embracing diversity in a strengths-based approach to promote health and equity, and avoid epistemic injustice

APP1155125. Publisher Copyright: © 2022 Author(s) (or their employer(s)).Definitions of health literacy have evolved from notions of health-related literacy to a multidimensional concept that incorporates the importance of social and cultural knowledge, practices and contexts. This evolution is evident in the development of instruments that seek to measure health literacy in different ways. Health literacy measurement is important for global health because diverse stakeholders, including the WHO, use these data to inform health practice and policy, and to understand sources of inequity. In this Practice paper, we explore the potential for negative consequences, bias and epistemic injustice to occur when health literacy instruments are used across settings without due regard for the lived experiences of people in various contexts from whom data are collected. A health literacy measurement approach that is emic-sensitive, strengths based and solution oriented is needed to minimise biased data interpretation and use and to avoid epistemic injustice.publishersversionpublishe

Psychometric properties of a Creole version of Medical Outcome Study – Short Form 36 among type II diabetes patients on Reunion Island

IntroductionHealth quality of life assessment is particularly important to measure the impact of chronic diseases. The aims of this study were to provide a cross-culturally adapted Creole-translation of the Medical Outcome Study Short-Form 36 (SF-36) and to assess psychometric performance of the Creole and French versions of the SF-36 among patients with type II diabetes in Reunion Island.Materials and methodsThe Creole translation and cross-cultural adaptation processes were based on the International Quality Of Life Assessment (IQOLA) methods. Internal consistency, test–retest reliability, convergent and discriminant validity using Multi-Trait-Multi-Method analysis and structural validity using exploratory factor analysis of the SF-36 for both versions were performed.ResultsIn the Creole version of the SF-36, Cronbach’s alpha exceeded 0.70 for all subscales except general health. In the French SF-36, Cronbach’s alpha exceeded 0.70 on all subscales except general health and bodily pain. In the Creole SF-36, intraclass correlation coefficient (ICC) for reproducibility was suboptimal. Multi-trait multi-method analysis showed that item-scale correlation exceeded 0.4 for all items except two general health items of the Creole SF-36 and one of the French SF-36. Factor analysis of 2 versions showed that the physical functioning, vitality, and mental health were each divided into two subscales.DiscussionOverall, our findings provided evidence that the SF-36 is adapted to Reunion Island in both Creole and French versions. However, further research could be conducted to investigate French–Creole differences in perceived health status and a cultural adaptation of the French version will be considered

A practical and socio-cultural approach in global cardiovascular risk assessment and preventive self-mangement by patients

International audienceno abstrac

Health literacy and physical activity: strengths and weaknesses in type 2 diabetes self-management

International audienc

From « face to face » sessions to education on smartphone : what are the implications for persons with chronic diseases ?

International audienceThe use of digital solutions is rapidly expanding, including for the prospect of reducing social inequalities and geographical disparities as respect to access to health care and therapeutic education. Here, we question the transformations caused by the switching from therapeutic patient education sessions conducted face to face to the use of virtual digital applications developed on smartphones. From the perspective of developing health literacy, we analyse three complementary corpus: in situ observations of educative sessions involving 34 patients, 27 observations of users of tablets with interactive application and 12 semi-structured interviews conducted with adults at home. Switching from face to face education sessions to education proposed on available smartphone application questions the changes of the trainers’ and carers’ roles and postures, the activities of the learners, the continuity of the educational process, and the contexts in which chronic illness is updated. The results obtained here question the development of digital education, while pinpointing numerous precautions to be taken for this development and the practical use of digital technology. Our analysis invite to continue innovations but suggests to accompany the advent of digital technology in the field of health and patient education by well-documented and grounded scientific work

Health literacy and physical activity: strengths and weaknesses in type 2 diabetes self-management

International audienc

Analyse des profils de littératie en santé chez des personnes diabétiques de type 2 : la recherche ERMIES-Ethnosocio

International audienceHealth literacy profiles in type 2 diabetes: the ERMIES-Ethnosocio study Introduction: Health literacy refers to the competences and resources required by individuals to meet the complex demands of health in modern society. This paper describes and analyses the health literacy profiles of type 2 diabetic patients included in a 2-year long self-management education programme. Methods: Nested in the ERMIES randomized controlled trial conducted in Reunion island, the ERMIES Ethnosocio study explored health literacy by means of two complementary approaches: description of health literacy profiles via the French version of the multidimensional “Health Literacy Questionnaire”, and a socio-anthropological perspective based on 40 semi-structured interviews carried out in 2012 and then in 2015. Results: The results highlight the existence of 8 constitutive variables in the management of type 2 diabetes in an ordinary context: diet, physical activity, treatment and monitoring of disease (disease management), access to knowledge and skills (health knowledge), relationships with health professionals and social support (expertise, support and social network). They also emphasize the differentiated relationships of individuals to each of these variables, ranging from functional to interactive or critical “levels”. Discussion: Considering the development of health literacy with patients and health professionals, and by questioning educational and therapeutic interventions as differentiating processes, this research opens up new perspectives for the approach to social inequalities in health. The combination of social sciences, medical sciences and public health is proving fruitful and potentially operative, provided that the definitions, methods, and strengths and limitations of selected prospects are clearly defined

