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International audience; Background: Human Papillomavirus (HPV) vaccine coverage in France is below 30%, despite proven effectiveness against HPV infections and (pre-)cancerous cervical lesions. To optimise vaccine promotion among adolescents, we used a discrete choice experiment (DCE) to identify optimal statements regarding a vaccination programme, including vaccine characteristics.Methods: Girls and boys enrolled in the last two years of five middle schools in three French regions (aged 13-15 years) participated in an in-class cross-sectional self-administered internet-based study. In ten hypothetical scenarios, participants decided for or against signing up for a school-based vaccination campaign against an unnamed disease. Scenarios included different levels of four attributes: the type of vaccine-preventable disease, communication on vaccine safety, potential for indirect protection, and information on vaccine uptake among peers. One scenario was repeated with an added mention of sexual transmission.Results: The 1,458 participating adolescents (estimated response rate: 89.4%) theoretically accepted vaccination in 80.1% of scenarios. All attributes significantly impacted theoretical vaccine acceptance. Compared to a febrile respiratory disease, protection against cancer was motivating (odds ratio (OR) 1.29 [95%-CI 1.09-1.52]), but not against genital warts (OR 0.91 [0.78-1.06]). Compared to risk negation ("vaccine does not provoke serious side effects"), a reference to a positive benefit-risk balance despite a confirmed side effect was strongly dissuasive (OR 0.30 [0.24-0.36]), while reference to ongoing international pharmacovigilance without any scientifically confirmed effect was not significantly dissuasive (OR 0.86 [0.71-1.04]). The potential for indirect protection motivated acceptance among girls but not boys (potential for eliminating the disease compared to no indirect protection, OR 1.57 [1.25-1.96]). Compared to mentioning "insufficient coverage", reporting that ">80% of young people in other countries got vaccinated" motivated vaccine acceptance (OR 1.94 [1.61-2.35]). The notion of sexual transmission did not influence acceptance.Conclusion: HPV vaccine communication to adolescents can be tailored to optimise the impact of promotion efforts.

Resume Introduction SAFETIM-APP fait un etat des lieux des pratiques professionnelles dans les 45 centres de ressources et de competence de la mucoviscidose (CRCM) francais, entre fevrier 2015 et decembre 2016, pour la transition des adolescents atteints de mucoviscidose vers les centres adultes. Methodologie Cette etude transversale, multicentrique, par auto questionnaires envoyes aux CRCM interrogeait les modalites de la transition et proposait de prioriser une liste de criteres de qualite. Une analyse qualitative des procedures et une quantitative des criteres ont ete faites. Resultats Un total de 77 % des CRCM ont repondu : la transition se deroule sur 3 a 5 ans et debute a 15 ans. Un total de 9 criteres fondamentaux sont retenus dont : collaborer entre equipes, prendre en compte l’adolescence, avoir un temps d’echange adolescent seul/medecin, definir un programme incluant l’education therapeutique, impliquer de la famille, accompagner les parents. Un total de 7 criteres sont importants dont : reannoncer le diagnostic, identifier un « fil rouge » (soignant) qui accompagne la famille, programmer le suivi adulte des la pediatrie, visiter le service adulte, organiser un temps formel de depart/accueil, initier le processus suffisamment tot, identifier des indicateurs permettant d’evaluer les pratiques. Conclusion Les processus de transition en place dans les CRCM peuvent etre ameliores par la mise en œuvre de ces criteres de qualite.

International audience; This study investigated the role of self-control in health behaviors at both trait and state levels. We examined if trait and state self-control independently predict health behaviors, as well as the mechanisms of these relationships (desire, conflict, and resistance). This question was investigated on unhealthy and healthy behaviors, in the domain of physical activity, diet, and smoking. 325 participants completed a questionnaire assessing trait and state self-control, as well as desire, conflict, resistance, and health behaviors. Path analyses revealed that trait self-control indirectly predicted unhealthy behaviors through reduced desire, conflict, and resistance, and directly predicted healthy behaviors. These relationships remained significant when controlling for state self-control, suggesting that people’s general tendency to prioritize distal goals over proximal motives uniquely predicts behaviors. Results also showed that adding state self-control to the model doubled the explained variance in healthy behaviors, highlighting the importance of considering self-control capacity at both trait and state levels.

