Improving autonomy support: a collaborative learning experience / Améliorer les pratiques d'accompagnement à l'autonomie en santé : effets d'un dispositif d'apprentissage coopératif

Introduction: The ACESO project, which was part of the Autonomy support in health national experimentation, brought together 21 partners from Ile-de-France. Among these partners, 14 had practices similar to autonomy support. Partners' presupposition was that experimenting a cooperative approach would encourage the empowerment of participants, improve their autonomy support and put into place the conditions necessary for the empowerment of people who would be supported. To help participants to meet this goal, the project leader took on a role as third party whose function was to facilitate the cooperative approach by proposing a framework and a method. Purpose of research: The study aimed to report the effects of this approach on the participants' practices as well as to identify the process for achieving this. Results: The participants' learning enabled them to align themselves with the good practice guidelines collectively constructed within the project. With the project leader's support, they initiated a transformative learning process that allowed them to develop their reflexivity and empowerment. These transformations had repercussions on their teams and structures, through a halo effect. The halo effect varied, in each partner structure, according to the participation and involvement of the project referent and the other members of the structure, in particular managers. Conclusions: This study has highlighted the value of a cooperative approach to facilitate the learning necessary for sustainable practices transformations and the improvement partners autonomy supports. This resulted in gains in autonomy for the autonomy support practitioners and the people they supported.

Introduction: Le projet ACESO, participant à l'expérimentation nationale des dispositifs d'accompagnement à l'autonomie en santé (AAS), a rassemblé 21 partenaires franciliens parmi lesquels 14 portaient des pratiques qui empruntent à l'accompagnement. Son présupposé était qu'en expérimentant une démarche coopérative favorisant l'empowerment des partenaires, ceux-ci amélioreraient leurs pratiques d'accompagnement et mettraient notamment en place les conditions nécessaires à l'empowerment des personnes accompagnées. Pour les y aider, le porteur de projet a tenu un rôle de tiers dont la fonction était de faciliter la démarche coopérative en proposant un cadre et une méthode. But de l'étude: L'étude visait à rendre compte des effets de cette démarche sur les pratiques des partenaires, ainsi qu'à identifier le processus pour y parvenir. Résultats: Les apprentissages réalisés ont permis aux partenaires de se donner des balises de bonnes pratiques construites collectivement au sein du projet (valeurs, principes et postures). Avec le soutien du tiers, ils ont initié un processus d'apprentissage transformationnel développant leur réflexivité et leur empowerment. Ces transformations ont eu des répercussions sur leurs équipes et structures, par effet de halo. Ce dernier a varié, dans chaque structure partenaire, en fonction de la participation et de l'implication du référent-projet et des membres de la structure, en particulier la direction. Conclusion: Cette étude met en évidence l'intérêt d'une démarche coopérative pour faciliter l'apprentissage nécessaire aux transformations durables des pratiques et l'amélioration des pratiques de partenaires d'un collectif apprenant. Dans le cas de l'AAS, ceci s'est traduit par des gains d'autonomie pour les accompagnants et les personnes accompagnées.

[How do general practitioners promote a more equitable access for patient education?]. / Comment les médecins généralistes favorisent-ils l'équité d'accès à l'éducation thérapeutique pour leurs patients.

Our research is designed to understand how and under what conditions general practitioners contribute to equitable access to patient education (PE).We conducted a survey based on interactionist sociology in a sample of 32 doctors. These practitioners worked in the context of health networks and health care centres and were also involved in the PE resource centre for the Île-de-France region, thereby providing a favourable setting for our study, also reflected by the fact that one-half of practitioners were aware of the importance of or had been trained in PE.Doctors stress that their engagement in the patient-doctor relationship does not depend on the patient's psycho-social characteristics. Their educational practice nevertheless appears to be influenced by their a priori judgement of these characteristics. Based on their judgement, some clinicians develop practices that seem to promote better access for their socially underprivileged patients. This process is facilitated by several dynamics described in this article.The results of this research open up opportunities for office-based physicians and PE development structures to facilitate better access to PE for all patients.

[Improving the complementarity of patient education proposals: Experience feedback and recommendations]. / Améliorer la complémentarité des offres d'éducation thérapeutique du patient : retour d'expérience et recommandations.

INTRODUCTION: Implementing patient education (PE) in a defined geographic area, based on a population-based approach, implies using community resources according to a logic of complementarity, in order to mitigate the risk of rupture in patient care. METHODS: The PE Resource Centre for the Ile-de-France Region convened a multidisciplinary and multi-setting meeting attended by 45 participants in order to define the ways to improve the complementarity of all available PE resources, while taking into account the diversity of patients' needs. Three working groups successively explored three dimensions: structure, processes and outcomes, in order to assess this complementarity. RESULTS: Each group worked on three aspects: PE resources; patient's health trajectory in a defined geographic area, and a multidisciplinary team approach.Participants identified various deficits: clustering and lack of visibility for PE resources, programme framing constraints and difficulties of access for patients. Nevertheless, they highlighted several positive elements emerging from their shared experience. They recommend: 1) sharing of the available resources by developing communication and multidisciplinary training and more flexible programme formats; 2) building links between stakeholders, by promoting local PE programmes, and by encouraging coordination and practice analysis; 3) using and articulating a diversity of evaluation approaches, while reinforcing the multidimensional nature of PE contributions, not only for patients but also for professionals and the healthcare system. DISCUSSION: PE Resource Centres may facilitate implementation of these recommendations by supporting a collective and dynamic approach, contributing to a reduction of social inequalities in PE access.

[A healthcare network reintroducing diabetic people to physical activity]. / Reprise d'une activité physique par des personnes diabétiques au sein d'un réseau.

The Paris Diabetes Network helps diabetic people to live more easily with their disease. Surrounded by professionals, the patients benefit from an innovative care approach which places as much emphasis on physical activity as on diet and treatments. In addition to the medical benefits, pleasure and fun are very much on the agenda.