[The qualitative research on social inequalities in health: the life courses]. / La recherche qualitative sur les inégalités sociales de santé : le parcours de vie.

OBJECTIVES: Adopting a lifecourse perspective is more and more frequent in the health inequalities research field. This article describes such an approach, as applied in a study on poverty and social exclusion. METHODS: In this study, life histories were collected through open interviews and focused on the meaning of lived experiences. An original analysis table was used, in which words are grouped within categories identifying the different components of a lifecourse. RESULTS: Whether it refers to experiences lived in childhood or adulthood, the life history enables the placing of these within the individual's lifecourse. The horizontal analysis of different individual stories makes it possible to identify experiences that have harmful, or conversely, beneficial effects. When transferring results, reporting the experiences lived by the populations using the same words they did to describe them can help those responsible for program development or implementation understand the genesis of social health inequities. CONCLUSION: The analysis of life histories, based on the different components of a lifecourse, allows the identification of key moments in the interviewees' life evolution and, in an action perspective, to do so while taking health and social intervention fields into account. Such results make it easier to design actions to counter social health inequities - and above all their chronic nature - that are suited to the realities encountered.

Why men experiencing deep poverty in Montréal avoid using health and social services in times of crisis.

This article describes the experiences of men living in deep poverty regarding their decision not to seek out health and social services in moments of crisis, even when they recognized needing help. It presents results from a qualitative research project done in collaboration with a community center in a disadvantaged neighborhood of Montreal, Canada. It was designed to increase understanding of men's experiences of poverty and the role played by health and social services in their lives. Data were collected through 80 days of participant observation, 22 semi-directed interviews, and six group discussions with men living in poverty. The results show that these men are reluctant to use health and social services for three main reasons: 1) the nature of their problems; 2) their difficulty in seeking help; 3) the nature of services offered. The paper concludes with implications of the findings for future research and interventions.

A qualitative study of the promotion of exclusive breastfeeding by health professionals in Niamey, Niger.

BACKGROUND: The practice of exclusive breastfeeding depends on various factors related to both mothers and their environment, including the services delivered by health professionals. It is known that support and counseling by health professionals can improve rates, early initiation and total duration of breastfeeding, particularly exclusive breastfeeding. Mothers' decisions are influenced by health professionals' advice. However, in Niger the practice of exclusive breastfeeding is almost non-existent.The purpose of this exploratory study, of which some results are presented here, was to document health professionals' attitudes and practices with regard to exclusive breastfeeding promotion in hospital settings in the urban community of Niamey, Niger. METHODS: Fieldwork was conducted in Niamey, Niger. A qualitative approach was employed. Health professionals' practices were observed in a sample of frontline public healthcare facilities. RESULTS: The field observation results presented here indicate that exclusive breastfeeding is not promoted in healthcare facilities because the health professionals do not encourage it and their practices are inappropriate. Some still have limited knowledge or are misinformed about this practice or do not believe in it. They do not systematically discuss exclusive breastfeeding with mothers, or they mention it only briefly and without giving any explanation. Worse still, some encourage the use of breast milk substitutes, which are frequently promoted in healthcare facilities. Thus mothers often receive contradictory messages. CONCLUSION: The results suggest the need to train or retrain health professionals with regard to exclusive breastfeeding, and regularly supervise their activities.

Living environments and health at the local level: the case of three localities in the Québec city region.