BACKGROUND Mindfulness-based programs have been shown to be effective in reducing stress, anxiety, and depression symptoms, and enhancing well-being. However, it remains unclear whether longer formal mindfulness practices are necessary to obtain such results. We therefore aimed to assess the effectiveness of a program (FOVEA, 8 weeks, 2h/week) which was only based on brief and informal practices. METHODS Using a switching replication design, participants (N = 139) were assigned to a FOVEA or a wait-list group, and completed the following self-report questionnaires online at three time points: perceived stress, anxiety, depression, satisfaction with life (dependent variables), and mindfulness (mediating variable). They also completed a daily practice diary. RESULTS Relative to the wait-list group, FOVEA participants showed significantly reduced perceived stress, anxiety, and depression, and increased satisfaction with life. These changes were completely mediated by increased mindfulness, and were maintained 2.5 months after the end of the program. The effect sizes were moderate to large. CONCLUSIONS These results underline the potential benefits of a mindfulness informal practices program for the general population. This type of program could constitute a first step towards more formal practices once the motivation to practice has been enhanced by the perceived benefits of brief practices.

En France, les professionnels de santé travaillant en établissement ont un très faible taux de vaccination contre la grippe. Ce dernier atteint seulement 25%. Pourtant cette population contribue à la propagation du virus de la grippe chez les patients à risque hospitalisés sur une longue période. Chaque année, de nombreux patients décèdent de complications dues à la grippe. Plusieurs études ont été réalisées afin de déterminer les facteurs, d'étudier les modèles théoriques permettant l'adoption du comportement de vaccination chez les professionnels de santé. Ainsi, des interventions ont également été développées, mais leur efficacité reste non systématique. Il semble donc important d'aborder les interventions pouvant être prometteuses mais aussi de mettre en lumière leur limite concernant l'évaluation de leurs effets sur le comportement. Requestionner la nature du comportement de vaccination afin de permettre de nouvelles pistes de réflexion semble également nécessaire. Ce chapitre abordera dans un premier temps (a) l'hésitation vaccinale chez les professionnels de santé travaillant en établissement et notamment les facteurs favorisant le recours ou non à la vaccination. Dans un second temps (b) une stratégie de planification issue du modèle HAPA (Schwarzer, 2001) sera abordée ainsi que ses limites. Puis (c) une stratégie de planification basée sur le modèle transthéorique du changement de Prochaska et Diclemente (1983) sera discutée ainsi que différentes interventions permettant d'augmenter la motivation des soignants à adopter le comportement de vaccination. Enfin (d) une dernière partie sera consacrée à reconsidérer le comportement de vaccination comme étant un comportement prosocial et ainsi à la proposition de nouvelles pistes d'interventions.

Objective: The aim of this study was to compare the clinical efficacy of two differently-designed psychological interventions for chronic pain. Design: 138 patients presenting chronic pain were ran...

This study tests the impact of threat on compassion and vaccination intention among healthcare workers (HCWs) with low and high socio-economic status (SES) in France.A total of 309 HCWs were analyzed (The primary outcome was the vaccination intention score. The secondary outcome included the compassion score.The interaction of the Group X SES Subjective on compassion was not significant (Ultimately, compassion inhibited the distress elicited in the threat condition in HCWs with high compassion.

We translated the ABC adherence taxonomy (i.e., seven terms and their corresponding definitions) published by Vrijens et al. (2012) into French (F) and German (G) without changing the original meaning with the aim to promote a standardised taxonomy for medication adherence to French- and German-speaking researchers and clinicians.; A Delphi survey was performed. To generate round one, we identified French and German synonyms for the seven adherence terms through a literature search in Pubmed. Investigators translated the original English definitions into French and German. Panellists were members of ESPACOMP - the International Society for Patient Medication Adherence; experts suggested by ESPACOMP members and first authors of medication adherence publications in French and German. Google forms were used to create online questionnaires. Delphi rounds were performed until consensus was reached. The consensus was defined according to the acceptance rate as moderate consensus (50-75%), consensus (>75-95%), and strong consensus (>95%).; The literature search resulted in four to six (F) and four to seven (G) items per English term. Delphi rounds were launched between November 2016 and April 2018. Three rounds sufficed to reach consensus on all terms and definitions from 26 French-speaking and 25 German-speaking panellists. Preferred terms for medication adherence are "adhesion medicamenteuse" (82%) in French and "Medikamentenadharenz" (88%) in German.; The use of a common terminology for medication adherence with translations in French and German will contribute to standardise the vocabulary, to harmonise research projects and ultimately ease comparison of study results among researchers and clinicians.

