Smoking and mental disability : A mixed observational study using a diverse sample of medical-social establishments and services / Tabagisme et handicap psychique : étude observationnelle mixte dans un échantillon diversifié d'établissements et de services médico-sociaux.

INTRODUCTION: A multi-center observational study was carried out in ten ESMS, using a mixed methodology (site visits, questionnaire survey, semi-directive group interviews with professionals and individual interviews with users). PURPOSE OF THE RESEARCH: The aim of this article is to describe the management and prevention of smoking in ESMS for people with mental health disorders, and to characterize and identify the smoking behaviors and representations of ESMS users and the professionals working there. RESULTS: The study made it possible to distinguish between ESMS in terms of the organization of smoking areas and tobacco prevention initiatives. It also revealed that 37 percent of respondents among the professionals said they smoked tobacco, with some of them explaining that they smoked with users and sometimes gave them cigarettes. With regard to prevention, there was a consensus among professionals that they should help users who wanted to stop smoking. Professionals were divided, however, on the need for more active prevention, citing the users' freedom and the fact that ESMS are places where people live. Among the users, 47 percent said they were smokers. Of the users who smoked, 55 percent said they wanted to stop. Interviews with the users revealed that twelve of them wanted to quit, with some asking for help and more assistance from professionals. CONCLUSIONS: This report suggests that intervention research could be developed in ESMS for people with mental health disorders, who could benefit from the smoking prevention actions identified in the facilities and services investigated.

Introduction: Une étude observationnelle multicentrique a été réalisée dans dix ESMS et mobilisait une méthodologie mixte (visite des structures, enquête par questionnaires, entretiens semi-directifs collectifs avec des professionnels et individuels avec des usagers). But de l'étude: Cet article vise à décrire la gestion et la prévention du tabagisme dans des établissements et services médico-sociaux (ESMS) accueillant des personnes avec un trouble psychique, et à caractériser et identifier les comportements tabagiques et les représentations de leurs usagers et professionnels. Résultats: L'étude a permis de distinguer les ESMS au regard de l'organisation des espaces du tabagisme et des actions de prévention du tabac. Elle a permis également de constater que 37 % des professionnels qui ont répondu déclaraient fumer du tabac, une partie d'entre eux expliquant fumer avec les usagers et leur donner parfois des cigarettes. Concernant la prévention, un consensus se dégageait chez les professionnels sur le fait d'aider les usagers qui souhaitaient arrêter. Les professionnels étaient cependant divisés à l'égard d'une prévention plus active, invoquant la liberté de l'usager et le fait que les ESMS sont des lieux de vie. 47 % des usagers se disaient fumeurs. 55 % des usagers fumeurs déclaraient vouloir arrêter. Les entretiens avec les usagers ont permis de constater que douze d'entre eux souhaitaient arrêter, une partie réclamant de l'aide et d'être davantage aidés par les professionnels. Conclusions: Cet état des lieux invite à développer des recherches interventionnelles dans les ESMS accueillant des personnes avec un trouble psychique qui pourraient tirer profit des actions de prévention du tabac repérées dans des structures enquêtées.

[Healthy volunteers' protection around the world]. / VolREthics - Une initiative internationale de l'Inserm pour définir la protection des volontaires sains.

Healthy volunteers participating in biomedical research benefit from varying levels of protection in different parts of the world since they are too rarely identified as a specific subset of study participants with specific vulnerabilities and risks. These differences in protection can lead to unfair and ethically unacceptable situations. Healthy volunteers are subject to a number of risks, not only regarding the respect of their rights and of their health but they are also at risk of being exploited because of their financial situation, educational level and motivations. In the end, the scientific validity of the studies may also be called into question. Through its work, the VolREthics (Volunteers in Research and Ethics) initiative, set up by the Inserm ethics committee, outlines the ethical issues raised by the involvement of healthy volunteers in biomedical research, and highlights the need to improve their protection worldwide. Healthy volunteers are essential to scientific progress and society, and their potential vulnerabilities must be recognized and taken into account.

