LE BONNIEC Alice

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Based on the theory of social representations, this study aims to identify the main determinants to participation in colorectal cancer screening. Six focus groups (N = 29 participants belonging to the general population) were conducted, followed by a theoretical thematic analysis. Screening obstacles are a lack of test’s accessibility, a low preoccupation for prevention and the negative image of colorectal cancer. Conversely, screening facilitators are the ease of the new test, being encouraged to get screened and appointment reminder. This study advances understanding of adherence to screening by addressing the beliefs and knowledge surrounding it.

Background : Why do patients practice fasting? The effects of fasting before treatment with chemotherapy for cancer in humans are currently unknown. However, there is an apparent enthusiasm for fasting among cancer patients. This qualitative study provides data on the motivations to fast and the experience of fasting among a population of women with breast cancer.Method : Sixteen semi‐structured interviews were conducted, and two researchers independently performed a thematic analysis. To ensure the internal validity of the study, patients had the possibility to rate their agreement with the study results through a satisfaction questionnaire.Results : Six main themes were identified in this study: main reasons to fast, alternative authorities to the oncologist, adapting the fast to social and lifestyle constraints, fasting effects felt during chemotherapy, barriers and facilitators of fasting during chemotherapy, and seeking for a more integrative medicine. Patients’ primary motivation to fast was to lower the negative side effects of chemotherapy. Fasting was also reported as a coping strategy to give them a greater sense of control over their treatment and to reduce their anxiety.Clinical implications : Results from the study suggest that, if discouraged from fasting, patients may turn to complementary health care practitioners for support. Medical professionals may thus not know of patients’ fasting practice. Health psychologists could play a key role fostering the dialogue between different health professionals and the patient. They could also help to meet patients’ needs during cancer treatment to reduce treatment anxiety.

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IntroductionColorectal cancer is the 2nd leading cause of cancer mortality in France (HAS, 2013) but also the 3rd most common cancer (INCa, 2014). Organized screening has existed since 2008, yet participation rates remain low: 33.5% in France (Santé Publique France, 20018). According to the literature, the main barriers to participation in screening are lack of trust in the health care system (Clavarino et al, 2004) . embarrassment, discomfort and unpleasantness accompanying the testing procedures (Varela et al, 2010) . or lack of time. Finally, the lack of recommendations from the physician is one of the most important barriers (Walsh et al, 2010 . Powell et al, 2009). The Hemoccult II test, used in organized screening until March 2015, has been replaced by a new immunological test, considered more sensitive, more specific and more reliable by the medical community (INCa, 2014).Objectives and methodIn view of the low screening rates and the main obstacles identified in the literature, the aim of this thesis work is to analyze the determinants of participation in screening both from the point of view of patients and general practitioners. This doctoral work is based on the triangulation technique (theoretical, methodological and data). More precisely, two validated and recognized theoretical frameworks in social psychology of health were mobilized, namely the Theory of Social Representations (Moscovici, 1984), and the Theory of Planned Behavior (Ajzen et al., 1991), allowing the adoption of a comprehensive as well as predictive approach to screening. Three studies were developed:- A qualitative study by semi-directive interviews, conducted with 17 general practitioners, with the aim of understanding their social representations of colorectal cancer screening as well as the way in which it can be anchored in their recommendation practice. A quantitative study by questionnaires, carried out with 160 participants from the general population, aimed at identifying the main predictors of the intention and behaviour of colorectal cancer screening.Main resultsThe analysis of the interviews revealed an inconsistency between the role that doctors think they should play with patients in prevention and screening, and the reality of their practice which leaves them little time to devote to it. The analysis of the focus groups revealed that the main obstacles to participation in screening are: the lack of accessibility of the test (need to consult the general practitioner to obtain the screening kit), a low level of concern for prevention, but also the fact that colorectal cancer refers to a part of the body that is taboo and considered dirty Finally, analysis of the questionnaires identified several variables that influenced screening intention and behavior, namely: previous screening behavior, screening frequency, denial, social proximity, social norms, and perceived behavioral control. The analyses particularly highlighted the importance of perceived behavioural control, which can directly influence behaviour without going through intention.ConclusionThe findings reveal the relevance of combining a comprehensive approach with a predictive approach. Our perspectives propose the implementation of interventions aiming at improving the level of perceived control of the general population towards this screening.

