Use of qualitative methods to optimize collaborative practices by highlighting differences in perceptions between professionals: an example of patient education.

Interprofessional working must be approached within health promotion interventions using systematic methods to identify areas of suboptimal collaboration. We designed a qualitative study with a purposive sample of seven French therapeutic patient education programs. Semi-structured individual interviews were conducted with 14 healthcare providers and seven clinician leaders (coordinators) involved in patient education. We used the same interview guide and thematic grid regardless of the professional's profile to compare their perceptions on elements affecting outcome, participation and sustainability of programs. Healthcare providers and coordinators addressed non-convergent issues at both ends of a continuum from a micro-level nested in the program delivery to a macro-level corresponding to the structured implementation and sustainability of the program. Meso-level issues featured convergent perspectives. Our methodology could be used at the level of health services in a health system to provide a complete recovery of stakeholders' perspectives (without "blind spots" from one stakeholder or another). In our study, we focused on patient education in the French health system and pointed out possible considerations to optimize the functioning of programs. Such considerations include specific training plan development, encouraging reflection on the content and use of initial assessment, leading sessions in pairs to save on work time, and communication on the ins and outs of organizational imperatives that require healthcare providers' contributions.

What contextual features affect the outcome and sustainability of therapeutic patient education interventions?

BACKGROUND: Therapeutic patient education interventions are influenced by contextual factors. Therefore, describing the context is crucial to understanding how it can affect therapeutic patient education interventions and contribute to outcomes. We aimed to identify the contextual features that may affect the outcome and sustainability of therapeutic patient education interventions from a healthcare professional perspective. METHODS: Semi-structured individual interviews were conducted with healthcare professionals involved in 14 therapeutic patient education interventions covering different chronic conditions (e.g., kidney and cardiovascular diseases, chronic pain, diabetes, obesity). Interviews were recorded and fully transcribed. We followed a general inductive approach to identify themes from healthcare professionals' discourse to properly capture their perception. RESULTS: Saturation was achieved with 28 interviews with 20 nurses, 6 dieticians, one physiotherapist and one psychologist. The average therapeutic patient education experience was 7 years. Identified contextual features clustered in 5 main themes: 1) conditions for the development of the intervention (genesis of the program: Who and what prompted it?; supports; content development; legislative framework); 2) integration of the program (in the healthcare pathway or the environment, relationship with the institution or local environment); 3) teamwork cohesion, interaction and integration with the environment (exchanges, cohesion of the team); 4) sustainability of the program; and 5) patient and healthcare professional contextual factors. CONCLUSION: New insights into contextual features that may be involved in therapeutic patient education interventions are represented in a framework based on the Medical Research Council evaluation framework. These features need to be addressed in studies of therapeutic patient education interventions and could help healthcare professionals build more effective interventions within the context. However, describing a list of elements of the context is not enough; analyses should also focus on how the contextual elements might affect an intervention and how they interact.

The (De)normalisation of Smoking Among Apprentices: Plurality of Settings, Norms and Vulnerability Levels.

When it comes to smoking, apprentices are considered a 'vulnerable' population. They have been the subject of targeted approaches based on the assumption of common characteristics. In contrast to most public health studies, that assume homogeneity of vulnerable groups, this article, based on Lahire's 'theory of the plural individual', aims to examine inter- and intra-individual variability in relation to tobacco exposure. It is based on a secondary analysis of 30 interviews with apprentices in France on the stigma attached to their use in their different living environments. Our study confirms that the family and the Centre de Formation des Apprentis, as a whole, encourage smoking. It also provides a better understanding of the mechanisms by which inequalities are perpetuated (permissive rules, loans and gifts of cigarettes, spillover effects, lack of incentives to quit). Nevertheless, it allows us to observe that, in some families and in some companies, smoking is denormalised, even stigmatised. Several apprentice profiles emerge: those who are protected from tobacco and seem to be able to quit easily; those who are permanently confronted with it and for whom it is difficult to consider quitting or reducing; and those who are confronted with a plurality of norms, who seem ambivalent and whose consumption varies significantly. These results will allow us to adapt the interventions according to the profile of the apprentices and by including their entourage. In particular, it will be necessary to propose a 'go-to' approach that goes beyond the school setting and involves the family and the workplace.

