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Ravalihasy A. L'évaluateur et l'évaluation d'impact d'une intervention comme levier potentiel de l' empowerment au niveau communautaire : un exercice réflexif à partir de l'intervention MAKASI. Glob Health Promot 2024:17579759241258193. [PMID: 39087362 DOI: 10.1177/17579759241258193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Affiliation(s)
- Andrainolo Ravalihasy
- Ceped (IRD-Université Paris Cité-Inserm ERL 1244), Paris, France
- DeSCID, IAME UMR1137 (Université Paris Cité-Inserm), Paris, France
- Institut Convergences Migrations, Aubervilliers, France
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Inthavong AB, Pourmarzi D. Characteristics of Sexual Health Programs for Migrants, Refugees, and Asylum Seekers: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:961. [PMID: 39200572 PMCID: PMC11353784 DOI: 10.3390/ijerph21080961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 07/12/2024] [Accepted: 07/19/2024] [Indexed: 09/02/2024]
Abstract
BACKGROUND Social, cultural, and structural determinants of health for migrants, refugees, and asylum seekers can contribute towards poorer sexual health outcomes. People from migrant, refugee, and asylum seeker backgrounds usually use less mainstream sexual healthcare services and have lower levels of sexual health literacy compared with the destination countries' general population. However, there is little collated knowledge about sexual health programs that have been implemented to improve sexual health among these groups. This study aimed to describe the characteristics of programs for improving sexual health among migrants, refugees, and asylum seekers. METHODS This study was a scoping review in which Scopus and PubMed were searched for peer-reviewed articles published in English since 2010 from countries similar to and including Australia such as New Zealand, the United States of America, Canada, the United Kingdom, and European Union countries). The final search of databases was performed on 26 June 2023, and resultant studies were inputted into Endnote and Covidence systematic review software to remove duplicates before screening. The study utilised a qualitative approach using inductive thematic analysis of the content of the studies to extract and categorise the characteristics of the program. RESULTS A total of 3044 articles were screened and 20 were included for data extraction. The included studies were conducted in six countries (the United States of America, Australia, France, Italy, Denmark, and Belgium). The key characteristics of sexual health programs identified included consumer consultation and engagement, cultural appropriateness, language support, peer education, self-directed learning, group learning, financial support, and outreach services. the programs had a combination of these characteristics to ensure that they can improve target population engagement with educational materials and decrease barriers to accessing sexual healthcare. CONCLUSION Consideration of migrants, refugees, and asylum seekers' culture, language, socioeconomic characteristics, and access to information and services in the design of the sexual health programs may improve sexual health outcomes among these groups. However, further research is needed to assess the importance and implementation feasibility of the identified characteristics for sexual health programs in specific context.
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Affiliation(s)
| | - Davoud Pourmarzi
- National Centre for Epidemiology and Population Health, Australian National University, Canberra 2600, Australia;
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Alcouffe L, Tareau MA, Oberlis M, Adenis A, Vignier N. Research in an intercultural context: mediator-investigators of epidemiological health studies, bridges between two worlds. Front Public Health 2024; 12:1342140. [PMID: 39022426 PMCID: PMC11251968 DOI: 10.3389/fpubh.2024.1342140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 06/03/2024] [Indexed: 07/20/2024] Open
Abstract
ContextFrench Guiana is a French overseas department where very different linguistic, cultural and societal populations live together in a small area. Health issues and their specific epidemiological profiles call for research projects crossing several cultures. In this context, health mediators have a role to play in research. The aim of this study was to describe the perceptions, attitudes and opinions on research of mediators and researchers collaborating on research projects, and to describe the strengths and difficulties encountered during this cooperation.MethodsThe Inter-med project was conducted in French Guiana between February 2022 and April 2023 on the base of semi-directive interviews with mediators, or researchers, all working in health research in the intercultural context of French Guiana. The socio-demographic characteristics of the participants were described. An inductive thematic analysis was carried out on all the interviews, and word occurrence analysis on certain themes. The information was triangulated with field coordination notebooks from two epidemiological surveys conducted in French Guiana between 2021 and 2022.ResultsA total of 26 semi-structured interviews were conducted and 1,328 notebook pages analyzed. Mediation was described as an indispensable interface between the world of research and that of the population targeted by a survey. Mediators have a role to play at different stages of projects, in respect of good clinical practice, ethics and legislation. They act as interfaces between languages, concepts and representations. Their profession remains under-defined and under-dimensioned. The jobs offered are often precarious. Mediation work is emotionally costly, calls on soft skills and requires a combination of rigor and flexibility. All these aspects are implemented in the specific world of research, where there are common concepts and divergent perceptions. Researchers and mediators converge on a common goal: improving health.ConclusionThis study covers several aspects of the development and implementation of research projects. Respect for good clinical practice and people, transparency and data quality are redundant concerns, and this study touches on ethnocentrism, stigmatization and cultural representations. This study points out that the integration and recognition of mediators could be beneficial in research conducted in a cross-cultural context.