Title: VolREthics - Une initiative internationale de l'Inserm pour définir la protection des volontaires sains. Abstract: Les volontaires sains qui participent aux recherches biomédicales sont très rarement identifiés comme un groupe spécifique. Pourtant, de par leur vulnérabilité et les risques potentiels auxquels ils sont exposés, ils ne bénéficient que d'un niveau de protection qui reste variable selon les régions du monde. Il en résulte différents risques, non seulement pour le respect de leurs droits, de leur santé, mais également pour la validité scientifique des recherches. L'initiative internationale VolREthics (pour volontaires sains en recherche et éthique, ou Volunteers in Research and Ethics), lancée par le comité d'éthique de l'Inserm, a mis en évidence les questions éthiques soulevées par la participation des volontaires sains dans la recherche biomédicale. Elle insiste également sur la nécessité d'améliorer la protection de ces volontaires lors des recherches menées à travers le monde.

Improving autonomy support: a collaborative learning experience / Améliorer les pratiques d'accompagnement à l'autonomie en santé : effets d'un dispositif d'apprentissage coopératif

Introduction: The ACESO project, which was part of the Autonomy support in health national experimentation, brought together 21 partners from Ile-de-France. Among these partners, 14 had practices similar to autonomy support. Partners' presupposition was that experimenting a cooperative approach would encourage the empowerment of participants, improve their autonomy support and put into place the conditions necessary for the empowerment of people who would be supported. To help participants to meet this goal, the project leader took on a role as third party whose function was to facilitate the cooperative approach by proposing a framework and a method. Purpose of research: The study aimed to report the effects of this approach on the participants' practices as well as to identify the process for achieving this. Results: The participants' learning enabled them to align themselves with the good practice guidelines collectively constructed within the project. With the project leader's support, they initiated a transformative learning process that allowed them to develop their reflexivity and empowerment. These transformations had repercussions on their teams and structures, through a halo effect. The halo effect varied, in each partner structure, according to the participation and involvement of the project referent and the other members of the structure, in particular managers. Conclusions: This study has highlighted the value of a cooperative approach to facilitate the learning necessary for sustainable practices transformations and the improvement partners autonomy supports. This resulted in gains in autonomy for the autonomy support practitioners and the people they supported.

Introduction: Le projet ACESO, participant à l'expérimentation nationale des dispositifs d'accompagnement à l'autonomie en santé (AAS), a rassemblé 21 partenaires franciliens parmi lesquels 14 portaient des pratiques qui empruntent à l'accompagnement. Son présupposé était qu'en expérimentant une démarche coopérative favorisant l'empowerment des partenaires, ceux-ci amélioreraient leurs pratiques d'accompagnement et mettraient notamment en place les conditions nécessaires à l'empowerment des personnes accompagnées. Pour les y aider, le porteur de projet a tenu un rôle de tiers dont la fonction était de faciliter la démarche coopérative en proposant un cadre et une méthode. But de l'étude: L'étude visait à rendre compte des effets de cette démarche sur les pratiques des partenaires, ainsi qu'à identifier le processus pour y parvenir. Résultats: Les apprentissages réalisés ont permis aux partenaires de se donner des balises de bonnes pratiques construites collectivement au sein du projet (valeurs, principes et postures). Avec le soutien du tiers, ils ont initié un processus d'apprentissage transformationnel développant leur réflexivité et leur empowerment. Ces transformations ont eu des répercussions sur leurs équipes et structures, par effet de halo. Ce dernier a varié, dans chaque structure partenaire, en fonction de la participation et de l'implication du référent-projet et des membres de la structure, en particulier la direction. Conclusion: Cette étude met en évidence l'intérêt d'une démarche coopérative pour faciliter l'apprentissage nécessaire aux transformations durables des pratiques et l'amélioration des pratiques de partenaires d'un collectif apprenant. Dans le cas de l'AAS, ceci s'est traduit par des gains d'autonomie pour les accompagnants et les personnes accompagnées.

Determinants of maternal and household social inequalities of dental caries among Senegalese children in the Department of Pikine.

