A municipal health center's co-constructed therapeutic patient education program for patients with single or multiple morbidities / Co-construction d'un dispositif d'ETP mono et polypathologique dans un centre municipal de santé

Introduction: The accessibility of Therapeutic Patient Education (TPE) is essential to reduce social inequalities and to meet the challenges posed by the increase in chronic diseases. In France, the distribution of TPE throughout the territory is heterogeneous and patients still lack sufficient access. With these perspectives in mind, a municipal health center has developed an innovative TPE device by involving concerned patients from the outset. Objectives: The objectives of this article are to present the methodology implemented to co-construct a TPE program for patients with one or more prevalent diseases in the territory, as well as the results of the co-construction. Methods: Creation of a project team with various actors: patients, health professionals, administrators, researchers. Organization of synchronous and asynchronous times. Results: Four meetings and numerous exchanges made it possible to: define the common values and operating rules of the project team, reflect on the coordination of the care pathway, identify the specific and shared needs of patients affected by type 2 diabetes, arterial hypertension and/or obesity, agree on the principles of the device. Conclusion: The advantages of this device were discussed: flexible organization with numerous links with local actors, development of partnerships, expansion of the population concerned. Questions and difficulties were encountered, such as the coordination of actors and the representation of partner patients for the targeted diseases. This device will be tested and evaluated, mainly with an objective of improving it.

Introduction: L'accessibilité de l'Éducation Thérapeutique du Patient (ETP) est essentielle pour contribuer à une réduction des inégalités sociales et répondre aux défis posés par l'accroissement des maladies chroniques. En France, la répartition de l'offre d'ETP sur le territoire est inhomogène et les patients y occupent une place encore trop modeste. Dans ces perspectives, un centre municipal de santé a élaboré un dispositif innovant d'ETP en impliquant, dès le début, des patients concernés. Objectifs: Les objectifs de cet article sont de présenter la méthodologie mise en œuvre pour co-construire un dispositif d'ETP pour des patients porteurs d'une ou de plusieurs maladies prévalentes sur le territoire, ainsi que les résultats de la co-construction. Méthodes: Constitution d'une équipe projet avec divers acteurs : patients, professionnels de santé, administratifs, chercheurs. Organisation de temps synchrones et asynchrones. Résultats: Quatre réunions et de nombreux échanges ont permis de : définir les valeurs communes et les règles de fonctionnement de l'équipe projet, réfléchir sur la coordination du parcours de soins, identifier des besoins propres et partagés des patients touchés par le diabète de type 2, l'hypertension artérielle et/ou l'obésité, se mettre d'accord sur les principes du dispositif. Conclusion: Ce dispositif présente des avantages certains : organisation souple avec de nombreux liens avec les acteurs locaux, développement du partenariat, élargissement de la population concernée. Néanmoins, des questionnements et des difficultés ont été rencontrés comme la coordination des acteurs et la représentation des patients partenaires pour les maladies ciblées. Ce dispositif sera expérimenté et évalué principalement en vue de son amélioration.

Monitoring Surveys in the Context of Covid-19, Published in Belgium and France, in the Light of Health Democracy.

Introduction: The management of a pandemic, such as COVID-19, requires the full participation of citizens. This recent situation has revealed the undermining of user participation in the decision-making process. Thus, this study aims to assess the involvement of users in the design and administration of surveys for health crisis monitoring and to stimulate reflection on information processes shared upstream during the decision-making process. Methods: A literature search was conducted on population monitoring surveys published during the first containment period in Belgium and France between April and May 2020. The selected studies were first analyzed according to a reading grid based on the criteria proposed by the World Health Organization (WHO) for monitoring populations and supplemented by data from a descriptive analysis of the selected studies. Second, with the objective of specifically evaluating the involvement of users in monitoring surveys, this study evaluated the surveys according to the following parameters: content of a study based on themes presented in surveys; inclusion of health literacy (HL); and factors of commitment of the respondents to the survey. Results: A total of 45 studies were selected for final analysis. The majority of the surveys focused on the effect of COVID-19 on well-being. Furthermore, analysis indicated that, in summary, the HL of people concerned as well as the involvement of respondents is poorly considered, which remains limited in terms of the design and administration of the surveys. Discussion: Although the principles of health democracy seemed to have been established, the exceptional regime induced by the epidemic overlooked the observance of such principles. This result indicates the need to reconsider the participation of citizens as real partners in care, including health crisis management.

