) Social Support Systems; and 6) Policies and Infrastructure Influencing Postpartum Care. The study findings demonstrated that nurses and midwives providing postpartum care in rural Kenya are the backbone of the healthcare system and greatly influence the health outcomes of the people they serve. Facilitators and barriers to the nurses’ and midwives’ work while providing postpartum care in this complex environment were identified. In this study, I have shown how gender, class, and power relations may be influencing the perinatal care that the nurses and midwives provide to postpartum women. The study also shines a light on how maternal and infant health may be influenced by power, politics, and policies. Therefore, I propose that use of an intersectionality lens to examine the experiences of nurses and midwives providing perinatal healthcare in rural Kenya could illuminate power dynamics within the healthcare sector. This study recommends relevant education, healthcare policies, and practice guidelines that support building the capacity of nurses and midwives through an inclusive, structured process, creating a robust environment in leadership, education, research, and nursing/midwifery practice.

Background: The health systems in many low-middle income countries are faced with an increasing number of patients with non-communicable diseases within a high prevalence of infectious diseases. Integrated chronic disease management programs have been recommended as one of the approaches to improve efficiency, quality of care and clinical outcomes at primary healthcare level. The South African Department of Health has implemented the Integrated Chronic Disease Management (ICDM) Model in Primary Health care (PHC) clinics since 2011. Some of the expected outcomes on implementing the ICDM model have not been achieved, and there is a dearth of studies assessing implementation outcomes of chronic care models, especially in low-middle income countries. This thesis aims to assess the degree of fidelity, moderating factors of fidelity and costs associated with the implementation of the ICDM model in South African PHC clinics. Methods: The study was a cross-sectional study design using mixed methods and following the process evaluation conceptual framework. A total of sixteen PHC clinics in the Dr. Kenneth Kaunda (DKK) health district of the North West Province as well as the West Rand (WR) health district of the Gauteng Province, that were ICDM pilot sites were included in the study. The degree of fidelity in the implementation of the ICDM model was evaluated using a fidelity criterion from the four major components of the ICDM model as follows: facility reorganization, clinical supportive management, assisted self-support and strengthening of the support systems. In addition, the implementation fidelity framework was utilized to guide the assessment of ICDM model fidelity moderating factors. The data on fidelity moderating factors were obtained by interviewing 30 purposively selected healthcare workers. The abbreviated Denison Organizational Culture (DOC) survey was administered to 90 healthcare workers to assess the impact of three cultural traits (involvement, consistency and adaptability) on fidelity. Cost data from the provider's perspective were collected in 2019. The costs of implementing the ICDM model current activities for three (facility reorganization, clinical supportive management and assisted self-management) components and additional costs of implementing with enhanced fidelity were estimated. Costs data was collected from budget reviews, interviews with management teams, and other published data. Descriptive statistics were used to describe participants and clinics. Fidelity scores were summarized using medians and proportions and compared by facilities and health districts. Qualitative data were analysed thematically. Pearson correlation coefficient was utilized to assess the association between fidelity and culture. The annual ICDM model implementation costs per PHC clinic and patient per visit were presented in 2019 US dollars. Results: The 16 PHC clinics had comparable patient caseload, and a median of 2430 (IQR: 1685-2942) patients older than 20 years received healthcare services in these clinics over six months. The overall implementation fidelity of the ICDM model median score was 79% (125/158, IQR: 117-132); WR was 80% (126/158, IQR: 123-132) while DKK was 74% (117/158, IQR: 106-130), p=0.1409. The highest clinic fidelity score was 86% (136/158), while the lowest was 66% (104/158). The fidelity scores for the four components of the ICDM model were very similar. A patient flow analysis indicated long (2-5 hours) waiting times and that acute and chronic care services were combined onto one stream. Interviews with healthcare workers revealed that the moderating factors of implementation fidelity of the ICDM model were the existence of facilitation strategies (training and clinical mentorship); intervention complexity (healthcare worker, time and space integration); and participant responsiveness (observing operational efficiencies, compliance of patients and staff attitudes). Participants also indicated that poor adherence to any one component of the ICDM model affected the implementation of the other components. Contextual factors that affected fidelity included supply chain management, infrastructure and adequate staff, and balanced patient caseloads. The overall mean score for the DOC was 3.63 (SD = 0.58), the involvement cultural trait had the highest (3.71; SD = 0.72) mean score, followed by adaptability (3.62; SD = 0.56), and consistency (3.56; SD = 0.63). Although there were no statistically significant differences in cultural scores between PHC clinics, culture scores for all three traits were significantly higher in WR (involvement 3.39 vs 3.84, p= 0.011; adaptability 3.40 vs 3.73, p= 0.007; consistency 3.34 vs 3.68, p= 0.034). The mean annual cost of implementing the ICDM model was $148 446.00 (SD: $65 125.00) per clinic, and 84% ($124 345.00) was for current costs while additional costs for higher fidelity accounted for were 16% ($24 102.00). The mean cost per patient per visit was $6.00 (SD:$0.77). Conclusion: There was some variability of fidelity scores on the components of the ICDM model by PHC clinics, and there are multiple (context, participant responsiveness, intervention complexity and facilitation strategies) interrelated moderating factors influencing implementation fidelity of the ICDM model. Organizational culture needs to be purposefully influenced to enhance adaptability and consistency cultural traits of clinics to enhance the ICDM model's principles of coordinated, integrated, patient-centred care. Small additional costs are required to implement the ICDM model with higher fidelity. Recommendations: Interventions to enhance the fidelity of chronic care models should be tailored to specific activities that have low degree of adherence to the guidelines. Addressing some of the moderating factors like training and mentoring of staff members, role clarification and supply chain management could contribute to enhanced fidelity. Organizational culture enhancements to ensure that the prevailing culture is aligned with the planned quality advancements is recommended prior to the implementation of new innovative interventions. Further research on the cost-effectiveness of the ICDM model in middle-income countries is recommended.

No description available.

Systematic Review / Advancements in medicine have resulted in decreased neonatal mortality and morbidity associated with congenital anomalies (CA). Unfortunately, the advantages of these developments have been confined to high-income countries (HICs), demonstrated by the comparatively high incidence of congenital anomalies in low and low-middle-income countries (LLMICs). Evidence suggests that neonates in LLMICs encounter considerably more barriers to care than those in HICs due to a malfunctioning referral system and poorly implemented health policies that hinder the timely provision of care. As many CA are now accepted as surgically treatable, the purpose of this study was to understand what inhibits the success of a neonate from obtaining surgery in LLMICs and how that could be improved. Seven databases were searched in this systematic review to identify articles on neonates with surgically treatable CA. A total of 370 studies were identified for screening; 16 were included in the final analysis. Studies were screened and selected individually by two researchers based on the research question, and all disagreements were resolved jointly. Studies were reviewed for factors affecting the delivery of surgical treatment and were then coded as a barrier or a facilitator. Barriers to care were identified in every study, and suggested facilitators were offered by the authors, but these facilitators were not tested in the studies. This study contributes to the literature by providing additional detail on what is known about the surgical referral system in LLMICs. The study findings will inform policymakers and local governments of the realities faced by neonates and their caregivers while navigating through the surgical referral system and establish the need for alternate policy implementation strategies. / Thesis / Master of Science (MSc) / Congenital anomalies (CA) have been identified as a significant contributor to the global burden of disease, accounting for 25.3-38.8 million disability-adjusted life-years worldwide. Many CA have been classified as surgically treatable however, approximately 295,000 neonates die annually due to these conditions. As 94% of CA occur in low- and low- middle-income countries (LLMICs), this study aims to elucidate any barriers and facilitators that may influence accessing surgical treatment. A systematic review has been selected to synthesize the literature regarding what is known about accessing surgery for neonates with CA in LLMICs.