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Affiliation(s)
- Leslie Alcouffe
- Institut Santé des Populations en Amazonie, Centre Hospitalier de Cayenne, Cayenne, French Guiana
- Centre Hospitalier de Cayenne, Inserm CIC1424, Cayenne, French Guiana
- Université de Guyane, Cayenne, French Guiana
| | - Marc-Alexandre Tareau
- Institut Santé des Populations en Amazonie, Centre Hospitalier de Cayenne, Cayenne, French Guiana
- Centre Hospitalier de Cayenne, Inserm CIC1424, Cayenne, French Guiana
- Université de Guyane, Cayenne, French Guiana
- Association Mélisse, Cayenne, French Guiana
| | | | - Antoine Adenis
- Institut Santé des Populations en Amazonie, Centre Hospitalier de Cayenne, Cayenne, French Guiana
- Centre Hospitalier de Cayenne, Inserm CIC1424, Cayenne, French Guiana
- Université de Guyane, Cayenne, French Guiana
| | - Nicolas Vignier
- Institut Santé des Populations en Amazonie, Centre Hospitalier de Cayenne, Cayenne, French Guiana
- Centre Hospitalier de Cayenne, Inserm CIC1424, Cayenne, French Guiana
- Université de Guyane, Cayenne, French Guiana
- Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne and Jean Verdier, AP-HP, Bobigny, French Guiana
- IAME, Inserm UMR 1137, Université Sorbonne Paris Nord, UFR SMBH, Bobigny, France
- Institut Convergences et Migration, Aubervilliers, French Guiana
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Oberlis M, Guyot M, Le Turnier P, Carvalho L, Succo T, Rousset D, De Thoisy B, Gaillet M, Lavergne A, Vandentorren S, Epelboin L. The role of health mediation in investigation of Hantavirus cases among informal settlements inhabitants of Cayenne area, French Guiana, 2022-2023. Front Public Health 2024; 12:1364229. [PMID: 38983256 PMCID: PMC11232507 DOI: 10.3389/fpubh.2024.1364229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 05/13/2024] [Indexed: 07/11/2024] Open
Abstract
Context In 2022, four severe cases of Hantavirus pulmonary syndrome (HPS) were reported in patients from informal settlements around Cayenne, the main city in French Guiana. Regional Health Agency (RHA) was commissioned by the French Public Health Agency to estimate the seroprevalence of Hantavirus infections in the neighborhoods of confirmed cases of HPS. RHA then commissioned the French Red Cross (FRC) mobile public health team, providing support in environmental health issues to the population living in informal settlements by health mediators, to facilitate the investigation. The objective of this study was to describe the health mediators' activities set up to improve the efficiency of the investigation. Methods The health mediators' team was specifically trained by virologist and infectiologist specialized in HPS. They helped the investigating team and health workers at various steps of the investigation. These interventions are then described in the results section. Results The investigation took place between Nov. 2022 and March 2023 in three neighborhoods. During the pre-investigation activities, the mediators raised awareness about HPS of 343 people, among whom 319 (93%) planned to participate in the investigation. Altogether, 274 people finally participated in the investigation, including, i.e., 30.8% of the estimated population living in the three concerned settlements. The global proportion of patients with positive IgG anti-Hantavirus was 5.1%. The health mediators team supported the following steps: preliminary meetings and training modules, identification of resource persons, field visits and awareness and information campaigns (pre-investigation); on field data collection in informal settlements (per-investigation) and communication of individual results, public feedback meeting (post-investigation). Discussion/Conclusion The involvement of mediators was probably a factor in the success of the public health response to socially vulnerable people living in the investigated neighborhoods. The preliminary prevention activities helped to raise awareness of the health risk and to enroll participants. Health mediation and outreach activities seem relevant tools of epidemiological field investigations in diseases affecting inhabitants of informal settlements.