Multiple health behaviour change (MHBC) represents one of the best ways to prevent reoccurrence of cardiovascular events. However, few individuals with cardiovascular diseases engage in this process. The present study examined the role of compensatory health beliefs (CHB; i.e., belief that a healthy behaviour compensates an unhealthy one)as a drag to engagement in this process. Some studies have shown that CHBs predict intention to engage in healthy behaviours, but no study has investigated CHBs in individuals who actually need to change multiple health behaviours. The goal was to better understand the role of CHBs in intentions formation process among individuals with cardiac diseases in an MHBC context. One hundred and four patients completed a questionnaire at the beginning of their cardiac rehabilitation program. Results showed that: (1) CHBs negatively predicted intentions (2) but only for participants with high self-efficacy or low risk perception; (3) CHBs predictions differed depending on the nature of the compensating behaviour, and were more predictive when medication intake was the compensating one. Findings only partially confirmed previous research conducted on healthy individuals who were not in an MHBC process, and emphasized the importance of considering CHBs for individuals in this process., Postprints der Universität Potsdam : Humanwissenschaftliche Reihe, 558

Sexual life is an important dimension of quality of life, which may be affected by the fear of transmission in people living with HIV/AIDS (PLWHA), despite the fact that antiretroviral therapy prevents person-to-person transmission. We, therefore, aimed to explore the sexual life satisfaction of PLWHA and its correlation with their fear of HIV transmission and self-esteem. Consecutive adult PLWHA from seven HIV care facilities in the Rhone-Alpes region, France, were asked to complete a self-administered, anonymous questionnaire concerning sociological and medical data, satisfaction with sexual life (18 questions), and self-esteem (Rosenberg score). Overall, 690 PLWHA answered the questionnaire (mean age 49.2 ± 11 years); 74.9% were men, of which 75.1% had sex with men. Overall, 68.0% of respondents feared transmitting HIV (a lot/a bit). A lower satisfaction with sexual life was significantly associated with being female, not having a stable sexual partner, being unemployed, having a low income, experiencing a fear of HIV transmission, having lower self-esteem, and not reporting an excellent/very good health status. These results strongly suggest that the information concerning the antiretroviral-induced suppression of infectivity should be widely diffused, as this may enhance the quality of sexual life in PLWHA.

Introduction In France, the cystic fibrosis (CF) care pathway is performed in 45 CF centers, the life expectancy of patients has steadily increased, but to date there are no national recommendations for the transition from pediatric to adult care. The transition to an adult CF center still raises questions about the relevance of its organizational arrangements. The “SAFETIM need” study aimed to identify the organizational needs both of patients and of parents before the transfer to an adult CF center. Methods This was a prospective, observational, multicenter study conducted between July 2017 and December 2018, involving the three CF centers of a regional network in southeastern France. Each adolescent registered with the center and his or her parents were interviewed individually, on the same day, during the 6 months leading up to transfer. They participated in semi-structured interviews during one of their routine consultations at the CF center. The interview manual, based on literature reviews and targeting national recommendations, was tested and validated by the national CF therapeutic education group (GETheM). All interviews were transcribed and checked by two different people, and analyzed by two researchers individually. The results were classified by topic according to content categorization. Results Overall, 43 adolescents and 41 parents were interviewed, respectively, who were followed up by CF centers: 14% (n = 6) in a mixed CF center (pediatric and adult); 19% (n = 8) and 67% (n = 29), respectively, in two different pediatric CF centers. Adolescents were between 16 and 19 years old. For adolescents, the average interview time was 5.11 min. (standard deviation [SD]: 3.8 min; minimum: 2.53 min; maximum: 17.14 min). For parents, the average interview time was 7.99 min (SD: 3.56 min, minimum: 3.43 min; maximum: 22.50 min). Discussion Our study enquired only about the preparation and organization of the transfer. We identified three areas of actions matching the needs of adolescents and parents before transfer. The first one is to anticipate team change to prepare follow-up in their future CF center: acquire new skills, consider the future CF center according to the adolescent's curriculum, be involved in the transition process. The second area is to accompany the upcoming change. The care team could help by providing information and support during the start of teenagers’ transition toward autonomy. And parents were aware that the CF center change will reverse roles. They must provide their own knowledge and manage the ambivalence of this as well as letting go. The third one is to announce the transition process and functioning of the future adult CF center, because the transition would require time to find their place (patients and parents) with the new team. Conclusion The “SAFETIM needs” pre-transfer study results show that we can identify the main criteria to be developed and strengthened, to promote a smooth, high-quality transition from pediatric to adult CF care for patients in France. For most patients, the transition cannot be prepared at the last minute. Caregivers need to develop specific skills in adolescent and young adult care and follow-up. Each team must consider the transition as a normal part of the patient care cycle. While it must be structured, some flexibility must be allowed so as to give everyone the chance to be prepared and to personalize the care.

