Rouge, jaune, vert-- et noir : expériences de pauvreté et rôle des ressources sociosanitaires selon des hommes en situation de pauvreté à Montréal

Ce projet de recherche se situe dans le champ de la santé publique et a pour objet l'étude de la pauvreté, de ses liens avec la santé et du rôle que peuvent jouer à cet égard les ressources sociosanitaires. L'étude, qui prend la forme d'une thèse par articles, poursuivait trois objectifs : permettre de mieux comprendre les expériences et les représentations d'hommes vivant en situation de pauvreté quant à cette dernière et à la manière d'en sortir ; mieux cerner le rôle des ressources d'aide sociosanitaires et leur importance relative dans les trajectoires de vies d'hommes en situation de pauvreté ; proposer, à partir d'un savoir expérientiel, des pistes d'interventions pertinentes en matière de lutte à la pauvreté en tant que déterminant de la santé. Ce projet, d'orientation qualitative et participative, a été effectué en collaboration avec un centre communautaire d'un quartier défavorisé de Montréal. Diverses méthodes de collecte de données ont été déployées : un journal de bord, 80 jours d'observation participante, 22 entrevues individuelles semi-dirigées et 6 groupes de discussion avec des hommes en situation de pauvreté. La stratégie d'analyse repose sur l'approche de théorisation ancrée interprétative de Charmaz et sur l'approche des récits de vie de Bertaux. Le premier objectif est abordé dans deux chapitres. Dans le chapitre 3, le premier article de la thèse présente les représentations, recueillies à l'aide d'un outil de type éducation populaire intitulé Mon histoire de vie dans le «rouge, jaune, vert», que les hommes rencontrés se font de la pauvreté et de la manière d'en sortir. Le chapitre 4 analyse quant à lui l'expérience de la pauvreté telle que perçue par les hommes pour en dégager les principales dimensions. En plus de cerner plusieurs dimensions significatives de la pauvreté et de sa sortie, ces deux chapitres montrent que les regards des hommes sur leur propre situation contrastent avec les représentations sociales couramment véhiculées. Dans le chapitre 5, les constats saillants entourant le deuxième objectif de la thèse sont d'abord synthétisés à l'aide de «Charlot Laforce», un outil de validation participative des résultats utilisé dans le cadre du projet. Le deuxième article de la thèse y présente ensuite les expériences des hommes concernant leur choix de ne pas recourir aux ressources sociosanitaires lors de moments de détresse où ils jugeaient pourtant avoir besoin d'aide. Le troisième objectif quant à lui est abordé dans le chapitre 6 où sont rapportées les suggestions proposées par les participants quant aux interventions à mettre en place pour lutter contre la pauvreté et améliorer les services d'aide. Finalement, le chapitre 7 résume l'ensemble des résultats, en apprécie les forces et les faiblesses, et conclut sur les pistes qu'ils ouvrent en termes de recherche et d'intervention en santé publique.This research project is in the field of public health and focuses on the study of poverty, its links to health and the role health and social resources can play in this regard. The project, which takes the form of a thesis composed of articles, pursued three objectives. First, it aimed to better understand how men living in poverty experience and perceive their situation and conceive of ways to change it. Secondly, it attempted to elucidate how health and social services influence the processes that cause men to fall in, and sometimes escape from, poverty. Thirdly, it drew on the knowledge thus generated to suggest interventions relevant to the fight against poverty. This qualitative and participatory oriented research was done in collaboration with a community Center in a disadvantaged neighbourhood of Montreal. The data were collected through a diary, 80 days of participant observation, 22 semi-directed interviews and 6 group discussions with men living in poverty. We based our analytical strategy on Charmaz's interpretive grounded theory methods and Bertaux's life-history approach. The first objective of the thesis is covered by two chapters. In Chapter 3, the first article of the thesis presents the representations of poverty and its exit collected through a popular education tool named My life course in the «red, yellow, green». Chapter 4, a complementary chapter, presents the experiences of poverty as perceived by men themselves and reveals the main dimensions they see about it. In addition to identifying several significant dimensions of poverty and its exit, the results of these two chapters show how the perspectives of the participants about their situation can challenge commonly held social representations about them. In Chapter 5 we first summarize the main results pertaining the second objective of our thesis with «Charlot Laforce», a participatory validation tool used in the study. The second article of the thesis then presents 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. The results about the third objective of the thesis are found in chapter 6. Men's suggestions and recommendations of relevant interventions to fight poverty and improve services are offered there. Finally, Chapter 7 reviews the main findings of the study, the limits and strengths of the project and the implications of these results for future research and interventions

