[Mixed methods research in public health: issues and illustration]. / Recherche par les méthodes mixtes en santé publique: enjeux et illustration.

For many years, researchers in a range of fields have combined quantitative and qualitative methods. However, the combined use of quantitative and qualitative methods has only recently been conceptualized and defined as mixed methods research. Some authors have described the emerging field as a third methodological tradition (in addition to the qualitative and quantitative traditions). Mixed methods research combines different perspectives and facilitates the study of complex interventions or programs, particularly in public health, an area where interdisciplinarity is critical. However, the existing literature is primarily in English. By contrast, the literature in French remains limited. The purpose of this paper is to present the emergence of mixed methods research for francophone public health specialists. A literature review was conducted to identify the main characteristics of mixed methods research. The results provide an overall picture of the mixed methods approach through its history, definitions, and applications, and highlight the tools developed to clarify the approach (typologies) and to implement it (integration of results and quality standards). The tools highlighted in the literature review are illustrated by a study conducted in France. Mixed methods research opens new possibilities for examining complex research questions and provides relevant and promising opportunities for addressing current public health issues in France.

A health promotion initiative in French primary schools based on teacher training and support: actionable evidence in context.

This article presents a health promotion initiative in French school settings. This initiative aims to promote children's social, emotional and physical health. The main strategy is the development of teachers' health-promoting practices and schools' health-promoting environment. The initiative was implemented in 115 primary schools in six French regions. Three types of evidence were used to develop the initiative: scientific, professional contextual, and critical evidence. The evidence was translated into the programme through a training and support process. According to their position, the actors used the evidence differently. The importance of the local context and actors' involvement is further explored.

Evaluation of health promotion in schools: a realistic evaluation approach using mixed methods.

BACKGROUND: Schools are key settings for health promotion (HP) but the development of suitable approaches for evaluating HP in schools is still a major topic of discussion. This article presents a research protocol of a program developed to evaluate HP. After reviewing HP evaluation issues, the various possible approaches are analyzed and the importance of a realistic evaluation framework and a mixed methods (MM) design are demonstrated. METHODS/DESIGN: The design is based on a systemic approach to evaluation, taking into account the mechanisms, context and outcomes, as defined in realistic evaluation, adjusted to our own French context using an MM approach. The characteristics of the design are illustrated through the evaluation of a nationwide HP program in French primary schools designed to enhance children's social, emotional and physical health by improving teachers' HP practices and promoting a healthy school environment. An embedded MM design is used in which a qualitative data set plays a supportive, secondary role in a study based primarily on a different quantitative data set. The way the qualitative and quantitative approaches are combined through the entire evaluation framework is detailed. DISCUSSION: This study is a contribution towards the development of suitable approaches for evaluating HP programs in schools. The systemic approach of the evaluation carried out in this research is appropriate since it takes account of the limitations of traditional evaluation approaches and considers suggestions made by the HP research community.

Assessment of a national network: the case of the French teacher training colleges' health education network.

The French teacher training colleges' health education (HE) network was set up in 2005 to encourage the inclusion of HE in courses for primary and secondary school teachers. A systematic process of monitoring the activity and the impact of this initiative was implemented. This analysis was systematically compared with the perceptions of teaching staff involved in the network. This paper assesses the network after 2 years using documents produced and interviews with 24 coordinators. Twenty-nine teacher training colleges out of a total of 31 are involved in the network. The network has helped to create links between teacher training colleges, extend HE training and encourage partnerships with other public health organizations. By 2007, HE was included in courses offered by 19 teacher training colleges as opposed to only 3 in 2005. This study not only showed the positive impact of the network but also revealed issues in its management and presented new challenges to ensure the effectiveness of the network. The network has succeeded in attracting and training trainers who were already providing or were interested in HE. Reaching other trainers who are not familiar with HE remains a challenge for the future.

A risk-benefit analysis of French high fish consumption: a QALY approach.

The health risk and the nutritional benefit of a food are usually assessed separately. Toxicologists recommend limiting the consumption of certain fish because of methylmercury; while nutritionists recommend eating more oily fish because of omega 3. A common evaluation is imperative to provide coherent recommendations. In order to evaluate the risks along with the benefits related to fish consumption, a common metric based on the quality-adjusted life year (QALY) method has been used. The impact of a theoretical change from a medium n-3 PUFAs intake to a high intake is studied, in terms of the cardiovascular system (CHD mortality, stroke mortality and morbidity) and on fetal neuronal development (IQ loss or gain). This application can be considered as a sensitive analysis of the model used and looks at the impact of changing the dose-response relationships between cardiovascular diseases and n-3 PUFAs intakes. Results show that increasing fish consumption may have a beneficial impact on health. However, the confidence interval of the overall estimation has a negative lower bound, which means that this increase in fish consumption may have a negative impact due to MeHg contamination. Some limits of the QALY approach are identified. The first concerns determination of the dose-response relationships. The second concerns the economic origins of the approach and of individual preferences. Finally, since only one beneficial aspect and one risk element were studied, consideration should be given to how other beneficial and risk components may be integrated in the model.