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Un faible niveau de littératie en santé (LS) constitue un obstacle majeur pour accéder à l’éducation thérapeutique du patient (ETP), particulièrement chez les patients illettrés. Le présent article souhaite dépasser ce constat et en cela propose des conditions préalables pour une intervention pédagogique visant à adapter l’ETP aux besoins spécifiques des patients chroniques en situation d’illettrisme. Cette recherche s’appuie sur trois méthodes qualitatives séquentielles : deux revues de portée, complétées par un focus group auprès de 10 coordonnateurs d’ETP et des entretiens semi-dirigés auprès de 10 personnes en situation d’illettrisme et de 9 experts du champ de l’illettrisme. Selon des logiques systémiques et socioconstructivistes, les résultats montrent que la prise en compte de l’illettrisme en ETP est possible et pourrait concourir à l’augmentation des compétences en LS et plus largement des compétences en littératie des patients. Les conditions préalables proposées concernent l’adaptation des programmes d’ETP actuels auxquels pourraient être adjointes des activités d’ETP qui pour l’instant, ne sont pas reconnues par les Agences Régionales de Santé. De ces conditions préalables découleront une intervention pédagogique qui peut contribuer à réduire les inégalités d’accès à l’ETP des patients chroniques en situation d’illettrisme. Ces conditions promeuvent une vision singulière et globale de la personne concourant à son autonomie en santé dans le cadre d’une médecine de la personne.

Despite the benefits related to ambulatory surgery such as cost reduction due to lack of accommodation and patient satisfaction due to early home return, it may not lead to these expected benefits. Indeed, this kind of practice can increase responsibility for the person being treated and his or her relatives. It is therefore essential to inform them as well as possible to obtain their adherence to the proposed care protocol. Nevertheless, patients’ failures to comply with preoperative instructions or the non-attendance of the patient may result in late cancellation of the scheduled surgery. In order to reduce this kind of dysfunction, the Assistance Publique-Hôpitaux de Paris (APHP) uses a reminder system by Short Message Service (SMS). This study is a descriptive cross-sectional multicenter study that focuses on outpatients’ lived experiences of their preoperative preparation and information. It aims to collect patients’ perceptions of their ability to follow preoperative instructions received by SMS the day before an operation performed for ambulatory surgery, according to their level of health literacy (HL) and preoperative anxiety. Indeed, poor communication between patients and doctors can contribute to preoperative anxiety, while low health literacy (LHL) can lead to poor understanding of preoperative preparation instructions. Therefore, it seems important to take these 2 criteria into account in this study. This research is designed to interview outpatients undergoing ambulatory surgery in the establishments of APHP. A self-questionnaire will be used for this purpose. The choice of this institution is justified by its decision to use in all care units the reminder of preoperative instructions by SMS. The main outcome is the perception of outpatients with LHL skills regarding preoperative information provided by doctors. French ethics review committee (Comité d’Ethique de la Recherche) of the University of Paris has approved the study protocol (IRB 00012020-14). Results from this study will be disseminated through oral communications and a scientific article in an international peer-reviewed journal. This protocol is registered on researchregistry.com (researchregistry5834). This version number is 1.1 Protocol dated July 22, 2020.

The COVID-19 pandemic has compelled public authorities to establish preventive measures involving individual behaviour modification strategies (mask-wearing, social distancing, etc.) with a view to community protection. In this context, documenting people’s behaviour changes, the impact of public health measures, and individuals’ knowledge, motivations, and beliefs – even their perception of how the crisis is being managed – is essential for understanding the experience of the population and adapting the management approach accordingly. This article presents findings and lessons on how to monitor a population’s behaviour during a crisis, obtained by reviewing forty-five surveys conducted in Belgium and France during the first Covid-19 stay-at-home order, from April to May 2020. The central message is to argue that the citizens’ role in this type of survey – and in managing the crisis, more generally – should be reconsidered by thinking of them as true health partners and members of a community that could be mobilised to help.

