Perceived Benefits and Disadvantages Associated with the Use of the Electronic Consultation Register by Health Providers in the Health District of Toma, Burkina Faso.

Background and Objective: Most countries in sub-Saharan Africa need to catch up in integrating information and communication technologies (ICT) into their health systems. This is mainly because of the need for more infrastructure that allows for reasonable use of the technologies. To support the actions of the Ministry of Health of Burkina Faso, a Non-governmental Organization (NGO) has implemented the integrated electronic diagnostic approach (IeDA) Project. The project includes the deployment of an electronic consultation register (ECR). This article aims to explore the perceptions of healthcare providers on the benefits and disadvantages of using the ECR. Methods: We conducted a qualitative, descriptive study through individual semi-structured interviews with healthcare providers. Data were collected in the Toma health district in December 2021. In addition, a thematic analysis was performed using NVivo software. Results: Thirty-five healthcare workers were interviewed (19 nurses, 7 midwives, 6 mobile community health and hygiene workers, and 3 birth attendants). Two main themes emerged from our analyses, which are the advantages and disadvantages perceived by ECR users. Our data suggest that using the ECR had many benefits ranging from improving healthcare providers' knowledge and performance in terms of patients' care, assisting and helping in patient diagnosis and treatment and improving patient satisfaction. However, the participants also shared their negative perceptions about the ECR, mentioning that it increased their workload. They also reported lengthened consultation time and work duplication as the tool was still in its trial phase and was used along with the paper consultation register. Conclusion and Global Health Implications: The ECR is an effective tool for diagnosis and management, which has several advantages and reasonably satisfies patients. However, disadvantages, including increased workload and lack of fluidity and stability of the system, must be considered to ensure better usability.

Barriers and enablers to the implementation of one health strategies in developing countries: a systematic review.

Introduction: One Health is a concept that establishes the link between humans, animals and the environment in a collaborative approach. Since One Health's inception, several interventions have been developed in many regions and countries worldwide to tackle complex health problems, including epidemics and pandemics. In the developed world, many collaborative platforms have been created with an international strategy to address issues specific or not to their environment. Unfortunately, there is a lack of synthesis on the challenges and opportunities Low and Middle-Income Countries (LMICs) face. Methods: Following The Preferred Reporting Elements for PRISMA Systematic Reviews and Meta-Analyses (PRISMA), we conducted a systematic review. We applied a search strategy to electronic bibliographic databases (PubMed, Embase, Global Health, Web of Science and CINAHL). We assessed the included articles' quality using the Mixed Methods Appraisal tool (MMAT). Results and discussion: A total of 424 articles were initially identified through the electronic database search. After removing duplicates (n = 68), 356 articles were screened for title and abstract, and 16 were retained for full-text screening. The identified barriers were the lack of political will, weak governance and lack of human, financial and logistics resources. Concerning the enablers, we listed the existence of a reference framework document for One Health activities, good coordination between the different sectors at the various levels, the importance of joint and multisectoral meetings that advocated the One Health approach and the Availability of funds and adequate resources coupled with the support of Technical and Financial partners. Conclusion: One Health strategy and interventions must be implemented widely to address the rising burden of emerging infectious diseases, zoonotic diseases, and antimicrobial resistance. Addressing those challenges and reinforcing the enablers to promote managing global health challenges is necessary. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/record_email.php, Unique Identifier: CRD42023393693.

Vulnerability analysis of Haitian adolescent girls before pregnancy: a qualitative study.

OBJECTIVES: This article aims to analyze the vulnerabilities experienced by Haitian adolescent girls before their pregnancy. METHODS: A qualitative research design was developed from Dewey's social survey. From October 2020 to January 2021, semi-structured interviews were conducted with 33 pregnant adolescents living in Haiti's North and North-East departments. Thematic data analysis was performed using the qualitative data analysis software QDA miner, 6.0.5. RESULTS: The adolescent girls interviewed were between 14 and 19. The study showed that adolescent girls experienced economic and social hardship, gender issues, and barriers to contraceptive use before pregnancy. These girls have experienced restrictive conditions that make them vulnerable to risky sexual practices and unwanted pregnancy. CONCLUSIONS: The results have indicated that Haitian adolescent girls' vulnerabilities before their pregnancy result from economic, social, and cultural injustices to which they are exposed from early childhood. These adolescent girls are also highly vulnerable to sexual exploitation and rape, as well as pregnancy. It is essential to address these issues when implementing programs aimed at improving the living conditions of adolescents in Haiti, including the prevention of early and unwanted pregnancy.