Beyond college for all : portrait of rapid and successful school-to-work transitions among vulnerable youth

For noncollege-bound youth, swiftly finding a satisfying job upon exiting compulsory schooling might support adjustment. Yet, youths’ own job perceptions have rarely been considered in school-to-work transition research. Sequence analysis of monthly occupational status over 4 years (ages 16–20) in a low socioeconomic status Canadian sample overrepresenting academically-vulnerable youth (N = 386; 50% male; 23% visible minority) generated five school-to-work pathways: two work-bound ones with jobs perceived as aligned with career goals (Career Job, 10%) or not (Fill-In Job, 26%), alongside three others (Disconnected [15%], Prolonged Secondary Education [25%], Postsecondary Education [24%]). Mental health was strongest in the Career Job pathway. Male sex and adolescent employment were precursors to this advantageous pathway, underscoring the crucial role of work experience

Beyond college for all: Portrait of rapid and successful school-to-work transitions among vulnerable youth

For noncollege-bound youth, swiftly finding a satisfying job upon exiting compulsory schooling might support adjustment. Yet, youths’ own job perceptions have rarely been considered in school-to-work transition research. Sequence analysis of monthly occupational status over 4 years (ages 16–20) in a low socioeconomic status Canadian sample overrepresenting academically-vulnerable youth (N = 386; 50% male; 23% visible minority) generated five school-to-work pathways: two work-bound ones with jobs perceived as aligned with career goals (Career Job, 10%) or not (Fill-In Job, 26%), alongside three others (Disconnected [15%], Prolonged Secondary Education [25%], Postsecondary Education [24%]). Mental health was strongest in the Career Job pathway. Male sex and adolescent employment were precursors to this advantageous pathway, underscoring the crucial role of work experience

Empowerment Beyond Numbers: Substantiating Women’s Political Participation

From our households and into our communities, from independent States to international governing bodies, gender operates as a construct of evolving aspects of women’s identities and is a medium through which expectations are prescribed, social norms are formed and power relations are negotiated. Gender constructs that impede women’s access to the public spheres of society diminish the possibility for equitable and empowering life conditions. Of particular emphasis in this paper, facilitating women’s entry into political bodies across the world is also compromised by persistent obstacles in women’s opportunities in both political and private spheres of life. Our research engages female and male panchayat members in rural Gujarat, India. We aim to understand how being a woman affects access to political office, experiences therein, negotiation procedures and decisions taken. It is theorized that facilitating female representation in local governmental structures (a panchayat) through a quota represents one of many routes toward empowerment and one potential means of improving health and household welfare. When empowerment is analyzed within India’s panchayat quota, dimensions such as gender and corresponding perceptions, norms and conditions evidence the centrality of gender as a persistent fault-line in number-based initiatives. The panchayat thus mirrors gendered social realities, demonstrating how complex the processes of substantial democratic political participation and women’s empowerment are, in India and elsewhere

Adaptation and validation of the life events and difficulties schedule for use with high school dropouts

The Life Events and Difficulties Schedule (LEDS) is considered the standard for measuring psychosocial stressor exposure, but it has not been used with academically at-risk adolescents, including high school dropouts. The goal of this study was to (1) adapt the LEDS for use with this population, and (2) examine the reliability (interrater) and validity (concurrent and predictive) of this adaptation among a sample of vulnerable adolescents (N = 545). Good reliability coefficients (.79–.90) were obtained, and stressor exposure was associated with concurrent criteria indexing mental health outcomes (depression) and major risk factors for dropout (administratively recorded and self-reported). Also, LEDS scores predicted dropout beyond these risk factors. The adapted LEDS appears useful for describing academically struggling adolescents’ stressor exposure

Musical extracurricular activities and adjustment among children from immigrant families : a 2-year quasi-experimental study