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Affiliation(s)
- Margot Oberlis
- Équipe Mobile Santé Environnement, Croix-Rouge française, Cayenne, French Guiana
| | | | - Paul Le Turnier
- Infectious and Tropical Diseases Unit, Centre Hospitalier de Cayenne, Cayenne, French Guiana
- Centre d'Investigation Clinique Antilles-Guyane, Inserm 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | | | | | - Dominique Rousset
- Centre national de référence des Hantavirus, Institut Pasteur de la Guyane, Cayenne, French Guiana
| | | | - Mélanie Gaillet
- Centres Délocalisés de Prévention et de Soins, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Anne Lavergne
- Centre national de référence des Hantavirus, Institut Pasteur de la Guyane, Cayenne, French Guiana
| | - Stéphanie Vandentorren
- Bordeaux University, Inserm, UMR1219, Vintage Team, Bordeaux, France
- Santé publique France, Saint-Maurice, France
| | - Loïc Epelboin
- Infectious and Tropical Diseases Unit, Centre Hospitalier de Cayenne, Cayenne, French Guiana
- Centre d'Investigation Clinique Antilles-Guyane, Inserm 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana
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Gonçalves Tasca B, Bousmah MAQ, Coulibaly K, Gosselin A, Ravalihasy A, Desgrées du Loû A, Melchior M. Depression and loneliness among Sub-Saharan immigrants living in the greater Paris area: results from the MAKASI empowerment stepped wedge cluster randomised controlled trial. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02665-7. [PMID: 38584200 DOI: 10.1007/s00127-024-02665-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 03/19/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE The MAKASI intervention aimed to empower Sub-Saharan African immigrants living in precarious situations in the Paris metropolitan area. Because there are factors specifically related to immigration that may increase the risk for common mental disorders, the present study aimed to examine participants' levels of depression and loneliness and analyze the effect of the intervention on depression and loneliness. METHODS The MAKASI study was designed as a stepped wedge cluster randomized trial. Study participants were recruited through an outreach program led by a nongovernmental organization and randomly assigned to two clusters, with an intervention delay of 3 months between them. Participants were assessed for 6 months after inclusion and the effect of the intervention on depression and loneliness was assessed using generalized linear mixed models. The study was conducted from 2018 to 2021 and took in consideration whether being interviewed during one of the Covid-19 confinement had an effect on the results. RESULTS Between 2018 and 2021 a total of 821 subjects participated in the Makasi study. High levels of depression and loneliness were found in the study population. We found no effect of the intervention on depression [95% CI 0.77 to 2.40]. Similarly, no effect of the intervention was found on loneliness [95% CI 0.87 to 2.54]. CONCLUSIONS The intervention tested did not appear to improve the level of depression and loneliness among participants. However, the high prevalence of mental and emotional problems in the study population suggests a public health crisis among immigrants in the greater Paris area. CLINICAL TRIAL REGISTRATION NUMBER Trial registration Clinicaltrials.gov, NCT04468724 (July 13, 2020).
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Affiliation(s)
- Bianca Gonçalves Tasca
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie Et de Santé Publique (IPLESP), Équipe de Recherche en Épidémiologie Sociale (ERES), Paris, France.
| | - Marwân-Al-Qays Bousmah
- Université Paris Cité, IRD, Inserm, Ceped, 75006, Paris, France
- CNRS, French Collaborative Institute On Migrations, Aubervilliers, France
- IRD, UMR LEDa-DIAL, PSL, Université Paris-Dauphine, CNRS, Paris, France
| | - Karna Coulibaly
- Université Paris Cité, IRD, Inserm, Ceped, 75006, Paris, France
- CNRS, French Collaborative Institute On Migrations, Aubervilliers, France
| | - Anne Gosselin
- Université Paris Cité, IRD, Inserm, Ceped, 75006, Paris, France
- CNRS, French Collaborative Institute On Migrations, Aubervilliers, France
- Ined, National Institute for Demographic Studies, Aubervilliers, France
| | - Andrainolo Ravalihasy
- Université Paris Cité, IRD, Inserm, Ceped, 75006, Paris, France
- CNRS, French Collaborative Institute On Migrations, Aubervilliers, France
| | - Annabel Desgrées du Loû
- Université Paris Cité, IRD, Inserm, Ceped, 75006, Paris, France
- CNRS, French Collaborative Institute On Migrations, Aubervilliers, France
| | - Maria Melchior
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie Et de Santé Publique (IPLESP), Équipe de Recherche en Épidémiologie Sociale (ERES), Paris, France
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Bousmah MAQ, Gosselin A, Coulibaly K, Ravalihasy A, Taéron C, Senne JN, Gubert F, Desgrées du Loû A. Immigrants' health empowerment and access to health coverage in France: A stepped wedge randomised controlled trial. Soc Sci Med 2023; 339:116400. [PMID: 37988803 DOI: 10.1016/j.socscimed.2023.116400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 11/03/2023] [Accepted: 11/04/2023] [Indexed: 11/23/2023]
Abstract
Throughout Europe, migration-related health inequalities are mirrored by large inequalities in health coverage. There is a need to develop novel strategies to secure access to health insurance for immigrants in Europe, in order to meet the shared Sustainable Development Goal of universal health coverage. We evaluated the impact of an original health-related empowerment intervention on access to health coverage among vulnerable, mostly undocumented immigrants in France. As part of the MAKASI study, we adopted an outreach approach and developed a community-based intervention with and for immigrants from sub-Saharan Africa living in precarious conditions in the Greater Paris area. This participatory intervention was grounded in the theory of individual empowerment. Using a stepped wedge randomised design, we first conducted a robust evaluation of the effect of the intervention on access to health coverage at three and six months post-intervention. We then investigated whether the intervention effect was mediated by a health empowerment process. Between 2018 and 2021, a total of 821 participants - 77% of whom were men - were recruited in public spaces and followed up for six months. Participants had been living in France for four years on average, 75% of them had no residence permit, and 44% had no health coverage at the time of inclusion. The probability of accessing health coverage increased by 29 percentage points at six months post-intervention (p < 0.01). This improvement was partially mediated by a health empowerment process, namely a reinforcement of participants' knowledge of and capacity to access available social and health resources. A health empowerment intervention largely improved access to health insurance among vulnerable immigrants in France. Our findings may be transferred to other settings where immigrants are entitled to health insurance. This study offers promising perspectives - beyond information provision and direct referral - to reduce migration-related inequalities in health coverage.