De-medicalized and decentralized HIV testing: a strategy to test hard-to-reach men who have sex with men in Cameroon.

Conventional HIV testing performed by a health professional has shown its limitations in targeting marginalized and vulnerable populations. Indeed, men who have sex with men (MSM) due to social discrimination are often uncomfortable using this service at the health facilities level. In this perspective, new differentiated approaches have been thought through de-medicalized and decentralized HIV testing (DDHT). This HIV testing strategy enables overcoming the structural, legal, and social barriers that prevent these populations from quickly accessing HIV services. This article discusses the prerequisites and added value of implementing this strategy for MSM living in a criminalized context and its implication in decentralizing health services toward the community level.

Evaluating the effects of an intervention to improve the health environment for mothers and children in health centres (BECEYA) in Mali: a qualitative study.

Introduction: an intervention aiming to improve the maternal and children environment in healthcare facilities (BECEYA) was launched in three regions of Mali. This study aimed to explore the perceptions and experiences of patients and their companions, community actors, and healthcare facilities staff on the effects of the BECEYA intervention in two regions of Mali. Methods: we conducted a qualitative study using an empirical phenomenological approach. Through purposive sampling, women who attended antenatal care in the selected healthcare centres, companions, and health facility staff members were recruited. Data were collected during January and February 2020 through semi-structured individual interviews and focus groups. According to Braun and Clarke's approach, audio recordings were transcribed verbatim, and a thematic analysis was conducted in five main steps. Donabedian conceptual framework of quality of care was used to present the perceived changes following the implementation of the BECEYA project. Results: we recruited 26 participants in individual interviews (20 women attending prenatal care and maternity services, 10 per health centre, four companions, and two healthcare centre managers) and 21 healthcare centre staff members (10 in Babala, 11 in Wayerma 2) in focus groups. Themes that emerged from data analysis are perceived changes in terms of infrastructure (perceived changes in the characteristics of the healthcare facilities setting, including the infrastructure introduced by the BECEYA project), process (changes in the delivery and use of care introduced or resulting from BECEYA activities), and outcome (the direct and indirect effects of these changes on the health status of patients and the population). Conclusion: the study highlighted some positive effects on women users of the services, their companions, and health centre staff following the implementation of the intervention. This study contributes to showing some links between improving the environment of healthcare centres and the quality of care in developing countries.

Socioecological analysis of determinants of early adolescent sexuality in Benin: a qualitative study.

Introduction: early adolescent sexuality is associated with an increase in risky sexual behaviour, unwanted pregnancies, and the occurrence of sexually transmitted infections. However, despite the efforts of governments and their partners, the implementation and effectiveness of appropriate and adapted services to improve adolescent sexual and reproductive health are lagging. Therefore, this study aimed to document determinants of early adolescent sexuality in the central district of Tchaourou in Benin based on a socio-ecological approach. Methods: an explorative and descriptive qualitative study was conducted using focus groups and individual interviews based on the socio-ecological model. Participants included adolescents, parents, teachers, and community leaders in Tchaourou. Results: the number of participants in each focus group was 8 (32). There were 20 girls and 12 boys aged 10-19 years, of whom 16 were students (7 females and nine males) and 16 were apprentice dressmakers and hairdressers. In addition, five participants attended individual interviews (two community leaders, one religious' leader, one teacher and one parent). Four themes were identified that influence early sexuality among adolescents and grouped into individual determinants related to knowledge about early sexuality; interpersonal determinants related to adolescents' function, including the influence of family and peers; community and organizational determinants related to where harmful sociocultural norms; political determinants comprising the disadvantaged socioeconomic status of the communities where adolescents live. Conclusion: many factors at multiple social levels influence early adolescent sexuality in the commune of Tchaourou in Benin. Therefore, interventions directed at these various levels are needed urgently.