Strengthening students' well-being and nutritional balance in Grand Est (France): "Lycéen Bouge" program intervention logic / Renforcement du bien-être et de la nutrition des lycéens : la logique d'intervention du programme « Lycéen Bouge ¼

Introduction: As part of a national health policy to fight excess weight and obesity, the "Lycéen Bouge" program aims to fight against social inequalities in health among adolescents by improving their well-being and nutritional balance. The aim of this article is to present the intervention logic of this program and to identify the key functions that are essential for the project to function properly and to be transferable. Method: Data was collected through interviews with project officers, observation sessions in several high schools. A documentary analysis was also carried out. The data was then analyzed thematically, in a collaborative process with the project leader, in order to develop the program logic model. Results: The analysis and development of the logic model identified the program's objectives and components, as well as six key functions. The key functions identified concern the format and co-construction of activities, local partnerships, high-school volunteering, social skills training and project length. Conclusion: In some respects, the program differs from the literature and the evidence and could therefore draw on it for improvement. These include the involvement of beneficiaries and the implementation of a comprehensive approach and a gender-sensitive approach, which would make it possible to reach more students.

Introduction: Dans le cadre d'une politique nationale de lutte contre le surpoids et l'obésité, le programme « Lycéen Bouge ¼ vise à combattre les inégalités sociales de santé chez les adolescents, en améliorant leur bien-être et leur équilibre nutritionnel. Cet article a pour objectif de présenter la logique d'intervention de ce programme, et d'en identifier les fonctions clés, indispensables au bon fonctionnement du programme et à son éventuelle transférabilité. Méthode: Les données ont été recueillies à travers des entretiens auprès des chargés de projet et des séances d'observation des activités au sein de plusieurs lycées. Une analyse documentaire a également été réalisée. Les données ont ensuite été analysées par thématiques, dans une démarche collaborative avec le porteur de projet, afin d'élaborer le modèle logique du programme. Résultats: Le travail d'analyse et d'élaboration du modèle logique a permis d'identifier les objectifs et les composantes du programme, ainsi que six fonctions clés. Les fonctions clés identifiées concernent le format et la co-construction des activités, les partenariats locaux, le volontariat des établissements, la formation aux compétences psychosociales (CPS) et la durabilité du projet. Discussion: Sur certains points, le programme se démarque de ce que l'on trouve dans la littérature et les données probantes, et pourrait donc s'en inspirer pour s'améliorer. Il s'agit notamment de l'implication des bénéficiaires et de la mise en place d'une approche globale et sensible au genre, qui permettraient de toucher plus d'élèves.

Patient Satisfaction and Perspectives on Self-Management Education Programs: A Qualitative Study.

Purpose: According to the Centre for Disease Control and Prevention, "Self-management education (SME) refers to programs that help people who have ongoing health conditions learn how to live life to the fullest". Most studies to date have focused on SME outcomes, such as the acquisition of predefined knowledge or skills or quality of life. However, no study has yet investigated patients' satisfaction with SMEs. The aim of the present study was therefore to explore participants' subjective appreciation of SME programs using qualitative methods and formulate propositions based on patients' preferences to improve ultimately clinical outcomes. Patients and Methods: Twenty-five participants from five French SME programs to conduct focus groups were recruited. An inductive approach using grounded theory as an overall methodology orientation for the thematic analysis process has been followed. The study was reported in compliance with the consolidated criteria for reporting qualitative research criteria (COREQ). Results: Patients expressed great satisfaction concerning the effective delivery of SME sessions. They appreciated the considerations for their concerns and needs, the adaptation of sessions' content to their interests and questions, and learning to take care of themselves. Moreover, patients had a positive opinion on the quality of their relationship with health care providers. However, the major point of improvement of SMEs was the opportunity to repeat the program if needed, as this opportunity was not offered. This consideration was particularly salient when patients did not consider themselves autonomous for disease management at the end of the program, ie, when they had low levels of perceived self-efficacy. Conclusion: While patients expressed great satisfaction regarding SME programs, our results suggest that some changes might be needed to make the endpoint of SME interventions coincide with the patient's perception of self-efficacy in disease self-management and ultimately improve clinical outcomes.

Health Promotion in Popular Web-Based Community Games Among Young People: Proposals, Recommendations, and Applications.