Introduction: the problematic of social Inequalities in oral health remains a global concern; it constitutes evidence of social injustice. The present work aims to study the determinants of maternal and household social inequalities of children´s dental caries in Pikine. Methods: cross-sectional epidemiological survey has been conducted in the department of Pikine, Senegal on 315 children aged 3 to 9 and their mothers. The clinical data on children´s caries have been obtained by clinical examination and the socio-economic data by a questionnaire submitted to mothers. Pearson chi-square and trend tests as well as a logistic model were used in the data analysis. Results: the prevalence of dental caries in children was 64.8% and the mixed decayed, filled, missing (DFM) index was 2.5 (±2.7). The trend test showed significant inequalities in the prevalence of dental caries according to level of studies (p<0.001), profession (p<0.010) and contacts frequency (p<0.001) of mothers; the level of wealth (p<0.001) and structure (p<0.005) of households. According to the logistic regression model, the level of secondary or university education [OR (IC 95%) = 0.59 (0.33'>OR (IC 95%) = 0.59 (0.33-0.93)] or social network dynamism [OR (IC 95%) = 0.32(0.15'>OR (IC 95%) = 0.32(0.15-0.67)] of mothers; as well as wealthy families [OR (IC 95%) = 0.23(0.08'>OR (IC 95%) = 0.23(0.08-0.64) were associated to fewer risks of dental caries among children. Conclusion: some socio-economic characteristics of the mother and the household social conditions are identified as determinants of dental caries social inequalities in Children. Proportionate universalism may be a good approach to reduce this problematic in Pikine.

Characteristics of oral health literacy in Senegal: A cross-sectional study among women in the Department of Pikine.

Senegal having a significant prevalence of socially differentiated oral diseases, oral health literacy (OHL), an individual and social resource, should be considered alongside a remedial response. This work aimed to analyze women's OHL characteristics. A cross-sectional study on 315 women in Pikine County was carried out, using the Oral Health Literacy-Adult Questionnaire (OHL-AQ) for the OHL data collection and a questionnaire for the women's socioeconomic characteristics data. These women had an OHL average score of 6.5±3.1 and a median of 6. Among them, 56.5% had a seemingly low OHL level, a little over 68.9% had a score above the median as regards the "listening, communication and understanding" aspect, 58.4% to "decision making", 55.2% to "understanding numbers" and 33% to "reading and understanding". According to a multivariate analysis, secondary and higher educated women (p<0.001) with an active social network (p<0.023), in a wealthy household (p<0.0001) and of nuclear household type (p<0.036) had a higher OHL level. Women in Pikine have low OHL and are from working- class households. Therefore, oral health policies must take into account the women's social network contribution to the OHL improvement.

Spatial determinants of excess all-cause mortality during the first wave of the COVID-19 epidemic in France.

BACKGROUND: The first wave of the COVID-19 pandemic in France was associated with high excess mortality, and anecdotal evidence pointed to differing excess mortality patterns depending on social and environmental determinants. In this study we aimed to investigate the spatial distribution of excess mortality during the first wave of the COVID-19 pandemic in France and relate it at the subnational level to contextual determinants from various dimensions (socioeconomic, population density, overall health status, healthcare access etc.). We also explored whether the determinants identified at the national level varied depending on geographical location. METHODS: We used available national data on deaths in France to calculate excess mortality by department for three age groups: 0-49, 50-74 and > 74 yrs. between March 1st and April 27th, 2020. We selected 15 variables at the department level that represent four dimensions that may be related to overall mortality at the ecological level, two representing population-level vulnerabilities (morbidity, social deprivation) and two representing environmental-level vulnerabilities (primary healthcare supply, urbanization). We modelled excess mortality by age group for our contextual variables at the department level. We conducted both a global (i.e., country-wide) analysis and a multiscale geographically weighted regression (MGWR) model to account for the spatial variations in excess mortality. RESULTS: In both age groups, excess all-cause mortality was significantly higher in departments where urbanization was higher (50-74 yrs.: ß = 15.33, p < 0.001; > 74 yrs.: ß = 18.24, p < 0.001) and the supply of primary healthcare providers lower (50-74 yrs.: ß = - 8.10, p < 0.001; > 74 yrs.: ß = - 8.27, p < 0.001). In the 50-74 yrs. age group, excess mortality was negatively associated with the supply of pharmacists (ß = - 3.70, p < 0.02) and positively associated with work-related mobility (ß = 4.62, p < 0.003); in the > 74 yrs. age group our measures of deprivation (ß = 15.46, p < 0.05) and morbidity (ß = 0.79, p < 0.008) were associated with excess mortality. Associations between excess mortality and contextual variables varied significantly across departments for both age groups. CONCLUSIONS: Public health strategies aiming at mitigating the effects of future epidemics should consider all dimensions involved to develop efficient and locally tailored policies within the context of an evolving, socially and spatially complex situation.

