[Beyond benefit evaluation: Considering the unintended consequences of telehealth]. / Au-delà de l'évaluation des bénéfices : réflexion sur les conséquences inattendues de la télésanté.

Telehealth is seen as a key lever in health policy choices. However, many challenges remain in terms of its successful integration into clinical practices. To date, many telehealth initiatives are struggling to move beyond the pilot project stage. This is partly due to a culture of innovation that is mainly focused on the expected benefits of the technology and less on the changes and transformations it can generate. Telehealth is used in health care organizations with complex social dynamics, to say the least. Its introduction has unintended consequences that can affect patients, communities, professionals, organizations, health systems and society as a whole. The aim of this article is to discuss some of the unintended consequences of using telehealth in health care organizations and systems.

Sociocultural determinants of nomadic women's utilization of assisted childbirth in Gossi, Mali: a qualitative study.

BACKGROUND: In sub-Saharan Africa (SSA), nomads account for 30 to 60 million people. Their mobility, due to a constant search for pastures and water points, makes health services less accessible to them. Few nomadic women use assisted delivery, which increases the risk of maternal mortality. The reasons behind this limited use have been poorly documented. The objective of this study was to understand the sociocultural determinants of assisted childbirth by nomadic women. METHODS: We conducted a qualitative research in the health area of Gossi (Mali), mainly populated by nomads. Data were collected through a literature review, 26 semi-structured interviews, a non-participant observation, and a logbook. Nomadic women who gave birth in the past three months were included in the study, whether they used assisted delivery or not. A thematic content analysis was performed with QDA Miner software. RESULTS: The study identified a complex combination of determinants resulting in the use or non-use of assisted childbirth by the nomads of Gossi. Several participants recognized the value of assisted delivery but gave birth at home. They identified sociocultural determinants related to their representations and bodily experiences; the risks and emotions (fear, stress, anxiety) associated with pregnancy; the onset of labor and delivery; and their weak autonomy in terms of movement, decision-making, and economic agency. Nomadic women are not free in their movements, and in order to seek care, they require the permission and support of a man (husband, brother, or father). Furthermore, the participants are housewives, and men control family resources and make decisions regarding all financial matters. Assisted delivery is often only considered when there are complications. CONCLUSION: This research has made it possible to understand the sociocultural determinants of the use of assisted childbirth among nomadic women, which should be taken into account when organizing health services for these populations.