Perception and experience of relatives of pregnant teenagers: A qualitative study in the North and Northeast departments of Haiti.

Teenage pregnancy remains a global problem because of its consequences for the teenager, her child, her family, and society. In Haiti, this type of pregnancy burdens the family economy. In addition, the adolescent fertility rate is still high, despite efforts to reduce it. This article aims to analyze the perception and experiential experience of relatives of pregnant adolescents in Haiti. A qualitative study design based on Dewey's social survey was conducted. Data were collected from 17 relatives (partners, parents, guardians, and others) of pregnant adolescents in Haiti's North and Northeast departments. These data were analyzed using thematic analysis. According to the results, teenage pregnancy is seen as a disaster or a social problem in Haiti. It leads to many psychosocial and economic difficulties for the relatives, who are the only source of economic and social support for pregnant adolescents. Considering the vulnerability of relatives, policies, and interventions aimed at reducing the negative consequences of teenage pregnancy should consider this group of individuals.

Socioecological analysis of determinants of early adolescent sexuality in Benin: a qualitative study

Introduction: early adolescent sexuality is associated with an increase in risky sexual behaviour, unwanted pregnancies, and the occurrence of sexually transmitted infections. However, despite the efforts of governments and their partners, the implementation and effectiveness of appropriate and adapted services to improve adolescent sexual and reproductive health are lagging. Therefore, this study aimed to document determinants of early adolescent sexuality in the central district of Tchaourou in Benin based on a socio-ecological approach. Methods: an explorative and descriptive qualitative study was conducted using focus groups and individual interviews based on the socio-ecological model. Participants included adolescents, parents, teachers, and community leaders in Tchaourou. Results: the number of participants in each focus group was 8 (32). There were 20 girls and 12 boys aged 10-19 years, of whom 16 were students (7 females and nine males) and 16 were apprentice dressmakers and hairdressers. In addition, five participants attended individual interviews (two community leaders, one religious' leader, one teacher and one parent). Four themes were identified that influence early sexuality among adolescents and grouped into individual determinants related to knowledge about early sexuality; interpersonal determinants related to adolescents' function, including the influence of family and peers; community and organizational determinants related to where harmful sociocultural norms; political determinants comprising the disadvantaged socioeconomic status of the communities where adolescents live. Conclusion: many factors at multiple social levels influence early adolescent sexuality in the commune of Tchaourou in Benin. Therefore, interventions directed at these various levels are needed urgently.

Barriers and facilitators for the sustainability of digital health interventions in low and middle-income countries: A systematic review.

Background: Digital health interventions (DHIs) have increased exponentially all over the world. Furthermore, the interest in the sustainability of digital health interventions is growing significantly. However, a systematic synthesis of digital health intervention sustainability challenges is lacking. This systematic review aimed to identify the barriers and facilitators for the sustainability of digital health intervention in low and middle-income countries. Methods: Three electronic databases (PubMed, Embase and Web of Science) were searched. Two independent reviewers selected eligible publications based on inclusion and exclusion criteria. Data were extracted and quality assessed by four team members. Qualitative, quantitative or mixed studies conducted in low and middle-income countries and published from January 2000 to May 2022 were included. Results: The sustainability of digital health interventions is very complex and multidimensional. Successful sustainability of digital health interventions depends on interdependent complex factors that influence the implementation and scale-up level in the short, middle and long term. Barriers identified among others are associated with infrastructure, equipment, internet, electricity and the DHIs. As for the facilitators, they are more focused on the strong commitment and involvement of relevant stakeholders: Government, institutional, sectoral, stakeholders' support, collaborative networks with implementing partners, improved satisfaction, convenience, privacy, confidentiality and trust in clients, experience and confidence in using the system, motivation and competence of staff. All stakeholders play an essential role in the process of sustainability. Digital technology can have long term impacts on health workers, patients, and the health system, by improving data management for decision-making, the standard of healthcare service delivery and boosting attendance at health facilities and using services. Therefore, management changes with effective monitoring and evaluation before, during, and after DHIs are essential. Conclusion: The sustainability of digital health interventions is crucial to maintain good quality healthcare, especially in low and middle-income countries. Considering potential barriers and facilitators for the sustainability of digital health interventions should inform all stakeholders, from their planning until their scaling up. Besides, it would be appropriate at the health facilities level to consolidate facilitators and efficiently manage barriers with the participation of all stakeholders.