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Affiliation(s)
- Marwân-Al-Qays Bousmah
- Université Paris Cité, IRD, INSERM, Ceped, F-75006, Paris, France; French Collaborative Institute on Migrations, CNRS, Aubervilliers, France.
| | - Anne Gosselin
- Université Paris Cité, IRD, INSERM, Ceped, F-75006, Paris, France; French Collaborative Institute on Migrations, CNRS, Aubervilliers, France; Institut National d'Études Démographiques, Aubervilliers, France
| | - Karna Coulibaly
- Université Paris Cité, IRD, INSERM, Ceped, F-75006, Paris, France; French Collaborative Institute on Migrations, CNRS, Aubervilliers, France
| | - Andrainolo Ravalihasy
- Université Paris Cité, IRD, INSERM, Ceped, F-75006, Paris, France; French Collaborative Institute on Migrations, CNRS, Aubervilliers, France
| | | | - Jean-Noël Senne
- RITM, Université Paris-Saclay, Sceaux, France; IRD, UMR LEDa-DIAL, PSL, Université Paris-Dauphine, CNRS, Paris, France
| | - Flore Gubert
- French Collaborative Institute on Migrations, CNRS, Aubervilliers, France; IRD, UMR LEDa-DIAL, PSL, Université Paris-Dauphine, CNRS, Paris, France
| | - Annabel Desgrées du Loû
- Université Paris Cité, IRD, INSERM, Ceped, F-75006, Paris, France; French Collaborative Institute on Migrations, CNRS, Aubervilliers, France
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Coulibaly K, Bousmah MAQ, Ravalihasy A, Taéron C, Mbiribindi R, Senne JN, Gubert F, Gosselin A, Desgrées du Loû A. Bridging the knowledge gap of biomedical HIV prevention tools among sub-saharan african immigrants in France. Results from an empowerment-based intervention. SSM Popul Health 2023; 23:101468. [PMID: 37560089 PMCID: PMC10407280 DOI: 10.1016/j.ssmph.2023.101468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/20/2023] [Accepted: 07/14/2023] [Indexed: 08/11/2023] Open
Abstract
Introduction Biomedical HIV prevention tools are available in France to prevent new infections. However, evidence suggests a lack of knowledge of these tools among sub-Saharan African immigrants, who are particularly affected by HIV due to social hardship, an indirect factor of HIV acquisition. We analysed the impact of an empowerment-based intervention on the knowledge of treatment as prevention (TasP), pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) in a population of precarious sub-Saharan African immigrants. Methods Data were collected throughout the MAKASI project. Following an outreach approach, participants were recruited in public places based on their precarious situations and followed for six months (0, 3, 6 months) between 2018 and 2021. Participants were randomized into two groups and received an empowerment intervention sequentially (stepped wedge design). We used random-effects logistic regression models to evaluate the intervention effect on the knowledge of biomedical HIV prevention tools. ClinicalTrials.gov Identifier: NCT04468724. Results The majority of the participants were men (77.5%), and almost half of them had arrived in France within 2 years prior to inclusion (49.3%). At baseline, 56% of participants knew about TasP, 6% knew about PEP and 4% knew about PrEP. Receiving the intervention increased the odds of knowing about PEP (aOR = 2.02 [1.09-3.75]; p < 0.026). Intervention effects were observed for TasP and PrEP only after 6 months. We found significant time effects for PEP (at 3 months, aOR = 4.26 [2.33-7.80]; p < 0.001; at 6 months, aOR = 18.28 [7.39-45.24]; p < 0.001) and PrEP (at 3 months, aOR = 4.02 [2.10-7.72]; p < 0.001; at 6 months, aOR = 28.33 [11.16-71.91]; p < 0.001). Conclusions We showed that the intervention increased the knowledge of biomedical HIV prevention tools. The effect of the intervention was coupled with an important time effect. This suggested that exposure to the intervention together with other sources of information contributed to increased knowledge of biomedical HIV prevention tools among precarious sub-Saharan African immigrants.