BACKGROUND: To arrive at a better understanding of the combined impact of social health determinants on health inequities a research project was carried out in three localities in the Québec city region. This paper aims to show how residents' health status and health determinants can be explored through various data sources and analytic perspectives, and how these can then be combined to create a more comprehensive picture of health status at the local level. METHODS: A multidisciplinary approach was adopted. Both quantitative and qualitative methods were used: information from databases entered into a geographic information system, telephone survey and face-to-face interviews with key informants, telephone surveys with representative samples of the population in each locality and in-depth interviews with citizens. The localities were subdivided into neighbourhood units to refine the analysis on local environment. RESULTS: The results obtained in the locality of Saint-Louis, which displays the worst scores of the three localities, illustrate the research strategy's potential. Socio-economic and health indicators show that Saint-Louis is less well-off than the two other localities and that huge disparities among neighbourhoods are present within this locality. Results from the interviews with key informants, the telephone survey and interviews with citizens confirm this overall picture, raising many hypotheses about the various factors interacting to contribute to levels of health. INTERPRETATION: Two main methodological conclusions can also be drawn from this study: that defining the appropriate spatial scale to study the impact of living environments is crucially important, and that a life course approach is essential to understanding how inequities develop.

Perception of place and health: differences between neighbourhoods in the Québec City region.

This paper addresses two questions: (1) Can people's perceptions of problems and social cohesion in the neighbourhood be considered as contextual variables; and (2) are these perceptions related to people's health? Data come from a general health survey carried out in 2004 among 1634 individuals living in three localities of the region of Québec City, namely a downtown, a suburban and a rural area, which were further subdivided into 34 smaller spatial units, hereafter called neighbourhoods. The survey included questions on individuals' perception of problems (social and environmental) and social cohesion (attraction to neighbourhood, neighbouring and psychological sense of community) in the neighbourhood, as well as questions on self-rated health, long-term disability and self-mastery. A first set of logistic multilevel models was performed to ascertain the existence of neighbourhood variations in the perception of problems and social cohesion, after accounting for individual attributes. A second set of multilevel models was carried out to examine the association between perceived problems and social cohesion in the neighbourhood and people's health. Results show that, after accounting for individual attributes, the perception of problems and social cohesion varies significantly by neighbourhood and/or localities and can be considered as contextual variables. Furthermore, these perceptions of place appear to be significant predictors of people's health.

Conceptualization and sources of costs from breast cancer: findings from patient and caregiver focus groups.

Assessment of economic burden of breast cancer to patient and family has generally been overlooked in assessing the impact of this disease. We explored economic aspects from the perspective of women and their caregivers. Focus groups were conducted in 3 Quebec cities representing urban and semi-urban settings: 3 with 26 women first treated for non-metastatic breast cancer in the past 18 months, and 3 with 24 primary caregivers. We purposefully selected participants with different characteristics likely to affect the nature or extent of costs. Thematic content analysis was conducted on verbatim transcripts. Costs of breast cancer could be substantial, but were not the most worrisome aspect of the illness during treatments. Some costs were considered unavoidable, others depended on ability to pay. Costs occurred over a long period, with long term impact, and were borne by the whole family and not just the woman. Principal cost sources discussed were those associated with accessing health care, wage losses, reorganization of everyday life, and coping with the disease. This study provided deeper understanding of cost dynamics and the experience of costs among Canadian women with non-metastatic breast cancer, whose treatment and medical follow-up costs are borne through a system of universal, publicly funded health care.

Production and reproduction: the issues involved in reconciling work and pregnancy.

Quebec legislation in occupational health contains a measure that gives pregnant workers the right to demand healthy and safe work conditions so that they can continue working while they are pregnant. About one-third of pregnant workers exercise this right every year. Nonetheless, even though the legislation's goal is to favor continued employment, more than 75 percent of the female workers who are eligible for protective reassignment are, in fact, not reassigned to other work stations or tasks, and instead must stop working. The results presented here stem from research intended to improve our understanding of the difficulties that arise in the workplace when the organization of work has to be reconciled with pregnancy. In telling us their experiences, the 51 pregnant workers we interviewed gave us their definition of "reconciliation." They did this by identifying the elements and areas of their occupational and family responsibilities that hindered or favored this reconciliation. They thus brought to light the predominant role that social relationships play in these situations. The comments of the women we met shed light on work conditions and organizations whose characteristics, once identified, suggest some of the changes needed to make this reconciliation possible.