Enabling the transferability of complex interventions: exploring the combination of an intervention's key functions and implementation.

OBJECTIVES: Several public health interventions are not described, not evaluated and not transferred. The objective was to assess the feasibility and acceptability of using a description model making a distinction between interventions' transferable elements, and those that are more context-specific, to make their evaluation and transferability easier. METHODS: The theoretical distinction between an intervention function and its form in a specific context has been empirically explored. A community-based intervention (named "Ciné-Ma-Santé") has been described, using a "key function/implementation/context" model. This process has been co-constructed through qualitative research and knowledge exchange process between project leaders and researchers from different disciplines. RESULTS: The use of the model proves feasible and useful for both project leaders and researchers. Nine key functions were described, as well as their implementation and the features of the intervention context. CONCLUSIONS: Rendering explicit key functions of public health interventions could constitute a useful step to their evaluation and transfer. It enables the formulation of hypotheses regarding the potentially standardizable elements of interventions, and elements that can be modified while maintaining the integrity of the intervention.

A health equity impact assessment umbrella program (AAPRISS) to tackle social inequalities in health: program description.

BACKGROUND: The failure to simultaneously address two objectives (increasing the average health of the population and reducing health inequalities) may have led to what has been observed in France so far: an overall decrease in mortality and increase in inequality. OBJECTIVE: The Apprendre et Agir pour Réduire les Inégalités Sociales de Santé (AAPRISS) methodology is to analyze and modify interventions that are already underway in terms of their potential impact on health inequalities. It relies on partnership between researchers and actors in the health field, as well as policy makers. In this paper, we describe the program and discuss its feasibility and acceptability. METHODS: This program is not a single intervention, but a process aiming at assessing and reshaping existing health programs, therefore acting as a kind of meta-intervention. The program develops scientific and methodological support stemming from co-construction methods aimed at increasing equity within the programs. Stakeholders from prevention policy-making and the health care system, as well as researchers, collaborate in defining interventions, monitoring their progress, and choosing indicators, methods and evaluation procedures. The target population is mainly the population of the greater Toulouse area. The steps of the process are described: (1) establishment of AAPRISS governance and partnerships; (2) inclusion of projects; and (3) the projects' process. DISCUSSION: Many partners have rallied around this program, which has been shown to be feasible and acceptable by partners and health actors. A major challenge is understanding each partner's expectations in terms of temporality of interventions, expected outcomes, assessment methods and indicators. Analyzing the projects has been quite feasible, and some modifications have been implemented in them in order to take inequalities in health into account.

Evaluation d'impact sur la santé et évaluation d'impact sur l'équité en santé : éventail de pratiques et questions de recherche.

L'Evaluation d'Impact sur la Santé (EIS) se développe au niveau international et est encore au stade émergent en France. Elle vise à évaluer les effets positifs et négatifs potentiels d'un projet, d'un programme ou d'une politique sur la santé. L'objectif est de produire des recommandations en direction des décideurs, afin d'en maximiser les effets positifs et d'en diminuer les effets négatifs. L'EIS est un moyen particulièrement intéressant d'action sur les déterminants de la santé au-delà des comportements individuels et du système de santé. Les politiques de logement, de transport, de solidarité, économiques, etc. ont, en effet, des impacts souvent non prévus sur la santé. Au-delà des effets sur la santé, l'EIS doit aussi permettre d'apprécier la distribution de ces effets dans la population.Si la préoccupation pour l'équité en santé est centrale dans l'EIS, elle reste cependant difficilement traduite en pratique. Face à cette difficulté, des démarches d'évaluation d'impact ont été développées pour renforcer la prise en compte de l'équité à chaque étape de l'EIS ou « Equity Focused Health Impact Assessment ¼, ou prendre en compte les impacts sur les inégalités de santé de façon spécifique. Ainsi, l'Evaluation de l'Impact sur l'Equité en Santé (EIES) semble, par exemple, particulièrement intéressante pour évaluer l'impact sur les inégalités de projets dans le champ sanitaire.L'EIS et l'EIES posent de nombreuses questions de recherche, notamment autour de la réunion, dans une même démarche, du politique, du citoyen et de l'expert. La participation des populations vulnérables potentiellement affectées par la politique évaluée est une valeur centrale de l'EIS, mais pose des questions d'acceptabilité sociale. La collaboration avec les décideurs politiques est également un enjeu majeur. Les difficultés méthodologiques, notamment de quantification des impacts, peuvent constituer des freins à la promotion de la démarche auprès des décideurs.

