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International audience ; Background: To reduce social inequities in health, the World Health Organization's Commission on Social Determinants of Health recommends acting as soon as life begins. In this context, parenting support is promoted as a major lever. The objective of the present research was to develop an intervention theory establishing the conditions for the success of interventions, policies, and organizations supporting parenting in terms of reducing or preventing social inequalities in health for both mother and child in the perinatal period. Methods: To meet these objectives, we conducted a realist evaluation based on a multiple-case study. The study evaluated two border towns in Europe. We collected data from three sources: documentary reviews, focus groups and interviews with professionals, and parental questionnaires. Results: The main results concerning the fight against social inequalities in health show a true willingness on the part of those involved to carry out universal actions, coordinated between professionals and institutions, in response to the demands of parents; however, the reality on the ground shows the complexity of their implementation and the multiplicity of results. Our middle-range theory showed that to be effective in tackling social inequalities in health, actions must address structural determinants at the macro-systemic level. However, the field of realist evaluation shows that it is first and foremost the actions focused on individual behavior that are implemented. While there is a general political desire to combat social inequalities in health in early childhood, the results show that the strategies in place are potentially not the most effective. Effective support actions would respond to individual strategies; however, current approaches target parents' behavior, aiming to empower them but without giving them the means to do so. Conclusions: This research constitutes a body of knowledge gathered for reflection and action. In particular, any perinatal policy should clearly state among its objectives the intention to reduce social inequalities in health. The policy should also state that it will be evaluated according to the criteria of proportionate universalism, interprofessional coordination, and actions based on the diversity of parents' needs.

International audience ; Background: To reduce social inequities in health, the World Health Organization's Commission on Social Determinants of Health recommends acting as soon as life begins. In this context, parenting support is promoted as a major lever. The objective of the present research was to develop an intervention theory establishing the conditions for the success of interventions, policies, and organizations supporting parenting in terms of reducing or preventing social inequalities in health for both mother and child in the perinatal period. Methods: To meet these objectives, we conducted a realist evaluation based on a multiple-case study. The study evaluated two border towns in Europe. We collected data from three sources: documentary reviews, focus groups and interviews with professionals, and parental questionnaires. Results: The main results concerning the fight against social inequalities in health show a true willingness on the part of those involved to carry out universal actions, coordinated between professionals and institutions, in response to the demands of parents; however, the reality on the ground shows the complexity of their implementation and the multiplicity of results. Our middle-range theory showed that to be effective in tackling social inequalities in health, actions must address structural determinants at the macro-systemic level. However, the field of realist evaluation shows that it is first and foremost the actions focused on individual behavior that are implemented. While there is a general political desire to combat social inequalities in health in early childhood, the results show that the strategies in place are potentially not the most effective. Effective support actions would respond to individual strategies; however, current approaches target parents' behavior, aiming to empower them but without giving them the means to do so. Conclusions: This research constitutes a body of knowledge gathered for reflection and action. In particular, any perinatal policy should ...

International audience ; Background: To reduce social inequities in health, the World Health Organization's Commission on Social Determinants of Health recommends acting as soon as life begins. In this context, parenting support is promoted as a major lever. The objective of the present research was to develop an intervention theory establishing the conditions for the success of interventions, policies, and organizations supporting parenting in terms of reducing or preventing social inequalities in health for both mother and child in the perinatal period. Methods: To meet these objectives, we conducted a realist evaluation based on a multiple-case study. The study evaluated two border towns in Europe. We collected data from three sources: documentary reviews, focus groups and interviews with professionals, and parental questionnaires. Results: The main results concerning the fight against social inequalities in health show a true willingness on the part of those involved to carry out universal actions, coordinated between professionals and institutions, in response to the demands of parents; however, the reality on the ground shows the complexity of their implementation and the multiplicity of results. Our middle-range theory showed that to be effective in tackling social inequalities in health, actions must address structural determinants at the macro-systemic level. However, the field of realist evaluation shows that it is first and foremost the actions focused on individual behavior that are implemented. While there is a general political desire to combat social inequalities in health in early childhood, the results show that the strategies in place are potentially not the most effective. Effective support actions would respond to individual strategies; however, current approaches target parents' behavior, aiming to empower them but without giving them the means to do so. Conclusions: This research constitutes a body of knowledge gathered for reflection and action. In particular, any perinatal policy should ...