Which determinants should be considered to reduce social inequalities in paediatric dental care access? A cross-sectional study in France.

Better access to dental care through systemic and educational strategies is needed to lessen the burden of disease due to severe early caries. Our study aims to describe family characteristics associated with severe early caries: parental knowledge, attitudes, practices in oral health and socio-demographic factors. For this cross-sectional study, 102 parents of children aged under 6 years with severe early caries and attending paediatric dentistry service in France completed a questionnaire during face-to-face interviews. Caries were diagnosed clinically by calibrated investigators, using the American Academy of Paediatric Dentistry criteria, and dental status was recorded using the decayed, missing, and filled teeth index. The majority of children were from underprivileged backgrounds and had poor oral health status, with a median dmft index of 10. Parents highlighted the difficulty of finding suitable dental care in private practices. Parents appeared to have good oral health knowledge and engaged in adapted behaviours but showed a low sense of self-efficacy. They perceived the severity of early caries as important but the susceptibility of their child as moderate. The study affirmed the importance of improving the accessibility of paediatric dental care and developing educational strategies to enhance the knowledge, skills, and oral health practices of families.

Mothers' oral health literacy and children's oral health status in Pikine, Senegal: A pilot study.

CONTEXT AND OBJECTIVE: As elsewhere, disadvantaged children in Senegal are those most affected by dental diseases and difficulties in obtaining dental care. Studies conducted mainly in developed countries suggest that a low level of mothers' OHL is correlated with poor oral health of their children. The objective of this study is to estimate the level of mothers' OHL in Senegal and its relationto the dental health of their children. METHODS: This cross-sectional epidemiological survey took place among 315 children aged from 3 to 9 years old and their mothers. It estimated the children's dental health status by clinical examination which used a disposable examination kit and a headlamp, took place at the child's home, in the mother's presence. Examiners interviewing the mothers administered the Oral Health Literacy-Adult Questionnaire to determine their OHL and questioned them further about their social characteristics and their children's dental health behaviour. Logistic regression and correlations were used for the statistical analysis. RESULTS: The OHL score ranges from 0 to 17; mothers' mean score was 6.5 (±3.1) and 56.5% had a low score (below the median). The prevalence of dental caries in children was 64.8%. Mothers' high OHL is associated with children caries free and low prevalence of dental caries. The logistic regression showed a significantly protective relation between children's dental caries and mothers' high OHL scores (mean score 12-17) (OR = 0.51, 95% CI: 0.29-0.88), high educational level (OR = 0.42, 95% CI: 0.23-0.76) and a high level of social contact (OR = 0.31, 95% CI: 0.15-0.63). The structural analysis showed that OHL was significantly correlated with both the mothers' social position (r = 0.61 and P<0.001) and the children's caries (r = -0.26 and P<0.001). CONCLUSION: The OHL level of Senegalese mothers was significantly associated with their children's dental caries. Improving mothers' OHL might therefore help strengthen their capacities to promote oral health, thus helping to improve their children's dental health and reduce inequalities.

L'évaluation des projets d'accompagnement à l'autonomie en santé : pourquoi privilégier une approche pragmatiste ?