Background: Performance-based financing (PBF) is a healthcare reform that is widely adopted in low- and middle-income countries (LMICs). PBF is an intervention designed to strengthen healthcare systems in LMICs. It represents a fundamental shift towards improving healthcare amongst the most vulnerable, with a focus on maternal and child health services. Broadly, there are gaps regarding PBF’s effect on healthcare systems and various aspect of healthcare, including efforts to implement universal healthcare coverage. PBF introduced an innovative component—the PBF equity instrument—geared towards achieving universal health coverage. The effect of this equity instrument has not been studied. There is significant gap regarding how it is defined and implemented in various context. Cameroon has one of the highest maternal mortality rates in sub–Saharan Africa and with high out-of-pocket expenses that impede access to maternal health services. PBF was introduced in Cameroon in 2012 with a focus on maternal health services and was adopted in 2017 as a national strategy towards achieving universal coverage, however, the definition and implementation of the PBF equity elements remain a gap in Cameroon and sub-Saharan Africa. This dissertation is focused on studying the PBF equity elements in Cameroon in order to get a broader perspective on the effect of the PBF equity elements as a policy tool in improving the lives of the most vulnerable population to ensure no one is left behind in the efforts towards achieving universal health coverage. Objectives: This dissertation aimed (1) to investigate and characterize the effect of the PBF equity elements in improving equity in access to selected maternal services (2) to understand how the equity elements is defined and implemented in Cameroon; and (3) to generate a framework that will facilitate the identification of gaps and challenges, in turn informing policy development that is relevant to PBF equity elements in Cameroon and PBF research on equity in other countries; and (4) to explore health providers experiences before and after the introduction of PBF in Cameroon. Methods: This dissertation employed a mixed methods approach to address the above objectives, involving the use of multiple frameworks and triangulation across and within objectives. First, to investigate the effect of PBF on equity in improving access to maternal services, I designed a systematic review with a focus on one of the equity elements—subsidizing user fees to reduce out-of-pocket expenses to improve access to maternal health services. The aim was to get a broader overview of the PBF equity element and to understand the effect of PBF on out-of-pocket expenses in improving access to selected maternal health services in sub–Saharan Africa. Second, I narrowed the assessment to a specific context-Cameroon. Given the heterogenous nature of care delivery in Cameroon, I investigated the effect of PBF on out-of-pocket expenses in improving access to selected maternal health services across healthcare sectors using a before-and-after study design. The rationale was to address the limitations of an earlier PBF impact evaluation in Cameroon, in particular, potential heterogeneity across settings and sectors which had not been considered. Third, to describe and define the implementation of the PBF equity elements in Cameroon, I conducted a grounded theory study -given that it is a new policy that has not been well studied -to understand the social processes and actions from health facilities, health providers, PBF managers and the community, and generated a theoretical framework to inform the challenges and gaps in the implementation process. Finally, as a newly adopted health reform, I conducted an in-depth qualitative study to understand the experiences of health care provides before -and-after the implementation of PBF and its equity elements and the potential for sustainability of the policy especially the equity strategies in Cameroon. Findings: The findings provide an overarching understanding on the effect of one of the PBF equity elements in improving access to maternal health services in sub–Saharan Africa, and in particular, an understanding of the effect of the PBF equity elements in improving access and utilization of selected maternal services in Cameroon. At the health system level, the findings provide an understanding of the focus of the equity elements within the context of Cameroon and further insight on the gaps and limitations in the implementation of the PBF equity elements and the potential challenges in sustainability towards achieving universal health coverage. At the health facility level, it provides an understanding on how the PBF equity elements is understood, defined, and implemented and provides directions on the challenges to inform policy and to guide research. At the individual level, it provides an overview of the expectations of health care providers from a supply side perspective and the potential effect it has on demand creation from women and households in improving access to maternal health services. Overall, the findings provide insight on how the equity elements are defined and implemented but also provides opportunity and areas of improvement and detailed how PBF equity elements can be further assessed and how delays in payment of PBF incentives can potentially affect the realization of the equity elements in improving access and utilization of maternal health services amongst the poor and vulnerable. Conclusion: Equity is central and essential to the delivery of services to achieve universal health coverage. The adoption of PBF in Cameroon is a step toward achieving universal health coverage with the recognition that universal health coverage cannot be effectively implemented in an institution without good governance. The PBF initiative is viewed as an entry point for universal health coverage, in order to evaluate the level of preparedness of health facilities to embrace universal health coverage in terms of quality of health care, production, good managerial skills, and financial management. However, due to administrative bottlenecks, the government has yet to accept some of the established principles of PBF—this in turn causes delays in payment and this hampers the effective implementation of some of the PBF equity strategies. Therefore, though PBF is a national policy, the actors at the central level, i.e., the Ministry of Public Health, are not playing their role effectively in enabling full implementation of PBF best practices and theories.