Perceptions of multiple chronic conditions and coping strategies among migrants from Sub-Saharan Africa living in France with diabetes mellitus and HIV: An interview-based qualitative study.

Although diabetes is common among people living with HIV/AIDS (PLWHA), few data exists on how migrants from Sub-Saharan Africa (SSA) experience living with these two coexisting conditions in France. The objective of this study was to analyze perception of polypathology among PLWHA from SSA with type 2 diabetes and identify barriers and facilitators to their self-management. A qualitative study was conducted using semi-structured interviews from November 2019 to April 2020 with participants selected from a cohort of PLWHA and diabetes at Avicenne University Hospital. A total of 12 semi-structured interviews were conducted and analyzed using thematic analysis with inductive approach. Stigma remained a major issue in self-managing HIV, and some participants did not consider themselves as having a polypathology, as HIV has always been considered as a distinct condition. In general, emotion-based resources (e.g spirituality, trust in the medical discourse) and social support were mobilized more than problem-solving resources (e.g perception of medication as life-saving). Participants used the same main resource in self-management of HIV and diabetes, and resources used differed from participant to participant. This study highlighted challenges in self-management of diabetes and HIV in this population and complexity related to the socioeconomic and cultural specificities. Self-management could be more successful if patients and carers move in the same direction, having identified the individual coping resources to reach objectives.

Learnings from Health Behavioural Survey Practices in France and Belgium During the First COVID-19 Stay-at-Home Order.

The COVID-19 pandemic has compelled public authorities to establish preventive measures involving individual behaviour modification strategies (mask-wearing, social distancing, etc.) with a view to community protection. In this context, documenting people's behaviour changes, the impact of public health measures, and individuals' knowledge, motivations, and beliefs - even their perception of how the crisis is being managed - is essential for understanding the experience of the population and adapting the management approach accordingly. This article presents findings and lessons on how to monitor a population's behaviour during a crisis, obtained by reviewing forty-five surveys conducted in Belgium and France during the first Covid-19 stay-at-home order, from April to May 2020. The central message is to argue that the citizens' role in this type of survey - and in managing the crisis, more generally - should be reconsidered by thinking of them as true health partners and members of a community that could be mobilised to help.

[Orientation practices among patient education nurses: A qualitative study with general doctors and patients at a health center in Lorraine]. / Pratiques d'orientation vers l'infirmière d'éducation thérapeutique : étude qualitative auprès de médecins généralistes et de patients d'une maison de santé en Lorraine.

INTRODUCTION: To cope with the increased number of patients with chronic diseases, the ASALEE scheme promotes cooperation between doctors and patient education (PE) nurses in a health center in Lorraine. They observe behaviors of absence, cancellation, and postponement of the first consultation among referred patients. OBJECTIVE: Our study explores the medical orientation practices for patients during their first PE consultation. METHOD: Observation of these practices was combined with semi-structured interviews. RESULTS: Four doctors and 17 patients were observed and interviewed, following referral to the PE nurse for six of them and to a specialist doctor for the remaining 11. 27 criteria and 72 indicators were involved, concerning PE orientation practices. 15 of these also appeared in the 22 criteria for the medical specialist. These criteria open up new prospects for improving PE, such as "Quality of the doctor-patient relationship" and "Lack of knowledge and skills in PE". DISCUSSION AND CONCLUSION: The improvement of medical orientation practices in PE is enabled by professional practice analysis groups and by the social acceptability of patient empowerment and engagement.

Pratiques d'orientation vers l'infirmière d'éducation thérapeutique : étude qualitative auprès de médecins généralistes et de patients d'une maison de santé en Lorraine.

INTRODUCTION: To cope with the increased number of patients with chronic diseases, the ASALEE scheme promotes cooperation between doctors and patient education (PE) nurses in a health center in Lorraine. They observe behaviors of absence, cancellation, and postponement of the first consultation among referred patients. OBJECTIVE: Our study explores the medical orientation practices for patients during their first PE consultation. METHOD: Observation of these practices was combined with semi-structured interviews. RESULTS: Four doctors and 17 patients were observed and interviewed, following referral to the PE nurse for six of them and to a specialist doctor for the remaining 11. 27 criteria and 72 indicators were involved, concerning PE orientation practices. 15 of these also appeared in the 22 criteria for the medical specialist. These criteria open up new prospects for improving PE, such as "Quality of the doctor-patient relationship" and "Lack of knowledge and skills in PE". DISCUSSION AND CONCLUSION: The improvement of medical orientation practices in PE is enabled by professional practice analysis groups and by the social acceptability of patient empowerment and engagement.

