Evaluation of a knowledge translation strategy to improve policymaking and practices in health promotion and disease prevention setting in French regions: TC-REG, a realist study

OBJECTIVE: This paper presents the results of a realist evaluation of a knowledge translation (KT) intervention implemented in the field of health promotion and disease prevention at the local level in France. DESIGN: Realist evaluation study. SETTING: The target population comprised decision-makers and field professionals working in prevention and public health services operating in regions of France (ie, ARS (Agence Régionale de Santé: regional health agency), IREPS (Instance Régionale d'Education et de Promotion de la Santé pour tous: regional organisation for health promotion and education) and their partners). PARTICIPANTS: This evaluation was based on data collected from 2 seminars, 82 interviews, 18 observations and 4 focus groups over 18 months. INTERVENTION: The TC-REG intervention aimed to increase the use of evidence in cancer prevention, health promotion and disease prevention across four geographical regions in France. The intervention combined various activities: Supporting access to and adaptation of usable evidence, strengthening professionals' skills in analysing, adopting and using policy briefs, and facilitating the use of evidence in organisations and processes. RESULTS: The collected data was used to define favourable/unfavourable contexts for the use of scientific data and mechanisms to be activated to encourage the use of scientific knowledge. From these raw results eight final refined middle-range theories were defined. Organised around the mechanisms to be activated, these middle-range theories illustrate how to activate knowledge and under what conditions. These analyses provided a basis for the production of seven operational and contextualised recommendations to develop KT to inform regional policymaking regarding health promotion and disease prevention. CONCLUSION: The results obtained from the analyses led us to formulate two perspectives of an operational nature for the benefit of those involved in prevention and health promotion

Int J Environ Res Public Health

This scoping study aims to explore the relationships between urban green spaces (UGSs) and the onset, remission and recovery of cancer. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews (protocol published in 2018). Eligibility criteria for papers were: (1) to be concerned with UGSs, (2) reporting effects of UGSs on cancer-related outcomes including direct or indirect measures, (3) reporting randomized controlled trials, prospective cohort studies, case studies, observational studies, non-comparative studies, (4) in English or French. The search covered primary studies in the published and unpublished (grey) literatures searching by hand and electronic databases (MEDLINE, Green File, Cumulative Index to Nursing and Allied Health Literature and ScienceDirect). Among 1703 records screened by two reviewers independently, 29 were included for qualitative synthesis. We classify the cancers concerned and the effects reported i.e., protective effect, risk or without association. The most investigated cancers are bladder, breast and lung cancer. Our study also identified contributing factors and their mediating effects between UGSs and cancer. Even though the strength of the evidence of the associations between UGSs and cancer is still weak due to the low number of studies and their design, results highlight the wide variety of possible mediating factors between the use of green spaces and cancer occurrence, remission and/or prevention. Knowledge gaps and future research perspectives should be oriented to qualitative research on protective factors with an attention to equity in UGS access and use

The case of health in all policies approach in French cities to promote healthy urban green spaces

International audienc

Les instruments au service de la réduction des inégalités sociales de santé selon les acteurs des agences régionales de santé : entre changement et continuité

International audienceReducing social inequalities in health (ISS) involves action from public politics, those who should harmonise a coordinated action for a set of social determinants for health. How to carry out these actions and the instruments they mobilise aren’t always made clear in the international literature. This article concerns the instruments summoned by the French Regional Health Agencies (ARS in French) to combat social inequalities in health. Using a qualitative analysis of interviews given by institutional bodies, we identify and analyse the variety and the types of policy instruments mobilised by the ARS depending on the type of government intervention to which they are connected. We then compare these instruments to those which the stakeholders are in favour of implementing. Analysing them in this way leads us to identify two instruments voted for by the stakeholders, upon which we will focus : a national instrument, the local health contract, and an international instrument, the hospital prevention program. This article focuses on the tension which the ARS action encounters in its struggle against social inequalities, between ensuring continuity and implementing change, which constitutes the mobilisation of some policy instruments.Réduire les inégalités sociales de santé (ISS) implique une action des politiques publiques, lesquelles doivent mettre en musique une action concertée sur un ensemble de déterminants sociaux de la santé. La manière de mener ces actions et les instruments qu’elles mobilisent ne sont pas toujours explicités dans la littérature internationale. Cet article s’intéresse aux instruments mobilisés par les agences régionales de santé (ARS) en France pour agir sur les ISS. À partir de l’analyse qualitative d’entretiens auprès d’acteurs institutionnels, nous identifions et analysons la variété et les types d’instruments d’action publique mobilisés par les ARS en fonction du type d’intervention publique auquel ils se rattachent. Nous comparons ensuite ces instruments à ceux que les acteurs préconisent de mettre en œuvre. Ces analyses nous conduisent à identifier deux instruments plébiscités par les acteurs sur lesquels nous proposons un focus : un instrument national, le contrat local de santé, et un instrument régional, le dispositif hospitalier de prévention. L’article s’intéresse ensuite à la tension que rencontre l’action de l’ARS dans sa lutte contre les ISS entre une forme de continuité et le changement que constitue la mobilisation de certains instruments d’action publique

