Pierre Verger

Dans un contexte de re-visibilisation par les autorités publiques du rôle des professionnel·les de soins primaires dans le repérage et la prise en charge de la violence conjugale (VC), cet article analyse les représentations sociales de ce phénomène chez les médecins généralistes. À partir d’une enquête socio-représentationnelle par questionnaire auprès de généralistes de la région PACA, ce travail examine également le rôle du genre, de l’expérience professionnelle et des conceptions explicatives du phénomène dans ces représentations. La combinaison de différentes méthodes qualitatives et quantitatives déployées dans l’analyse des associations verbales produites révèle la multiplicité des places à partir desquelles la VC est appréhendée et interroge sur la façon dont ces différentes places participent à une certaine définition du phénomène. Si les résultats décrits dans l’article pointent vers une forme récente d’intériorisation par les médecins de la légitimité de leur rôle vis-à-vis de la VC, d’autres concernant les représentations des causes questionnent sur les conséquences d’une conception médicale de la VC. Enfin, la dimension genrée de l’approche de la VC par ces professionnel·les de santé, mise en évidence dans cet article, mérite d’être approfondie, notamment dans le contexte récent de médiatisation des violences dites sexistes et sexuelles en santé.

Parental vaccine hesitancy (VH) remains a significant public health challenge in France, despite mandatory childhood vaccination policies. Motivational interviewing (MI) has shown promise in reducing VH and increasing vaccination intentions. This study aimed to evaluate the sustained impact of an MI-based intervention on VH and vaccination intentions among postpartum mothers in Southeastern France. We conducted a randomized controlled trial (RCT) in two maternity wards in Southeastern France between November 2021 and April 2022. A total of 733 mothers were randomly assigned to receive either a MI session delivered by trained midwives or an educational leaflet. We used the Parent Attitudes about Childhood Vaccines questionnaire to assess VH (0-100 score) and a single question to measure vaccination intentions (1-10 score). Data on VH and vaccination intentions were collected pre-intervention (T0), immediately post-intervention (T1), and seven months later on average (T2). Linear regression models adjusted on potential confounders and Heckman's two-step selection method were used to analyze the data. Seven months post-intervention, we observed a reduction in VH scores (10.1/100 points, p < .0001) and an increase in vaccination intention scores (0.8/10 points, p = .01) compared to the control group. The impact of MI was consistent across different perceived financial situations. Our findings demonstrate that MI has a sustained effect in reducing VH and increasing vaccination intentions among postpartum mothers. MI should be considered as a key strategy to strengthen and sustain vaccine confidence. Further research is needed to test the impact of MI interventions among other under-vaccinated populations, such as pregnant women.

Introduction: Since the late 2000s, several major measles epidemics have occurred in Europe, including France. In 2017, the French Health Ministry extended from three to 11 the number of mandatory childhood vaccines required for preschool and primary school admission; these included the vaccine against measles, mumps and rubella (MMR). Aim: Our aim was to assess if this measure helped to improve MMR vaccine timeliness (VT) or reduce socioeconomic inequalities in MMR vaccine coverage. Methods: A nationwide study of three birth cohorts (2015, 2017, 2019) followed up 2.1 million children for 48 months to assess the course of the timeliness of MMR vaccine dispensation, before and after it became mandatory in France (January 2018). Data came from the French national health insurance fund drug reimbursement database. Results: Despite improvements from 2015 to 2019, pharmacies dispensed MMR vaccines late for 33% of children in the 2019 cohort (mean cumulative delay compared with recommended dates: 7.1 months). Vaccines for children from low-income families were dispensed later (mean delay of at least +1 month) than those from higher-income families. The 2019 cohort did not reach the 95% WHO target of two MMR doses at 24 months of age, nor at 48 months. Discussion: With measles intensifying worldwide, these vaccination delays and inequalities may contribute to the resurgence of epidemics. In addition to vaccination mandates, an ambitious public health policy is needed to reduce inequalities in access to vaccination and to improve parents’ vaccine acceptance through educational strategies.

Healthcare professionals (HCPs) play a primary role in the delivery of population-based vaccination programs. Their emotional well-being can influence the quality of their relationships with patients and generally the outcome of their consultations. This qualitative study sought to identify the types of emotions that HCPs feel during conversations with vaccine-hesitant patients and their styles of interaction. Semi-structured interviews were conducted between June and November 2022 with 41 HCPs (mainly general practitioners and nurses) responsible for vaccinating patients: 23 in England and 18 in France. Framework analysis showed that participants reported numerous emotions, some associated with connection to patients (such as self-confidence and satisfaction) and others with distance (including anger, frustration, unease, and exhaustion). We identified four clusters of emotions reported together when reflecting on interactions with vaccine-hesitant patients: “self-confidence and emotional empathy” (satisfaction, sadness regarding the patient’s situation); “anxiety and insecurity” (doubts about skills, concern for the patients); “exhaustion and weariness” (feeling of incompetence, nervousness); and “discredit and frustration” (feeling discredited, anger). Three styles of interaction were identified: most HCPs reassured and encouraged patients to get vaccinated (“patient-centered” style), some sought to convince them (“adamant” style), and some to inform them without discussion (“detached” style). In our study, HCPs describing a patient-centered interaction style emphasized emotions of connection more than of distance in their discourse, in contrast to those describing an adamant or detached style. Our results suggest that training programs offered to HCPs involved in vaccination discussions should consider the importance of emotions associated with vaccine discussions.

