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Ridde V, Carillon S, Desgrées du Loû A, Sombié I. Analyzing implementation of public health interventions : a need for rigor, and the challenges of stakeholder involvement. Rev Epidemiol Sante Publique 2022; 71:101376. [PMID: 35835715 DOI: 10.1016/j.respe.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/01/2022] [Accepted: 06/01/2022] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVES This article shows how conceptual models can help to develop and evaluate public health interventions. It also reports on the challenges of getting stakeholders involved. METHOD The analysis is based on the reflexive approach applied by the authors during their participation in two public health intervention research (PHIR) projects, in France and in Burkina Faso. RESULTS In Paris, PHIR aimed to enable sub-Saharan immigrants to appropriate the existing means of prevention and sexual health care and to strengthen their empowerment in view of preserving their health. Evaluation was carried out using mixed methods. The intervention process theory is based on Ninacs' conceptual model of individual empowerment. The Consolidated Framework For Implementation Research (CFIR) was mobilized a posteriori to analyze the process. PHIR stemmed from collaboration between a research team and two associations. The different stakeholders were involved in the evaluation process, as were, at certain times, persons in highly precarious situations. In Ouagadougou, a community-based dengue vector control intervention was deployed to address an essential but neglected need. As regards evaluation, we opted for a holistic, mixed method approach (effectiveness and process). The contents of the intervention were determined based on tacit knowledge, a community preference survey and solid evidence. The theoretical framework of the intervention consisted in an eco-biological model of vector control. The implementation analysis combined an internal assessment of implementation fidelity with an external CFIR process analysis. All stakeholders were involved in the evaluation process. DISCUSSION Analysis confirmed not only the value of process evaluations in PHIR, but also the primordial importance of a rigorous approach. Stakeholder involvement is a major challenge to be addressed early in the planning of RISPs; with this in mind, effective and ethically sound assessment mechanisms need to be drawn up. Interdisciplinary evaluative approaches should be preferred, and the use of justified, relevant, and flexible frameworks is highly recommended. CONCLUSION Lessons learned for those wishing to engage in the process evaluation of a public health intervention are hereby presented.
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Affiliation(s)
- V Ridde
- Centre population et développement (Ceped), Institut de recherche pour le développement (IRD) et Université Paris Cité, Inserm ERL 1244, 45 rue des Saints-Pères, 75006 Paris, France.
| | - S Carillon
- Centre population et développement (Ceped), Institut de recherche pour le développement (IRD) et Université Paris Cité, Inserm ERL 1244, 45 rue des Saints-Pères, 75006 Paris, France
| | - A Desgrées du Loû
- Centre population et développement (Ceped), Institut de recherche pour le développement (IRD) et Université Paris Cité, Inserm ERL 1244, 45 rue des Saints-Pères, 75006 Paris, France
| | - I Sombié
- Institut des Sciences des Sociétés (INSS), Centre National de la Recherche Scientifique et Technologique (CNRST), 03 BP 7047, Avenue du Capitaine Thomas Sankara, Ouagadougou, Burkina Faso
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Loignon C, Dupéré S, Leblanc C, Truchon K, Bouchard A, Arsenault J, Pinheiro Carvalho J, Boudreault-Fournier A, Marcotte SA. Equity and inclusivity in research: co-creation of a digital platform with representatives of marginalized populations to enhance the involvement in research of people with limited literacy skills. RESEARCH INVOLVEMENT AND ENGAGEMENT 2021; 7:70. [PMID: 34610847 PMCID: PMC8491375 DOI: 10.1186/s40900-021-00313-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 09/22/2021] [Indexed: 06/13/2023]
Abstract
To improve health equity, as well as equity in research, community-engaged research and participatory research needs to be inclusive. Equity in health research refers to the principle that anyone affected by research or who can benefit from its outcomes should have equal opportunities to contribute to it. Many researchers advocate the importance of promoting equity in research and engage in processes that foster the research involvement of lay persons, patients, and community members who are otherwise "absent" or "silent". Still, people with limited literacy skills who experience unwarranted structural barriers to healthcare access have little involvement in research. Low literacy is a major barrier to equity in health research. Yet there exist approaches and methods that promote the engagement in research of people with literacy challenges. Building on our previous research projects conducted with community members using participatory visual and sound methods (participatory mapping, photovoice, digital storytelling, etc.), we embarked on the co-creation of a digital platform in 2017. Our aim in this commentary is to report on this co-creation experience that was based on a social justice-oriented partnership. The development of the online platform was overseen by a steering committee made up of workers from community organizations involved with people with limited literacy skills, students, and researchers. In the development process, the co-creation steps included a literature review, informal interviews with key informants, and discussion and writing sessions about format and content. After numerous challenges raised and addressed during co-creation, the Engage digital platform for engagement in research went live in the winter of 2020. This platform presents, on an equal footing, approaches and methods from academic research as well as from the literacy education community engaged with people with limited literacy skills.
