Co-construction d'une étude sur la santé des Gens du voyage : retours d'expériences.

INTRODUCTION: Travelers have poorer health than the general population due to more precarious living conditions. In France, there are no epidemiological studies on Travelers, accentuating their invisibility in public health policy and planning. Discrimination against them, their distrust of the state and institutions, and their non-prioritization of health were the reasons for a participatory research project on Travelers’ health status. This research was carried out collaboratively by researchers, decision-makers, associations, and volunteer Travelers in Nouvelle-Aquitaine. PURPOSE OF RESEARCH: In this article we aim to share the challenges and benefits of the co-construction of this research. RESULTS: The approach allowed the specific and sometimes divergent expectations of the stakeholders to be expressed and taken into consideration. It required a period of mutual acculturation, which resulted in a high level of participation in the study (74 percent), the acquisition of knowledge and skills, and the identification of points of contention. This participatory approach led to a better appropriation of the study and a greater awareness of health issues among the respondents, particularly thanks to the co-construction of the questionnaire and the communication tools. CONCLUSIONS: This approach highlights the need to involve stakeholders in the governance of the research project from the very beginning. The approach was all the more crucial as it involved socially excluded people, and aims to avoid the possibility of excluding them further in the production of knowledge that concerns them.

Health status, healthcare use and child MMR vaccination coverage in Travellers according to their environmental and living conditions in Nouvelle-Aquitaine, France, 2019-2022.

BACKGROUND: The poor health status of underserved populations is compounded by low vaccination uptake, leading to a greater risk of epidemics. On October 2017, a measles outbreak started in the southwest of France among under-vaccinated social groups, including Travellers. We aimed to describe the health status, healthcare use and child measles-mumps-rubella (MMR) vaccination coverage in Travellers according to their environmental and living conditions. METHODS: A cross-sectional study with a three-stage random sample design was conducted between October 2019 and March 2022 in the Nouvelle-Aquitaine region in France. Trained social workers administered face-to-face questionnaires to collect data on adults and children. Anthropometric measurements, vaccination records and data using an environmental exposure questionnaire were also collected. RESULTS: The participation rate was high (73.6%), with 1030 adults and 337 children included. Concerning the adults, 36.6% had obesity, 14.4% reported diabetes, 24.7% hypertension and 14.4% major depression. The prevalence of major depression was significantly higher in adults living in precarious and unauthorized housing than in those with adequate housing (19.8 vs. 14.7%, P = 0.03). With regard to children, 45.3% had full (i.e. 2-dose) MMR vaccination coverage at 24 months and 17.9% had obesity. Finally, 74.5% of the households experienced housing insecurity, and 22.2% did not have a supply of drinking water. CONCLUSION: Traveller children and adults faced deleterious environmental and living conditions potentially affecting their health, healthcare use and vaccination coverage. These results demonstrate the need for urgent interventions for underserved populations which take into account their specific needs.

Gérer la crise de la première vague de COVID-19 : retour d'expérience d'une agence régionale de santé.

The crisis linked to COVID-19 has shaken up the organization of healthcare in France, particularly its administration. However, little is known about the crisis management action by the regional health agencies (ARS), at the crisis' forefront.Based on an internal feedback exercise, thanks to a qualitative method dealing with cross-referencing documentary sources and semi-structured interviews (90), this monograph reports on the regional management of the COVID-19 crisis of an administrative organization over the first half of 2020 by analyzing the temporal and organizational dynamics of crisis management, the role of this public authority, the public health strategies mobilized to tackle the epidemic in interaction with regional and national actors.From January to June 2020, COVID-19 management has been characterized by the sudden disruption of the usual benchmarks and agendas of priorities and by an unusual installation over time. The agency found itself in a permanent adaptation-reaction situation, setting up an ad hoc crisis management organization. It positioned itself as a key player, interacting with various actors and relying upon a wide range of public policy tools to do so.This monograph highlights the management of a recent and unprecedented social and healthcare crisis which questions usual health management knowledge and skills, at national and regional levels in France. It demonstrates the interest of crisis feedback discussions, with both internal and heuristic objectives.