Aging-simulation experience: impact on health professionals' social representations.

BACKGROUND: Health professionals working with older persons are not sufficiently aware of the sensory and functional difficulties experienced by older patients. Innovative educational activities, such as the aging-simulation experience, can facilitate this awareness. This study describes the effects of an aging-simulation experience on health professionals' representations towards age-related limitations. METHODS: 306 health professionals, enrolled in university training in geriatrics/gerontology in the 2015-2016 and 2016-2017 academic years, experienced an aging-simulation session wearing a special suit according to a predefined scenario. Before and after the aging-simulation experience, participants completed free association tests, with the inductive words vision, hearing, movement, fine dexterity and balance. Semantic categories were created from participants' free evocations using a correspondence table manually produced in Excel 2013 for Windows (Microsoft Corporation, Redmond, Washington). Moreover, participants' opinions on difficulties experienced by older people in relation to age-related limitations were studied using Likert scale questions. RESULTS: In total, 3060 free evocations were collected, and ten semantic categories were created. These categories were composed of participants' geriatric knowledge, about age-related limitations, and participants' feelings, about the experience of these limitations. These two aspects were impacted by the aging-simulation experience. Moreover, changes observed resulted in a better consideration of difficulties associated with age-related limitations. CONCLUSIONS: The aging-simulation experience is an effective educational tool to raise awareness among health professionals of age-related difficulties. This sensory activity allows health professionals to put themselves in the shoes of older patients and to feel age-related difficulties.

[Therapeutic Patient Education training for nursing students: A case study.] / La formation en éducation thérapeutique « niveau 1 ¼ des étudiants en soins infirmiers : étude de cas.

INTRODUCTION: Many educational institutions offer professionals continuing education in therapeutic patient education (TPE). Some also provide it for students in initial training. OBJECTIVES: 1) Describe the methods of implementing the training in two nurse training institutes (IFSI); 2) Determine the conditions conducive to the development of competencies for students in initial training. METHOD: Nineteen semi-structured interviews were conducted with trainers, external speakers, students in training, and registered nurses. A questionnaire sent to trainers and external speakers was used to supplement the information gathered. RESULTS: All stakeholders had different levels of training and had experience in TPE. Multiprofessionality in teaching was favored. Several pedagogical activities were proposed to make up for the lack of experience of the students and the shortage of internships, among them role-playing, exchanges of practices, and creation of tools. The training was evaluated in terms of satisfaction and acquisition. DISCUSSION: The training courses implemented largely follow the quality criteria described in the literature. CONCLUSION: This type of training could be replicated with other students in initial training, or even interprofessional training. The effects of this training should be assessed.

Observance to antiretroviral treatment in the rural region of the Democratic Republic of Congo: a cognitive dissonance.

INTRODUCTION: This study aimed to understand the influence of local media, religion and cultural beliefs on the therapeutic compliance of patients living with HIV. METHODS: This study was conducted in two rural hospitals in the Central Kongo province of the Democratic Republic of Congo. Semi-directional interviews were conducted with patients on antiretroviral therapy using a phenomenological qualitative method. RESULTS: Our results indicated that patients living with HIV in the rural region of the Democratic Republic of Congo are in a constant state of tension between the messages for compliance to antiretroviral treatment advocated by caregivers, and those broadcasted by audiovisual media, religious leaders and local beliefs. This dissonance constitutes a real barrier to therapeutic compliance. CONCLUSION: Collaborative strategies between healthcare providers, patients, as well as religious, media and traditional organizations are urgently needed.

Children with chronic disease and extracurricular activities: training needs / Enfants atteints de maladies chroniques et activités périscolaires : des besoins de formation.

Background: ln the current context of increasing numbers of children living with a chronic disease and increasing numbers of people supervising extracurricular activities, difficulties appear to persist despite the Personalised Core Project (PCP). This study explores the accessibility and usefulness of the information provided by the Personalised Care Project and the value of complementary support. Methods: Based on the key messages identified by experts in the four most common chronic diseases, a questionnaire was deve/oped and sent to people supervising extracurricular activities in three districts of the Saône-et-Loire department. Descriptive statistical analysis was performed. Results: 55 people participated in the study. 30 (54.5%) had already supervised children with a chronic disease, 21 (70%) of them had been able to read the PCP and 17 (57%) had participated in an information meeting. 23 out of 28 (82%) considered thot the information contained in the PCP was helpful and 21 (81%) expressed their needs for further information. 98% of respondents thought thot additional support would be useful. Their main needs corresponded to 3 main self-core ski/Js: to recognize, analyse and measure; to deal with and decide; to resolve prevention problems. Conclusion: This study confirms the value of the PCP, but also the Jack of preparation of people supervising extracurricu/ar activ ities. lt highlights the need for training to allow these people to ensure the safety of chi /dren living with chronic diseases.

