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Tareau MA, Demars Y, Alcouffe L, Pierre-Louis R, Walter G, Djossou F, Vignier N, About F. Anthropology and ethnobotany in health mediation: an illustration of a clinical, personalized approach for Haitian migrants in a French Guianese hospital. Front Public Health 2024; 12:1306508. [PMID: 38887245 PMCID: PMC11182452 DOI: 10.3389/fpubh.2024.1306508] [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: 10/03/2023] [Accepted: 03/06/2024] [Indexed: 06/20/2024] Open
Abstract
Introduction In French Guiana, a European territory in Guiana shield in the Amazon area, close to 40% of the current population was born abroad. In this context, it is important to listen to the experiences of migrants to better understand the difficulties encountered within the healthcare pathways. This is the aim of ANRS Parcours d'Haïti project, an epidemiological, biographical and socio-anthropological study conducted on a representative sample of the Haitian community in French Guiana and focusing on the social determinants of health. Methodology Within the framework of this study, the Infectious and Tropical Diseases clinical team of Cayenne Hospital has established close collaboration with health mediators and the ethnobotanist anthropologist of the study. To illustrate the contribution of a personalized approach to health mediation, we report the case of a migrant woman of Haitian origin admitted to the Infectious and Tropical Diseases Unit. We highlight the different socio-cultural aspects addressed and their place in the care process through a thematic discussion and socio-anthropological analysis of the care relationship, based on participatory ethnography and inductive analysis of an in-depth interview with the patient. Result This example illustrates the need for a multidisciplinary approach to ensure culturally adapted care for patients. Personal interviews are important because they allow to better take into account the cultural specificities of patients' experiences and the socio-cultural environment in which they live (and especially, in the case of Haitian patients, their religious affiliation). By allowing them to speak and express themselves freely, they integrate not only their own cultural baggage, but also their own expectations and representations of the disease they suffer from and how it should be treated. Ultimately, this tripartite collaboration between patient, caregiver, and anthropologist or health mediator leads to a better therapeutic alliance. Conclusion The analysis of this health care relationship is emblematic of the issue of cultural competence and pre-conceptualizes what intercultural mediation in health care could be, as close as possible to the caregiver and the individual.
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Affiliation(s)
- Marc-Alexandre Tareau
- CIC INSERM 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana
- Département de Formation et de Recherche - Lettres et Sciences Humaines, Université de Guyane, Cayenne, French Guiana
| | - Yoris Demars
- Unité de Maladies Infectieuses et Tropicales, Centre Hospitalier de Cayenne, French Guiana
| | - Leslie Alcouffe
- CIC INSERM 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana
- Ecole Doctorale (ED 587), Université de Guyane, Cayenne, French Guiana
- COREVIH Guyane, Centre hospitalier de Cayenne, Cayenne, French Guiana
| | - Ruth Pierre-Louis
- CIC INSERM 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Gaelle Walter
- Unité de Maladies Infectieuses et Tropicales, Centre Hospitalier de Cayenne, French Guiana
| | - Félix Djossou
- Unité de Maladies Infectieuses et Tropicales, Centre Hospitalier de Cayenne, French Guiana
- Département de Formation et de Recherche - Santé, Université de Guyane, Cayenne, French Guiana
| | - Nicolas Vignier
- CIC INSERM 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana
- COREVIH Guyane, Centre hospitalier de Cayenne, Cayenne, French Guiana
- Hôpitaux universitaires Paris Seine-Saint-Denis, Hôpital Avicenne and Jean Verdier, AP-HP, Bobigny, France
- IAME, INSERM UMR 1137, Université Sorbonne Paris Nord, UFR SMBH, Paris, France
- Institut Convergences et Migration, Aubervilliers, France
| | - Frédégonde About
- CIC INSERM 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana
- Unité de Maladies Infectieuses et Tropicales, Centre Hospitalier de Cayenne, French Guiana
- Département de Formation et de Recherche - Santé, Université de Guyane, Cayenne, French Guiana
- Faculté de médecine Hyacinthe Bastaraud, Université de Guadeloupe, Pointe-à-Pitre, Guadeloupe
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Rotily M, Persico N, Lamouroux A, Rojas-Vergara AC, Loundou A, Boucekine M, Apostolidis T, Odena S, Chischportich C, Auquier P. Health mediation does not reduce the readmission rate of frequent users of emergency departments living in precarious conditions: what lessons can be learned from this randomised controlled trial? BMC Emerg Med 2024; 24:83. [PMID: 38750416 PMCID: PMC11094847 DOI: 10.1186/s12873-024-01000-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 05/06/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Severe overcrowding of emergency departments (EDs) affects the quality of healthcare. One factor of overcrowding is precariousness, but it has rarely been considered a key factor in designing interventions to improve ED care. Health mediation (HM) aims to facilitate access to rights, prevention, and care for the most vulnerable persons and to raise awareness among healthcare providers about obstacles in accessing healthcare. The primary aim was to determine whether HM intervention for frequent users of EDs (FUED) living in precarious conditions could reduce the readmission rate at 90 days. METHODS Between February 2019 and May 2022, we enrolled and interviewed 726 FUED in four EDs of southeastern France in this randomised controlled trial. The HM intervention started in the ED and lasted 90 days. In addition to the primary endpoint (first readmission at 90 days), secondary endpoints (readmission at 30 and 180 days, number of hospitalisations at 30, 90, 180 days, admissions for the same reasons as the first admission) were also studied. The outcomes were measured in the ED information systems. Statistical methods included an intention-to-treat analysis and a per-protocol analysis. Comparisons were adjusted for gender, age, ED, and health mediator. RESULTS 46% of patients reported attending the ED because they felt their life was in danger, and 42% had been referred to the ED by the emergency medical dispatch centre or their GP; 40% of patients were considered to be in a serious condition by ED physicians. The proportion of patients who were readmitted at 90 days was high but did not differ between the control and the HM intervention groups (31.7% vs. 36.3%, p = 0.23). There was no significant difference in any of the secondary outcome measures between the control and HM intervention groups. Per-protocol analysis also showed no significant difference for the primary and secondary endpoints. CONCLUSIONS This randomised controlled trial did not show that our health mediation intervention was effective in reducing the use of emergency services by FUED living in precarious conditions. Some limitations are discussed: the duration of the intervention (90 days), the long-term effects (> 6 months), the involvement of the ED staff. TRIAL REGISTRATION Registered on clinicaltrials.gov as NCT03660215 on 4th September 2018.
