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Biomedical subjects

Lucie Richard

Publications and source records attributed to Lucie Richard.

15 recordsLinked to original sources
PubMed2006

Fighting a tobacco-tax rollback: a political analysis of the 1994 cigarette contraband crisis in Canada.

We identify factors that led a regional government (Quebec, Canada) to opt for a reduction of its tobacco tax to combat tobacco smuggling. Then we explore the fallout of Quebec's tobacco-tax rollback on its tobacco control policy. We conducted qualitative research using a case-study design and multiple sources of data. We applied the Advocacy Coalition Framework in respect of data collection and analysis. Advocates of the tobacco-tax rollback framed the contraband problem in a way that won the support of an array of actors. However, anti-tobacco activists succeeded in convincing the government to invest more in tobacco control. The new resources were instrumental in enhancing the activists' ability to promote legislative measures. Our approach sheds light on the tobacco industry's strategy to have governments reducing their tobacco tax. Quebec offers an example of how tobacco control activists can transform defeat into the cornerstone of a comprehensive tobacco control policy.

Consumer Advocacy↗
PubMed2005

Perception of dental illness among persons receiving public assistance in Montreal.

OBJECTIVES: We examined rationales for behaviors related to dental care among persons receiving public assistance in Montreal, Quebec. METHODS: Fifty-seven persons receiving public assistance participated in 8 focus groups conducted in 2002. Sessions were recorded on audiotape and transcribed; analyses included debriefing sessions and coding and interpreting transcribed data. RESULTS: In the absence of dental pain and any visible cavity, persons receiving public assistance believed they were free of dental illness. However, they knew that dental pain signals a pathological process that progressively leads to tooth decay and, therefore, should be treated by a dentist. However, when in pain, despite recognizing that they needed professional treatment, they preferred to wait and suffer because of a fear of painful dental treatments and a reluctance to undertake certain procedures. CONCLUSIONS: Persons receiving public assistance have perceptions about dental health and illness that prevent them from receiving early treatment for tooth decay, which may lead to disagreements with dentists when planning dental treatments.

Adult↗
PubMed2005

From walkability to active living potential: an "ecometric" validation study.

BACKGROUND: The purpose of this paper is to establish the reliability and validity of a neighborhood-level measure of active living potential by applying principles of ecometrics. METHODS: Following a 3-day training session, observers (n =8) were provided with a map of a predetermined walking route constructed through the joining of ten randomly selected street blocks. Then, using an 18-item observation grid, pairs of observers performed ratings of 112 neighborhoods. Resulting observations produced a hierarchically structured data set including 4032 observations nested within observers, which in turn were nested within neighborhoods. Data from the 2001 Canadian census were linked to the neighborhood data. RESULTS: Application of ecometric multilevel modeling analyses showed that once interitem and interobserver variability were statistically controlled, about one third of the variability in observations were at the between-neighborhood level. Reliability estimates were 0.78 for items measuring activity-friendliness, 0.76 for safety, and 0.83 for density of destinations. Assessment of the convergent validity of the instrument identified that safety of the environment was positively associated with neighborhood affluence. Density of destinations was negatively associated with affluence and positively associated with higher proportions of persons in the neighborhood walking to work. CONCLUSIONS: The three dimensions of the neighborhood active-living potential measure have good reliability and convergent validity and are able to capture between neighborhood differences. Measurement characteristics would have been difficult to ascertain without the ecometrics methodology.

Environment Design↗
PubMed2005

The diversity of prevention and health promotion services offered by Québec Community Health Centres: a study of infant and toddler programmes.