Haemophilia: how sentinel patients have developed a warning semiotics / Hémophilie : comment des patients-sentinelles ont élaboré une sémiologie d'alerte

Haemophilia: how sentinel patients have developed warning semiotics. The experience of the disease may help the patient to develop effective actions to manage every day, if it is accompanied by a personal reflection. Following a process that sometimes can be long, some people with hemophilia, called sentinel patients have developed a personal semiology of early and subclinical signs of hemarthrose, complementary to medical semiology. Learning such an approach can be made possible within therapeutic education workshops co-facilitated by patient/parent and caregiver resources. Facilitated by peer intervention, the expression of singular feelings of early signs, helps patients reflect on strategies adapted to their situation and conducive to faster adequate reaction towards their bleeding episodes, particularly through self-care actions. This collaborative work between patients and caregivers also brings benefits to professionals who, for some, consider differently the care they provide to people they meet in their healthcare activity.

Hémophilie : comment des patientssentinelles ont élaboré une sémiologie d'alerte. L'expérience de la maladie peut aider le patient à développer des actions efficaces pour la gérer au quotidien, si elle s'accompagne d'un travail de réflexion personnelle. À la suite d'un processus parfois long, certaines personnes hémophiles, appelées patients sentinelles, ont développé une sémiologie personnelle de signes précoces et infracliniques d'hémarthrose, complémentaire de la sémiologie médicale. L'apprentissage d'une telle démarche s'avère possible dans le cadre d'ateliers d'éducation thérapeutique co-animés par des patients/parents ressources et des soignants. Facilitée par l'intervention des pairs, l'expression du ressenti singulier des signes précoces aide les patients à réfléchir à des stratégies adaptées à leur situation et favorables à la prise en charge plus rapide de leurs accidents hémorragiques, notamment à travers l'auto-soin. Ce travail de collaboration entre patients et soignants apporte également des bénéfices aux professionnels qui, pour certains, envisagent différemment la prise en charge des personnes qu'ils rencontrent dans leur activité de soins.

[Learning strategies and computer lectures]. / Stratégies d'apprentissage et cours dématérialisés en formation infirmnière.

INTRODUCTION: French nurse schools use more and more frequently scanned lecture courses because of their partnership with universities. OBJECTIVE: This study was aimed to identify the training strategies set up by nursing students with regard to lecture courses given by CD-ROM/DVD, as well as their perceptions of such an educational system. METHOD: 88 nursing students (second semester) answered a questionnaire; 62 were collected, from which a frequency study was led. RESULT: Students attempt to set up in-depth training strategies but do not succeed significantly and spare much efforts. It does result discouragement with lack of motivation in regard to their training. DISCUSSION: Using CD-ROM without adapted didactic environment disturb the development of requested training strategies compared to socio-constructivist principles it does refer to.

Characteristics and development of therapeutic patient education in rheumatoid arthritis: analysis of the 2003-2008 literature.

OBJECTIVE: The aim of this study is to point out the recent characteristics and developments of therapeutic patient education (TPE) in rheumatoid arthritis through an analysis of the international articles published from 2003 to 2008. METHOD: Studies were selected from major databases, using the following keywords: rheumatoid arthritis, patient education, self-management, programs. Three authors independently reviewed each study and selected the data using the patient education research categories (PERC). Articles consistently related to patient education in rheumatoid arthritis (37 among 109) were included. RESULTS: The selected articles have been published in 23 scientific journals. The majority of them concern TPE for adult patients with rheumatoid arthritis. TPE is delivered in several structures and group education represents the most widespread educational strategy mainly provided by a multiprofessional team. There are two types of programs: educational, aiming to make the patient competent in the daily management of his disease and psycho-educational ones, aiming to improve coping and to decrease stress, anxiety and depression. Twenty-eight studies show the effectiveness of TPE on the basis of bio-clinical, educational, psychosocial, economical criteria, but the majority of these positive results are observed in short-term. Barriers to TPE are linked to cultural and socio-economic factors. CONCLUSION: A large number of studies still assess the positive effects of TPE. Nowadays, the problems of short-term efficacy of TPE and the cultural and social barriers to this practice have become a major issue for research.