Syftet med detta examensarbete är att undersöka hur några lärare i årskurs 1-6 arbetar med kamratrespons vid bedömning av elevtexter i ämnet svenska. Ytterligare ett syfte med examensarbetet är att få kunskap om vilka möjligheter och svårigheter det finns med arbetssättet kamratrespons samt att ta reda på hur de intervjuade lärarna tror att eleverna upplever kamratrespons. Utgångspunkten är Vygotskijs teori om sociolkulturellt lärande i socialt samspel. I studien har semistrukturerade kvalitativa intervjuer med fem lärare från tre olika skolor använts. Lärarnas beskrivningar av arbetssättet överensstämmer med vad som framkommer i litteraturen. Framför allt används kamratrespons i svenskans skriva-delar. Den vanligaste metoden är Två stjärnor och en önskan. De möjligheter och svårigheter som lärarna lyfter stämmer i stort sett överens med vad som framkommer i litteraturen. Av intervjuerna framgår att ett positivt klassrumsklimat är det viktigaste för att kamratrespons ska fungera. Av studien framgår att det finns en skillnad mellan lärarnas tankar och det som framkommer av litteraturen. De intervjuade lärarna framför att det är svårt att hitta fungerande responspar, vilket inte framgår av litteraturen. Den lyfter endast att det är bra att byta responspar ofta. / The purpose of the thesis is to investigate how some teachers in grades 1-6 work with peer responses when assessing student texts in the subject Swedish. Another purpose of the thesis is to gain knowledge about the possibilities and difficulties with the peer response method and to find out how the interviewed teachers believe that the students experience peer response. The starting point is Vygotsky's theory of social-cultural learning in social interaction. The study has used semi-structured qualitative interviews with five teachers from three different schools. Teachers' practice coincides with examples in the literature on how the work method can be used. Most importantly, peer response is used in Swedish writing. The most common method is two stars and a wish. The opportunities and difficulties that the teachers raise are broadly in line with what appears in the literature. What appeared in the interviews as the most important thing to make the peer response work was a positive climate in the group. The study finds a difference between the thoughts of the interviewed teachers and what appears in the literature. The interviewed teachers express that it is difficult to find effective response pairs. What emerged in the literature was instead that it is good to change response pairs often.

A proposta deste trabalho tem por objetivo a análise da trilogia das crônicas de Fernão Lopes (1380? 1460), a saber: a Crônica de D. Pedro I, a Crônica de D. Fernando e a Crônica de D. João I para se compreender a construção das imagens relacionadas ao exercício do poder régio delineadas por este cronista. Para além de registrar e ordenar a história do seu reino, Fernão Lopes tem como projeto a recuperação da memória da dinastia Avisina. A leitura da trilogia lopeana revela os caminhos que o cronista escolhe para reforçar a criação desta dinastia modelo, que servirá de espelho para a sua contemporaneidade e para as gerações futuras. Entendemos também que as representações do estado de Rey de cada monarca biografado presentes nestas narrativas são medidas essenciais para a revelação de como o cronista percebe formas e modos diferentes de se governar o reino. Estas prerrogativas ou a ausência delas faz com que o poder régio possa ser justificado e legitimado na prosa do cronista. Pretendemos aqui fazer a análise das três crônicas em conjunto, reconhecendo a importância de cada uma delas enquanto uma contribuição à construção da perspectiva evolutiva pretendida pelo cronista, a fim de se identificar a carga da intencionalidade no discurso lopeano, que é construído com base em símbolos e imagens do poder em cada capítulo de suas crônicas. / This work aims at analyzing the Lopes trilogy of chronicles (1380? - 1460), namely the Chronicle of D. Pedro I, the Chronicle of D. Fernando and the Chronicle of D. João I, in order to understand the construction of images related to the exercise of royal power outlined by this chronicler. In addition to recording and organizing the history of his kingdom, Fernão Lopess project is to recover the memory of the Avis dynasty. The reading of the Lopes trilogy reveals the ways in which the chronicler chooses to enhance the creation of this model of dynasty, which serves as a mirror to his contemporary and future generations. We also understand that the representations of the \"state of king\" of each monarch presented in these narratives are essential to reveal how the chronicler perceives the different forms and ways of ruling the kingdom. These requirements or the lack of them justify and legitimize the royal power within the chroniclers prose. In this work, we propose to analyze the profiles of the three kings as built by the medieval chronicler Fernão Lopes in his three chronicles. We intend to analyze these chronicles as a whole, recognizing the meaning of each one as a contribution to the construction of the diachronic perspective in the chroniclers speech. In that way we attempt to identify the charge of intention in Lopess speech, which is built on images and symbols of power in each chapter of his chronicles.