BACKGROUND: Young people use digital technology on a daily basis and enjoy web-based games that promote social interactions among peers. These interactions in web-based communities can develop social knowledge and life skills. Intervening via existing web-based community games represents an innovative opportunity for health promotion interventions. OBJECTIVE: The aim of this study was to collect and describe players' proposals for delivering health promotion through existing web-based community games among young people, elaborate on related recommendations adapted from a concrete experience of intervention research, and describe the application of these recommendations in new interventions. METHODS: We implemented a health promotion and prevention intervention via a web-based community game (Habbo; Sulake Oy). During the implementation of the intervention, we conducted an observational qualitative study on young people's proposals via an intercept web-based focus group. We asked 22 young participants (3 groups in total) for their proposals about the best ways to carry out a health intervention in this context. First, using verbatim transcriptions of the players' proposals, we conducted a qualitative thematic analysis. Second, we elaborated on recommendations for action development and implementation based on our experiences and work with a multidisciplinary consortium of experts. Third, we applied these recommendations in new interventions and described their application. RESULTS: A thematic analysis of the participants' proposals revealed 3 main themes and 14 subthemes related to their proposals and process elements: the conditions for developing an attractive intervention within a game, the value of involving peers in developing the intervention, and the ways to mobilize and monitor gamers' participation. These proposals emphasized the importance of interventions involving and moderating a small group of players in a playful manner but with professional aspects. We established 16 domains with 27 recommendations for preparing an intervention and implementing it in web-based games by adopting the codes of game culture. The application of the recommendations showed their usefulness and that it was possible to make adapted and diverse interventions in the game. CONCLUSIONS: Integrated health promotion interventions in existing web-based community games have the potential for promoting the health and well-being of young people. There is a need to incorporate specific key aspects of the games and gaming community recommendations, from conception to implementation, to maximize the relevance, acceptability, and feasibility of the interventions integrated in current digital practices. TRIAL REGISTRATION: ClinicalTrials.gov NCT04888208; https://clinicaltrials.gov/ct2/show/NCT04888208.

Selective reporting of antibiotic susceptibility testing results for urine cultures: feasibility and acceptability by general practitioners and laboratory professionals in France.

Background: Selective reporting of antibiotic susceptibility testing (AST) is a recommended antibiotic stewardship strategy, aiming at reducing inappropriate antibiotic prescriptions. Objectives: Our objectives were to evaluate (i) the feasibility of the implementation of selective reporting of AST for urine cultures for laboratory professionals; and (ii) its acceptability by prescribers and laboratory professionals, to explore facilitators and barriers to its potential implementation on a national scale. Methods: As part of the 'ANTIBIO-ciblés' interventional study (north-eastern France, August 2018-December 2019), we prospectively collected quantitative data on all resources dedicated by the laboratories of the intervention group to implement selective reporting of AST for Escherichia coli-positive urine cultures, and on the numbers and reasons of complete reporting of AST the prescribers requested to the laboratories. We also collected qualitative data using semi-structured interviews and focus groups of GPs and laboratory professionals. Results: The implementation of selective reporting of AST required around 80 h and cost 23 000 euros. All interviewed professionals were favourable toward the principle of this tool. Most of them found it clear, simple and useful to improve the appropriateness of antibiotic prescriptions and reduce antibiotic resistance. Its major constraint was the necessity for GPs to call the laboratory to obtain the complete reporting of AST, but the number of requests was actually low (1.2% of all selective reporting of AST). Conclusions: Selective reporting of AST resulted in reasonable human and financial costs, and was well accepted by both GPs and laboratory professionals.

A Smoking Prevention Intervention Among Young People in an Online Community Game: Results from a Pilot Randomized Controlled Trial.

Background: Innovative methods for smoking prevention interventions need to be investigated to increase attractiveness, access hard-to-reach populations, and increase effectiveness. We studied the feasibility and immediate effects of an intervention to reinforce norms and behaviors of young people related to antismoking, integrated into a popular online community game. Methods: A pilot randomized controlled trial was conducted through the HABBO online community. The intervention group was exposed to repeated discussion sessions with small groups of peer players and two facilitators once a week for 1 month (four sessions), inside the game. The control group had access to antismoking information websites. Process indicators (attractiveness, participation) and immediate outcomes (norms and intentions with regard to smoking) were assessed by questionnaire. Results: One hundred sixteen players were invited to participate in the intervention; 10 did not meet eligibility criteria, 30 were allocated to the intervention group, and 76 to the control group. Median age was 23. Twenty-four percent were not in education, employment, or training. A median of eight players attended each session and the median number of exchange chats by session was 399; 70% of chat time was occupied by the players. Twenty players attended all four sessions. Immediate norms, representations, and intentions were evaluated in 39 players and showed small differences between groups. Conclusion: Delivering and evaluating a smoking prevention intervention in an online game is feasible. In the targeted online community game, the intervention was attractive and allowed the delivery of innovative interventions to audiences with diverse social profiles. Long-term effects, sustainability, and evaluation methodology are discussed.