Public attitudes towards COVID-19 vaccines in Africa: A systematic review.

As COVID-19 vaccine acquisition and deployment accelerates, tensions also increase. This review aims to identify and understand the significance of population attitudes toward COVID-19 vaccines in Africa. A systematic review was conducted. Searches were conducted in MEDLINE, CINAHL, EMBASE, and Global Health databases. Database searches began on June 23, 2021, and the last search date was June 30, 2021. The methodological quality of the studies included in this review was assessed using the Mixed methods appraisal tool. A total of 609 articles were retrieved, and 23 met the eligibility criteria. All 23 included studies were cross-sectional. Three attitudes were identified: acceptance, reluctance, and refusal to be vaccinated. Acceptance of vaccination was motivated by confidence in the accuracy of the government's response to COVID-19 and the fact that relatives had been diagnosed with or died from COVID- 19. Reluctance was based on fear of vaccine quality and side effects, and insufficient clinical trials. Finally, refusal to be vaccinated was justified by reasons such as the unreliability of clinical trials and insufficient data regarding the vaccine's adverse effects. This review revealed common attitudes of African populations toward COVID-19 vaccines. The results indicate that research needs to focus more on identifying facilitators of COVID-19 vaccination. However, they also provide essential elements for health personnel in charge of vaccination to develop strategies to achieve satisfactory coverage rates.

Knowledge, beliefs and perceptions of religious leaders on modern contraceptive use in Burkina Faso: a qualitative study.

INTRODUCTION: in Burkina Faso, despite the strategies implemented to increase the use of contraceptives, the prevalence rate of modern contraceptives remains low. Religion is an important part of the socio-cultural fabric of many communities. Besides, religious leaders play an essential role in adopting and using contraceptive methods to support family health. The study objective was to explore the knowledge, beliefs and perceptions of religious leaders about modern contraceptives among women of childbearing age. METHODS: data were collected in September 2018 from twenty-one religious' leaders of the urban municipality of Dori. Study participants were selected based on reasoned sampling with maximum variation (sex, religion, age, residence and level of education). We conducted semi-structured individual interviews, non-participant observations and documentary review. RESULTS: religious leaders have a good knowledge of modern contraceptive methods, but they prefer traditional contraceptive methods and abstinence. They consider modern contraception as abortion and female sterilization and emphasize birth spacing. Furthermore, religious leaders lack training on contraception and have no real links and exchanges with sexual and reproductive health services. As a result, their assessment of the quality of these services is very mixed. CONCLUSION: religious leaders play a crucial role in improving modern contraceptive methods in Burkina Faso. Close collaboration with family planning services should, at all times, be maintained. The implementation of training and educational activities for religious leaders could help raise modern contraceptive use in Burkina Faso.

Evaluating the implementation of interdisciplinary patient-centred care intervention for people with multimorbidity in primary care: a qualitative study.