Research has shown that preventive and health promotion (PHP) services offered by community health centres are often vulnerable in times of health reform or budgetary cutbacks. The present study was conducted in Québec, Canada, approximately 10 years after the start of a major transformation of health care services. The objectives were: (1) to examine the diversity of infant/toddler prevention and health promotion services offered by centres locaux de services communautaires (CLSCs, local community health and social services centres); and (2) to investigate the organisational and environmental correlates of such diversity. All Québec CLSCs were invited to complete a survey questionnaire regarding their PHP services (response rate = 69%). Data on environmental and organisational factors were extracted from existing Québec government data sets. Bivariate and multivariate analyses were performed to identify the correlates of the CLSCs' level of diversity of PHP services. The results revealed that CLSCs varied greatly in terms of their diversity of PHP services. The number of full-time equivalents in the Child and Family Services Programme (one of two programmes aimed at reaching the targeted clientele) and the degree of CLSC collaboration with other community-based organisations in the planning and delivery of PHP activities were positively associated with the level of diversity, whereas the unemployment rate in the population served was a negative predictor. This study makes an important contribution in being one of the very few which contribute to building our knowledge about the performance of community health centres. Identifying the correlates of diversity among PHP services offered by CLSCs helps us to begin to understand the processes at work in the production of PHP activities, as well as the potential leveraging forces.

Child Health Services↗
PubMed2005

[Theories of behavior change through preventive and health promotion interventions in occupational therapy].

BACKGROUND: Community occupational therapy practice challenges therapists in their health educator role and incites them to implement preventive strategies with their clients. Working in the community also provides an interesting context for the implementation of strategies targeting health promotion at the community level. PURPOSE: This article describes some of the theories that are used in the public health and health promotion fields to explain health-related behaviour change. It also highlights their potential for community practice in occupational therapy. The theories presented in this paper are the health belief model, social cognitive theory, theory of reasoned action and theory of planned behavior. They are among the most widely used for health-related behaviour analysis and intervention. PRACTICE IMPLICATIONS: Since these theories emphasize a set of factors that influence health behaviours, reviewing these theories could contribute to enhance the effectiveness of educational interventions with regards to clients'adherence to their prevention and health promotion recommendations.

Behavior Therapy↗
PubMed2005

Evaluation of a developmental care training programme for neonatal nurses.

Although the impact of developmental care on premature infants has been investigated at length, often the issue of professional development and training related to this type of care has not been examined. The aim of the present study was to evaluate the impact of a developmental care training programme on nurses' behaviours and cognitive attributes with regard to the prevention of overstimulation of premature infants. The Theory of Reasoned Action (TRA) was the framework underlying the study. This programme evaluation used a quasi-experimental one group pre-test/post-test design. Participants were nurses working in a neonatal intensive care unit. Data were collected by self-administered questionnaires. Significantly higher post-test scores were observed for knowledge and for a variety of theoretical constructs. The results of this study showed the potential of such training programmes to help nurses implement developmental care.

Adult↗
PubMed2004

The use of technology at home: what patient manuals say and sell vs. what patients face and fear.

Over the past 15 years, the use of specialised medical equipment by patients at home has increased in most industrialised countries. Adopting a conceptual framework that brings together two research perspectives, i.e. the sociology of technology and the sociology of illness, this paper empirically examines why and how patients use health technology at home and in the broader social world. Our study compares and contrasts the use of four interventions: antibiotic intravenous therapy, parenteral nutrition, peritoneal dialysis and oxygen therapy. We conducted interviews with patients (n = 16) and caregivers (n = 6), and made direct observations of home visits by nurses (n = 16). The content and structure of patient manuals distributed by major manufacturers and hospitals were analysed (n = 26). The aim of our study was to determine how technology was supposed to be used versus how it was actually used. This study shows that patients are deeply ambivalent about the benefits and drawbacks of technology, and that these advantages and disadvantages are shaped by the various places in which the technology is used. While technology can be pivotal in making patients autonomous and able to participate in the social world, it also imposes heavy restrictions that are intimately interwoven with the nature of the particular disease and with the patient's personal life trajectory.

Adaptation, Psychological↗
PubMed2003

The dental care pathway of welfare recipients in Quebec.