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Affiliation(s)
- Karna Coulibaly
- Université Paris Cité, IRD, Inserm, Ceped, F-75006, Paris, France
- French Collaborative Institute on Migrations, CNRS, Aubervilliers, France
| | - Marwân-al-Qays Bousmah
- Université Paris Cité, IRD, Inserm, Ceped, F-75006, Paris, France
- French Collaborative Institute on Migrations, CNRS, Aubervilliers, France
| | - Andrainolo Ravalihasy
- Université Paris Cité, IRD, Inserm, Ceped, F-75006, Paris, France
- French Collaborative Institute on Migrations, CNRS, Aubervilliers, France
| | | | | | | | - Flore Gubert
- IRD, UMR LEDa-DIAL, PSL, Université Paris-Dauphine, CNRS, Paris, France
| | - Anne Gosselin
- Université Paris Cité, IRD, Inserm, Ceped, F-75006, Paris, France
- French Collaborative Institute on Migrations, CNRS, Aubervilliers, France
- Institut National D’Études Démographiques, Aubervilliers, France
| | - Annabel Desgrées du Loû
- Université Paris Cité, IRD, Inserm, Ceped, F-75006, Paris, France
- French Collaborative Institute on Migrations, CNRS, Aubervilliers, France
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Coulibaly K, Gosselin A, Carillon S, Taéron C, Mbiribindi R, Desgrées Du Loû A. Low knowledge of antiretroviral treatments for the prevention of HIV among precarious immigrants from sub-Saharan Africa living in the greater Paris area: Results from the Makasi project. PLoS One 2023; 18:e0287288. [PMID: 37315089 DOI: 10.1371/journal.pone.0287288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 06/03/2023] [Indexed: 06/16/2023] Open
Abstract
INTRODUCTION In France, combination prevention tools, particularly antiretroviral treatment for HIV prevention has been available for several years. We described the knowledge of these antiretroviral treatments among immigrants from sub-Saharan Africa, who are particularly affected by HIV, and the factors associated with this knowledge. METHODS The data come from the Makasi study, which was conducted between 2019 and 2020 among precarious immigrants from sub-Saharan Africa recruited through a community-based outreach approach in the greater Paris area (n = 601). We described levels of knowledge of HIV treatment effectiveness (HTE), treatment as prevention (TasP), post-exposure prophylaxis (PEP), and pre-exposure prophylaxis (PrEP), by sex with chi2 test. We investigated factors associated with their knowledge with logistic regressions adjusted for sociodemographic characteristics, living conditions and sexual behaviors (p≤0.2). RESULTS Respondents were mostly men (76%), from West Africa (61%), in precarious situation: 69% were unemployed, 74% were undocumented and 46% had no health coverage. Among this population, knowledge of HIV preventive treatments was heterogeneous. While HTE was well known (84%); TasP was known by only half of the respondents (46%), and PEP and PrEP were hardly known: 6% and 5%, respectively. Multivariate regressions models showed that these antiretroviral treatments for the prevention of HIV was better known by people with a higher level of education (PEP: aOR = 3.33 [1.09-10.20], p = 0.03; HTE: aOR = 4.33 [1.87-10.04], p<0.001), those who had a social network in France (TasP: aOR = 1.90, [1.33-2.73], p<0.001), those who had access to the health system and those who were exposed to sexual risks (TasP: aOR = 3.17, [1.03-9.69], p = 0.04; PrEP: aOR = 2.60 [0.72-9.34], p = 0.14). CONCLUSIONS There is a need for specific communication on antiretroviral treatment for HIV prevention that targets sub-Saharan immigrants, particularly those who have no access to the health-care system and those who are less educated.
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Affiliation(s)
- Karna Coulibaly
- Université Paris Cité, IRD, INSERM, Ceped, Paris, France
- French Collaborative Institute on Migration, CNRS, Aubervilliers, France
| | - Anne Gosselin
- Université Paris Cité, IRD, INSERM, Ceped, Paris, France
- French Collaborative Institute on Migration, CNRS, Aubervilliers, France
- French Institute for Demographic Studies (INED), Aubervilliers, France
| | | | | | | | - Annabel Desgrées Du Loû
- Université Paris Cité, IRD, INSERM, Ceped, Paris, France
- French Collaborative Institute on Migration, CNRS, Aubervilliers, France
- Institute for Research on Sustainable Development (IRD), Bondy, France
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Moser A, Korstjens I. Series: Practical guidance to qualitative research. Part 5: Co-creative qualitative approaches for emerging themes in primary care research: Experience-based co-design, user-centred design and community-based participatory research. Eur J Gen Pract 2022; 28:1-12. [PMID: 35037811 PMCID: PMC8765256 DOI: 10.1080/13814788.2021.2010700] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 11/07/2021] [Accepted: 11/16/2021] [Indexed: 11/03/2022] Open
Abstract
This article, the fifth in a series aiming to provide practical guidance for qualitative research in primary care, introduces three qualitative approaches with co-creative characteristics for addressing emerging themes in primary care research: experience-based co-design, user-centred design and community-based participatory research. Co-creation aims to define the (research) problem, develop and implement interventions and evaluate and define (research and practice) outcomes in partnership with patients, family carers, researchers, care professionals and other relevant stakeholders. Experience-based co-design seeks to understand how people experience a health care process or service. User-centred design is an approach to assess, design and develop technological and organisational systems, for example, eHealth, involving end-users in the design and decision-making processes. Community-based participatory research is a collaborative approach addressing a locally relevant health issue. It is often directed at hard-to-reach and vulnerable people. We address the context, what, why, when and how of these co-creative approaches, and their main practical and methodological challenges. We provide examples of empirical studies using these approaches and sources for further reading.