BACKGROUND: To reduce social inequities in health, the World Health Organization's Commission on Social Determinants of Health recommends acting as soon as life begins. In this context, parenting support is promoted as a major lever. The objective of the present research was to develop an intervention theory establishing the conditions for the success of interventions, policies, and organizations supporting parenting in terms of reducing or preventing social inequalities in health for both mother and child in the perinatal period. METHODS: To meet these objectives, we conducted a realist evaluation based on a multiple-case study. The study evaluated two border towns in Europe. We collected data from three sources: documentary reviews, focus groups and interviews with professionals, and parental questionnaires. RESULTS: The main results concerning the fight against social inequalities in health show a true willingness on the part of those involved to carry out universal actions, coordinated between professionals and institutions, in response to the demands of parents; however, the reality on the ground shows the complexity of their implementation and the multiplicity of results. Our middle-range theory showed that to be effective in tackling social inequalities in health, actions must address structural determinants at the macro-systemic level. However, the field of realist evaluation shows that it is first and foremost the actions focused on individual behavior that are implemented. While there is a general political desire to combat social inequalities in health in early childhood, the results show that the strategies in place are potentially not the most effective. Effective support actions would respond to individual strategies; however, current approaches target parents' behavior, aiming to empower them but without giving them the means to do so. CONCLUSIONS: This research constitutes a body of knowledge gathered for reflection and action. In particular, any perinatal policy should clearly state among its ...

L'ulcère de Buruli (UB), infection bactérienne cutanée, est provoqué par Mycobactérium ulcérans. En l'absence de traitement précoce, il entraîne des déformations et amputations. La plupart des cas surviennent dans des régions tropicales ou subtropicales. Le Bénin, pays parmi les plus touchés, a recensé 365 cas en 2012. Cet article présente les résultats d'une enquête psycho socio comportementale menée dans le cadre d'un projet de promotion de la santé (PS) par participation communautaire. Son objectif est de décrire les facteurs cognitifs, comportementaux préventifs, curatifs ainsi que les perceptions et vécus des populations concernant l'UB. Une étude transversale a été réalisée dans 2 villages (Azonmè, Houédota) situés dans les arrondissements de Kpomè et Hécanmè, du département de l'Atlantique au Bénin. Du 15 mai au 19 juin 2011, une enquête par entretiens, s'est déroulée auprès d'un échantillon de 15 malades, 15 anciens malades sélectionnés par choix raisonné et 30 personnes saines choisies aléatoirement. L'encodage et l'analyse des données ont été faits dans SPSS et Excel. Les enquêtés sont âgés de 11 à 100 ans, avec une moyenne d'âge de 36,63 ans, 55% sont des hommes. Plus de 96% des interviewés ont au moins une connaissance correcte sur l'UB (prévention, transmission, symptômes, traitement). De tous les enquêtés, 20% connaissent les modes de transmission et un seul, tous les moyens préventifs. Les causes de la maladie attribuées ou perçues (et non médicales) sont l'eau (52), la bactérie (17) le mauvais sort (5). Les interviewés s'approvisionnent majoritairement en eau dans les citernes (33), forages (26), rivières (25). Sur 30 malades ou anciens malades, 29 ont été soignés à l'hôpital. Une majeure partie des répondants (92%) est satisfaite des prestations des professionnels mais proposent des changements (76%) concernant l'accessibilité à l'hôpital et le coût des soins. Ces résultats montrent des similitudes et des différences comparés à ceux retrouvés dans la littérature sur le sujet. Au Bénin, l'UB est une priorité nationale illustrée par une politique de lutte intensive, qui a modifié favorablement les connaissances et comportements des populations victimes enquêtées. Il existe un dynamisme communautaire, mais individuellement, les interviewés manquent de confiance en eux mêmes, d'initiative et de contrôle. Ces enquêtes ont amorcé l'intervention en PS car elles ont entraîné l'adhésion des 2 communautés. ; [Health promotion and community-based approach to Buruli ulcer: Results of a psychosocial- and behavioural survey in two villages in Benin] Buruli ulcer (BU), is an infectious disease, caused by Mycobacterium ulcerans. In the absence of early treatment, this "neglected" disease can end up with lasting deformities and amputation of limbs. Most cases occur in tropical or subtropical regions. Benin, one of the most affected countries, notified 365 cases in 2012. This article presents the results of a psycho socio behavioral survey conducted through a health promotion (HP) drafted by community-based participation. Its objective is to describe its diagnosis, prevention, behaviors, as well as perceptions and experiences of the people related to BU. A cross-sectional study was conducted in two villages (Azonme, Houedota) of Benin Atlantic department. From 15 May to 19 June 2011, a volunteering survey was conducted with the former 15 patients, the 15 new patients, selected by purposive and 30 healthy individuals randomly selected. Encoding and data analysis were done in SPSS and Excel. Respondents aged 11 to 100 years, with an average age of 36.63 years. 55% were men. Off school (73%), polygamous (60%) and Christians (50%). Over 96% of respondents had an awareness on the BU ( Symptoms, spread, prevention and treatment). 20% knew the way it spread, but one was aware of preventive measures. 55 They mostly got water in, tanks (33), wells (26) and rivers (25). Of 30 patients or former patients, 29 were treated with CS. The causes of the disease were water (52), bacteria (17), bad luck (5). 92% of respondents were satisfied with the services of health professionals but proposed changes (46) regarding the hospital accessibility and the care cost. These results had shown similarities and differences compared with those found in the literature on the subject. In Benin, the BU is a national priority illustrated by a strong policy struggle, which has favorably modified the knowledge and behavior of the populations surveyed. There is a community dynamism, but individually, respondents lack self-confidence, initiative and control. These surveys began intervention PS as they led the accession of two communities.