IN Quebec (Canada), the utilization of dental care services varies greatly from one social class to another: whereas the well-to-do visit the dentist often for check-ups, those most in need demonstrate a "wait-and-see" attitude. The objective of our research was to describe the dental care pathway of the underprivileged when confronted with symptoms, and to understand how this pathway might be interrupted and possibly lead to tooth extractions. We arranged 16 one-on-one interviews with adult Montrealers who had experienced a dental problem during the 12 months preceding the interview. These participants, 9 women and 7 men aged between 30 and 48, lived in great poverty: all were welfare recipients, and as such, enjoyed the benefits of a government programme that entitled them to free basic dental care. During the interviews, the interviewers asked the participants to describe their latest dental problem and their subsequent behaviour. The dental care pathway of our participants was characterized by a strategy of adapting to the symptoms. This process of adapting, which can last several months, is essentially an individual process in which the individuals often resort to self-medication to soothe their pain. They decide to visit a dentist when the pain is too great and self-medication is no longer effective. Once this decision is made, their dental care pathway may nevertheless be interrupted in two ways: first, in the failure to find a dentist, and second, later, in the failure to complete treatments that are not covered by the welfare program, such as endodontic treatment. The fragmented character of these dental care pathways refers us to two features of accessibility: financial accessibility and acceptability. With regard to financial accessibility, our study shows that the public coverage intended for welfare recipients presents major gaps. As for acceptability, our participants are strongly critical of the dental profession, and develop a culture of rejection of it.

Adult↗
PubMed2003

Illicit drug use and injection practices among drug users on methadone and buprenorphine maintenance treatment in France.

AIMS: To evaluate the associations between methadone and high-dose buprenorphine maintenance treatment and illicit drug use and injection among drug users in France. DESIGN: A cross-sectional study. Data were gathered using a questionnaire administered containing closed-ended questions. SETTING: Drug dependence clinics (DDC) and general practitioners' (GPs) offices in three French cities. PARTICIPANTS: Drug users undergoing maintenance treatment with methadone (n = 197) and buprenorphine (n = 142). MEASUREMENTS: Interviews covered the use of illicit drugs (heroin, cocaine or crack) and injection practices (illicit drugs and/or substitution drugs) during the last month, current treatment modalities, socio-demographic and health characteristics. Bivariate analysis and multivariate logistic regressions were conducted. FINDINGS: Overall, 35.4% of respondents (34.5% in the methadone group, 36.6% in the buprenorphine group, P= 0.69) had used at least one illicit drug, 25.7% reported having injected drugs and 15.3% had injected the substitution drug. Injection was more common among buprenorphine-maintained individuals (40.1%) than among users on methadone (15.2%) (P < 0.01). Multivariate analyses indicate that the type of substitution drug (buprenorphine versus methadone) was not associated with illicit drug use (OR = 1.1; 95% CI = 0.7-1.8). In the buprenorphine group, injection was related independently to social situation, as measured by housing (unstable versus stable housing, OR = 4.3; 95% CI = 1.6-11.5), but this was not the case in the methadone group. The risk of injection increased with buprenorphine dosage (high/low dosage OR = 6.2; 95% CI = 2.0-19.7), but this association was not observed in the methadone group. CONCLUSION: Further studies comparing the benefits of these two types of treatment should be carried out, taking outcomes such as physical health, mental health and social functioning into consideration.

Adolescent↗
PubMedDate not supplied

Making youth tobacco control programs more ecological: organizational and professional profiles.

PURPOSE: To identify the organizational and professional correlates of the integration of the ecological approach in Canadian public health organizations' tobacco control programs for youth. DESIGN: Cross-sectional survey. SETTING: Canadian public health organizations. SUBJECTS: One hundred and ten tobacco control programs implemented in 90 organizations. The response rate for the organizations was 87%. MEASURES: Descriptions of programs were obtained by telephone interviews. An analytical procedure was applied to the program data to identify intervention settings, targets and strategies for each program. Using this information, a summary score of the integration of the ecological approach was estimated for each program. Organizational and professional variables were assessed by self-administered questionnaires to managers and professionals involved in these programs. RESULTS: The level of integration of the ecological approach in programs was related to organizational (frequency of contacts and collaborations with external partners, team composition) and extraorganizational factors (size of the city in which the public health unit is located). Cognitive attributes of the practitioners (knowledge and beliefs) also emerged as significant predictors. Finally, positive associations were observed between practitioners' personal characteristics (educational achievement, working status in health promotion [full vs. part-time], previous experience, gender, and disciplinary/professional background) and cognitive predictors. CONCLUSIONS: Organizational environment and staff preparation play a critical role in the adoption of the ecological approach in tobacco control programs.

Access to Information↗
PubMedDate not supplied

[The preventive and health promotion services for infants, children and youth. What is problematic for clients of the CLSCs].