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Affiliation(s)
- Albine Moser
- Research Centre Autonomy and Participation of Chronically Ill People, Zuyd University of Applied Sciences, Heerlen, The Netherlands
- Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
| | - Irene Korstjens
- Research Centre for Midwifery Science, Zuyd University of Applied Sciences, Maastricht, The Netherlands
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Santoso D, Asfia SK, Mello MB, Baggaley RC, Johnson CC, Chow EP, Fairley CK, Ong JJ. HIV prevalence ratio of international migrants compared to their native-born counterparts: A systematic review and meta-analysis. EClinicalMedicine 2022; 53:101661. [PMID: 36147629 PMCID: PMC9486043 DOI: 10.1016/j.eclinm.2022.101661] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/29/2022] [Accepted: 08/30/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND People on the move, including international migrants, may face health inequities that expose them to a higher risk for HIV than native-born populations. We conducted a systematic review to calculate the HIV prevalence ratio of international migrants compared with native-born populations. METHODS We searched five databases between January 2010 and March 2022. Using random-effects meta-analysis, we calculated the pooled HIV prevalence ratios (PR) by comparing the HIV prevalence of migrants with native-born populations. Our research protocol is registered in the International prospective register of systematic reviews (PROSPERO, CRD42021250867). FINDINGS In total, 5,121 studies were screened, and 38 were included in the final analysis: 7,121,699 migrants and more than 270 million natives were included in the analysis. The pooled PR for any foreign-born migrants was 1·70 (95% CI 1·11 - 2·61, I2 =99·67%, n = 33 studies), refugees was 2·37 (95% CI 0·33-16·99, I2 =99·5%, n = 5), undocumented people was 3·98 (95% CI 0·11-143·01, I2 =94·6%, n = 3), whilst asylum seekers was 54·79 (95% CI 17·23-174·23, I2 =90·2%, n = 2). Meta-regression revealed that population type (adjusted R-squared 11.5%), region of origin (11.3%) and migrant type (10.8%) accounted for heterogeneity more than country-income (2.4%) and study setting (2.3%). INTERPRETATION Although it was not possible to assess if HIV infection occurred in the country of origin or destination, the HIV prevalence ratio was higher among migrants than in native-born populations. Inclusive health policies and strategies for delivering HIV testing, prevention and treatment services for migrant populations tailored to their needs are urgently needed. FUNDING J.J.O. and E.P.F.C. are supported by the Australian National Health and Medical Research Council (NHMRC) Emerging Leader Fellowship (GNT1193955 and GNT1172873, respectively).
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Affiliation(s)
- Devy Santoso
- Central Clinical School, Monash University, Melbourne, Australia
| | | | - Maeve B. Mello
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Rachel C. Baggaley
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Cheryl C. Johnson
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Eric P.F. Chow
- Central Clinical School, Monash University, Melbourne, Australia
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher K. Fairley
- Central Clinical School, Monash University, Melbourne, Australia
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Australia
| | - Jason J. Ong
- Central Clinical School, Monash University, Melbourne, Australia
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Australia
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Corresponding author at: 580 Swanston Street, Carlton, Victoria 3053, Australia.
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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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Who falls between the cracks? Identifying eligible PrEP users among people with Sub-Saharan African migration background living in Antwerp, Belgium. PLoS One 2021; 16:e0256269. [PMID: 34407146 PMCID: PMC8372948 DOI: 10.1371/journal.pone.0256269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 08/03/2021] [Indexed: 12/25/2022] Open
Abstract
Introduction This study produces an estimate of the proportion of eligible PrEP users among people of Sub-Saharan African background based on the Belgian PrEP eligibility criteria and examines associations with socio-economic and demographic characteristics. Methods We performed logistic regression analysis on data of a representative community-based survey conducted among Sub-Saharan African communities (n = 685) living in Antwerp. Results Almost a third (30.3%) of the respondents were eligible to use PrEP. Those who were male, single, lower educated, undocumented, and had experienced forced sex were more likely to be eligible for PrEP use. The findings highlight the importance of taking intra-, interpersonal and structural HIV risk factors into account. Conclusions The study shows high unmet PrEP needs in this population, especially among those with high vulnerability for HIV acquisition. A better understanding of barriers to PrEP use in this population group is needed to allow for equitable access.