L'ulcère de Buruli (UB), infection bactérienne cutanée, est provoqué par Mycobactérium ulcérans. En l'absence de traitement précoce, il entraîne des déformations et amputations. La plupart des cas surviennent dans des régions tropicales ou subtropicales. Le Bénin, pays parmi les plus touchés, a recensé 365 cas en 2012. Cet article présente les résultats d'une enquête psycho socio comportementale menée dans le cadre d'un projet de promotion de la santé (PS) par participation communautaire. Son objectif est de décrire les facteurs cognitifs, comportementaux préventifs, curatifs ainsi que les perceptions et vécus des populations concernant l'UB. Une étude transversale a été réalisée dans 2 villages (Azonmè, Houédota) situés dans les arrondissements de Kpomè et Hécanmè, du département de l'Atlantique au Bénin. Du 15 mai au 19 juin 2011, une enquête par entretiens, s'est déroulée auprès d'un échantillon de 15 malades, 15 anciens malades sélectionnés par choix raisonné et 30 personnes saines choisies aléatoirement. L'encodage et l'analyse des données ont été faits dans SPSS et Excel. Les enquêtés sont âgés de 11 à 100 ans, avec une moyenne d'âge de 36,63 ans, 55% sont des hommes. Plus de 96% des interviewés ont au moins une connaissance correcte sur l'UB (prévention, transmission, symptômes, traitement). De tous les enquêtés, 20% connaissent les modes de transmission et un seul, tous les moyens préventifs. Les causes de la maladie attribuées ou perçues (et non médicales) sont l'eau (52), la bactérie (17) le mauvais sort (5). Les interviewés s'approvisionnent majoritairement en eau dans les citernes (33), forages (26), rivières (25). Sur 30 malades ou anciens malades, 29 ont été soignés à l'hôpital. Une majeure partie des répondants (92%) est satisfaite des prestations des professionnels mais proposent des changements (76%) concernant l'accessibilité à l'hôpital et le coût des soins. Ces résultats montrent des similitudes et des différences comparés à ceux retrouvés dans la littérature sur le sujet. Au Bénin, l'UB est une priorité nationale illustrée par une politique de lutte intensive, qui a modifié favorablement les connaissances et comportements des populations victimes enquêtées. Il existe un dynamisme communautaire, mais individuellement, les interviewés manquent de confiance en eux mêmes, d'initiative et de contrôle. Ces enquêtes ont amorcé l'intervention en PS car elles ont entraîné l'adhésion des 2 communautés. ; [Health promotion and community-based approach to Buruli ulcer: Results of a psychosocial- and behavioural survey in two villages in Benin] Buruli ulcer (BU), is an infectious disease, caused by Mycobacterium ulcerans. In the absence of early treatment, this "neglected" disease can end up with lasting deformities and amputation of limbs. Most cases occur in tropical or subtropical regions. Benin, one of the most affected countries, notified 365 cases in 2012. This article presents the results of a psycho socio behavioral survey conducted through a health promotion (HP) drafted by community-based participation. Its objective is to describe its diagnosis, prevention, behaviors, as well as perceptions and experiences of the people related to BU. A cross-sectional study was conducted in two villages (Azonme, Houedota) of Benin Atlantic department. From 15 May to 19 June 2011, a volunteering survey was conducted with the former 15 patients, the 15 new patients, selected by purposive and 30 healthy individuals randomly selected. Encoding and data analysis were done in SPSS and Excel. Respondents aged 11 to 100 years, with an average age of 36.63 years. 55% were men. Off school (73%), polygamous (60%) and Christians (50%). Over 96% of respondents had an awareness on the BU ( Symptoms, spread, prevention and treatment). 20% knew the way it spread, but one was aware of preventive measures. 55 They mostly got water in, tanks (33), wells (26) and rivers (25). Of 30 patients or former patients, 29 were treated with CS. The causes of the disease were water (52), bacteria (17), bad luck (5). 92% of respondents were satisfied with the services of health professionals but proposed changes (46) regarding the hospital accessibility and the care cost. These results had shown similarities and differences compared with those found in the literature on the subject. In Benin, the BU is a national priority illustrated by a strong policy struggle, which has favorably modified the knowledge and behavior of the populations surveyed. There is a community dynamism, but individually, respondents lack self-confidence, initiative and control. These surveys began intervention PS as they led the accession of two communities.