OBJECTIVE: A patient-centred care interdisciplinary pragmatic intervention to support self-management for patients with multimorbidity was implemented in one region of Quebec, Canada. This embedded study aimed to evaluate the process of implementation. DESIGN: A descriptive qualitative study was conducted in 2016-2017 using semistructured individual interviews. The Consolidated Framework for Implementation Research (CFIR) was used to guide the data coding, analysis and reporting of the findings. SETTING: The study took place in seven Family Medicine Groups in one region (Saguenay-Lac-Saint-Jean) of Quebec, Canada. PARTICIPANTS: Ten managers (including two family physicians) and 19 healthcare professionals (HCPs), nurses, kinesiologists, nutritionists and a respiratory therapist, were interviewed. RESULTS: Many key elements within the five CFIR domains were identified as impacting the implementation of the intervention : (1) intervention characteristics-evidence strength and quality, design quality and packaging, relative advantage and complexity; (2) outer setting-patients' needs and resources, external policies and incentives; (3) inner setting-structural characteristics, networks and communication, culture, compatibility, readiness for implementation and leadership engagement; (4) characteristics of the managers and HCPs-knowledge and belief about the intervention; (5) process-planning, opinion leaders, formally appointed internal implementation leaders, reflecting and evaluating. CONCLUSION: This study revealed the organisational and contextual aspects of the implementation based on different and complementary perspectives. With the growing demand for interdisciplinary teams in primary care, we believe that our insights will be helpful for practices, researchers, and policymakers interested in the implementation of disease prevention and management programmes for people with multiple chronic conditions in primary care. TRIAL REGISTRATION NUMBER: NCT02789800.

An Imperative for the National Public Health School in Burkina Faso to Promote the Use of Information and Communication Technologies in Education During the COVID-19 Pandemic: Critical Analysis.

BACKGROUND: Several studies have reported the positive impact of information and communication technologies (ICTs) on academic performance and outcomes. Although some equipment is available, the ICTs for education at the National Public Health School (NPHS) of Burkina Faso have many shortcomings. These shortcomings were clearly revealed during the search for responses to the crisis caused by the COVID-19 pandemic. Indeed, to curb the spread of COVID-19, some measures were taken, such as closure of educational institutions. This resulted in a 2.5-month suspension of educational activities. Despite its willingness, the NPHS was unable to use ICTs to continue teaching during the closure period of educational institutions. OBJECTIVE: In this paper, we aim to propose practical solutions to promote ICT use in teaching at the NPHS by analyzing the weaknesses and challenges related to its use. METHODS: We conducted a critical analysis based on information from the gray literature of NPHS. This critical analysis was preceded by a review of systematic reviews on barriers and facilitating factors to using ICTs in higher education and a systematic review of ICT use during the COVID-19 pandemic in higher education. An ICT integration model and a clustering of ICT integration factors guided the analysis. RESULTS: The weaknesses and challenges identified relate to the infrastructure and equipment for the use of ICTs in pedagogical situations in face-to-face and distance learning; training of actors, namely the teachers and students; availability of qualified resource persons and adequate and specific financial resources; motivation of teachers; and stage of use of ICTs. CONCLUSIONS: To promote the use of ICTs in teaching at the NPHS, actions must be performed to strengthen the infrastructure and equipment, human resources, the skills of actors and the motivation of teachers in the pedagogical use of ICTs.

Involvement of Male Partners of Pregnant Women in the Prevention of Mother-to-Child Transmission (PMTCT) of HIV in Haiti: A Mixed-Methods Study.

This mixed-methods study aimed to determine the level of male involvement in the prevention of mother-to-child transmission (PMTCT) services in Haiti and identify barriers and associated factors. From May to June 2018, a questionnaire was used to measure the level of male involvement. Semistructured interviews with pregnant women were also conducted. Multivariate linear regression and qualitative content analyses were performed to explore factors associated and barriers to male partners' involvement in PMTCT services. One hundred and two pregnant women living with HIV completed the questionnaire. About 47% of male partners had a high level of involvement. Specifically, 90% financially supported their spouse, and 82% knew her appointment date at the antenatal clinic (ANC). Only 25% of male partners accompanied their spouse to the ANC, and 19% routinely used a condom during sexual intercourse. Factors associated with male involvement in PMTCT were being married and sharing HIV status with the male partner. Male partners with a positive HIV status were more likely to be involved in PMTCT. Qualitative findings revealed that barriers to male involvement included the conflict between opening hours of the ANC and the male partner's schedule, waiting time at the ANC, and the perception of antenatal care as being women's business. Overall male partners' involvement in PMTCT services is moderate. Gender relations, sociocultural beliefs, and care organization are likely to hinder this involvement. Developing and implementing contextually and culturally accepted strategies for male partners of pregnant women could contribute to strengthening their involvement in the PMTCT program.

