Monitoring Surveys in the Context of Covid-19, Published in Belgium and France, in the Light of Health Democracy.

Introduction: The management of a pandemic, such as COVID-19, requires the full participation of citizens. This recent situation has revealed the undermining of user participation in the decision-making process. Thus, this study aims to assess the involvement of users in the design and administration of surveys for health crisis monitoring and to stimulate reflection on information processes shared upstream during the decision-making process. Methods: A literature search was conducted on population monitoring surveys published during the first containment period in Belgium and France between April and May 2020. The selected studies were first analyzed according to a reading grid based on the criteria proposed by the World Health Organization (WHO) for monitoring populations and supplemented by data from a descriptive analysis of the selected studies. Second, with the objective of specifically evaluating the involvement of users in monitoring surveys, this study evaluated the surveys according to the following parameters: content of a study based on themes presented in surveys; inclusion of health literacy (HL); and factors of commitment of the respondents to the survey. Results: A total of 45 studies were selected for final analysis. The majority of the surveys focused on the effect of COVID-19 on well-being. Furthermore, analysis indicated that, in summary, the HL of people concerned as well as the involvement of respondents is poorly considered, which remains limited in terms of the design and administration of the surveys. Discussion: Although the principles of health democracy seemed to have been established, the exceptional regime induced by the epidemic overlooked the observance of such principles. This result indicates the need to reconsider the participation of citizens as real partners in care, including health crisis management.

CEdRIC: Strategy for Patient Education During COVID-19 Triage.

The current coronavirus disease 2019 (COVID-19) pandemic is forcing healthcare systems around the word to organise care differently than before. Prompt detection and effective triage and isolation of potentially infected and infectious patients are essential to preventing unnecessary community exposure. Since there are as yet no medications to treat or vaccines to prevent COVID-19, prevention focuses on self-management strategies, creating patient education challenges for physicians doing triage and testing. This article describes a five-step process for effectively educating, at discharge, patients who are suspected of being infectious and instructed to self-isolate at home. We are proposing the CEdRIC strategy as a practical, straightforward protocol that meets patient education and health psychology science requirements. The main goal of the CEdRIC process is to give patients self-management strategies aimed at preventing complications and disease transmission. The COVID-19 pandemic is challenging clinicians to rapidly teach their patients self-management strategies while managing the inherent pressures of this emergency situation. The CEdRIC strategy is designed to deliver key information to patients and standardize the discharge process. CEdRIC is currently being tested at triage centres in Belgium. Formal assessment of its implementation is still needed.

[Therapeutic education in pediatric dentistry: analysis of obstacles and levers to the development of programmes in France in 2016]. / Éducation thérapeutique en odontologie pédiatrique : analyse des obstacles et leviers au développement de programmes en France en 2016.

OBJECTIVE: Over recent years, therapeutic patient education has become part of dental medicine. Management of early childhood caries, known to be a very common chronic disease, has evolved to include an educational dimension. The objective of this study was to identify the levers and barriers to the development of formalized therapeutic education programmes and alternatives. METHODS: A comprehensive exploratory qualitative study was conducted between November 2015 and June 2016 on a targeted sample of 15 people aware of the problem of TPE in dentistry. RESULTS: The study showed that TPE training in dentistry is underdeveloped, despite its numerous benefits: change of the healthcare professional's approach, implementation of structured educational programmes, development of research, etc. There are many obstacles to the development of TPE programmes: insufficient resources, rigid legislation or lack of knowledge of TPE practices. The dental profession is an obstacle itself because of its lack of understanding and variable degrees of integration the medical community. There are multiple levers, but the main ones are changing attitudes of the profession and the provision of resources to develop TPE. Although alternatives to TPE programmes exist (accompanying measures, short educational strategies, connected health), they cannot replace TPE. CONCLUSION: More educational strategies must be developed in the field of dentistry. However, the framework of TPE must be adapted to the profession to ensure good uptake.

[The needs and expectations of HIV patients before starting a therapeutic patient education program]. / Besoins et attentes des patients vivant avec le VIH dans la perspective de la mise en place d'un programme d'éducation thérapeutique.

OBJECTIVES: The purpose of this study was to identify and quantify needs and expectations among HIV patients with a view to developing and implementing a therapeutic patient education program. MATERIALS AND METHODS: A qualitative study using semi-structured interviews was conducted to identify patient education needs. A quantitative study based on a personal questionnaire was subsequently conducted at the teaching hospitals of Nantes and Angers (France). RESULTS: The study was based on a sample of 351 patients (73% of the sample were men and 27% were women). The mean age of the participants was 45.7 years. 73% of the patients stated that they had spoken to a hospital practitioner, while just 29% claimed to have spoken to nurses. 83% stated that they were satisfied with the availability of nursing staff. 88% considered that practitioners explained their treatment decisions, while 80% stated that they had been asked for their opinion. Of the 301 patients treated, 97% felt that they were able to correctly take their medication, while 48% felt that they had no knowledge of HIV-related complications. 68% of the patients expressed concerns about infection risks, particularly young patients (p< 0.001). Concerning the side effects of treatment (lipodystrophy, pain, insomnia, physical changes), half of the patients felt that they had been adequately informed. In terms of emotional support, 79% of the patients stated that they had someone to talk to in the event of a problem. Half of the patients felt isolated and 19% felt discriminated against. Three quarters of the patients did not wish to discuss their financial difficulties, their work problems or the death of a close relative due to HIV infection. Finally, patients treated for more than ten years felt a stronger need to join an association (p = 0.001). CONCLUSION: The results suggest the need to improve patients' ability to express their needs, particularly those who are not members of an association. In addition to the implementation of a therapeutic education program, a social support program is also needed.