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Affiliation(s)
- Michel Rotily
- Centre d'Etudes et de Recherche sur les services de santé et la qualité de vie (CEReSS), Aix Marseille Université, Marseille, France.
| | - Nicolas Persico
- Service des Urgences, Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Aurore Lamouroux
- Centre de santé hospitalo-universitaire des Aygalades, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Ana Cristina Rojas-Vergara
- Centre de santé hospitalo-universitaire des Aygalades, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Anderson Loundou
- Centre d'Etudes et de Recherche sur les services de santé et la qualité de vie (CEReSS), Aix Marseille Université, Marseille, France
| | - Mohamed Boucekine
- Centre d'Etudes et de Recherche sur les services de santé et la qualité de vie (CEReSS), Aix Marseille Université, Marseille, France
| | - Themistoklis Apostolidis
- Laboratoire de Psychologie Sociale (LPS), Aix Marseille Université, Aix en Provence, Marseille, France
| | - Sophie Odena
- Laboratoire d'Economie et de Sociologie du Travail, Aix Marseille Université, Centre National de la Recherche Scientifique, Aix en Provence, Marseille, France
| | | | - Pascal Auquier
- Centre d'Etudes et de Recherche sur les services de santé et la qualité de vie (CEReSS), Aix Marseille Université, Marseille, France
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Vaugoyeau E, Rambliere L, David M, Lemguarni H, Le Gac S, Pasquet-Cadre A, Rasli S, Ghosn J, Rozenbaum W, Bouvet E, Prioux M. Proof of concept of a sexual health outreach program led by community health workers in homeless hostels in the greater Paris region. Front Public Health 2024; 11:1305874. [PMID: 38283290 PMCID: PMC10811606 DOI: 10.3389/fpubh.2023.1305874] [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: 10/02/2023] [Accepted: 12/12/2023] [Indexed: 01/30/2024] Open
Abstract
Context Homeless individuals face exacerbated risks of infectious diseases, including sexually transmitted infections (STIs). Programs led by Community Health Workers (CHWs) have demonstrated potential to enhance healthcare access for marginalized groups such as homeless families. This study aims to evaluate the feasibility and effectiveness of a novel CHW-based outreach program addressing sexual health issues among individuals residing in homeless hostels. Methods Twelve social homeless hostels in the greater Paris region were selected as program implementation sites. An outreach program was developed consisting of two interventions: sexual health workshops and STI screening sessions (HIV and hepatitis B and C) accompanied by individual interviews, both conducted by CHWs within each hostel over an 8-week period and scheduled weekly. Feasibility, participation and engagement were evaluated using complementary methods including qualitative field observations, semi-structured interviews and focus groups with CHWs, satisfaction questionnaires for participants, and quantitative outcome data collection of each intervention. Results A total of 80 program activities (workshops and screening sessions) were conducted. Among the participants, 542 women and 30 men engaged in workshops. During the 30 Rapid Diagnostic Testing sessions, 150 individuals underwent testing for HIV, hepatitis B, and/or hepatitis C. Positivity rates were 6.7% for hepatitis B and 0.9% for hepatitis C. No HIV infections were detected. Participant satisfaction rates were consistently high (>76%) across workshops. Qualitative analysis unveiled two critical axes influencing program feasibility and effectiveness: program organization and CHW involvement. Discussion This assessment of the program highlights its feasibility among a population that is difficult to reach through conventional healthcare efforts. The intervention's potential effectiveness is suggested by self- and CHW-reported improvements in sexual health literacy and high rates of referral to the healthcare system, as well as holistic well-being considerations. CHW involvement is a vital determinant of program success, as are robust coordination among stakeholders, deep understanding of the target population, and strong partner engagement. Conclusion This outreach program amplifies the voices of often-overlooked populations while empowering them to navigate health and social challenges. Although these workshops serve as lifelines for those frequently excluded from mainstream services, long-term improvements to the health and wellbeing of homeless populations will necessitate systemic governmental intervention.
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Affiliation(s)
| | - Lison Rambliere
- Observatoire du Samusocial de Paris, Samusocial de Paris, Paris, France
| | - Manon David
- Pôle DELTA, Samusocial de Paris, Paris, France
| | | | | | | | - Samy Rasli
- Pôle DELTA, Samusocial de Paris, Paris, France
| | - Jade Ghosn
- COREVIH Île-de-France Nord, Paris, France
| | | | | | - Maëlle Prioux
- Pôle médical et soins, Samusocial de Paris, Paris, France
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