Bases scientifiques et méthodologiques d’élaboration de situations de groupe en éducation pour la santé : l’approche par les Nids d’Apprentissage

National audienceno abstrac

L'éducation du patient diabétique de type 2 à l'île de La Réunion : perceptions et besoins des professionnels libéraux impliqués dans un réseau.

International audienceAIM: This study focused on issues in the education of type 2 diabetes patients in primary care on Reunion Island which, in a medical context, is broadly similar to metropolitan France, but with a much greater prevalence of diabetes. The aim was to assess the perceptions, training, reported practices and needs of health care providers in the field of patient education in advance of the initiation of a health care management network for diabetic patients. METHODS: A total of 74 physicians and 63 nurses completed a detailed questionnaire comprising 52 items divided into six parts: professional activity, initial and postgraduate training, educational practices, objectives of patient education, perceived barriers and prospects for optimization. RESULTS: Educational activities for patients are almost nonexistent. Information and explanations given during a face-to-face encounter with the physician or nurse that combine technical and caring approaches are the main reasons reported for patient education. The obstacles reported by professionals that need to be overcome are limited available time, patient passivity and inadequate staff training. Practitioners and nurses are poorly taught as regards patient education and self-management of chronic diseases. The suggested improvements include professional acknowledgement, more convenient and available tools and improved postgraduate training. CONCLUSION: Patient education in primary care is still mostly an illusion, with many gaps that hinder education for both patients and professionals. The training of health professionals needs to meet the challenge of chronic diseases by integrating aspects from the fields of education and the social sciences.Objectifs : Cette étude examine la question de l'éducation des patients en pratique de médecine de ville à la Réunion. Dans un système de soins similaires à celui de la France métropolitaine, mais dans un contexte de prévalence bien plus importante de diabète de type 2, l'objectif était d'analyser les perceptions, la formation, les pratiques et les obstacles à l'éducation rapportés par des professionnels de santé, avant l'entrée dans un réseau de prise en charge du diabète. Méthodes : Un questionnaire détaillé a été rempli par 74 médecins et 63 infirmières. Il comprenait 52 items divisés en six parties thématiques : activité professionnelle, formation, objectifs et pratiques d'éducation, obstacles ressentis, propositions d'amélioration. Résultats : Les activités réelles d'éducation du patient sont quasi inexistantes. L'information et l'explication par transmission lors de la rencontre en face-à-face, avec une approche à la fois techniciste et humaniste, représentent le modèle prédominant rapporté par les professionnels. Les barrières décrites par les professionnels pour la mise en place effective d'éducation du patient concernant la disponibilité en temps, la passivité des patients et l'inadaptation de la formation initiale et continue. Parmi les améliorations suggérées, dominent la reconnaissance professionnel de l'acte d'éducation, la mise à disposition d'outils adaptés et un renforcement de la formation

Le questionnaire heiQ : un outil d’intelligibilité de l’impact de l’éducation thérapeutique dans les maladies chroniques

Introduction :  L’évaluation de l’impact des programmes d’éducation thérapeutique du patient (ETP) dans les maladies chroniques est complexe, et manque d’indicateurs de résultats intermédiaires pertinents et fiables en dehors des indicateurs médicaux spécifiques à chaque maladie. Objectifs : Questionner de façon multidimensionnelle via le heiQ (health education impact questionnaire) 8 domaines d’impact de l’ETP dans la gestion et le parcours de la maladie chronique. Méthodes : Le questionnaire heiQ, traduit et validé en Français, a été administré à 53 patients diabétiques avant et 6 mois après (4 à 9 mois) un programme d’éducation thérapeutique. Les scores moyens et la taille d’effet ont été calculés pour chacun des 8 domaines du questionnaire. Résultats : À 6 mois, les scores étaient nettement améliorés pour 2 domaines, de façon modérée pour 5 autres domaines avec des évolutions individuelles différenciées. Discussion : Le questionnaire heiQ s’est révélé sensible, d’utilisation simple, permettant d’aborder « en vraie vie » l’impact de l’ETP sur des indicateurs intermédiaires correspondant à des objectifs pertinents dans le cadre du parcours de la maladie chronique. Conclusion : Le questionnaire heiQ permet une analyse fine de l’impact d’un programme d’éducation de façon globale, mais aussi individuelle. Au niveau institutionnel, il permet une évaluation objective de différents programmes