[Hemophilia patient education: teaching and assessment of 10 programs]. / Éducation thérapeutique des patients hémophiles : évaluation pédagogique et formative de 10 programmes.

A group of health professionals and patients conducted a pedagogical assessment of Therapeutic Patient Education (TPE) in haemophilia in France, focused on 2 main subjects: "the objectives and aims of TPE programs" and "the health professionals' ability to lead and contribute to TPE programs" (3). The use of a research laboratory and a participatory methodology allowed for identifying the assessment's challenges and contributed to its smooth running. TPE is starting to be integrated with medical care for patients, and a multidisciplinary approach better meets patients' educational needs. Two prerequisites for improving the pedagogical quality of these programs are self-reported patient needs and coordination of the TPE activities. The parties involved in this study are now better prepared to meet the ARS (4) TPE program specifications in haemophilia, and, importantly, are better prepared to undergo the assessment that takes place every 4 years.

[The development of therapeutic education in France: current public policies and treatment options]. / Le développement de l'éducation thérapeutique en France: politiques publiques et offres de soins actuelles.

Therapeutic patient education (TPE) has significantly expanded in the last few years. This article explains the major trends underpinning and supporting its development in France, and how they have rendered it a central place in the system, and provided an integral role for therapeutic education within the wider perspective of medical care and treatment options. The organisation of TPE is analysed and numerous initiatives in hospitals, medical and health care structures, social centres, cities, and non-profit organisations are described. This analysis suggests a range of proposals in order to structure and integrate TPE in a sustainable manner for the long term, as well as to expand the existing initiatives to have a broader reach across the country.

[The development of therapeutic education in France: proposals for its sustainable integration in the health system]. / Le développement de l'éducation thérapeutique en France: propositions pour une intégration durable dans le système de soins.

The significant development of therapeutic patient education (TPE) in light of the current disparities observed in the organization of health care necessitates the consideration and delineation of proposals to better integrate TPE in the French health care setting and context in the long term. These proposals take into account the fundamental values of therapeutic patient education as well as the specificities of chronic disease management. They are based on actual examples from practice in medical structures that are recognized for the implementation of TPE activities and programmes: they aim at strengthening these through networking and at facilitating the work of all health professionals regardless of the methods of practice relative to the specific medical interventions they perform. These proposals aim to enrich current thinking on the organization, value and benefits of investing in TPE.

[Implementation and assessment of an HIV treatment training program (2000-2001) for patients in Casablanca (Morocco)]. / Mise en oeuvre et évaluation d'un programme d'éducation thérapeutique (2000-2001) pour les patients atteints du VIH à Casablanca (Maroc).

An educational program to improve the management of HIV patients was introduced in the department of infectious diseases of Ibn Rochd hospital, Casablanca, Morocco in January 2000. The project, funded by the GlaxoSmithKline Foundation, began by training ward physicians as well as volunteers from the ALLOCS (Association de lutte contre le sida) in pedagogy and patient education techniques (four-day course). Other sessions reviewed HIV management and treatment. Treatment training sessions were offered to all patients receiving antiretroviral treatment when the program began. All had been taking medication for at least two months and gave their informed consent to participation in the project. Each patient's sessions took place just after his or her medical consultation, in a room set aside for this purpose in the hospital. During the first session the educator established an educational diagnosis and defined educational objectives according to the individual patient's needs. Objectives were related to patients' knowledge about HIV transmission prevention and treatment management (including problem-solving for mild adverse events, delays, forgetting, vacations etc.). Trainers used several educational tools, including therapeutic planning (planning card with self-adhesive stickers showing the treatment medication); a folder of drawings depicting HIV transmission, prevention, and natural history, as well as the aims of antiretroviral therapy; decks of cards illustrating symptoms and psycho-sociological problems. Each patient had to attend at least 3 educational sessions. The program was evaluated at the end of one year. Patients' attendance, treatment adherence, laboratory test results (CD4 count, viral load), satisfaction about patient-staff relationships and knowledge about HIV disease and treatment were assessed on an on-going basis with various questionnaires and data collection systems. In all, 96 patients attended classes, with a mean of 14 sessions per patient per year. After 6 and 12 months of training, patients' CD4 cell counts increased, and the proportion with viral loads below the detection level rose, as did adherence scores. Patients' knowledge appeared to have improved at 6 months but regressed somewhat at 12 months. This may be explained by program timing: most educational sessions take place during the first 6 months of patient enrolment in the program. Patient satisfaction about the program and their care reveals that they acquired autonomy in managing their disease and treatment. Their satisfaction at 12 months, however, was lower than it was at 6 months. One explanation may be that more educated patients are more demanding, but another is the staff turnover in the program. New staff may have required more support and training than was then available. This pilot program allowed us to draft guidelines for setting up educational programs for HIV patients in relatively poor countries.