BackgroundAdherence in the context of patients with acute conditions is a major public health issue. It is neglected by the research community and no clinically validated generic scale exists to measure it.ObjectiveTo construct and validate a Global Adherence Scale usable in the context of Acute Conditions (GASAC) that takes into account adherence both to advice and to all types of prescriptions that the doctor may give. To measure adherence and to study its determinants.Materials and methodWe based the construction of the GASAC questionnaire on a theoretical model and a literature search. Then, between 2013 and 2014, we validated it in a prospective observational study in two hospital emergency departments. Patients were contacted by phone about one week after their consultation to answer several questionnaires, including GASAC and the Girerd self-administered questionnaire about medication adherence as a control.ResultsGASAC consists of four adherence subscales: drug prescriptions; blood test/ radiography prescriptions; lifestyle advice and follow-up instructions. An analysis of the 154 sets of answers from patients showed that the GASAC drug subscale had satisfactory internal coherence (Cronbach’s alpha = 0.78) and was correlated with the Girerd score, as was GASAC as a whole (pConclusionsGASAC is a generic score to measure all dimensions of adherence in emergency departments for clinical research and the evaluation of clinical practice. The level of adherence was high for acute conditions and could be further improved by good Doctor-Patient Communication.

ObjectiveIn the context of acute conditions seen in an emergency department, where communication may be difficult, patient information leaflets (PILs) could improve doctor–patient communication (DPC) and may have an impact on other outcomes of the consultation. Our objective was to assess the impact of PILs on DPC, patient satisfaction and adherence, and on patient and doctor behaviours.DesignProspective, controlled, before–after trial between November 2013 and June 2015.SettingTwo French emergency departments.ParticipantsAdults and adolescents >15 years diagnosed with ankle sprain or an infection (diverticulitis, infectious colitis, pyelonephritis, pneumonia or prostatitis).InterventionPhysicians in the intervention group gave patients a PIL about their condition along with an oral explanation.Main outcome measures7–10 days later, patients were contacted by phone to answer questionnaires. Results were derived from questions scored using a 4-point Likert scale.Main findingsAnalysis of the 324 patients showed that PILs improved the mean DPC score (range: 13–52), with 46 (42–49) for 168 patients with PILs vs 44 (38-48) for 156 patients without PILs (p35/52) was 2.54 (1.27 to 5.06). The overall satisfaction and adherence scores did not show significant differences. In contrast, satisfaction with healthcare professionals and timing of medication intake were improved with PILs. The overall satisfaction score improved significantly on per-protocol analysis. When using PILs, doctors prescribed fewer drugs and more examinations (radiology, biology, appointment with a specialist); the need for a new medical consultation for the same pathology was reduced from 32.1% to 17.9% (OR 0.46 [0.27 to 0.77]), particularly revisiting the emergency department.ConclusionIn emergency departments, PILs given by doctors improve DPC, increase patients’ satisfaction with healthcare professionals, reduce the number of emergency reconsultations for the same pathology and modify the doctor’s behaviour.Trial registration numberNCT02246361.

peer-reviewed We aimed to contrast implicit and explicit measures of attitudes towards complementary and alternative medicines, to determine which best predicts medicine adherence. 117 participants from Université Grenoble Alpes completed online measures of attitudes towards complementary and alternative medicines, including implicit measures (Affect Misattribution Procedure (AMP); Implicit Association Test (IAT)), and explicit measures (Beliefs about Medicines Questionnaire (BMQ), modified explicit AMP); and self-reported medicine adherence (Medication Adherence Scale (MARS); Probabilistic Medication Adherence Scale (ProMAS)). AMP measures of implicit and explicit attitudes predicted beliefs toward medicine and medicines adherence. Models including implicit measures were stronger than models with explicit measures alone. Further, the AMP predicted beliefs toward medicine as well as medicine adherence, and the AMP was a stronger predictor compared to the IAT, although the IAT predicted adherence. These preliminary findings suggest that ‘hot’ implicit attitudes are a useful predictor of people's medicine choices, and that the AMP outperforms the IAT.

Medication adherence can be defined as the link between "what the patient implements" and "what the patient and his doctor have decided together after negotiating without constrains". This definition should be put into perspective with the chronology of the disease and the way the patient experiences it. Counselling actions should always be adapted to the situation and negotiated with the patient, all along the process of care. This article proposes a model for this process and offers options pour tailored counselling. Key elements for pharmacist's practice are: simplify the prescription; communicate with the patient according to his stage of acceptation of the disease; get adequate training for motivational interviewing.