INTRODUCTION: In connection with article 92 of the last Health Act, twenty-eight projects are being tested nationwide with a view to demonstrate the value of support to gain autonomy in health. These projects will be assessed on a case-by-case basis according to their specific situations. However, with the possible generalization of this type of programs, it was also necessary to assess them against the same frame of reference. METHOD: To this end, a participatory approach was conducted with their coordinators to identify a single evaluation framework, even though these projects were very heterogeneous. RESULTS: This development process led to the identification of a common intervention logic that made it possible, in the aftermath, to define support for autonomy in health, i.e. to set out the conditions under which a health intervention may be used. A pragmatic vision guided the production of the evaluation framework which articulates four dimensions (individual empowerment, enabling environment, collective empowerment, organizational empowerment) composed of 21 criteria and presented as inseparable. DISCUSSION: According to this logic, the process of empowering individuals, as an objective of interventions, cannot be pursued if it is not embedded in practices that are consistent with the values inherent to the original intention. This also calls for the effects of the empowerment of supported persons to be granted as much importance as the processes of the interventions and the learning processes of individuals and organizations.

Decisional issues in antibiotic prescribing in French nursing homes: An ethnographic study.

Background:Medication prescription is generally the responsibility of doctors. In nursing homes, the nursing staff is often the first to suspect an infection. Today, physicians are more confident with nursing assessment, relying primarily on nursing staff information. Very few studies have investigated the nurses' influence on decision of medical prescription. This study investigates the role of nurses in antibiotic prescribing for the treatment of suspected infections in nursing home residents. Design and methods:An ethnographic study based on semi-structured interviews and participant observations was conducted. Sixteen nurses and five doctors working in five nursing homes in Paris, France participated between October 2015 and January 2016. Results:Given their proximity to elderly residents, registered nurses at the nursing homes occasionally assisted doctors in their medical diagnostic. However, nurses who are theoretically incompetent have met difficulties in their ability to participate in their decisions to prescribe antibiotics when managing residents' infections. Conclusion: if proximity and nursing skills reinforce the relevance of the clinical judgment of nurses, the effective and collaborative communication between the nurse and the doctor may help the nurse to enhance their role in the antibiotic prescribing in nursing homes, which would enhance antimicrobial stewardship efficiency.

[Towards equity in migrant's health ?] / Quelles pistes pour améliorer la santé des migrants en situation de vulnérabilités ?

Migrant populations, due to their condition of migrants, are exposed to structural vulnerability factors, which influence their health status. Globally, evidences on the negative impact of these structural factors on migrants' health are increasing. We hereby describe these structural factors, which exert their influence at health system's macro-, meso- and micro-levels. We then propose some solutions in order to mitigate the negative effects of these factors on migrants' health. We highlight some key attributes which would qualify an organization as "health literacy sensitive", which would constitute a step towards migrant's health equity.

QUELLES PISTES POUR AMÉLIORER LA SANTÉ DES MIGRANTS EN SITUATION DE VULNÉRABILITÉ ?. Les migrants sont exposés, du fait de leur situation de migration, à des facteurs structurels de vulnérabilité, qui affectent leur santé. Après une brève revue de la littérature mondiale qui confirme l'impact négatif de ces facteurs structurels sur la santé des migrants, nous proposons quelques pistes pour mitiger ces facteurs, aux niveaux « micro ¼, « méso ¼ et « macro ¼ du système de santé. Nous fournissons entre autres une liste d'attributs qui qualifieraient une organisation de « conscience à la littératie en santé ¼, ce qui contribuerait à tendre vers l'équité en santé.

Nursing Role for Medication Stewardship Within Long-Term Care Facilities.

Elderly residents in long-term care facilities (LTCFs) constitute a population noted to have a large number of medications prescribed and administered. The aim of this article is to explore the nursing role for medication management, with an emphasis on antimicrobial stewardship, guided by disciplinary knowledge of King's theory of goal attainment and skill-based medication knowledge. The outcome is a nursing workforce truly engaged in working with interdisciplinary colleagues and focusing on care planning that includes medication management to improve the health status of residents in long-term care facilities.

ATOUM 6: does a multimodal intervention involving nurses reduce the use of antibiotics in French nursing homes?: A protocol for a cluster randomized study.