OBJECTIVE: This article presents the results of a survey on preventive and health promotion (PHP) services provided by Quebec CLSCs for infants, children and youth. Two dimensions of services are examined: the diversity of PHP issues addressed and the type of clientele targeted by the CLSC team. METHODS: Questionnaire survey. RESULTS: Although identified a priori as public health priorities, many PHP issues remain less often addressed by CLSCs. This is particularly the case for activities aimed at children and youth as compared to infants. In addition, the data show that CLSC teams are less inclined to target specific clienteles; when they do so, it is more often in the context of services for infants. DISCUSSION: This study is important in that it constitutes one of the first efforts to systematically document PHP services for infants, children, and youth. In shedding new light on intervention sectors that need to be reinforced, these results should help managers and policymakers as they reflect on the role of PHP services in CLSCs within the context of health reform.

Adolescent↗
PubMedDate not supplied

What do Canadian seniors say supports their quality of life? Findings from a national participatory research study.

BACKGROUND: A national project investigated seniors' perceptions of the influences upon their quality of life. The seven participating cities were Montreal, Quebec City, Ottawa, Toronto, Regina, Vancouver and Whitehorse. The project focussed on policy decisions affecting the quality of life of seniors. It was a participatory study in which seniors controlled the direction and shape of the project in each city. METHODS: Focus groups and individual interviews with seniors and stakeholders. Data analysis used qualitative methods to see the world through the eyes of participants. Each project was committed to hearing the voices of seniors and their views on which issues were affecting the quality of their lives. RESULTS: Across the seven cities, seniors highlighted access to information, health care, housing, income security, safety and security, social contacts and networks, and transportation as key issues that affect the quality of life of seniors in Canada. CONCLUSIONS: The findings affirm the value of participatory activities that involve seniors working with other sectors as a productive policy-informing approach. The Seniors' Quality of Life projects demonstrate the conceptual power of the determinants of health perspective to understand seniors' quality of life issues. While seniors considered health care to be a continuing concern, they also recognized socio-economic issues as significantly affecting the quality of their lives.

Access to Information↗
PubMedDate not supplied

[Breastfeeding promotion and support services in local community health centers].

This study had a two-fold goal. First, to document services relating to breastfeeding promotion and support in CLSCs and, second, to examine the links between the delivery of such services and certain organizational and environmental factors. The data were collected in 1999 by means of a self-administered questionnaire sent to all CLSCs in Quebec. The responses indicated that breastfeeding is most often systematically addressed at prenatal meetings and through integrated perinatal programs. CLSCs belonging to a multipurpose establishment are more apt to integrate the issue of breastfeeding into perinatal activities; in addition, many of them offer breastfeeding activities considered innovative, although the average for this kind of activities is fairly low (33%). In addition, CLSCs that collaborate more closely with community organizations and those that spend more on perinatal programs are the ones that most often offer "innovative" breastfeeding activities.

Breast Feeding↗
PubMedDate not supplied

Health promotion and disease prevention for older adults: Intervention themes and strategies used in Quebec local community health centres and seniors' day centres.

OBJECTIVE: Despite the considerable potential of disease prevention and health promotion (DPHP) among older adults, extant data suggest that this field of intervention is still underdeveloped. To shed further light on this issue, this paper presents the results of an inventory of DPHP interventions for older adults conducted in local community health centres (CLSCs) and seniors' day centres in the province of Quebec. METHODS: All CLSCs (N=147) and day centres (N=124) were invited to participate (response rates: 74% and 79%). Data were collected through telephone interviews. Interventions were coded according to type of intervention strategies and target themes. RESULTS: Awareness-raising and health education strategies emerged as the most frequently-cited type of intervention strategies, reported by 77% of CLSCs and 95% of day centres, respectively. The two themes reported by a majority of CLSCs were physical health (87%) and community issues (58%). Lifestyle habits (92%) and social issues (92%) were the two most frequently-cited themes in day centres. DISCUSSION: DPHP for older adults is substantially well developed in terms of intervention offerings in the two types of organizations under study. However, the range of available interventions requires expansion to increase the potential of DPHP programs to tackle the numerous challenges posed by the aging of the population.

Aged↗