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Affiliation(s)
- Christine Loignon
- Department of Family and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, QC Canada
- Department of Anthropology, University of Victoria, Victoria, BC Canada
| | - Sophie Dupéré
- Faculty of Nursing, Université Laval, Quebec, QC Canada
| | - Caroline Leblanc
- Department of Family and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, QC Canada
| | - Karoline Truchon
- Department of Social Sciences, Université du Québec en Outaouais, Gatineau, QC Canada
| | - Amélie Bouchard
- Villeray Literacy Center – La Jarnigoine, Montreal, QC Canada
| | | | - Julia Pinheiro Carvalho
- Department of Family and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, QC Canada
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Ngo Bikoko Piemeu CS, Loignon C, Dionne É, Paré-Plante AA, Haggerty J, Breton M. Expectations and needs of socially vulnerable patients for navigational support of primary health care services. BMC Health Serv Res 2021; 21:999. [PMID: 34551747 PMCID: PMC8456577 DOI: 10.1186/s12913-021-06811-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 07/23/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Primary healthcare is the main entry to the health care system for most of the population. In 2008, it was estimated that about 26% of the population in Quebec (Canada) did not have a regular family physician. In early 2017, about 10 years after the introduction of a centralized waiting list for patients without a family physician, Québec had 25% of its population without a family physician and nearly 33% of these or 540,000, many of whom were socially vulnerable (SV), remained registered on the list. SV patients often have more health problems. They also face access inequities or may lack the skills needed to navigate a constantly evolving and complex healthcare system. Navigation interventions show promise for improving access to primary health care for SV patients. This study aimed to describe and understand the expectations and needs of SV patients. METHODS A descriptive qualitative study rooted in a participatory study on navigation interventions implemented in Montérégie (Quebec) addressed to SV patients. Semi-structured individual face-to-face and telephone interviews were conducted with patients recruited in three primary health care clinics, some of whom received the navigation intervention. A thematic analysis was performed using NVivo 11 software. RESULTS Sixteen patients living in socially deprived contexts agreed to participate in this qualitative study. Three main expectations and needs of patients for navigation interventions were identified: communication expectations (support to understand providers and to be understood by them, discuss about medical visit, and bridge the communication cap between patients and PHC providers); relational expectations regarding emotional or psychosocial support; and pragmatic expectations (information on available resources, information about the clinic, and physical support to navigate the health care system). CONCLUSIONS Our study contributes to the literature by identifying expectations and needs specified to SV patients accessing primary health care services, that relate to navigation interventions. This information can be used by decision makers for navigation interventions design and inform health care organizational policies.
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Affiliation(s)
- Carine Sandrine Ngo Bikoko Piemeu
- Department of Community Health Sciences, Université de Sherbrooke, Longueuil, Canada
- Centre de Recherche-Hôpital Charles-Le Moyne - Saguenay Lac-St-Jean sur les Innovations en Santé, Longueuil Campus, 150 Place Charles-Le Moyne, Office 200, Longueuil, J4K0A8, Canada
| | - Christine Loignon
- Centre de Recherche-Hôpital Charles-Le Moyne - Saguenay Lac-St-Jean sur les Innovations en Santé, Longueuil Campus, 150 Place Charles-Le Moyne, Office 200, Longueuil, J4K0A8, Canada
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Longueuil, Canada
| | - Émilie Dionne
- VITAM - Centre de Recherche en Santé Durable, Québec, Canada; Department of Sociology, Université Laval, Québec, Canada
| | - Andrée-Anne Paré-Plante
- Centre de Recherche-Hôpital Charles-Le Moyne - Saguenay Lac-St-Jean sur les Innovations en Santé, Longueuil Campus, 150 Place Charles-Le Moyne, Office 200, Longueuil, J4K0A8, Canada
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Longueuil, Canada
- Charles-Lemoyne University Medicine Group, Saint-Lambert, Canada
| | - Jeannie Haggerty
- VITAM - Centre de Recherche en Santé Durable, Québec, Canada; Department of Sociology, Université Laval, Québec, Canada
- Department of Family Medicine, McGill University, Montréal, Canada
| | - Mylaine Breton
- Department of Community Health Sciences, Université de Sherbrooke, Longueuil, Canada.