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IntroductionColorectal cancer is the 2nd leading cause of cancer mortality in France (HAS, 2013) but also the 3rd most common cancer (INCa, 2014). Organized screening has existed since 2008, yet participation rates remain low: 33.5% in France (Santé Publique France, 20018). According to the literature, the main barriers to participation in screening are lack of trust in the health care system (Clavarino et al, 2004) . embarrassment, discomfort and unpleasantness accompanying the testing procedures (Varela et al, 2010) . or lack of time. Finally, the lack of recommendations from the physician is one of the most important barriers (Walsh et al, 2010 . Powell et al, 2009). The Hemoccult II test, used in organized screening until March 2015, has been replaced by a new immunological test, considered more sensitive, more specific and more reliable by the medical community (INCa, 2014).Objectives and methodIn view of the low screening rates and the main obstacles identified in the literature, the aim of this thesis work is to analyze the determinants of participation in screening both from the point of view of patients and general practitioners. This doctoral work is based on the triangulation technique (theoretical, methodological and data). More precisely, two validated and recognized theoretical frameworks in social psychology of health were mobilized, namely the Theory of Social Representations (Moscovici, 1984), and the Theory of Planned Behavior (Ajzen et al., 1991), allowing the adoption of a comprehensive as well as predictive approach to screening. A qualitative study by semi-directive interviews, conducted with 17 general practitioners, with the aim of understanding their social representations of colorectal cancer screening as well as the way in which it can be anchored in their practice of recommendation - A qualitative study by focus groups, conducted with 29 participants from the general population, with the aim of understanding their social representations of colorectal cancer screening as well as the obstacles and facilitators to its adherenceA quantitative study by questionnaires, carried out with 160 participants from the general population, aimed at identifying the main predictors of the intention and behaviour of colorectal cancer screening.Main resultsThe analysis of the interviews revealed an inconsistency between the role that doctors think they should play with patients in prevention and screening, and the reality of their practice which leaves them little time to devote to it. The analysis of the focus groups revealed that the main obstacles to participation in screening are: the lack of accessibility of the test (need to consult the general practitioner to obtain the screening kit), a low level of concern for prevention, but also the fact that colorectal cancer refers to a part of the body that is taboo and considered dirty Finally, analysis of the questionnaires identified several variables that influenced screening intention and behavior, namely: previous screening behavior, screening frequency, denial, social proximity, social norms, and perceived behavioral control. The analyses particularly highlighted the importance of perceived behavioural control, which can directly influence behaviour without going through intention.ConclusionThe findings reveal the relevance of combining a comprehensive approach with a predictive approach. Our perspectives propose the implementation of interventions aiming at improving the level of perceived control of the general population towards this screening.

Background: Detected early, colorectal cancer can be cured in nine cases out of ten, but it remains the second leading cause of cancer mortality in France. However, current participations in organized screening continue to be low and must be improved. Based on the Theory of Planned Behaviour (TPB, Ajzen, 1994), this study aims to identify the psychosocial determinants of participation in organized screening for colorectal cancer.Methods: Two qualitative studies were previously conducted with GPs and patients to develop a questionnaire measuring salient beliefs related to attitudes, subjective norms and perceived behavioural control toward colorectal cancer screening (Ajzen, 2006). Participants in the present study came from the general population (men and women aged between 50 and 74) and were recruited through a screening structure. Ultimately, 160 questionnaires were collected. All TPB determinants were measured at baseline, screening behaviour was evaluated 4 months later. A path analysis with a Bayesian estimator was applied to examine the hypothesized model.Findings: Analysis revealed that model fit was acceptable (predictive p-value = .54). The model explained 35% of intentions and 6 % of screening behaviour. Both subjective norms (β = .26, 95% CI [.10, .40])and perceived behavioural control (β = .38, 95% CI [.20, .54]) were related to intentions. Only perceived behavioural control was significantly related to screening behaviour (β=.21, 95% CI [.01, .40]).Discussion: This study highlighted the importance ofperceived behavioural control in colorectal cancer screening participation. Future researches focusing on intention-behaviour gap would be necessary.

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Despite national and local French information campaigns, when acute stroke occurs, waiting times before calling mobile emergency medical services (EMS) to receive appropriate treatment (i.e. thrombolysis) and decrease the risk of physical disability, remain long. We aimed to identify the representations of stroke in the general population and to determine barriers to and facilitators for rapidly contacting EMS.We conducted a qualitative study among the general population with 10 focus groups, 5 comprising employed people (N = 29) and 5 comprising retirees (N = 32). The themes discussed were general knowledge about stroke and its risk factors, symptoms, appropriate management and the awareness that stroke is an emergency issue.In addition to a lack of knowledge about stroke, other barriers to rapidly contacting the EMS were difficulties in recognizing symptoms and understanding that these symptoms constitute an emergency. Furthermore, when faced with stroke, a feeling of inevitability and fatalism about the consequences of a stroke was highlighted. Participants were unaware of the existence of an effective treatment and they mistrusted medical competences. Finally, we found a strong presence and participant appreciation of common knowledge, resulting in the sharing of experiences of stroke. This could partly compensate for the lack of specific knowledge about symptom recognition and appropriate action.Information campaigns should not only inform the public about stroke symptoms in order to ensure people act appropriately, but should also focus on increasing public awareness about the fact that an effective treatment exists.

Background Despite national and local French information campaigns, when acute stroke occurs, waiting times before calling mobile emergency medical services (EMS) to receive appropriate treatment (i.e. thrombolysis) and decrease the risk of physical disability, remain long. We aimed to identify the representations of stroke in the general population and to determine barriers to and facilitators for rapidly contacting EMS. Method We conducted a qualitative study among the general population with 10 focus groups, 5 comprising employed people (N = 29) and 5 comprising retirees (N = 32). The themes discussed were general knowledge about stroke and its risk factors, symptoms, appropriate management and the awareness that stroke is an emergency issue. Results In addition to a lack of knowledge about stroke, other barriers to rapidly contacting the EMS were difficulties in recognizing symptoms and understanding that these symptoms constitute an emergency. Furthermore, when faced with stroke, a feeling of inevitability and fatalism about the consequences of a stroke was highlighted. Participants were unaware of the existence of an effective treatment and they mistrusted medical competences. Finally, we found a strong presence and participant appreciation of common knowledge, resulting in the sharing of experiences of stroke. This could partly compensate for the lack of specific knowledge about symptom recognition and appropriate action. Conclusion Information campaigns should not only inform the public about stroke symptoms in order to ensure people act appropriately, but should also focus on increasing public awareness about the fact that an effective treatment exists.

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