International audience; Objectives: The purpose of this study is to evaluate and compare the effects of two education programs on patients' understanding of the disease, self-efficacy, locus of control, and application of prevention behaviors for foot ulcer. Methods: In four centers that manage patients with diabetes and grade 2 or 3 neuropathy, the first arm of patients (G1 = 53) participated in a "standard" program usually managed in each center, and those in the second arm (G2 = 56) in a "new" program. The patients completed four questionnaires at inclusion (T0) and six months after the education (T1). Occurrence of a new foot ulcer and care behaviors were collected at T1. Z-test was used to compare mean scores for each questionnaire and Fisher's exact test for percentages (p = 0.05). Results: There was no significant difference between groups G1 and G2 in terms of scores for each questionnaire at T0 and T1. Group G2 showed a significant change in score between T0 and T1 for understanding the disease (p = 0.04) and prevention behaviors (p = 0.01). For the sample as a whole (n = 109), there was a significant improvement between T0 and T1 for two questionnaires: understanding of disease (p < 0.01) and declared prevention behaviors (p < 0.01). Patients who reported having relative to participate in care had a significantly higher mean score on prevention behaviors (p < 0.01). Twenty patients had developed one new ulcer since the education (20.2%). Conclusion: This study reinforces the importance of devoting time during education to patients' understanding of the disease and involving relatives to improve foot ulcer prevention behaviors.; Évaluation de deux programmes d'éducation thérapeutique du patient sur la prévention des plaies de pieds diabétiques à risques. Objectif : Le but de cette étude est d'évaluer et de comparer les effets de deux programmes d'éducation sur la compréhension de la maladie par les patients, l'auto efficacité, le locus de contrôle et l'application des comportements de prévention de l'ulcère du pied. Méthode : Dans quatre centres de référence pour les patients atteints de diabète avec une neuropathie de grade 2 ou 3, le premier groupe de patients (G1 = 53) a participé à un programme "standard" habituellement utilisé dans chaque centre, et ceux du deuxième groupe (G2 = 56) à un "nouveau" programme. Les patients ont rempli quatre questionnaires à l'inclusion (T0) et six mois après l'éducation (T1). L'apparition d'un nouvel ulcère du pied et d'autres comportements de prévention ont été notés à T1. Le test Z a été utilisé pour comparer les résultats moyens de chaque questionnaire et le test exact de Fisher pour les pourcentages (p = 0,05). Résultats : Il n'y avait pas de différence significative entre les groupes G1 et G2 concernant les résultats de chaque questionnaire à T0 et T1. Le groupe G2 a montré un changement significatif dans le score entre T0 et T1 pour deux questionnaires : compréhension de la maladie (p

Fruits and Vegetables (FV) consumption is considered a marker of social inequalities in health since it is considerably decreased in disadvantaged populations. The main objective of this trial was to evaluate the impact of vouchers for FV purchase on the consumption of FV among children living in disadvantaged families in a French urban district. The FLAM study was a controlled randomized intervention trial, performed in Saint-Denis (North suburbs of Paris). The study group (intervention or control) was randomly attributed to parent-child pairs at inclusion. The intervention group received vouchers exchangeable for FV over a 1 year period. Nutritional education through workshops was available for both groups. FV consumption was assessed through face-to-face food frequency questionnaires. Participants who reported eating less than 3.5 FV per day were considered low FV consumers. A total of 92 parent-child pairs were included, in which 45 were allocated to the intervention group and 47 to the control group. Amongst them, 64 completed the final follow-up questionnaire (30% lost to follow-up). After one year, the proportion of low FV consumers in children was significantly lower in the intervention group (29.4%) compared to the control group (66.7%, p = 0.005). Overall, 82% of the vouchers were used by the families. This study found a decreased proportion of small consumers in children after 1 year of distribution of FV vouchers compared to the control group. FV vouchers could be an effective lever to increase FV consumption among children from disadvantaged households. ClinicalTrials.gov identifier no. NCT02461238 .

Introduction : Alors que le nombre d’etudes traitant de la « Health Literacy » (HL) est en pleine augmentation depuis ces dix dernieres annees, de nombreuses recherches ont mis en evidence l’impact significatif du niveau de HL sur l’etat de sante des personnes. Plus recemment, un constat met en evidence qu’un faible niveau de HL constituerait un obstacle potentiel a l’acces a l’education therapeutique du patient (ETP). Il en decoule un questionnement quant au rapport entre ces deux champs de pratiques et d’etudes. Methode : Afin d’interroger les rapports entre HL et ETP, une recension des ecrits a ete realisee entre janvier 2013 et Janvier 2014 a partir d’une selection finale de 52 references. Discussion : La HL et l’ETP s’inscrivent dans le meme but de conferer aux personnes des competences en sante au service d’une auto-determination plus grande. Cette congruence dans les finalites et les buts de la HL et de l’ETP est renforcee par les liens conceptuels entre les modeles qui sous-tendent ces deux champs repondant principalement a des logiques sociocognitives et systemiques. C’est ainsi que les competences que soutient la HL centrees sur le traitement de l’information en sante sont particulierement complementaires avec celles de l’ETP et influent sur l’efficacite des programmes d’education therapeutique en activant des ressources cognitives et emotionnelles d’une personne pour acquerir les competences d’auto-soins et d’adaptation a la maladie. Conclusion : Les programmes d’education therapeutique gagneraient a prendre en compte le niveau de competence en HL en proposant avec differents partenariats des methodes de lutte contre l’illettrisme et l’analphabetisme, l’ensemble concourant a la diminution des inegalites sociales de sante.