Besoins éducatifs en santé en Appartement de Coordination Thérapeutique.

OBJECTIVE: The aim of this study was to identify the health education needs of people suffering from several pathologies including HIV and/or hepatitis, living in vulnerable conditions in Therapeutic Coordination Apartments (known in French as Appartements de Coordination Thérapeutique under the acronym ACT). METHOD: This article is based on a qualitative and collaborative study involving in research team people living in ACT, professionals of ACT and academics. Interview guides based on the literature were developed. Nine ACTs participated: there were interviews with 36 people with chronic conditions, 9 focus groups with staff members and 9 additional interviews with ACT managers. RESULTS: Health education needs were identified. These involved: managing one's multiple conditions, managing certain diseases in particular, daily life with multiple chronic conditions, the connections and origins of the diseases. Factors influencing how they deal with one disease rather than another were expressed. The educational needs of people with HIV and/or hepatitis have been highlighted. CONCLUSION: Health education needs still exist despite the care that people living in ACTs receive. The study makes it possible to put forward proposals for improving support and, more specifically, health education interventions implemented in ACTs: asking additional questions to identify health education needs more precisely, providing polypathology therapeutic patient education (TPE) training to the teams, involving the affected populations, taking into account health literacy levels.

Fruits and vegetables at home (FLAM): a randomized controlled trial of the impact of fruits and vegetables vouchers in children from low-income families in an urban district of France.

BACKGROUND: Fruits and Vegetables (FV) consumption is considered a marker of social inequalities in health since it is considerably decreased in disadvantaged populations. The main objective of this trial was to evaluate the impact of vouchers for FV purchase on the consumption of FV among children living in disadvantaged families in a French urban district. METHODS: The FLAM study was a controlled randomized intervention trial, performed in Saint-Denis (North suburbs of Paris). The study group (intervention or control) was randomly attributed to parent-child pairs at inclusion. The intervention group received vouchers exchangeable for FV over a 1 year period. Nutritional education through workshops was available for both groups. FV consumption was assessed through face-to-face food frequency questionnaires. Participants who reported eating less than 3.5 FV per day were considered low FV consumers. RESULTS: A total of 92 parent-child pairs were included, in which 45 were allocated to the intervention group and 47 to the control group. Amongst them, 64 completed the final follow-up questionnaire (30% lost to follow-up). After one year, the proportion of low FV consumers in children was significantly lower in the intervention group (29.4%) compared to the control group (66.7%, p = 0.005). Overall, 82% of the vouchers were used by the families. CONCLUSIONS: This study found a decreased proportion of small consumers in children after 1 year of distribution of FV vouchers compared to the control group. FV vouchers could be an effective lever to increase FV consumption among children from disadvantaged households. TRIAL REGISTRATION: ClinicalTrials.gov identifier no. NCT02461238 .

Adoption of municipal bylaw legislating mandatory helmet use for cyclists under the age of 18: impact on cycling and helmet use. / Adoption d'un règlement municipal pour obliger les moins de 18 ans à porter un casque à vélo : effet sur la pratique du vélo et le port du casque.

INTRODUCTION: Bicycle helmet use is recognized as an effective way to prevent head injuries in cyclists. A number of countries have introduced legislation to make helmets mandatory, but many object to this type of measure for fear that it could discourage people, particularly teenagers, from cycling. In 2011, the City of Sherbrooke adopted a bylaw requiring minors to wear a bicycle helmet. The objective of this study was to assess the impact of this bylaw on cycling and bicycle helmet use. METHODS: The impact of the bylaw was measured by comparing the evolution of bicycle helmet use among youth aged 12 to 17 years in the Sherbrooke area (n = 248) and in three control regions (n = 767), through the use of logistic regression analyses. RESULTS: Cycling rates remained stable in the Sherbrooke area (going from 49.9% to 53.8%) but decreased in the control regions (going from 59.1% to 46.3%). This difference in evolution shows that cycling rates increased in the Sherbrooke area after the adoption of the bylaw, compared to the control regions (odds ratio [OR] of the interaction term: 2.32; 95% confidence interval [CI]: 1.01-5.35). With respect to helmet use, a non-statistically significant upward trend was observed in the Sherbrooke area (going from 43.5% to 60.6%). This figure remained stable in the control regions (going from 41.5% to 41.9%). No significant difference was observed in the evolution of helmet use between the two groups (OR of the interaction term of 2.70; 95% CI: 0.67-10.83). CONCLUSION: After the bylaw was adopted, bicycle use among youth aged 12 to 17 years in the Sherbrooke area remained stable and helmet used increased, though not significantly.

Understanding Breastfeeding Women's Behaviors Toward Medication: Healthcare Professionals' Viewpoint.

BACKGROUND:: Taking medication during breastfeeding is often a major concern for mothers. Knowledge, representations, and attitudes condition a mother's behavior in this situation. Healthcare professionals, whose medication advice for breastfeeding women is often described in scientific literature as inappropriate, play a major role in counseling mothers. Healthcare professionals' perceptions of mothers' behaviors regarding medication use during breastfeeding may influence mothers' behaviors. RESEARCH AIM:: The aim of this study was to identify healthcare professionals' perceptions of breastfeeding women's knowledge, representations, and attitudes and behaviors about medication use. METHOD:: A cross-sectional, prospective qualitative design was used. Semistructured interviews were conducted with a broad array of healthcare professionals ( N = 20) in different practice settings in the Angers area (France). Thematic analysis of the interview transcripts was carried out using the planned behavior theory of Ajzen. RESULTS:: Seventy themes concerning medication use while breastfeeding were identified and then combined into 8 categories. Healthcare professionals perceived that maternal behaviors regarding medication were mostly focused on the child's safety and were linked to poor knowledge and negative representations, attitudes, and feelings toward medication. Healthcare professionals also perceived significant negative influences from the mother's friends and family in regard to breastfeeding. Relationships between healthcare professionals and women were problematic when it came to drug use during breastfeeding. CONCLUSION:: Taking into account healthcare professionals' perceptions of maternal behavior will help improve education for these professionals. Indeed, knowing precisely what difficulties are met by healthcare professionals when they encounter medication use during breastfeeding can help educators improve training for these professionals.

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

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