INTRODUCTION: Urinary tract infection (UTI) is common in elderly living in nursing homes, and antibiotics prescription for this infection is particularly challenging. In these facilities, due to the absence of on-site physicians, nurses play an essential role when an infection is suspected, as they are the ones who collect and communicate by phone all the information needed by the physician for the decision-making process. In that context, our study aims to reduce antibiotic consumption in nursing homes, using a multimodal intervention, by strengthening nurses' involvement during the process of prescription for UTI. METHODS/DESIGN: This is a planned 2-arm cluster randomized study of 40 nursing homes randomly assigned either to the control group or to the intervention group, using a 1:1 ratio. The intervention consists of reinforcing the nurses' knowledge concerning antibiotics and UTI; assist their clinical judgment using a decision aid diagram; improving their communication skills with the residents, their relatives, and the prescribers; and also increasing their involvement in the intervention' process by organizing a competition opposing the nursing homes of the interventional group to select additional intervention tools. ANALYSIS: The main outcome is the reduction of the relative frequency of antibiotics prescription for UTIs in the interventional group. ETHICS AND DISSEMINATION: Ethics approval was obtained from the French Committee for the Protection of Persons (N. 19.01.04/SI CNRIPH 18.12.07.48123). An article including the main outcome will be submitted to a peer review journal.

Health enhancing physical activity in all policies? Comparison of national public actors between France and Belgium.

Despite evidence on the benefits of health enhancing physical activity (HEPA), only few countries have developed "health in all policies" and specifically integrated HEPA policies. Paucity of studies have questioned the role of public national actors in PA policies enactment and delivery, the barriers and levers for adopting cross-sectoral HEPA. The present work seeks at comparing France and Belgium in regard to their competencies of ministries promoting HEPA, the presence of leadership and coordination in HEPA policies implementation, their key public legal entities working on HEPA. Expert interviews and document analysis were realized to complete the HEPA policy audit tool in each country. Results have shown that HEPA cross-sectoral policies are at their early stage. A broad diversity of sectors was implicated in HEPA policies: sport, health, transport, environment, and education, but often with weak activity. No leadership or coordination exist to implement HEPA policies, although different public legal entities could work on this aim. Ministries relationships were principally coming from formal co-interventions mandated by national public plans in France, where in Belgium relationships were punctual. Lobbying within each sector and in key public legal entities to promote HEPA is needed, and the development of official national coordination is essential.

Impact of fruits and vegetables vouchers on food insecurity in disadvantaged families from a Paris suburb.

BACKGROUND: Social inequalities in nutrition lead a high number of families to struggle with food insecurity, even in developed countries. We aimed to assess the impact of fruits and vegetables vouchers on food security among disadvantaged households from a Paris suburb. METHODS: We used a pre-post assessment design. Families answered face-to-face questionnaires on food consumption and food security status before and after a randomly assigned intervention. Households in the intervention group received vouchers to buy exclusively fruits and vegetables over one year. Both intervention and control groups benefitted from nutritional education through workshops performed by dieticians during the study period. The Household Food Security Module (HFSM) was used to assess food security status of households at inclusion. Food Insufficiency Indicator (FSI) was used to assess food security at inclusion and follow-up. Evolution of FSI on both groups was evaluated using McNemar test. RESULTS: Among the 91 families included between May 2015 and May 2016, 64 completed the post assessment questionnaire. At inclusion, 68.3% of families were experiencing food insecurity and 78.1% were experiencing food insufficiency. No association was found between food consumptions and food security status. After one-year follow-up, the prevalence of food insufficiency was significantly decreased in the intervention group (61.8%, with p value = 0.03), and unchanged in the control group. CONCLUSION: In this pilot study, food insufficiency was significantly decreased in families receiving vouchers for fruits and vegetables over a one-year period. TRIAL REGISTRATION: NCT02461238, registered 3 June 2015 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT02461238.

A qualitative study on the educational needs of young people with chronic conditions transitioning from pediatric to adult care.