Healthcare providers perception of therapeutic patient education efficacy according to patient and healthcare provider characteristics.

OBJECTIVES: Therapeutic patient education improves numerous health and psychological outcomes in patients with chronic diseases. However, little is known about what makes a therapeutic patient education intervention more effective than another one. This study aims to identify in healthcare professionals the perceived determinants of therapeutic patient education efficacy at the individual level. METHODS: Semi-structured individual interviews have been conducted with healthcare professionals (HCP, n=28, including 20 nurses) involved in therapeutic patient education programs (n=14) covering various chronic conditions (kidney and cardiovascular diseases, chronic pain, diabetes, etc.). A thematic content analysis following an inductive approach was used (Nvivo.11 software). RESULTS: Five themes were retrieved for patient characteristics: understanding and education, personality, readiness and motivation, social environment, and misinformation and beliefs. Four themes were retrieved for healthcare professionals' characteristics: medical knowledge, appropriate attitude and relational skills, pedagogical skills, and training. DISCUSSION: Patient personality is rarely discussed in the literature. Patients who are introverted, lack curiosity, or are not compliant might benefit from specific therapeutic patient education practices or formats. All these potential determinants regarding patients and healthcare professionals should be routinely assessed in future studies about therapeutic patient education efficacy to understand precisely what makes an intervention successful.

Accompagnement à la parentalité en Protection maternelle et infantile : co-construction de la logique d'intervention PERL.

INTRODUCTION: In the Greater Eastern region of France, a primary prevention intervention in perinatal care has shown promising results on child development. In order to make this intervention transferable and sustainable outside a research context, it was adapted into a universal family health program. The PERL (Petite Enfance Recherche-action en Lorraine: early childhood research-action in Lorraine) research-action aimed to evaluate the effects of this new intervention. METHOD: The objective of the article was to present the intervention logic of the PERL program, based on the evaluation of processes and mechanisms (2018-2019). The method was based on 18 semi-structured interviews with actors involved in the construction and implementation of PERL, and a consultation process. RESULTS: Supported by the Maternal and Child Protection services (PMI), PERL is a program based on home visits by nurses, analysis of practices and supervision. In contrast to a standardized or an injunctive perspective, the approach recognizes and supports the parent as an expert of his or her own child. The importance of supervision in facilitating the adoption of an unconditional benevolent posture and the professional development of nurses confronted with complex situations is one of the cornerstones of the system. CONCLUSIONS: PERL is a structured and non-standardized parenting support program, based on strong health promotion concepts. This evaluation underlines the importance and challenges of having a shared vision of the intervention logic. In the perspective of the deployment and transfer of PERL, it will be necessary to adapt the system to the contexts and territories. In this perspective, an implementation guide has been produced.

French general practitioners' and patients' acceptability of a public commitment charter and patient information leaflets targeting unnecessary antibiotic use: a qualitative study.

BACKGROUND: The 'AntibioCharte' randomised controlled study aimed at assessing the impact of a multifaceted antibiotic stewardship intervention targeting French general practitioners with higher-than-average antibiotic use. The intervention included a public commitment charter signed by the general practitioner, a non-prescription pad, and a patient information leaflet. OBJECTIVES: We conducted a qualitative study to evaluate general practitioners' fidelity in the intervention and its acceptability by patients and general practitioners. METHODS: This investigation was performed in northeastern France from July 2019 to May 2020, among the AntibioCharte intervention group after a 1-year implementation period. General practitioners' fidelity in the charter was assessed by direct observations; general practitioners' fidelity in the other tools, and acceptability of both general practitioners and patients were assessed through semi-structured face-to-face individual interviews. RESULTS: Twenty-seven general practitioners and 14 patients participated. General practitioners' fidelity varied according to the tool: the charter was clearly displayed in most waiting rooms; the non-prescription pad was used throughout the intervention period by most general practitioners while the leaflet was used by fewer general practitioners. Both general practitioners and patients found the charter's content and form relevant, but few general practitioners felt themselves publicly engaged. The waiting room may not be appropriate to display the charter as some general practitioners forgot it and patients did not always read the displayed documents. General practitioners appreciated the pad and found that it could help them change their practices. It was perceived as a good tool to educate patients and manage their expectations for antibiotics. Patients appreciated the pad too, especially information on the infections' symptoms and their duration. Still, some patients feared that it could encourage doctors not to prescribe antibiotics. Unlike general practitioners, who considered the leaflet redundant with the information given during the consultation, patients found it useful to raise awareness on antibiotics' specificities and risks, and remind them of good practices. CONCLUSIONS: The AntibioCharte intervention was overall well accepted by general practitioners and patients. The non-prescription pad was the best perceived tool. Trial registration number ClinicalTrials.gov: NCT04562571.