- Centre de Recherche-Hôpital Charles-Le Moyne - Saguenay Lac-St-Jean sur les Innovations en Santé, Longueuil Campus, 150 Place Charles-Le Moyne, Office 200, Longueuil, J4K0A8, Canada.
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Maillet L, Champagne G, Déry J, Goudet A, Charest S, Abou-Malham S, Desjardins F, Touati N, Duhoux A, Jouego Fotso AC, Doré C, Roy B, Gagnon S, Lane J. Implementation of an intersectoral outreach and community nursing care intervention with refugees in Quebec: A protocol study. J Adv Nurs 2021; 77:4586-4597. [PMID: 34423471 DOI: 10.1111/jan.15022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 07/24/2021] [Indexed: 11/28/2022]
Abstract
AIM To establish and assess an intersectoral local network focused on the roles of registered nurses and primary healthcare nurse practitioners to ensure the continuity of care and service pathways for refugees in Quebec. DESIGN Developmental evaluation with a mixed methodology. METHODS The qualitative component will include: (1) a document review; (2) observations of participants during meetings of different governance structures; (3) semi-structured interviews with key actors (n = 40; 20/neighbourhood interventions); and (4) focus groups with end users of the services (refugees) (n = 4; 6 to 8 participants per group). The quantitative component will be based on: (1) a data sheet on health and social interventions for refugees users filled in by registered nurses, primary healthcare nurse practitioners and physicians and (2) data analysis of the clinical-administrative database since 2012. This study received funding in June 2019 and Research Ethics Committee approval was granted in July 2020. DISCUSSION In Quebec, refugee vulnerability is exacerbated by the lack of integration of existing resources and the lack of access to care and continuity of services. To address these issues, an integrated local network for refugees must be developed. Additionally, we will explore the role of registered nurses and their collaboration with primary healthcare nurse practitioners. IMPACT This study will provide recommendations on how to optimize the scopes of practice of registered nurses and primary healthcare nurse practitioners, adapt care and services and develop a local intersectoral network to better meet the complex needs of refugees. It will evaluate the use and the appreciation of new services for targeted populations (neighbourhoods and refugees) and aim to improve the accessibility, continuity and user experience of all health services for those populations.
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Affiliation(s)
- Lara Maillet
- National School of Public Administration, Montreal, Canada.,Institut Universitaire de première ligne en santé et services sociaux, Sherbrooke, Canada
| | | | | | - Anna Goudet
- National School of Public Administration, Montreal, Canada.,Institut national de la recherche scientifique, Montreal, Canada
| | - Stéphanie Charest
- Institut Universitaire de première ligne en santé et services sociaux, Sherbrooke, Canada.,Centre intégré universitaire de santé et des services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Canada
| | - Sabina Abou-Malham
- Institut Universitaire de première ligne en santé et services sociaux, Sherbrooke, Canada.,Université de Sherbrooke, Longueuil, Canada
| | - France Desjardins
- Institut Universitaire de première ligne en santé et services sociaux, Sherbrooke, Canada.,Centre intégré universitaire de santé et des services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Canada
| | - Nassera Touati
- National School of Public Administration, Montreal, Canada
| | | | | | - Chantal Doré
- Institut Universitaire de première ligne en santé et services sociaux, Sherbrooke, Canada.,Université de Sherbrooke, Sherbrooke, Canada
| | | | - Suzanne Gagnon
- Université Laval, Quebec, Canada.,Centre intégré universitaire de santé et des services sociaux de la Capitale-Nationale, Université Laval, Quebec, Canada
| | - Julie Lane
- Institut Universitaire de première ligne en santé et services sociaux, Sherbrooke, Canada.,Université de Sherbrooke, Sherbrooke, Canada
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Turcotte PL, Carrier A, Levasseur M. Levers for Change and Unexpected Outcomes of a Participatory Research Partnership: Toward Fostering Older adults' Social Participation to Promote Health Equity. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2020; 66:417-426. [PMID: 32696482 DOI: 10.1002/ajcp.12444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Promoting health equity in aging requires ensuring older adults' effective access to community-based services fostering their social participation. This study aimed to (a) identify levers for change in community-based services to foster older adults' social participation and (b) explore unexpected outcomes of stakeholder engagement. Based in a large Canadian city, a critical participatory research partnership was formed in a district experiencing considerable health disparities. Four focus groups and seven individual interviews were followed by a collaborative workshop with 28 community stakeholders. Participants identified mainly systemic and organizational levers for change. These levers comprised changing performance indicators and the institutional culture of homecare to value services fostering social participation opportunities. Other levers included supporting individual change agency through participatory research involving community members. Stakeholder engagement led to five unexpected outcomes: "Marking a new beginning," "Expressing ourselves," "Feeling better," "Working together," and "Influencing the community." Recognizing levers for change is essential to understand how to develop services fostering social participation to promote health equity, with whom and in which contexts.