Background There is no validated generic tool to measure Doctor-Patient-Communication (DPC) in a context of acute conditions. Objective To create and validate such a scale in a real population. Materials and method We performed a systematic review of validated DPC scales available in English. From these, using a theoretical model based on a multidisciplinary approach, we selected pertinent items that met the inclusion criteria and included them in a simple questionnaire. This tool based on a synthesis of the literature was then validated in a prospective study in two hospital emergency departments. Results We found 22 pertinent questionnaires and scoring systems. From these, we extracted items and built a scale based on 15 questions with graded responses (Likert from 1 to 4). The mean time for questionnaire completion was 3 minutes. We included 189 adults and adolescents in the study and analyzed complete responses to the questionnaire by 149 patients, gathered over the phone one week after their consultation. The scale had high internal consistency (Cronbach's alpha = 0.89) and good external validity. Two questions were removed due to redundancy giving a scale based on 13 questions. Conclusions We have created an easy-to-use and validated generic questionnaire to assess DPC in a context of acute conditions, usable both in clinical research and in routine practice.

Background In the past, several authors have attempted to review randomized clinical trials (RCT) evaluating the impact of Patient Information Leaflets (PILs) used during a consultation and draw some general conclusions. However, this proved difficult because the clinical situations, size and quality of RCTs were too heterogeneous to pool relevant data. Objective To overcome this 30-year stalemate, we performed a review of reviews and propose general recommendations and suggestions for improving the quality of PILs, how to use them and methods for evaluating them. Methodology We searched five databases for reviews, systematic reviews and meta-analyses describing PILs. We drew general and condition-linked conclusions concerning the impact of PILs. Checklists summarize criteria for quality PILs, and ways of using and evaluating them. Results Of 986 articles found, 24 reviews were pertinent; the five oldest considered the impact of PILs irrespective of the condition the patient consulted for; the 19 more recent ones mostly addressed precise clinical situations. Discussion Whatever the clinical situation, PILs improve patients' knowledge and satisfaction. For acute conditions, in the short-term PILs also improve adherence to treatment. For chronic diseases, invasive procedures or screening situations, their impact on adherence varies depending on the context, how the PILs are given and the invasiveness of the intervention. Conclusion PILs are considered to be very useful, especially for acute conditions where the patient is the first to suffer from lack of information. We propose checklists for writing, designing, using and evaluating PILs in RCTs to enable comparisons between different studies.

Background Low levels of adherence to medication prescribed to treat and manage chronic disease may lead to maladaptive health outcomes. Theory-based, easy-to-administer interventions that promote patients’ effective self-regulation of their medication-taking behaviour are needed if adherence is to be maximised. We tested the effectiveness of an intervention adopting planning techniques to promote medication adherence. Methods Outpatients with cardiovascular disease (N = 71) were allocated to either an experimental condition, in which participants were asked to form implementation intentions and coping plans related to their treatment, or to a no-planning control condition, in which participants received no treatment. Patients also completed self-report measures of medication adherence, self-efficacy, and beliefs in medication necessity and concerns. Measures were administered at baseline and at 6-week follow-up. Results Results revealed no overall main effect for the intervention on medication adherence. Post-hoc moderator analyses revealed that the intervention was effective in patients with lower necessity beliefs compared to those with higher necessity beliefs. Conclusion While current findings have promise in demonstrating the conditional effects of planning interventions, there is a need to replicate these findings by manipulating planning and beliefs independently and testing their direct and interactive effects on medication adherence.

Resume Introduction Identifier les difficultes du patient vis-a-vis de la prise de ses medicaments reste complexe pour le soignant. Cette difficulte reside dans le caractere multidimensionnel de l’adhesion medicamenteuse et, de ce fait, de son evaluation. L’objectif de ce travail est de faire le point sur les differentes methodes visant a mesurer l’adhesion medicamenteuse du patient. Materiel et methodes Nous avons opere une recherche sur PubMed completee par une recherche manuelle. Resultats Deux types de methodes de mesure de l’adhesion medicamenteuse sont decrits. Les methodes « directes » reposent sur des dosages plasmatiques et/ou urinaires des medicaments et/ou de leurs metabolites ; des marqueurs cliniques et/ou biologiques de l’efficacite des medicaments. Les methodes « indirectes » sont representees par l’analyse des bases de donnees administratives (prescription, renouvellements d’ordonnances a la pharmacie) ; le decompte des comprimes ; l’utilisation de systemes electroniques ; les mesures auto-rapportees par le patient ou ses proches (questionnaires, agendas de suivi, entretiens) ; l’avis des soignants. Discussion Aucun de ces outils ne supplante les autres, chacun ayant des limites soit de faisabilite, soit de fiabilite. Au final, c’est sans doute le croisement des donnees issues de ces differents outillages qui permet de se faire une idee sur le comportement d’adhesion du patient et, surtout, des dimensions sur lesquelles il se trouve le plus en difficulte. Conclusion L’identification de ces difficultes doit permettre au soignant de developper un savoir-etre, un savoir-faire et une organisation specifique pour accompagner le patient.