Scaling Up Patient-Centered Interdisciplinary Care for Multimorbidity: A Pragmatic Mixed-Methods Randomized Controlled Trial.

PURPOSE: To measure the effectiveness of a 4-month interdisciplinary multifaceted intervention based on a change in care delivery for patients with multimorbidity in primary care practices. METHODS: A pragmatic randomized controlled trial with a mixed-methods design in patients aged 18 to 80 years with 3 or more chronic conditions from 7 family medicine groups (FMGs) in Quebec, Canada. Health care professionals (nurses, nutritionists, kinesiologists) from the FMGs were trained to deliver the patient-centered intervention based on a motivational approach and self-management support. Primary outcomes: self-management (Health Education Impact Questionnaire); and self-efficacy. SECONDARY OUTCOMES: health status, quality of life, and health behaviors. Quantitative analyses used multi-level mixed effects and generalized linear mixed models controlling for clustering within FMGs. We also conducted in-depth interviews with patients, family members, and health care professionals. RESULTS: The trial randomized 284 patients (144 in intervention group, 140 in control group). The groups were comparable. After 4 months, the intervention showed a neutral effect for the primary outcomes. There was significant improvement in 2 health behaviors (healthy eating with odds ratios [OR] 4.36; P = .006, and physical activity with OR 3.43; P = .023). The descriptive qualitative evaluation revealed that the patients reinforced their self-efficacy and improved their self-management which was divergent from the quantitative results. CONCLUSIONS: Quantitatively, this intervention showed a neutral effect on the primary outcomes and substantial improvement in 2 health behaviors as secondary outcomes. Qualitatively, the intervention was evaluated as positive. The combination of qualitative and quantitative designs proved to be a good design for evaluating this complex intervention.

A bibliometric analysis of multimorbidity from 2005 to 2019.

CONTEXT: Multimorbidity is frequently seen in primary care. We aimed to identify and analyze publications on multimorbidity, including those that most influenced this field. METHOD: A bibliometric analysis of publications from 2005 to 2019 in the PubMed database containing "multimorbidity" or "multi-morbidity" identified with the tool iCite. We analyzed the number of publications, total citations, the article-level metric Relative Citation Ratio (RCR), type of study, and journals with the most cited articles. RESULTS: The number of publications using "multimorbidity" has continuously increased since 2005 (2005-2009: 138; 2010-2014: 823; 2015-2019: 3068). The median number of total citations per article was 3. The median RCR was 1.04. Articles with RCR at or above the 97th percentile (RCR = 7.43) were analyzed in detail (n = 104). In 34 publications of this subgroup (33%), the word multimorbidity was used but was not the subject of study. The remaining top 70 publications included 32 observational studies, 22 reviews, five guideline statements, three analysis papers, two randomized trials, three qualitative studies, two measurement development reports, and one conceptual framework development report. The publications were produced by authors from 32 countries. They were published in 37 different journals, ranging from one to four articles in the same journal. CONCLUSIONS: We found a continuous increase in the number of publications about multimorbidity since 2005. However, our study suggests that the numbers should be considered only a general trend because multimorbidity was not the main subject in 33% of publications in a subgroup of 104 analyzed in detail.

Impact of Pre-antiretroviral Therapy CD4 Counts on Drug Resistance and Treatment Failure: A Systematic Review.

The continuous rising of HIV drug resistance in low- and middle-income countries and its impact on treatment failure is a growing threat for the HIV treatment response. This review aimed to document pre-antiretroviral therapy (ART) CD4 counts, emerging drug resistance, and treatment failure in HIV-infected individuals initiating ART. We performed an online search in PubMed, Embase, Web of Science, African Index Medicus, Cochrane library, and The National Institute for Health Clinical Trials Registry of relevant articles published from January 1996 to June 2019. Of 1755 original studies retrieved, 28 were retained for final analysis. Treatment failure varied between 5% (95% confidence interval [CI]: 2.7-7.4) and 72% (95% CI: 55-89.6), while resistance varied between 1% (95% CI: 0.47-1.5) and 48% (95% CI: 28.4-67.6). Participants with a pre-ART CD4 count below 200 cell/µl and low adherence showed higher percentages of resistance and failure, while those with CD4 count above 200 showed lower resistance and failure regardless adherence levels. Most frequent resistance mutations included the M184I/V for the nucleoside reverse-transcriptase inhibitors (NRTIs), K103N, and Y181 for the non-NRTIs (NNRTIs), and L90M for the Protease inhibitors. Pre-ART CD4 count and adherence to treatment could play a key role in reducing drug resistance and treatment failure. The increased access to ART in resources limited settings should be accompanied by regular CD4 count testing, drug resistance monitoring, and continuous promotion of adherence. In addition, the rising of resistance mutations associated with NRTIs and NNRTIs, suggest that alternative ART regimens should be considered. (AIDS Rev. 2020;22:-0).

