Benoît Pétré

From therapeutic patient education principles to educative attitude: the perceptions of health care professionals – a pragmatic approach for defining competencies and resources

Educative attitude is an essential, if implicit, aspect of training to acquire competency in therapeutic patient education (TPE). With multiple (or nonexistent) definitions in the literature, however, the concept needs clarification. The primary aim of this study was to analyze the representations and transformations experienced by health care professionals in the course of TPE training in order to characterize educative attitude. We conducted an exploratory qualitative study using several narrative research-based tools with participants of two TPE continuing education courses. We then performed an inductive thematic analysis. Thirty-three people participated in the study; the majority were women (n=29), nurses (n=17) working in a hospital setting (n=28). Seven categories of statements were identified: time-related (“the right moment, how much time it takes”), the benefits of TPE (to health care professionals’ personal well-being), emotions and feelings (quality of exchanges, sharing), the professional nature of TPE (educational competencies required), the holistic, interdisciplinary approach (complexity of the person and value of teamwork), the educational nature of the care relationship (education an integral part of care) and the ethical dimension (introspection essential). The first three components appear fairly innovative, at least in formulation. The study’s originality rests primarily in its choice of participants – highly motivated novices who expressed themselves in a completely nontheoretical way. Health models see attitude as critical for adopting a behavior. Best TPE practices should encourage personal work on this, opening professionals to the social, experiential and emotional aspects of managing chronic illness.

Body image discrepancy and subjective norm as mediators and moderators of the relationship between body mass index and quality of life

Background and objective Despite the strength and consistency of the relationship between body mass index (BMI) and quality of life (QoL), a reduction in BMI does not necessarily lead to an improvement in QoL. Between-subject variability indicates the presence of mediators and moderators in the BMI–QoL association. This study aimed to examine the roles of body image discrepancy (BID) and subjective norm (SN) as potential mediators and moderators. Subjects and methods In 2012, 3,016 volunteers (aged ≥18 years) participated in a community-based survey conducted in the French-speaking region of Belgium. Participation was enhanced using a large multimedia campaign (which was supported by a large network of recruiters) that employed the nonstigmatizing slogan, “Whatever your weight, your opinion will count”. Participants were invited to complete a web-based questionnaire on their weight-related experiences. Self-reported measures were used to calculate each participant’s BMI, BID, SN, and QoL (a French obesity-specific QoL questionnaire was used to calculate the participants’ physical dimension of QoL scores [PHY-QoL], psychosocial dimension of QoL scores [PSY/SOC-QoL], and their total scores). The covariates included gender, age, subjective economic status, level of education, household size, and perceived health. The mediation/moderation tests were based on Hayes’ method. Results Tests showed that the relationships between BMI and PHY-QoL, PSY/SOC-QoL, and TOT-QoL were partially mediated by BID in both males and females and by SN in females. Moreover, BID was a moderator of the relationship between BMI and PSY/SOC-QoL in males and females. SN was a moderator of the relationship between BMI and PSY/SOC-QoL in males and between BMI and total scores in males (when used without BID in the models). Conclusion BID and SN should be considered as important factors in obesity management strategies. The study shows that targeting BMI only is not sufficient to improve the QoL of overweight and obese subjects, and that other variables, including perceptual factors, should be considered.

Weight loss expectations and determinants in a large community-based sample

While weight-loss expectations have primarily been studied in people enrolled in weight-loss programs, the present study explores patient expectations about weight-loss and identifies related determinants in a large, non-clinical population. 3916 volunteers (age > 18 years) participated in 2012 in a community-based survey in the French-speaking region of Belgium. Participants were asked to define “dream”, “goal”, “happy”, “acceptable”, and “disappointed” weights. Other self-reported measures were used to determine each participants body mass index (BMI), body image discrepancy (BID), subjective norm (SN), weight loss activity, weight history, quality of life (QoL), and demographic and socioeconomic characteristics. The study focused on the determinants of unrealistic weight-loss “goal” (≥10% of initial weight). Results showed median weight loss targets ranged from 5 kg (“disappointed” weight loss) to 21 kg (“dreamed” weight loss). Respondents considered the recommended weight-loss target (5–10%) disappointing. Severe and morbid obesity categories are at high risk of unrealistic weight loss goal. Unrealistic weight-loss goals was associated with female gender, weight loss activity, overweight history and lower QoL in overweight and moderate obesity respondents. These findings confirm the urgent need to help patients accept more modest weight loss outcomes and the need for personalized care that considers the patients specific profile and both weight loss expectations and determinants.