Background: Physician attitude influences the way patients cope with diagnosis and therapy in chronic severe diseases such as cancer. Previous studies showed that such an effect exists in HIV care; it is likely that it begins with the first contact with a physician. Objective: We aimed to explore in HIV-infected persons their perception of the first consultation they had with an HIV specialist (PFC-H), and whether this perception correlates with adherence to antiretroviral therapy. Method: The study was conducted in Grenoble University Hospital, France, a tertiary care center. Every antiretroviral-experienced patient was asked to freely complete a self-reported, anonymous questionnaire concerning retrospective PFC-H, present adherence (Morisky scale), and present perceptions and beliefs about medicine (BMQ scale). Results: One hundred and fifty-one questionnaires were available for evaluation. PFC-H score and adherence were correlated, independently from age, gender, and numbers of pill(s) and of pill intake(s) per day. BMQ score also correlated with adherence; structural equation analysis suggested that the effect of PFC-H on adherence is mediated by positive beliefs. Conclusion: These results suggest that for HIV-infected persons, the perceptions remaining from the first consultation with an HIV specialist physician influence important issues such as adherence and perception about medicine. Physicians must be aware of this potentially long-lasting effect.

Objective.Concerns have been raised about nonadherence behavior among patients with chronic inflammatory rheumatic diseases (CIRD) receiving biologics. This nonadherence may be caused by various factors. The main objective was to explain why patients discontinue their biologics of their own accord.Methods.A quantitative and descriptive study was performed using a self-report questionnaire that was sent through the Internet to members of different patient associations. Sociodemographic data, medical and therapeutic history, management of biologic administration, previous experiences, and patients’ beliefs and perceptions about treatment efficacy and side effects were studied to explain self-discontinuation (SD).Results.A total of 581 patients answered the questionnaire between June 16, 2012, and July 4, 2012, including patients with ankylosing spondylitis (351/581, 60.4%), rheumatoid arthritis (196/581, 33.7%), psoriatic arthritis (30/581, 5.2%), and other CIRD (4/581, 0.7%). More than 1000 different biologics were described by the 581 patients, with a median of 2 lines per patient. Eighty-six patients discontinued their biologics of their own accord (14.8%). In a multivariate analysis, factors that were significantly related to SD were low level of pain, more than 1 line of biologics tried, self-administration of biologics, negative beliefs about the treatment, and a lack of medical and social support.Conclusion.Five predictive factors of this SD were identified, which should be assessed in routine with patients with CIRD receiving biologic treatment: pain, treatment history, self-administration of injections, negative beliefs about treatment, and a lack of perceived medical and social support.

Interventions to assist individuals in initiating and maintaining regular participation in physical activity are not always effective. Psychological and behavioral theories advocate the importance of both motivation and volition in interventions to change health behavior. Interventions adopting self-regulation strategies that foster motivational and volitional components may, therefore, have utility in promoting regular physical activity participation. We tested the efficacy of an intervention adopting motivational (mental simulation) and volitional (implementation intentions) components to promote a regular physical activity in two studies. Study 1 adopted a cluster randomized design in which participants (n = 92) were allocated to one of three conditions: mental simulation plus implementation intention, implementation intention only, or control. Study 2 adopted a 2 (mental simulation vs. no mental simulation) × 2 (implementation intention vs. no implementation intention) randomized controlled design in which fitness center attendees (n = 184) were randomly allocated one of four conditions: mental simulation only, implementation intention only, combined, or control. Physical activity behavior was measured by self-report (Study 1) or fitness center attendance (Study 2) at 4- (Studies 1 and 2) and 19- (Study 2 only) week follow-up periods. Findings revealed no statistically significant main or interactive effects of the mental simulation and implementation intention conditions on physical activity outcomes in either study. Findings are in contrast to previous research which has found pervasive effects for both intervention strategies. Findings are discussed in light of study limitations including the relatively small sample sizes, particularly for Study 1, deviations in the operationalization of the intervention components from previous research and the lack of a prompt for a goal intention. Future research should focus on ensuring uniformity in the format of the intervention components, test the effects of each component alone and in combination using standardized measures across multiple samples, and systematically explore effects of candidate moderators. peerReviewed