The revised Patient Perception of Patient-Centeredness Questionnaire: Exploring the factor structure in French-speaking patients with multimorbidity.

BACKGROUND: The Patient Perception of Patient-Centeredness (PPPC) questionnaire was revised, and there is a need for the questionnaire to be tested in diverse primary care populations. OBJECTIVES: This study aimed to examine the factor structure of the Revised PPPC questionnaire (PPPC-R) in French-speaking patients with multimorbidity. DESIGN: Secondary analysis from baseline data of the French arm of Patient-Centered Innovations for Persons with Multimorbidity Study (PACEinMM Study). SETTING AND PARTICIPANTS: Participants were adult patients with multimorbidity attending primary health-care settings. OUTCOME MEASURES: Exploratory factor analyses were applied to examine the factor structure of the PPPC-R. Cronbach's alpha values were calculated to assess the internal consistency of the whole questionnaire and of each factor explored. RESULTS: There were 301 participants, mean age 61.0, 53.2% female. The PPPC-R showed very good internal consistency, with three factors: Patient-Centered Clinical Method (PCCM) Component 1-Exploring the health, disease and illness experience + PCCM Component 4-Enhancing the patient-clinician relationship (Factor 1); PCCM Component 2-Understanding the whole person (Factor 2); and PCCM Component 3-Finding common ground (Factor 3). There was a good internal consistency within each factor (Cronbach's α = 0.87 for 8 items in Factor 1, 0.77 for 5 items in Factor 2 and 0.87 for 5 items in Factor 3). DISCUSSION AND CONCLUSIONS: The French PPPC-R factor structure was in accordance with the underpinning conceptual model and presented with three factors. Further assessment of its validity and reproducibility are needed to allow its use as a measure of patient's perception of patient-centeredness.

Patients, caregivers and health-care professionals' experience with an interdisciplinary intervention for people with multimorbidity in primary care: A qualitative study.

BACKGROUND: Multimorbidity challenges the health-care system and requires innovative approaches. In 2015, a 4-month patient-centred interdisciplinary pragmatic intervention was implemented in primary care with the aim of supporting self-management for patients with multimorbidity. OBJECTIVE: To explore the perceptions and experiences of health-care professionals, patients and their caregivers with a 4-month patient-centred interdisciplinary pragmatic intervention in primary care. DESIGN: A descriptive, qualitative study using semi-structured interviews was conducted. SETTING AND PARTICIPANTS: A purposive sample of 30 participants was recruited from seven family medicine groups including patients, caregivers and health-care professionals (HCPs). Interviews were analysed using Thorne's interpretive description approach. RESULTS: Findings were grouped into the benefits and challenges of participating in the intervention. The programme allowed patients to adopt realistic and adapted objectives; to customize interventions to the patient's reality; and to help patients gain confidence, improve their knowledge, skills and motivation to manage their condition. Interprofessional collaboration eased the exchange of information via team meetings and electronic medical records. Challenges were related to collaboration, communication, coordination of work and integration of newly relocated HCPs mainly due to part-time assignments and staff turnover. HCPs part-time schedules limited their availability and hindered patients' follow-up. DISCUSSION AND CONCLUSION: This intervention was useful and rewarding from the HCPs, patients and caregivers' perspective. However, to ensure the success of this complex interdisciplinary intervention, implementers and managers should anticipate organizational barriers such as availability and time management of relocated HCPs.