Tailored patient therapeutic educational interventions: A patient-centred communication model.

BACKGROUND: Tailoring therapeutic education consists of adapting the intervention to patients' needs with the expectation that this individualization will improve the results of the intervention. Communication is the basis for any individualization process. To our knowledge, there is no guide or structured advice to help healthcare providers (HCPs) tailor patient education interventions. OBJECTIVES: We used a data-driven qualitative analysis to (1) investigate the reasons why HCPs tailor their educational interventions and (2) identify how this tailoring is effectively conducted. The perspective aimed to better understand how to individualize therapeutic patient education and to disentangle the different elements to set up studies to investigate the mechanisms and effects of individualization. DESIGN: Individual semistructured interviews with 28 HCPs involved in patient education were conducted. The present study complied with the COREQ criteria. RESULTS: Why individualization is necessary: participants outlined that the person must be thought of as unique and that therapeutic education should be adapted to the patient's personality and cognitive abilities. The first step in the individualization process was formalized by an initial patient assessment. Several informal practices were identified: if needed, giving an individual time or involving a specific professional; eliciting individual objectives; reinforcing the relationship by avoiding asymmetrical posture; focusing on patients' concerns; leading sessions in pairs; and making the patient the actor of decisions. CONCLUSION: From our thematic data analysis, a model for tailoring patient education interventions based on the Haes and Bensing medical communication framework is proposed. The present work paves the way for evaluation, then generation of recommendations and finally implementation of training for individualization in educational interventions. SHORT INFORMATIVE: Tailoring in therapeutic education consists of an adaptation to patients' needs. Communication is the basis for any individualization process. There is no model of patient-centred communication in educational interventions. From semistructured interviews with HCPs, we propose a patient-centred communication model for tailoring patient education intervention.

Stigmatisation et santé publique : le côté obscur des interventions anti-tabac.

Tobacco control strategies, considered legitimate and effective, are rarely the subject of critical analysis in France. This is specifically true with regard to their potentially harmful effects, particularly against people who continue to smoke. This article introduces this debate, focusing on the potentially stigmatizing effects of anti-smoking policies. It has been attested by numerous international studies, and by a study in France, that the general process of tobacco denormalization has led to the stigmatization of smokers who then may be subject to discrimination. To the extent that smoking is now concentrated in the most disadvantaged socio-economic populations in France, the latter are thus more exposed to stigma. While underscoring the need to develop targeted interventions against them, this article also warns and calls for vigilance regarding the potential iatrogenic effects of these interventions. It is therefore necessary to develop research and evaluations on this subject in order to accurately measure the effects of these interventions, particularly in terms of stigmatization and self-stigma, and to ensure that public health actors do not generate more problems than they solve.

Patients and spouses coping with inflammatory arthritis: Impact of communication and spousal perceived social support and burden.