Qualitative thematic analysis of the phenomenology of near-death experiences

Near-death experiences (NDEs) refer to profound psychological events that can have an important impact on the experiencers’ (NDErs) lives. Previous studies have shown that NDEs memories are phenomenologically rich. In the present study, we therefore aimed to extract the common themes (referred to as “features” in the NDE literature) reported by NDErs by analyzing all the concepts stored in the narratives of their experiences. A qualitative thematic analysis has been carried out on 34 cardiac arrest survivors’ NDE narratives. Our results shed the light on the structure of the narratives by identifying 10 “time-bounded” themes which refer to isolated events encountered during the NDE and 1 “transversal” theme which characterizes the whole narrative and generally appears as a retrospective comment of self-reflection on the experience. The division of narratives into themes provides us with detailed information about the vocabulary used by NDErs to describe their experience. This established thematic method enables a rigorous description of the phenomenon, ensuring the inclusion of all self-reported manifestations of themes in narratives.

Perception of Belgian nurses about evidence-based clinical practice implementation: a focus group study

Abstract Background/objectives: Despite recommendations to integrate evidence-based practice into nursing care, evidence-based nursing (EBN) implementation is generally lacking. Strategies for developing an EBN implementation plan require an evaluation of nurses’ needs and expectations. The aim of this study was to evaluate how Belgian nurses perceive EBN. Methods: Descriptive qualitative data were obtained via focus groups. Fifty-six nurses took part in the study and were assigned to one of seven focus groups based on their work setting and the local language. Results: The main results revealed little familiarity with the EBN concept. There were a number of reported barriers to integrating EBN into practice: lack of time; lack of skills needed to find, process, and apply information; lack of support from management; and lack of recognition of the nursing profession. Conclusion: Participants identified four strategies for facilitating EBN development: specific staff dedicated to supporting EBN implementation; an interactive web-based platform to help nurses find, select, and interpret relevant scientific sources; an electronic tool to help nurses in clinical decision-making based on patients’ clinical data; and a change in clinical culture to include EBN in decision-making processes.

Représentations individuelles et attribuées de la prise en charge de l’obésité au sein de la triade patient/soignant/famille

Resume La prise en charge de l’obesite exige une communication efficace entre soignant, patient et entourage. Les discordances et les convergences de representations entre les trois acteurs influencent la dynamique relationnelle qui se joue entre eux. Cette etude de cas rend compte du fonctionnement communicationnel peu optimal entre les acteurs de cinq triades (patient obese/soignant/entourage) sur la base de l’analyse de leurs representations individuelles et projetees des elements participants a la prise en charge. Ce fonctionnement s’organise sur une structure implicite, integrant de nombreux « non-dits » dont l’existence peut parfois mener a une rupture de la relation therapeutique.

Psychological mechanisms underlying overweight and obesity during adolescence. Triads study from the EDUDORA2 project.

Strategies for prevention and treatment of obesity in adolescents are too often limited to lifestyle modifications and dietary counseling. EDUDORA 2 (Education therapeutique et preventive face au Diabete et a l’Obesite a Risque chez l’Adulte et l’Adolescent) project focused on going beyond this dyadic and biological vision. 12 Triads were recruited in regions of Belgium, Luxembourg and France, each including an overweight or obese adolescent, the attending healthcare professional and a family member. Each subject of the triad was interviewed individually using the “life story” technique. Psychosocial factors influencing the degree of adherence to the prescribed treatment were assessed by speech thematic analysis. The most common strategy inside a triad remained focused on symptoms limiting the change of life style or diet. More complex and generally ignored underlying psychological mechanisms were highlighted: interaction with peers was a factor of awareness and strength for change, while food compensation difficulties, body image and devalued self-esteem were inhibitory factors for weight management. Psychological behavior affecting adolescence with respect to body ratio as well as projection of the mother’s experience with her own weight further strengthened these factors. Having a global view of obesity is also essential, at least when integrated in real life situations and in the psychological development during adolescence. Therapeutic Patient Education appears as a real opportunity provided professionals are properly trained.