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Ravalihasy A, Rude N, Yazdanpanah Y, Kardas-Sloma L, Desgrées du Loû A, Gosselin A, Ridde V. Development and Validation of an HIV/AIDS Empowerment Scale for Impact Intervention Evaluation. An Example from the MAKASI Intervention. AMERICAN JOURNAL OF HEALTH EDUCATION 2021. [DOI: 10.1080/19325037.2021.1955230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Andrainolo Ravalihasy
- Centre Population et Développement (IRD, Université de Paris, Inserm ERL 1244 SAGESUD)
- Institut de Recherche Pour le Développement
- UMR 1137, Inserm, University of Paris, IAME
- French Collaborative Institute on Migrations, CNRS
| | - Nathalie Rude
- UFR Santé, EA 481 Neurosciences, Université de Franche Comté
| | | | | | - Annabel Desgrées du Loû
- Centre Population et Développement (IRD, Université de Paris, Inserm ERL 1244 SAGESUD)
- Institut de Recherche Pour le Développement
- French Collaborative Institute on Migrations, CNRS
| | - Anne Gosselin
- Centre Population et Développement (IRD, Université de Paris, Inserm ERL 1244 SAGESUD)
- French Collaborative Institute on Migrations, CNRS
- ERES, Social Epidemiology Unit, IPLESP, INSERM S1136
| | - Valéry Ridde
- Centre Population et Développement (IRD, Université de Paris, Inserm ERL 1244 SAGESUD)
- Institut de Recherche Pour le Développement
- French Collaborative Institute on Migrations, CNRS
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Gosselin A, Melchior M, Carillon S, Gubert F, Ridde V, Kohou V, Zoumenou I, Senne JN, Desgrées du Loû A. Deterioration of mental health and insufficient Covid-19 information among disadvantaged immigrants in the greater Paris area. J Psychosom Res 2021; 146:110504. [PMID: 33965676 PMCID: PMC9188482 DOI: 10.1016/j.jpsychores.2021.110504] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 04/20/2021] [Accepted: 04/27/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The aim of this study is to provide information on changes in mental health among disadvantaged immigrants from Sub-Saharan Africa in the Greater Paris area and their level of information about Covid-19. METHODS Prior to the Covid-19 epidemic, the Makasi community-based cohort followed 850 immigrants from sub-Saharan Africa in the Greater Paris area. Between the 1st of April and the 7th of June 2020, all participants scheduled for a follow-up survey were systematically included into an additional COVID-19-related wave of data collection (N = 100). We compared participants' type of housing, level of food insecurity, work and mental health (PHQ9) before and during the first COVID-19-related lockdown, using paired-Mc Nemar chi-2 tests. We next described their level of information on Covid-19 and policy measures, broken down by sex. RESULTS Among the 100 participants, 68% had no legal residence permit. Food insecurity was more often reported during lockdown than before (62% vs 52%). 9% of participants had a score indicative of severe depression (PHQ9) before lockdown and 17% afterwards (p = 0.17). Only 51% knew about the possibility of asymptomatic transmission of the COVID-19 virus. CONCLUSIONS This study brings original information on a hard-to-reach population group. Our results suggest that the lockdown had a detrimental impact on various economic and mental health aspects among disadvantaged migrants residing in the Greater Paris area.
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Affiliation(s)
- Anne Gosselin
- French Collaborative Institute on Migrations/CNRS, Aubervilliers, France; Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Equipe de Recherche en Epidémiologie Sociale (ERES), Paris, France; CEPED (Université de Paris, IRD, Inserm), Paris, France.
| | - Maria Melchior
- French Collaborative Institute on Migrations/CNRS, Aubervilliers, France; Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Equipe de Recherche en Epidémiologie Sociale (ERES), Paris, France
| | | | - Flore Gubert
- French Collaborative Institute on Migrations/CNRS, Aubervilliers, France; DIAL (Université Paris Dauphine, IRD), Paris, France
| | - Valéry Ridde
- French Collaborative Institute on Migrations/CNRS, Aubervilliers, France; CEPED (Université de Paris, IRD, Inserm), Paris, France
| | | | | | - Jean-Noël Senne
- DIAL (Université Paris Dauphine, IRD), Paris, France; Université Paris Saclay (RITM), France
| | - Annabel Desgrées du Loû
- French Collaborative Institute on Migrations/CNRS, Aubervilliers, France; CEPED (Université de Paris, IRD, Inserm), Paris, France
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Carillon S, Gosselin A, Coulibaly K, Ridde V, Desgrées du Loû A. Immigrants facing Covid 19 containment in France : An ordinary hardship of disaffiliation. J Migr Health 2020; 1-2:100032. [PMID: 34405180 PMCID: PMC8351997 DOI: 10.1016/j.jmh.2020.100032] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/04/2020] [Accepted: 12/06/2020] [Indexed: 12/16/2022] Open
Abstract
The precarious immigrant population is often invisible because it is at the interstices of care devices and, in the current epidemic context, isolation facilities. Confinement affects individuals' abilities to act, and generates a "disaffiliation process" to placing this precarious immigrant population even more on the margins of society. Covid-19 crisis exacerbates pre-existing difficulties, generating not so new situations for these precarious immigrant population. Need to formulate specifics interventions : targeted outreach intervention, participatory approach and deliberative spaces ; promote health promotion intervention; right based intervention.
In order to limit the spread of the SARS-CoV-2 virus, the majority of governments have introduced population containment. Certain population groups, including immigrants in precarious situations, are experiencing the impact of this measure in a brutal manner. This article is based on accounts of containment experiences collected by telephone within the framework of a pre-existing intervention research carried out among immigrants to France from Sub-Saharan Africa who are in a precarious situation. It highlights certain social effects of containment and the logics at work in the precarious situations. This research shows how this a priori unprecedented situation affects individual capacities to act and generates a ‘disaffiliation process’ causing individuals to shift towards ‘social non-existence’, repeating lived experiences and exacerbating pre-existing logics. The ordeal of containment proves to be an ordinary experience for these individuals.