Context: The shortage of general practitioners (GPs) is a growing concern in Europe, especially in France. This problem is likely to continue until the end of the 2020s. Objectives: To study the GPs’ perceptions of access to care in medically underserved areas (i.e. with low physician density), its consequences on their working conditions, and how they cope with the resulting difficulties. Methods: Semi-structured individual interviews were conducted between May and August 2021 of 29 GPs practising in areas of southeastern France with a low physician density or at risk of a doctor shortage. Purposive sampling was used to include profiles of diverse physicians and diverse rural and urban areas. The interviews, conducted with an interview guide, were transcribed and analysed thematically. Results: The participants described a serious degradation of access to care in their areas. These issues also concerned urban areas, where they were, according to the participants, underrecognized. The participants’ workloads were rising, at a rate often perceived as unsustainable: many participants, including the youngest group, reported they were exhausted. Their principal source of dissatisfaction was their impression that they could not do their work correctly. Participants reported that these difficulties required them to improvise and adapt without any official or formal method to keep their practice manageable. Conclusion: These GPs were worried about the future of their profession and their patients. They expected strong measures by public policymakers and officials, but paradoxically seemed to have little interest in the solutions these officials are promoting.

Background: Despite childhood vaccine mandates imposed in 2018 in France, parental vaccine hesitancy (VH) remains frequent. Interventions in Quebec, Canada, applying motivational interviewing (MI) techniques have successfully reduced parents’ VH for childhood immunisations. Aim: To determine whether MI intervention for mothers in maternity wards in the days after birth in France could significantly reduce VH, increase intentions to vaccinate (VI) their child at 2 months and reduce VH social inequalities. Methods: We conducted a parallel-arm multicentre randomised controlled trial from November 2021 to April 2022 to compare impacts of MI performed by MI-trained midwives (intervention) vs a vaccination leaflet (control). We included 733 mothers from two maternity hospitals in south-eastern France, randomly assigned either arm. The validated Parents Attitudes about Childhood Vaccines questionnaire was used before and after MI or leaflet to assess mothers’ VH (13 items, 0–100 score) and VI (1 item, 1–10 score). Difference-in-difference (D-I-D) models were used to estimate net impact of MI vs leaflet for the entire sample and stratified by VH and education level. Results: Motivational interview intervention reduced mothers' VH score by 33% (p < 0.0001) and increased VI by 8% (p < 0.0001); the effect was largest for the highest initial VH levels. D-I-D analyses estimated net VH decrease at 5.8/100 points (p = 0.007) and net VI increase at 0.6/10 points (p = 0.005). Net VH decrease was highest for high initial VH levels and low education levels. Conclusions: Our results show positive effects of MI intervention, and means of its implementation should be investigated in France.

Healthcare professionals (HCPs) play an important role in vaccination; those with low confidence in vaccines are less likely to recommend them to their patients and to be vaccinated themselves. The study's purpose was to adapt and validate long- and short-form versions of the International Professionals' Vaccine Confidence and Behaviors (I-Pro-VC-Be) questionnaire to measure psychosocial determinants of HCPs' vaccine confidence and their associations with vaccination behaviors in European countries. After the original French-language Pro-VC-Be was culturally adapted and translated, HCPs involved in vaccination (mainly GPs and pediatricians) across Germany, Finland, France, and Portugal completed a cross-sectional online survey in 2022. A 10-factor multigroup confirmatory factor analysis (MG-CFA) of the long-form (10 factors comprising 34 items) tested for measurement invariance across countries. Modified multiple Poisson regressions tested the criterion validity of both versions. 2,748 HCPs participated. The 10-factor structure fit was acceptable to good everywhere. The final MG-CFA model confirmed strong factorial invariance and showed very good fit. The long- and short-form I-Pro-VC-Be had good criterion validity with vaccination behaviors. This study validates the I-Pro-VC-Be among HCPs in four European countries; including long- and short-form tools for use in research and public health.

Vaccine hesitancy has become a threat to public health, especially as it is a phenomenon that has also been observed among healthcare professionals. In this study, we analyzed the relationship between endorsement of complementary and alternative medicine (CAM) and vaccination attitudes and behaviors among healthcare professionals, using a cross-sectional sample of physicians with vaccination responsibilities from four European countries: Germany, Finland, Portugal, and France (total N = 2,787). Our results suggest that, in all the participating countries, CAM endorsement is associated with lower frequency of vaccine recommendation, lower self-vaccination rates, and being more open to patients delaying vaccination, with these relationships being mediated by distrust in vaccines. A latent profile analysis revealed that a profile characterized by higher-than-average CAM endorsement and lower-than-average confidence and recommendation of vaccines occurs, to some degree, among 19% of the total sample, although these percentages varied from one country to another: 23.72% in Germany, 17.83% in France, 9.77% in Finland, and 5.86% in Portugal. These results constitute a call to consider health care professionals' attitudes toward CAM as a factor that could hinder the implementation of immunization campaigns.

Background: Media coverage of Lyme disease (LD) has led to an increase in consultations for presumed LD in Europe. However, LD is confirmed in only 10%–20% of patients, with a significant number remaining in a diagnostic dead-end. Objectives: To reach a deeper understanding of how patients themselves contribute to the diagnostic process. To describe the genesis of the LD hypothesis in care pathways. Methods: In 2019, 30 patients from a prospective cohort consulting in the infectious diseases department at University Hospital in Marseille for presumed LD were recruited for semistructured interviews. The inclusion criteria were: suffering from subjective symptoms for 6 months, no clinical or paraclinical argument suggesting current LD. The patients’ medical trajectories were collected using a biographical approach. Results: The diagnosis of LD was primarily triggered by identification with personal testimonies found on the Internet. Most of patients were leading their own diagnostic investigation. The majority of participants were convinced they had LD despite the lack of medical evidence and the scepticism of their referring GP. Conclusion: GPs should first systematically explore patients’ aetiologic representations in order to improve adherence to the diagnosis especially in the management of medically unexplained symptoms. Long COVID-19 syndrome challenge offers an opportunity to promote active patient involvement in diagnosis.