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Affiliation(s)
- Pier-Luc Turcotte
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
- Research Centre on Aging, Integrated Health and Social Services University Centre, University Institute of Geriatrics of Sherbrooke, Sherbrooke, Québec, Canada
| | - Annie Carrier
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
- Research Centre on Aging, Integrated Health and Social Services University Centre, University Institute of Geriatrics of Sherbrooke, Sherbrooke, Québec, Canada
| | - Mélanie Levasseur
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
- Research Centre on Aging, Integrated Health and Social Services University Centre, University Institute of Geriatrics of Sherbrooke, Sherbrooke, Québec, Canada
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Community-based participatory research remodelling occupational therapy to foster older adults’ social participation. The Canadian Journal of Occupational Therapy 2019; 86:262-276. [DOI: 10.1177/0008417419832338] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Occupational therapists who provide community-based services are well positioned to foster older adults’ social participation. However, community occupational therapists rarely address social participation and require support to change their practice. Purpose. This study initiated a remodelling of community occupational therapy services by (a) selecting practices fostering older adults’ social participation and (b) identifying factors that could affect their integration. Method. A community-based participatory research study was conducted in a large Canadian city. Four focus group meetings and seven individual interviews were held with 28 key informants. Findings. A continuum of emerging practices was identified, including personalized, group-based, and community-based interventions. Potential enablers of these practices included clinical support, better communication, and user involvement. Organizational and systemic barriers were related to the institutional culture and performance indicators. Implications. These results point to innovative ways to foster older adults’ social participation and identify potential enablers and barriers affecting their integration.
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Boivin A, L'Espérance A, Gauvin FP, Dumez V, Macaulay AC, Lehoux P, Abelson J. Patient and public engagement in research and health system decision making: A systematic review of evaluation tools. Health Expect 2018; 21:1075-1084. [PMID: 30062858 PMCID: PMC6250878 DOI: 10.1111/hex.12804] [Citation(s) in RCA: 118] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2018] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Patient and public engagement is growing, but evaluative efforts remain limited. Reviews looking at evaluation tools for patient engagement in individual decision making do exist, but no similar articles in research and health systems have been published. OBJECTIVE Systematically review and appraise evaluation tools for patient and public engagement in research and health system decision making. METHODS We searched literature published between January 1980 and February 2016. Electronic databases (Ovid MEDLINE, Embase, Cochrane Database of Systematic Reviews, CINAHL and PsycINFO) were consulted, as well as grey literature obtained through Google, subject-matter experts, social media and engagement organization websites. Two independent reviewers appraised the evaluation tools based on 4 assessment criteria: scientific rigour, patient and public perspective, comprehensiveness and usability. RESULTS In total, 10 663 unique references were identified, 27 were included. Most of these tools were developed in the last decade and were designed to support improvement of engagement activities. Only 11% of tools were explicitly based on a literature review, and just 7% were tested for reliability. Patients and members of the public were involved in designing 56% of the tools, mainly in the piloting stage, and 18.5% of tools were designed to report evaluation results to patients and the public. CONCLUSION A growing number of evaluation tools are available to support patient and public engagement in research and health system decision making. However, the scientific rigour with which such evaluation tools are developed could be improved, as well as the level of patient and public engagement in their design and reporting.