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Affiliation(s)
- Séverine Carillon
- Centre Population et Développement (CEPED), Institut de recherche pour le développement (IRD) et Université de Paris, Inserm ERL 1244, Paris, France
- Corresponding author at: Centre Population et Développement (CEPED), Institut de recherche pour le développement (IRD) et Université de Paris, Inserm ERL 1244, Paris, France.
| | - Anne Gosselin
- Centre Population et Développement (CEPED), Institut de recherche pour le développement (IRD) et Université de Paris, Inserm ERL 1244, Paris, France
- French Collaborative Institute on Migrations/CNRS, Paris, France
- Department of Social Epidemiology (ERES), Pierre Louis Institute for Epidemiology and Public Health (IPLESP/ INSERM UMR_S 1136), Paris, France
| | - Karna Coulibaly
- Centre Population et Développement (CEPED), Institut de recherche pour le développement (IRD) et Université de Paris, Inserm ERL 1244, Paris, France
| | - Valéry Ridde
- Centre Population et Développement (CEPED), Institut de recherche pour le développement (IRD) et Université de Paris, Inserm ERL 1244, Paris, France
- French Collaborative Institute on Migrations/CNRS, Paris, France
- IRD, French Institute for Sustainable Development, France
| | - Annabel Desgrées du Loû
- Centre Population et Développement (CEPED), Institut de recherche pour le développement (IRD) et Université de Paris, Inserm ERL 1244, Paris, France
- French Collaborative Institute on Migrations/CNRS, Paris, France
- IRD, French Institute for Sustainable Development, France
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Gosselin A, Coulibaly K, Ravalihasy A, Carillon S, Ridde V, Derche N, Mbiribindi R, Desgrées du Loû A. Finding the missing link: when community-based outreach in public space is key to engage migrants in health prevention programmes in Paris, France. J Epidemiol Community Health 2020; 74:668-675. [PMID: 32350125 DOI: 10.1136/jech-2019-213394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 03/18/2020] [Accepted: 03/31/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND One of the classic challenges for prevention programmes is reaching the populations they serve. In France, a substantial number of African migrants living with HIV acquired their infection after migrating. The aim of this paper is to better understand the characteristics of the population reached by a community-based outreach approach. METHODS We compared sociodemographic characteristics across three different groups in the Paris greater area: (1) the general African migrant population (Population census), (2) the African migrant population using either the regular healthcare system or the system for vulnerable populations (PARCOURS Survey) and (3) the African migrant population reached through a community-based mobile unit (Afrique Avenir). Comparisons were conducted according to sex, age, region of origin, duration of residence and occupational and legal statuses using χ2 tests. RESULTS The migrants reached by the mobile unit were mostly men (69%), 52% of whom were younger than 35 years old. They more often lived in precarious situations than did the general sub-Saharan population (49% vs 35% were unemployed, respectively, p<0.001) and the ones accessing the regular healthcare system. Fewer of them lived in precarious situations than did migrants seeking healthcare consultations for vulnerable populations (42% in the mobile unit vs 54% in healthcare consultations were undocumented, p<0.028). CONCLUSION Our study shows that the outreach approach can constitute a missing link in the prevention chain among sub-Saharan African migrants, reaching a group that differs from the general migrant population and from the migrant population in healthcare services-not only the newly arrived migrants who live in more precarious situations but also those who have been in France for several years and are still affected by social hardship.
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Affiliation(s)
- Anne Gosselin
- French Collaborative Institute on Migrations, CNRS, Aubervilliers, France .,ERES, Social Epidemiology Unit, IPLESP, INSERM S1136, Faculté de Médecine de Saint Antoine, Paris, France.,Centre Population et Développement (Université Paris Descartes, IRD, ERL Inserm SAGESUD), Paris, France
| | - Karna Coulibaly
- Centre Population et Développement (Université Paris Descartes, IRD, ERL Inserm SAGESUD), Paris, France.,Institut de Recherche Pour le Développement, Marseille, France
| | - Andrainolo Ravalihasy
- Centre Population et Développement (Université Paris Descartes, IRD, ERL Inserm SAGESUD), Paris, France.,Institut de Recherche Pour le Développement, Marseille, France
| | - Séverine Carillon
- Centre Population et Développement (Université Paris Descartes, IRD, ERL Inserm SAGESUD), Paris, France
| | - Valéry Ridde
- French Collaborative Institute on Migrations, CNRS, Aubervilliers, France.,Centre Population et Développement (Université Paris Descartes, IRD, ERL Inserm SAGESUD), Paris, France.,Institut de Recherche Pour le Développement, Marseille, France
| | | | | | - Annabel Desgrées du Loû
- French Collaborative Institute on Migrations, CNRS, Aubervilliers, France.,Centre Population et Développement (Université Paris Descartes, IRD, ERL Inserm SAGESUD), Paris, France.,Institut de Recherche Pour le Développement, Marseille, France
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