Resume Objectif L’adhesion des patients atteints de rhumatisme inflammatoire chronique (RIC) a leur traitement s’avere sous optimal, comme dans la plupart des maladies chroniques. Notre objectif etait de developper une analyse qualitative du comportement d’adhesion medicamenteuse des patients atteints de RIC et traites par biotherapie (BT). Methodes Sur la base de l’analyse preliminaire des donnees de la litterature, nous avons construit un plan d’entretien semi-structure. Nous avons interroge 12 patients atteints de RIC sur 1. leurs antecedents medicaux, 2. leurs experiences avec les biotherapies, 3. leur perception des benefices et des risques des biotherapies. L’analyse de donnees thematique a ete developpee, au regard des donnees de la litterature. Resultats Cinq grands themes emergent comme explicatifs du defaut d’adhesion medicamenteuse : 1. la maladie, 2. le traitement, 3. le profil demographique et socio-economique du patient, 4. le lien entre le patient et le systeme de soins, 5. le profil du patient. Conclusions L’amorce du traitement par BT est assise sur la relation de confiance avec le therapeute, une representation favorable des benefices du traitement par rapport aux risques encourus ainsi que la facilite de prise du medicament. La maintenance, sous tendue par la peur d’avoir mal a nouveau, se joue sur l’experience que fait le patient des benefices du traitement et sur un soutien adapte de la part des soignants, pour renforcer sa motivation a prendre le traitement.

International audience; IntroductionBecause changing personal beliefs about treatment could help improve adherence, having a validated tool for identifying these beliefs is important.ObjectiveThis study sought to validate the French version of the Beliefs about Medicines Questionnaire (BMQ-f©).MethodData were gathered among 253 patients with type 2 diabetes and 123 HIV patients with the help of self-reported questionnaires, including the Beliefs about Medicines Questionnaire, a French adherence assessment, and some demographic variables.ResultsConfirmatory factor analyses show the French version of the BMQ has the same factorial structure as the English original in both diabetes and HIV samples. All items load on their expected factor namely specific-necessity, specific-concern, general-harm, and general-overuse. Moreover, each scale revealed good internal consistency and retained the psychometric qualities of the original version. These satisfactory properties were consolidated by predictive validity data that demonstrate the impact of treatment beliefs on adherence levels.ConclusionFindings are discussed in light of previous diabetes and HIV studies. The French BMQ proved to be a good way of quickly identifying inaccurate beliefs about treatment. It could be a useful tool in French clinical practice, such as in patient education.

International audience; Depuis une vingtaine d’années, la psychologie de la santé s’est imposée comme un cadre théorique et méthodologique particulièrement riche pour guider praticiens et chercheurs dans leurs interventions dans le domaine de la santé. Des actions ont été proposées aux psychologues, aux associations, aux usagers, aux services hospitaliers, pour améliorer les conduites de santé ou potentialiser le changement et l’adaptation chez les personnes malades. Présentation de ces différents modes d’intervention dont le but est d’apporter des réponses concrètes aux malades.

International audience

Summary Background The objective of this study was to gain detailed insight concerning liver transplanted patients’ representations about transplantation, graft rejection and immunosuppressive drugs to adapt the educational follow-up. Patients and methods Semi-structured interviews were conducted with 8 patients. Each interview was recorded and fully transcribed. The verbatim was first coded according to the themes of the Common Sense Model and an inductive approach for the remaining text. Results Transplantation is perceived both as a recovery and a new chronic condition. Participants feel powerless in the face of the risk of graft rejection. This risk is perceived as out of control as it is not associated with specific symptoms and external causes. The individual knowledge gained about transplantation relies on real-life experience shared between patients. Many participants feel anxiety. It responds to stress caused by immunosuppressant medication intake, routine check-ups, potential side effects and chronicity of immunodepression. Messages stressing the importance of the tacrolimus in the medication therapy are strengthened by a pre-discharge pharmaceutical consultation. Discussion and conclusions This study suggests that healthcare providers should systematically seek to determine illness representations to optimize the educational follow-up. The patient education program for liver transplanted patients should include three types of intervention: individualized education, behavioral intervention and psychological support. It should provide a support for stress management and acceptance of the new chronic condition. The involvement of a clinical pharmacist is relevant.

Background Adherence to chronic therapy is a key determinant of patient health outcomes in chronic disease. However, only about 50 % of patients adhere to chronic therapy. One of the challenges in promoting adherence is having an accurate understanding of adherence rates and the factors that contribute to non-adherence. There are many measures available to assess patient medication adherence. Aim of the review This review aims to present the commonly used indirect methods available for measuring medication adherence in routine healthcare and research studies. Method A literature review on medication adherence measures in patient populations with chronic conditions taking chronic medications was conducted through Medline (2003–2013). A complementary manual search of references cited in the retrieved studies was performed in order to identify any additional studies. Results Of the 238 initial Medline search results, 57 full texts were retrieved. Forty-seven articles were included as a result of the manual search. Adherence measures identified were: self-report (reported in 50 publications), electronic measures (33), pharmacy refills and claims data (26) and pill counts (25). Patient self-report, electronic measures, pharmacy refill and claims data were the most commonly used measures of adherence in research, routine practice, epidemiological and intervention studies. These methods, and their strengths and limitations have been described in this paper. Conclusion A multitude of indirect measures of adherence exist in the literature, however, there is no “gold” standard for measuring adherence to medications. Triangulation of methods increases the validity and reliability of the adherence data collected. To strengthen the adherence data collected and allow for comparison of data, future research and practice interventions should use an internationally accepted, operational standardized definition of medication adherence and clearly describe the medication adherence methods used.