OBJECTIVES: Although patient education is recommended to facilitate the transition from pediatric to adult care, a consensus has not been reached for a particular model. The specific skills needed for the transition to help in facilitating the life plans and health of young people are still poorly understood. This study explored the educational needs of young people with diverse chronic conditions during their transition from pediatric to adult care. METHODS: Qualitative semi-structured interviews were conducted with 17 young people with chronic conditions. A thematic analysis was conducted to examine the data. RESULTS: Five themes emerged from the data, identified through the following core topics: learning how to have a new role, learning how to adopt a new lifestyle, learning how to use a new health care service, maintaining a dual relationship with pediatric and adult care, and having experience sharing with peers. CONCLUSION: A shift in perspective takes place when the transition is examined through the words of young people themselves. To them, moving from pediatric to adult care is not viewed as the heart of the process. It is instead a change among other changes. In order to encourage a transition in which the needs of young people are met, educational measures could focus on the acquisition of broad skills, while also being person-centered.

[Methodological approaches to the evaluation of Local Health Contracts and their capacity to reduce social inequalities in health]. / Repères méthodologiques pour l'évaluation des Contrats Locaux de Santé et de leur capacité à réduire les inégalités sociales de santé.

INTRODUCTION: Local health contracts are a promising tool to reduce social and geographical inequalities in health. They are optimally effective when they are designed to mobilize the resources of various sectors to target the essential, upstream determinants of inequalities. METHODS: We propose a checklist of their capacities to achieve this goal, comprising two parts. RESULTS: the targets and objectives of each action (what needs to be changed to achieve what long-term results?); and the strategies and modalities of intervention to address the issue of how to act. An example of application to a sample of first-generation contracts in the Ile-de-France region is presented, showing the importance attributed to the health system rather than to the inhabitants' living conditions. DISCUSSION: The authors discuss the limits of a working tool that does not address either the conditions of implementing actions according to territories or regional governance.

[How do general practitioners promote a more equitable access for patient education?]. / Comment les médecins généralistes favorisent-ils l'équité d'accès à l'éducation thérapeutique pour leurs patients.

Our research is designed to understand how and under what conditions general practitioners contribute to equitable access to patient education (PE).We conducted a survey based on interactionist sociology in a sample of 32 doctors. These practitioners worked in the context of health networks and health care centres and were also involved in the PE resource centre for the Île-de-France region, thereby providing a favourable setting for our study, also reflected by the fact that one-half of practitioners were aware of the importance of or had been trained in PE.Doctors stress that their engagement in the patient-doctor relationship does not depend on the patient's psycho-social characteristics. Their educational practice nevertheless appears to be influenced by their a priori judgement of these characteristics. Based on their judgement, some clinicians develop practices that seem to promote better access for their socially underprivileged patients. This process is facilitated by several dynamics described in this article.The results of this research open up opportunities for office-based physicians and PE development structures to facilitate better access to PE for all patients.

Recruitment of precarious families in an interventional study: Lessons from the French "Fruits and vegetables at home" (FLAM) trial.

BACKGROUND: The FLAM study was set up in order to assess the effectiveness of FV vouchers allowed to low-income households, on their FV consumption. The aim of the present study was to investigate issues associated with conducting interventional trials in disadvantaged populations using the FLAM study as an example of reaching target populations and recruitment difficulties. METHODS: Families were recruited in Saint-Denis city (North Paris suburb), via social and municipal structures. Main interest variables in the study (food consumptions) were collected using face-to-face food interviews, either at home or municipal facilities. A qualitative analysis was performed among people who refused to participate in order to understand the barriers to participation. RESULTS: A total of 95 parents-child pairs were included from May 2015 to May 2016. The families were mostly in precarious situation (63.3%), and most of parents were unemployed (71.3%). Almost the two third of children and 79.4% of parents were small consumers of FV (less than 3.5 servings per day). Several reasons for non-participation were reported including time constraints, understanding and mistrust issues. CONCLUSIONS: Though using facilitating strategies, we recruited fewer participants than expected. The population finally included was mainly made of precarious families with a low consumption of FV. These results highlight the importance of identifying effective facilitating strategies to improve recruitment in disadvantaged populations. TRIAL REGISTRATION: ClinicalTrial.gov no. NCT02461238, on June 3, 2015, retrospectively registered.