This quasi-experimental study examines the impact on emotional/behavioral functioning (hyperactivity-inattention and internalizing symptoms) and school experiences (school engagement, positive experience in school) of La classe enchantée, a high-quality, non-selective extracurricular music program. Based on the program’s objectives and on the positive youth development model, it was anticipated that elementary school students participating in La classe enchantée would evolve more favorably in terms of these outcomes over the 2-year duration of the program spanning Grades 4 and 5, compared to non-participating schoolmates. The sample includes 72 children (25% in the intervention group, 47% girls, 93% first/second generation immigrants) from one low-income school, followed over 2 years starting in grade four (Mage = 9.30, SD = 0.49). Latent Growth Curve models show that, compared to classmates not in the program, children in La classe enchantée progressed more favorably over time on self-reported measures of internalizing symptoms and positive experiences in school. For teacher-rated hyperactivity-inattention and school engagement, the slopes indicated stability over time in both groups, although hyperactivity-inattention tended to improve among those with relatively high initial levels in the intervention group. These results suggest that engagement in quality musical extracurricular activities might boost emotional and school well-being and potentially reduce hyperactivity-inattention among a specific subgroup of children from immigrant families

Using systems thinking to understand the scale-up and sustainability of health innovation: a case study of seasonal malaria chemoprevention processes in Burkina Faso

Background Scale-up and sustainability are often studied separately, with few studies examining the interdependencies between these two processes and the implementation contexts of innovations towards malaria prevention and control. Researchers and implementers offer much more attention to the content of innovations, as they focus on the technological dimensions and the conditions for expansion. Researchers have often considered innovation a linear sequence in which scaling up and sustainability represented the last stages. Using systems thinking in this manuscript, we analyze complex scaling and sustainability processes through adopting and implementing seasonal malaria chemoprevention (SMC) in Burkina Faso from 2014 to 2018. Methods We conducted a qualitative case study involving 141 retrospective secondary data (administrative, press, scientific, tools and registries, and verbatim) spanning from 2012 to 2018. We complemented these data with primary data collected between February and March 2018 in the form of 15 personal semi-structured interviews with SMC stakeholders and non-participant observations. Processual analysis permitted us to conceptualize scale-up and sustainability processes over time according to different vertical and horizontal levels of analysis and their interconnections. Results Our results indicated six internal and external determinants of SMC that may negatively or positively influence its scale-up and sustainability. These determinants are effectiveness, monitoring and evaluation systems, resources (financial, material, and human), leadership and governance, adaptation to the local context, and other external elements. Our results revealed that donors and implementing actors prioritized financial resources over other determinants. In contrast, our study clearly showed that the sustainability of the innovation, as well as its scaling up, depends significantly on the consideration of the interconnectedness of the determinants. Each determinant can concurrently constitute an opportunity and a challenge for the success of the innovation. Conclusion Our findings highlight the usefulness of the systemic perspective to consider all contexts (international, national, subnational, and local) to achieve large-scale improvements in the quality, equity, and effectiveness of global health interventions. Thus, complex and systems thinking have made it possible to observe emergent and dynamic innovation behaviors and the dynamics particular to sustainability and scaling up processes. -- Keywords : Scale-up ; Sustainability ; Innovation ; Africa ; Burkina Faso ; Malaria ; Seasonal malaria chemoprevention ; Systems thinking

A conceptualisation of scale-up and sustainability of social innovations in global health: a narrative review and integrative framework for action

Background The scale-up and sustainability of social innovations for health have received increased interest in global health research in recent years; however, these ambiguous concepts are poorly defined and insufficiently theorised and studied. Researchers, policymakers, and practitioners lack conceptual clarity and integrated frameworks for the scale-up and sustainability of global health innovations. Often, the frameworks developed are conceived in a linear and deterministic or consequentialist vision of the diffusion of innovations. This approach limits the consideration of complexity in scaling up and sustaining innovations. Objective By using a systems theory lens and conducting a narrative review, this manuscript aims to produce an evidence-based integrative conceptual framework for the scale-up and sustainability of global health innovations. Method We conducted a hermeneutic narrative review to synthetise different definitions of scale-up and sustainability to model an integrative definition of these concepts for global health. We have summarised the literature on the determinants that influence the conditions for innovation success or failure while noting the interconnections between internal and external innovation environments. Results The internal innovation environment includes innovation characteristics (effectiveness and testability, monitoring and evaluation systems, simplification processes, resource requirements) and organisational characteristics (leadership and governance, organisational change, and organisational viability). The external innovation environment refers to receptive and transformative environments; the values, cultures, norms, and practices of individuals, communities, organisations, and systems; and other contextual characteristics relevant to innovation development. Conclusion From these syntheses, we proposed an interconnected framework for action to better guide innovation researchers, practitioners, and policymakers in incorporating complexity and systemic interactions between internal and external innovation environments in global health. -- Keywords : Scale-up ; sustainability ; social innovation ; narrative review ; global health ; systems thinking.hinking