Le chapiteau ibéro-maghrébin apparaît aujourd’hui comme l’une des expressions les plus caractéristiques de la sculpture islamique médiévale : il connaît du IXe au XIVe siècle, avec une riche production, une incessante adaptation à son contexte politique et social ; il s’affirme ainsi comme un reflet privilégié de l’art islamique en Occident et de son évolution. Notre choix s’est porté sur cet élément architectural car il apparaît comme un élément clé — membre d’architecture et œuvre ornementale à la fois — pour appréhender l’art et les techniques du monde ibéro-maghrébin du bas Moyen Age confrontée à la poussée chrétienne des XIIIe et XIVe siècles. Seules les villes nasrides, mérinides et abd al-wadides échappent aux reconquêtes du XIIIe siècle. Le chapiteau constitue l’un des témoins de ce nouveau contexte historique et géographique de l’art islamique d’Occident. Pour mieux saisir ce phénomène, nous avons pris le parti d’étudier les chapiteaux islamiques ibéro-maghrébins dans une perspective diachronique. Ils apparaissent comme le fruit d’une longue évolution que nous avons tenté de saisir dans sa globalité avant de mettre en lumière, à partir d’un catalogue raisonné, la production des trois émirats et des diverses écoles développées au bas Moyen Age. La perspective ibéro-maghrébine retenue a permis d’établir une grille de classement typologique inédite, qui englobe toute la zone visée. Elle met en lumière une évidente évolution et une diversité qui révèle les particularismes liés à la vitalité de foyers d’art sans cesse plus nombreux. Cette évolution, marquée par bien des diversifications régionales, témoigne, au reste aussi bien, de riches échanges entre les émirats de l’aire culturelle ibéro-maghrébine. / The Ibero-Maghrebian capital is one of the most characteristic forms of medieval Islamic sculpture. Prolifically produced from the 9th to the 14th century, it was constantly adapted to its social and political context, and became a prime reflection of Islamic art in the West and its evolution. In the present work I chose to focus on this architectural element because it is key, as at once architectural member and ornamental work, to understanding the art and techniques of the Ibero-Maghrebian world of the Low Middle Ages, and notably its confrontation with the Christian push of the 13th and 14th centuries. Only Nasrid, Marinid and Zayyanid cities escaped the reconquests of the 13th century, and the capital is one of the reflections of this new historical and geographical context for Islamic art in the West. To better grasp this phenomenon, I chose to study Ibero-Maghrebian Islamic capitals from a diachronic perspective. These capitals are the fruit of a long process of evolution, which I describe overall before examining the production of the three emirates and the various schools developed in the Low Middle Ages. By taking an Ibero-Maghrebian perspective, I was able to establish a novel typological framework which encompasses productions throughout the entire area. It highlights clear change over time and a diversity that reflects particularisms linked to the vitality of increasingly numerous centres of production. This evolution, marked by many regional diversifications, testifies to the rich exchanges between the emirates of the Ibero-Maghrebian cultural space.

A proposta deste trabalho tem por objetivo a análise da trilogia das crônicas de Fernão Lopes (1380? 1460), a saber: a Crônica de D. Pedro I, a Crônica de D. Fernando e a Crônica de D. João I para se compreender a construção das imagens relacionadas ao exercício do poder régio delineadas por este cronista. Para além de registrar e ordenar a história do seu reino, Fernão Lopes tem como projeto a recuperação da memória da dinastia Avisina. A leitura da trilogia lopeana revela os caminhos que o cronista escolhe para reforçar a criação desta dinastia modelo, que servirá de espelho para a sua contemporaneidade e para as gerações futuras. Entendemos também que as representações do estado de Rey de cada monarca biografado presentes nestas narrativas são medidas essenciais para a revelação de como o cronista percebe formas e modos diferentes de se governar o reino. Estas prerrogativas ou a ausência delas faz com que o poder régio possa ser justificado e legitimado na prosa do cronista. Pretendemos aqui fazer a análise das três crônicas em conjunto, reconhecendo a importância de cada uma delas enquanto uma contribuição à construção da perspectiva evolutiva pretendida pelo cronista, a fim de se identificar a carga da intencionalidade no discurso lopeano, que é construído com base em símbolos e imagens do poder em cada capítulo de suas crônicas. / This work aims at analyzing the Lopes trilogy of chronicles (1380? - 1460), namely the Chronicle of D. Pedro I, the Chronicle of D. Fernando and the Chronicle of D. João I, in order to understand the construction of images related to the exercise of royal power outlined by this chronicler. In addition to recording and organizing the history of his kingdom, Fernão Lopess project is to recover the memory of the Avis dynasty. The reading of the Lopes trilogy reveals the ways in which the chronicler chooses to enhance the creation of this model of dynasty, which serves as a mirror to his contemporary and future generations. We also understand that the representations of the \"state of king\" of each monarch presented in these narratives are essential to reveal how the chronicler perceives the different forms and ways of ruling the kingdom. These requirements or the lack of them justify and legitimize the royal power within the chroniclers prose. In this work, we propose to analyze the profiles of the three kings as built by the medieval chronicler Fernão Lopes in his three chronicles. We intend to analyze these chronicles as a whole, recognizing the meaning of each one as a contribution to the construction of the diachronic perspective in the chroniclers speech. In that way we attempt to identify the charge of intention in Lopess speech, which is built on images and symbols of power in each chapter of his chronicles.