Action on social health determinants in France: which policy in 2012 and beyond?

International audienc

Social inequalities in health according to the actors of the Regional Health Agencies and its bodies : from ideas to the instrumentation of regional policies

Les inégalités sociales de santé sont des problèmes complexes dont les institutions de santé publique doivent pourtant se saisir pour ajuster leurs politiques. En France, ces politiques sont à la charge des Agences Régionales de Santé depuis 2009. Nous avons à comprendre de quelle manière les ARS conçoivent leur rôle sur les inégalités sociales de santé. Nous nous sommes pour cela appuyé sur une approche cognitive des politiques publiques en accordant une importance particulière aux acteurs et aux idées circulant au sein des institutions. Une étude empirique menée entre 2014 et 2016 auprès des acteurs des Agences Régionales de Santé visait à étudier leurs idées sur les inégalités sociales de santé et à comprendre l’influence de ces idées sur l’action institutionnelle. Nous avons mobilisé l’étude de cas multiples par cas comparables et avons sélectionné trois Agences Régionales de Santé et leurs instances de démocratie dans trois régions. Nous avons mobilisé une approche qualitative par théorisation ancrée pour mener l’analyse de discours de soixante-neuf acteurs interrogés par entretiens semi-directifs, complétée d’une analyse documentaire et d’observations participantes. Les idées des inégalités sociales de santé sont diverses et sont plus ou moins tournées vers une définition des déterminants sociaux de la santé. Le rôle attribué à l’institution pour agir sur celles-ci est aussi plus ou moins important selon les acteurs. Ces deux tendances dessinent quatre profils d’idées caractérisant l’action institutionnelle sur les inégalités sociales de santé. Ces profils reflètent aussi les stratégies d’intervention et les instruments mobilisés. L’analyse comparée de ces profils entre les trois régions met en évidence les facteurs favorisant la circulation des idées au sein de l’institution. Ces derniers esquissent les leviers d’action pour favoriser la prise en compte des inégalités sociales de santé dans les politiques régionales.Social inequalities in health are complex problems that public health institutions need to address in order to improve their policies. In France, Regional Health Agencies have had responsibility for these policies since 2009. It is necessary to understand how Regional Health Agencies see their role in reducing social inequalities in health. To achieve this understanding, we used a cognitive approach to public policy, which places particular importance on the actors and ideas circulating within the institutions. An empirical study carried out between 2014 and 2016 among the actors of the Regional Health Agencies aimed to study their ideas on social inequalities in health and to understand their influence on institutional action. Using a comparable case study method and three Regional Health Agencies and their democratic bodies were selected. We used a qualitative approach by anchored theory to conduct and analyze the material gathered from semi-directive interviews with sixty-nine actors, supplemented by a documentary analysis and participant observations. The ideas of social inequalities in health are diverse and are, in part, oriented towards a definition of the social determinants of health. The role assigned to the institution to act on them is also variable depending on the actors. From these two tendencies, four profiles of ideas can be drawn which characterize institutional action on social inequalities in health. These profiles also reflect the intervention strategies and instruments used. The comparative analysis of the profiles between the three regions highlights the factors that promote the circulation of ideas within the institution. They also indicate the levers for action to encourage the consideration of social inequalities in health in regional policies

Le projet médical de territoire en Périnatalité

National audienc

La promotion de la santé : concepts et perspectives pour le Territoire de Redon

National audienc

Périnatalité, parentalité et petite enfance, des temps stratégiques? in Ateliers ≪ Périnatalité et inegalités sociales de santé : points de vue d’universitaires et leviers d’action pour élus ≫

National audienc