OBJECTIVES: To guide Therapeutic Patient Education (TPE) programs to improve patients' and spouses' perceived health, we aimed to analyze the effect of the spouse health state and patient-spouse relationship on functional impairment, mental health and self-efficacy of patients with RA or SpA. METHODS: In this observational cross-sectional study, inclusion criteria were age≥18years and diagnosis of RA or SpA. The outcome criteria were functional impairment and mental health measured by the Medical Outcomes Study Short-Form 12-item version (SF-12-MCS); mental health measured by the General Health Questionnaire (GHQ-12); and self-efficacy by the General Self-Efficacy Scale (GSE Scale). Caregiver-patient relationship was assessed by the Personal Assessment of Intimacy in Relationships (PAIR) questionnaire and the Dyadic Adjustment Scale (DAS); social support by the Social Support Questionnaire-6 and spousal burden by the Zarit questionnaire. RESULTS: A total of 88 patient-spouse couples were included. Patients were mostly female (n=68, 77%), with mean age 59 (SD 12.6) years; 69% had RA. On bivariate analyses, only spousal burden was associated with patients' functional impairment. Patients' mental health was associated with satisfaction with social support and the dyad relationship. Self-efficacy of patients was associated with spousal burden, satisfaction with social support, spousal anxiety/depression and the dyad relationship. On multivariate analysis, improved mental health and perceived self-efficacy of patients were associated with spousal satisfaction with social support (Beta=0.8, P=0.1 with GHQ-12) good communication in the couple (Beta=0.5, P=0.04 with SF-12-MCS and Beta=0.4, P=0.04 with GSE Scale) and low spousal-assessed burden (Beta=-0.2, P=0.003 with GSE Scale). CONCLUSION: This study has identified potential focus for intervention. It has highlighted the importance of recognizing the role of couple communication (experiencing an open and fluent exchange of ideas) in the patient's mental health and self-efficacy but also perceived satisfaction with social support of both members of the couple on the patient's mental health.

Dimensions of the Complexity of Health Interventions: What Are We Talking About? A Review.

Many recommendations and innovative approaches are available for the development and evaluation of complex health interventions. We investigated the dimensions of complexity described in health research and how these descriptions may affect the adopted research methodology (e.g., the choice of designs and methods). We used a mixed method approach to review the scientific literature evaluating complex interventions in the health field. Of 438 articles identified, 179 were subjected to descriptive analysis and 48 to content analysis. The three principal dimensions of complexity were: stakeholder characteristics, intervention multimodality and context. Recognition of such dimensions influenced the methodological choices made during evaluation of the interventions with their use of designs and methods, which aimed to address the complexity. We analysed not only how researchers view complexity but also the effects of such views on researcher practices. Our results highlight the need for clarification of what complexity means and to consider complexity when deciding how to evaluate research interventions.

Postponing vaccination in children with an infection: a qualitative study among general practitioners and pediatricians.

BACKGROUND: Vaccination postponement is an important contributing factor to low vaccination coverage. The causes of vaccine postponement are numerous, but the presence of viral infection, whether febrile or not, is the most frequent cause. OBJECTIVE: The objective was to explore the factors motivating the practice of vaccination postponement in a child with an infection by general practitioners (GPs) and paediatricians. METHODS: An exploratory qualitative study using semi-directive individual interviews was carried out among GPs and paediatricians in a French region between November 2015 and January 2018. After the interviews were fully transcribed, an analysis of the data was performed using an inductive method derived from the grounded theory. RESULTS: Fourteen GPs and four paediatricians participated in the study. Vaccination postponement during infection in children is rooted in doctors' practices; it is considered a low-risk habit that is shared with parents, and vaccine hesitancy reinforces this practice. In children presenting with an infection, the presence of uncertainty about vaccine safety and effectiveness seems to justify postponing vaccination. The organization of a consultation dedicated to vaccination catch-up was cited as the best tool to limit the effects of vaccination delay on vaccination coverage. DISCUSSION: In children presenting with an infection, vaccination postponement is widely used by GPs and paediatricians. Simplification of the vaccination catch-up process and clear and consistent recommendations on the indications and modalities for vaccination postponement would be useful.

'I don't know if we can really, really change that': a qualitative exploration of public perception towards antibiotic resistance in France.

BACKGROUND: Since the 2000s, French authorities have put in place various national plans to make the general public aware of antibiotic stewardship. Twenty years later, France is still one of the countries with the highest use of antibiotics in Europe. OBJECTIVES: Our study explored the general public's perceptions of antibiotic resistance, their behaviour around antibiotic use and their expectations regarding awareness campaigns. METHODS: A qualitative study was performed from March 2018 to March 2019 in a French region using focus groups. Two types of public were targeted: parents of young children and retired people. The interview guide contained open-ended questions organized around three main themes: perceptions of antibiotic resistance; experience and use of antibiotics; and health information and campaigns. RESULTS: Nine focus groups were created, including 17 parents and 19 retirees. Participants did not link antibiotic overuse and antibiotic resistance. Antibiotic resistance was not perceived as a personal responsibility but as a suffered phenomenon on which the participants could not act. The blame was particularly put on the presence of antibiotics in the environment. Although participants expressed trust in their GPs, antibiotics remained perceived as the only solution for them to be cured quickly. CONCLUSIONS: The study highlighted that the GPs were the preferred information source regarding the use of antibiotics. Actions targeting the public and health professionals will have little impact if, at the same time, efforts on work environment representation are not undertaken.