[pt] O presente estudo investiga o fenômeno do compartilhamento como prática de consumo em famílias brasileiras urbanas de classe média baixa. Para tal, utiliza-se da perspectiva da Consumer Consumption Theory (CCT), de caráter interpretativo e adotando-se a família estendida residente em um mesmo domicílio como unidade de análise.O compartilhamento é uma prática cotidiana, presente na vida dos indivíduos tanto na esfera pública, quanto privada. Nos lares, compartilha-se desde a geladeira e seu conteúdo até os móveis, os utensílios e os espaços da casa. Compartilham-se a refeição, o entretenimento e as atividades domésticas. Fora dos lares, compartilham-se os espaços públicos, espaços comerciais como restaurantes e cinemas, os transportes, as paisagens, o mundo. O compartilhamento realizado pelas famílias é um fenômeno social que, apesar de sempre ter existido como prática de consumo cotidiana, esteve praticamente ausente dos estudos em Comportamento do Consumidor e de áreas correlatas. O arcabouço teórico está baseado na Consumer Culture Theory, especificamente sobre o processo de significação do consumo e no compartilhamento como prática de consumo. Foi utilizada abordagem interpretativa, com base em entrevistas em profundidade com diferentes membros das famílias estendidas. Seguiu-se o método abdutivo de combinação sistemática, em um processo de idas e vindas entre teoria e campo. Este estudo contribui para a ampliação do conhecimento sobre práticas de consumo de três formas principais: i) expandindo o entendimento da temática do compartilhamento, delineando melhor fronteiras conceituais e temáticas; ii) estudando o fenômeno no contexto da família estendida brasileira, em contraposição à família nuclear norte-americana; e iii) identificando as especificidades do fenômeno entre famílias urbanas de classe média baixa. Do estudo emergiram novas categorias para descrever o compartilhamento, assim como foram obtidas evidências de o emprestar ser um modo de consumo distinto de compartilhamento. / [en] This research investigates sharing as a consumption practice in Brazilian low-middle class urban families. Given this purpose, the study adopts the Consumption Culture Theory (CCT) interpretative perspective, using the extended family residing in the same household as the unit of analysis. Sharing is an everyday practice in the individuals lives in both public and private spheres. Within the households, artifacts such as the refrigerator and its contents are shared, as well as furniture, utensils, and physical spaces. Individuals share meals, entertainment, and domestic chores. Outside the home, public spaces, commercial spaces such as restaurants and cinemas, transportation, landscapes, and other aspects of the physical world are all shared. Sharing within families is a social phenomenon that, although it has always been a daily consumption practice, it has practically been absent from studies on Consumer Behavior and related areas. The theoretical framework is based on the Consumer Culture Theory, specifically on the process of extracting meaning from consumption. The study used an interpretative approach, based on in-depth interviews with different members of the extended families. It followed the abductive method of systematic combining, which is characterized by continuous comings and goings between the theory and the field. This study contributes to increase the knowledge on consumption practices in three main ways: i) by expanding the understanding of the phenomenon of sharing, better outlining its conceptual and thematic borders; ii) by studying the phenomenon in the context of the Brazilian extended family, as opposed to the American nuclear family; and iii) by identifying specificities of how the phenomenon manifests among low middle class urban families. New categories emerged from the study to describe sharing, as well as comparative elements between sharing and lending as consumption practices. The study proposes a conceptual framework for the different types of sharing.