[An intervention research program (AAPRISS) to reduce social inequalities in health: methods and validation]. / Un programme de recherche interventionnelle (AAPRISS) visant à réduire les inégalités sociales de santé : méthodes et validation.

OBJECTIVE: The AAPRISS intervention-research program (Apprendre et Agir Pour Réduire les Inégalités Sociales de Santé) aims to change prevention projects to improve the extent to which they take health inequalities into account. The goal is to assess a project's feasibility and its acceptability, from the viewpoint of the sponsors of the project in question, and to present its tools and potentially-transferable elements. PARTICIPANTS: Five cancer-prevention projects focused on nutrition have been included in the AAPRISS program: two projects conducted in school, one community-health project conducted in a disadvantaged neighbourhood and two hospital therapeutic-education programes. For each one, a workgroup was created bringing together the project sponsors and their team as well as researchers from various disciplines. LOCATION: The study involves projects currently underway in the Midi- Pyrénées region of France. INTERVENTION: AAPRISS is based on the exchange of knowledge among project sponsors and researchers and the co-construction of the analysis, reorientations and the assessment of the prevention projects included in the program. The validation of the program and its feasibility from the project sponsors' point of view is based on a questionnaire and presentations carried out during a symposium that took place in May 2014 in Toulouse. RESULTS: Twelve key program functions have been described. They have been shown to be feasible and acceptable and concrete project modifications towards a better consideration of social inequalities of health (SIH) have been realized in most of the projects. Co-construction among the stakeholders raises many issues and difficulties that could have been overcome by the establishment of a relationship of trust between project sponsors and researchers. CONCLUSION: The complexity of the determinants leading to SIH calls for programs that revisit existing projects rather than a new intervention aimed at reducing them.

[Interdisciplinarity in action: "trap-words" in interdisciplinary research]. / L'interdisciplinarité en action: les "mots-pièges" d'une recherche interdisciplinaire.

CONTEXT: Interdisciplinary work is essential to understand and address Social Inequalities in Health (SIH), but involves a number of practical difficulties. The AAPRISS programme, comprises project leaders and researchers from various disciplines in order to co-construct the reorientation of prevention projects, in order to more effectively reduce SIH. Certain challenges emerged during this project concerning the interdisciplinary work, especially misunderstanding of certain terms with different meanings according to various disciplines, within the same discipline, or even between British and US English. The objective is to identify these "trap-words" in order to create a glossary clearly explaining the various meanings, rather than rigidly defining a unique correct definition. METHODS: The words leading to misunderstandings were identified and several definitions were provided by participating researchers and literature searches. RESULTS: Five sets of words were defined: "politique, programme, projet et intervention"; "impact"; "ressortissant, public cible, population cible, bénéficiaire, et communauté"; "inégalités sociales de santé, disparités et iniquités"; and "protocole". DISCUSSION: Issues raised by the construction of this glossary, designed to support co-construction between researchers from different disciplines, allow reflection on the richness and difficulties of interdisciplinary research.

[Promoting sexual and reproductive health as part of an educational program among Romani women]. / Education a la santé reproductive et sexuelle avec des femmes rom.

In 2012, the "Centre d'Accueil, de Soins et d'Orientation" run by Médecins du Monde in Bordeaux (France) developed an educational program aimed at promoting sexual and reproductive health among Romani women from Bulgaria and Romania. A preliminary study was conducted using a qualitative methodology involving focus groups and individual interviews. A close relationship was found between the participants' cultural beliefs about sexual and reproductive health and their precarious living conditions. An analytical framework focusing on representations of motherhood and birth control highlighted the resources and constraints shaping their attitudes and the challenges they face. The results provide support for a recent attempt to promote health among Romani women living in the area. More specifically, an educational approach designed to provide support and assistance was recently developed to help women find solutions tailored to their needs and designed to increase their decision-making abilities. The program also involves an advocacy approach. The implementation of the project is further supported by an assessment process, which will be followed by a summative evaluation of the resulting effects and an assessment of the impact of the program on the perception of reproductive health among the local Romani population.