Antibio'Malin: an e-health resource to raise awareness of antibiotic stewardship and resistance in France.

OBJECTIVES: To develop a nationwide French website with reliable, practical and public-oriented information on antibiotic stewardship and resistance. METHODS: The design and evaluation were based on the following process: (i) development of a pilot website by a multidisciplinary group; (ii) evaluation phase, using mixed methods and involving health professionals (GPs and community pharmacists) and the general population; and (iii) launch of a final version of the website with 6 month follow-up usage statistics. RESULTS: The Antibio'Malin website (https://sante.fr/antibiomalin), supported by the French Ministry of Health, contains practical information for the general population on antibiotics marketed in the outpatient setting and on the most common infections, with an antibiotic stewardship perspective. A 'For further information' section provides details on various concepts, such as antibiotic resistance. As part of the evaluation, 8 general practitioners and 5 community pharmacists were individually interviewed, 46 health system users replied to an online questionnaire and 5 focus groups were conducted (17 participants). In addition, more than 100 people (professionals and general population) provided feedback directly on the website. The website was well received by health professionals, particularly general practitioners, and described as a reference site for patients and a communication tool. The general population also found the site useful. Several comments helped improve the website before the launch of the final version on 18 November 2019. At 6 month follow-up, more than 25 000 persons had visited the website. CONCLUSIONS: The Antibio'Malin information website was developed and tested. Post-launch data suggest a useful addition to the multifaceted French national antibiotic stewardship strategy.

[Stigmatization and public health: The dark-side of anti-smoking interventions]. / Stigmatisation et santé publique : le côté obscur des interventions anti-tabac.

Tobacco control strategies, considered legitimate and effective, are rarely the subject of critical analysis in France. This is specifically true with regard to their potentially harmful effects, particularly against people who continue to smoke. This article introduces this debate, focusing on the potentially stigmatizing effects of anti-smoking policies. It has been attested by numerous international studies, and by a study in France, that the general process of tobacco denormalization has led to the stigmatization of smokers who then may be subject to discrimination. To the extent that smoking is now concentrated in the most disadvantaged socio-economic populations in France, the latter are thus more exposed to stigma. While underscoring the need to develop targeted interventions against them, this article also warns and calls for vigilance regarding the potential iatrogenic effects of these interventions. It is therefore necessary to develop research and evaluations on this subject in order to accurately measure the effects of these interventions, particularly in terms of stigmatization and self-stigma, and to ensure that public health actors do not generate more problems than they solve.

Patients and relatives coping with inflammatory arthritis: Care teamwork.

OBJECTIVE: To explore how patients and relatives experience and talk together about their life with inflammatory arthritis. DESIGN: Qualitative research. SETTING: A convenience sample was used. Participants were recruited in seven rheumatology departments in France. PARTICIPANTS: Patients with rheumatoid arthritis or spondyloarthritis, agreeing to participate in the study with a relative, age at least 18 years. DATA COLLECTION AND ANALYSIS: Two psychologists conducted face-to-face interviews with 20 patient-relative dyads (40 individuals). A thematic analysis followed a general inductive approach. RESULTS: Saturation was reached after interviews with 20 dyads. The analysis revealed four main themes: (a) disease 'lived' together: a new role for the relative (providing help in physical tasks, emotional support, acting as a driving force, having a role in medical care) and communication around the disease (not focusing on the disease); (b) impact of the disease on the relationship; (c) social impact of the disease on the dyad (social isolation); (d) difficulties and needs of the relative (need to better know the disease). CONCLUSION: This study has highlighted the importance of recognizing the role of the relative in the management of inflammatory arthritis disease, especially when medical decisions are shared with professionals. A joint approach to treatment is a basis for coping with the disease. This approach supposes (a) discussions about relatives' new roles to clarify them, (b) patients' and relatives' communication skills and (c) a good understanding of each other, which can be improved by providing information on the disease and coping strategies for both the patient and the relative.