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Affiliation(s)
- Antoine Boivin
- University of Montreal Hospital Research Center (CRCHUM), Montreal, QC, Canada.,Department of family medicine, University of Montreal, Montreal, QC, Canada.,Center of Excellence on Partnership with Patients and the Public (CEPPP), Montreal, QC, Canada.,Department of health management, evaluation and policy, Ecole de santé publique de l'Université de Montréal, Montreal, QC, Canada
| | - Audrey L'Espérance
- Center of Excellence on Partnership with Patients and the Public (CEPPP), Montreal, QC, Canada
| | - François-Pierre Gauvin
- Center of Excellence on Partnership with Patients and the Public (CEPPP), Montreal, QC, Canada.,McMaster Health Forum, McMaster University, Hamilton, ON, Canada
| | - Vincent Dumez
- Center of Excellence on Partnership with Patients and the Public (CEPPP), Montreal, QC, Canada.,Direction Collaboration et Partenariat Patient, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
| | - Ann C Macaulay
- Participatory Research at McGill, Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Pascale Lehoux
- Department of health management, evaluation and policy, Ecole de santé publique de l'Université de Montréal, Montreal, QC, Canada
| | - Julia Abelson
- Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, ON, Canada
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Loignon C, Dupéré S, Fortin M, Ramsden VR, Truchon K. Health literacy - engaging the community in the co-creation of meaningful health navigation services: a study protocol. BMC Health Serv Res 2018; 18:505. [PMID: 29954407 PMCID: PMC6022349 DOI: 10.1186/s12913-018-3315-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 06/19/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND A large proportion of patients encounter barriers to access and navigation in complex healthcare systems. They are unable to obtain information and services and to take appropriate action to improve their health. Low health literacy affects the ability of individuals to benefit from health services. Some social groups are disproportionately affected by low health literacy, including those with low educational attainment, Aboriginal people, and those on social assistance. These individuals face significant barriers in self-management of chronic diseases and in navigating the healthcare system. For these people, living in a context of deprivation contributes to maintaining disparities in access to healthcare and services. The objective of this study is to support knowledge co-construction and knowledge translation in primary care and services by involving underserved and Aboriginal people in research. METHODS This study will integrate participatory health processes and action research to co-create, with patients, individuals, and community members impacted by health literacy, practical recommendations or solutions for facilitating navigation of the healthcare system by patients, individuals, and community members with less than optimal health literacy on how to best access health services. With this approach, academics and those for whom the research is intended will collaborate closely in all stages of the research to identify findings of immediate benefit to those impacted by health literacy and work together on knowledge translation. This study, carried out by researchers, community organizations and groups of people with low health literacy from three different regions of Quebec and Saskatchewan who can play an expert role in improving health services, will be conducted in three phases: 1) data collection; 2) data analysis and interpretation; and, 3) knowledge translation. DISCUSSION Persons with low health literacy experience major obstacles in navigating the health system. This project will therefore contribute to addressing the gap between healthcare challenges and the needs of underserved patients with multi-morbidity and/or low health literacy who have complex health-related needs. It will pave the way for co-creating successful solutions for and with these communities that will increase their access to health services.
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Affiliation(s)
- Christine Loignon
- Faculty of Medicine and Health Sciences, Department of Family and Emergency Medicine, Université de Sherbrooke, Québec, Canada.
| | - Sophie Dupéré
- Faculty of Nursing, Université Laval, Québec, Canada
| | - Martin Fortin
- Faculty of Medicine and Health Sciences, Department of Family and Emergency Medicine, Université de Sherbrooke, Québec, Canada
| | - Vivian R Ramsden
- Department of Academic Family Medicine, College of Medicine, University of Saskatchewan, Saskatchewan, Canada
| | - Karoline Truchon
- Faculty of Medicine and Health Sciences, Department of Family and Emergency Medicine, Université de Sherbrooke, Québec, Canada
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Loignon C, Hudon C, Goulet É, Boyer S, De Laat M, Fournier N, Grabovschi C, Bush P. Perceived barriers to healthcare for persons living in poverty in Quebec, Canada: the EQUIhealThY project. Int J Equity Health 2015; 14:4. [PMID: 25596816 PMCID: PMC4300157 DOI: 10.1186/s12939-015-0135-5] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 01/06/2015] [Indexed: 11/16/2022] Open
Abstract
Introduction Ensuring access to timely and appropriate primary healthcare for deprived patients is an issue facing all countries, even those with universal healthcare systems. There is a paucity of information on how patients living in a context of material and social deprivation perceive barriers in the healthcare system. This study combines the perspectives of persons living in poverty and of healthcare providers to explore barriers to responsive care for underserved persons with a view to developing equity-focused primary care. Methods In this participatory action research we used photovoice, together with a method known as ‘merging of knowledge and practice’ developed by ATD Fourth World, an international community organization working to eradicate poverty. The study was conducted in two teaching primary care practices in the Canadian province of Quebec. Participants consisted of 15 health professionals and six members of ATD Fourth World; approximately 60 group meetings were held. Data were analyzed through thematic analysis, in part with the involvement of persons living in poverty. Results Three main barriers to responsive care in a context of poverty were highlighted by all participants: the difficult living conditions of people living in poverty, the poor quality of interactions between providers and underserved patients, and the complexity of healthcare system organization and functioning. Conclusion Our research revealed that unhealthy living conditions prevent persons living in poverty from accessing quality healthcare and maintaining good health. Also, the complexity of the healthcare system’s organization and functioning has a negative impact on the interactions with healthcare providers. Changes in policy and practice are needed to address those barriers and to achieve greater equity and provide more responsive care for persons living in poverty.
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Affiliation(s)
- Christine Loignon
- Department of Family Medicine, Faculty of Medicine and Health Sciences, University of Sherbrooke, Quebec, Canada.
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