Actualités du laboratoire Hesper

 - Marie Rambure : « PHARMA ILIADE Study : Determinants of the implementation of communication techniques adapted to patients' health literacy levels in French community pharmacies & intervention proposals, using the Theoretical Domains Framework and the Behaviour Change Wheel »

Background

Community pharmacy professionals have a crucial role to play to enhance patients’ understanding and empowerment about their disease in accordance with their health literacy (HL) level. We aimed to explore the determinants of the implementation of patient HL level assessment and HL-tailored communication practices towards chronic patients among community pharmacy professionals.

Methods

We conducted a cross-sectional sequential explanatory mixed-method study. As a first step, an online self-completed questionnaire underpinned by the Theoretical Domain Framework (TDF) was sent to community pharmacy workers (pharmacists and pharmacy technicians of the Auvergne-Rhône-Alpes region, France). Findings were analysed using the confidence interval-based estimation of relevance (CIBER) method. As a second step, semi-structured interviews were conducted with a sample of survey respondent volunteers, to deepen the information previously gathered. The determinants explored, within these two steps, were the 12 domains of the TDF. Finally, we used the Behaviour Change Wheel (BCW), to propose, in a structured way, intervention ideas.

Results

Among the 111 respondents (91 pharmacists and 20 technicians), count (84%) were not familiar with HL. However, after being shortly introduced to the concept, most claimed to informally assess patient HL level and adapt their communication to the understanding of patients. Key determinants that impeded these behaviours were the lack of adapted environment (no clear signage in the pharmacy environment) and resources (lack of time, staff, adapted remuneration system, tools dedicated to assess patients' HL level), the lack of automatism (they did not assess all patients’ HL and the time of the day influenced whether they adapt or not their communication to patients’ HL level), and the difficulties to contact other healthcare providers. Thanks to the BCW and based on the AHRQ universal precaution toolkit and the Effective Practice and Organisation of Care (EPOC) taxonomy, we identified implementation strategies that might be useful for these behaviours ( the creation of trainings, specific tools, checklists and practices community or the reorganisation of the pharmacy...).

Conclusions

Several target TDF determinants of the implementation of the HL-tailored communication techniques in community pharmacy were identified in this study. Our results might guide the design of effective theory-based interventions to improve the implementation of HL-tailored behaviours among community pharmacy workers.

 - Christine Rousset-Jablonski : « Santé de la femme et pathologies chroniques : exemple de la mucoviscidose »

Chez les femmes atteintes de  maladies chroniques, le suivi et la prise en charge gynécologique (participation aux dépistages mammaire et cervical, information et couverture contraceptive...) sont parfois insuffisants en regard des recommandations, et en comparaison avec les femmes de la population générale. Cependant, certaines particularités liées à leur pathologie justifierait une prise en charge spécifique et adaptée. 

L’espérance de vie des patients atteints de mucoviscidose s’est améliorée. En conséquence, des problématiques et questions nouvelles émergent, comme celles de la prise en charge gynécologique et de la santé sexuelle des femmes adultes atteintes de mucoviscidose.

L’objectif de ce travail a été d’évaluer la prise en charge gynécologique des femmes atteintes de mucoviscidose, de décrire leurs comorbidités gynécologiques, et de proposer des pistes d’amélioration de prise en charge et de prévention.

- Corinne Dupont et Laurent Gaucher : « Women’s dissatisfaction with inappropriate behavior by health care workers during childbirth care in France: A survey study »

Background

Quality care during childbirth requires that health care providers have not only excellent skills but also appropriate and considerate attitudes and behavior. Few studies have examined the proportion of women in Western countries expressing dissatisfaction with such inappropriate or inconsiderate behavior. This study evaluated this proportion in a sample presumably representative of French maternity units.

Methods

This prospective multicenter study, using data from a selfadministered questionnaire, took place in 25 French maternity units during one week in September 2018. The primary outcome measure was mothers' self-reported dissatisfaction with blatantly inappropriate behavior (ie, inappropriate attitude, inadequate respect for privacy, insufficient gentleness of care, and/or inappropriate language) by health care workers in the delivery room. The secondary outcome was their self-reported dissatisfaction with these workers' inconsiderate behavior (ie, unclear and inappropriate information, insufficient participation in decision-making, or deficient consideration of pain).

Results

Of 803 potentially eligible women, 627 completed the questionnaire after childbirth; 5.62% (35/623, 95% CI: 3.94-7.73) reported dissatisfaction with blatantly inappropriate behaviors and 9.79% (61/623, 95% CI: 7.57-12.40) with inconsiderate behaviors. The main causes of dissatisfaction reported by women in this survey were the inadequate consideration of their pain and the failure to share decision-making.

Conclusions

Most of the women were satisfied with how health care workers behaved towards them in the delivery room. Nonetheless, health care staff must be aware of women's demands for greater consideration of their expressions of pain and of their voice in decisions.

- Alexandra Dima, Julie Haesebaert, Adèle Perrin, Luiza Siqueira Do Prado, Anne-Marie Schott-Pethelaz : « What is Patient and Public Involvement in Research and how to do it? »

Patient oriented research – Key features and RESHAPE guidelines

Nowadays, partnering with patients in health research is strongly recommended. Patient and Public Involvement (PPI) in research is defined as research actively carried out ‘with’ or ‘by’ members of the public rather than ‘to’, ‘about’, or ‘for’ them (INVOLVE group UK). In 2015, as part of the patient partnership strategy,

The BMJ began requiring authors to include a PPI statement in all research articles. In the year before the PPI reporting requirement, 0.5% of research articles reported PPI activity. In the year following the requirement, 11% of research articles reported PPI activity (Price A, BMJ 2018). In France, researchers awareness about PPI in research is less developed. Our presentation aims to disseminate these approaches within RESHAPE projects. After presenting the foundations and benefits of partnership in research, we will propose a guide and tools designed to support RESHAPE researchers and patients to engage in partnership in research.