Resume Cet article presente des pratiques cliniques recentes et validees en psychologie de la sante, notamment pour la gestion de la douleur et des maladies chroniques. Des techniques telles que l’acceptation et l’engagement, et la pratique de la pleine conscience ont fait leurs preuves, ainsi que les exercices favorisant l’experience d’emotions positives. Des methodes issues des theories cognitives et comportementales permettent egalement une amelioration de la qualite de vie et de l’observance des patients atteints de pathologies severes. Enfin, le biofeedback centre sur la variabilite cardiaque favorise le developpement des ressources cognitives et emotionnelles des patients, leur permettant de mieux faire face au stress et de maintenir un etat de sante optimal. Les limites de ces pratiques ainsi que des pistes de recherches sont proposees.

Resume Introduction Cette etude est issue d’une enquete dont le premier volet a montre que 18,7 % des patients suivis pour une hepatite chronique C etaient exclus d’un traitement optimal pour raisons psychiatriques et que moins de 50 % des cliniciens specialistes de l’hepatite C collaboraient avec un psychiatre ou un psychologue. L’objectif de ce second volet etait de decrire les modalites actuelles de prise en charge de ces patients par les psychiatres et les psychologues. Patients et methodes Une enquete a ete menee aupres de 47 psychiatres et 43 psychologues impliques dans la prise en charge de l’hepatite C, travaillant ou non avec les poles de reference de l’hepatite C. Ils ont ete interroges individuellement au moyen d’un questionnaire standardise. Resultats L’analyse des 90 questionnaires a montre que la prise en charge psychiatrique et/ou psychologique n’etait pas systematisee, que les poles de reference proposaient des pratiques plus adaptees en termes d’evaluation ou de soins specifiques, et que les psychiatres et psychologues pourraient beneficier de formations complementaires. Conclusion Les soins psychiatriques et psychologiques des patients atteints d’hepatite C pourraient etre ameliores par une formalisation des consultations et une formation specifique des professionnels. Cette coordination et ces formations pourraient s’organiser a partir de chaque pole de reference de l’hepatite C.

En quelques annees, le groupe graph s’est modele une identite dans une volonte d’echange pluridisciplinaire, repondant a la fois a la demande des patients atteints d’hepatite C et de leurs associations, des professionnels de sante, de l’institution medicale et des psychologues unis dans la prise en charge des malades.L’experimentation de la dimension groupale par le groupe graph lui-meme a revele un mouvement identificatoire entre les dynamiques du groupe de travail et celles des groupes de parole proposes aux patients. Ce travail a permis une elaboration du cadre et du dispositif pour les deux groupes.La reflexion s’ouvre aussi sur la facon de savoir redonner du sens a cette maladie, puisque « chronique et guerissable » et venant souligner le decalage entre le temps psychique et le temps medical qui peut influer sur la maniere de vivre la maladie et le traitement. Voici une problematique nouvelle a travailler.

International audience

International audience

This study deals with the sociocognitive organization of the self-schema in alcoholic patients. It was aimed at understanding how the self-schema takes shape within the framework of social judgments known to be determinants of personality. Alcoholic subjects were interviewed twice, once during their first consultation for treatment and then again four months later after completion of treatment. Our approach was derived directly from the methodology used by Markus (1977) and Clemmey & Nicassio (1997) in their studies on the self-schema. The subjects had to perform three tasks that required manipulating personality traits with positive and negative connotations (a self-description task in which decision time was measured, an autobiographical task, and a recall task). The results of the first interview showed that 1. in their self-descriptions, alcoholics took more time than control subjects both to accept positive traits and to reject negative ones; 2. unlike control subjects, alcoholics considered more negative traits to be self-descriptive than positive traits, and 3. unlike controls, alcoholics recalled more negative traits than positive ones. By the second interview, the results for the alcoholic subjects on the autobiographical and recall tasks had changed: 1. they now described themselves more positively and less negatively than on the first meeting; 2. they recalled a marginally greater number of positive traits and a significantly smaller number of negative traits, and 3. the differences between the alcoholics and controls indicated an improvement in the alcoholics' self-perceptions.