Center for Research in Medicine, Science, Health, Mental Health and Society

Abstract Background Mobile health applications (apps) are increasing in interest for enhancing patient self-management in rheumatology. However, few have been developed with the involvement of patients and health professionals and actually used by patients. Objective To develop and implement a mobile app for safety, self-assessment and medication adherence for patients with inflammatory arthritis treated with disease modifying anti-rheumatic drugs (DMARDs) and assess its real-life use. Methods A mixed qualitative-quantitative study including 42 and 344 patients, respectively, identified patients’ treatment practices and their use of health apps in general and their needs in terms of content and potential use. A multidisciplinary team including 7 rheumatologists, 3 patient association representatives and 4 members of a digital company developed the first version of the app with face-to-face meetings and patient feedback during the process. After the launch of the app, users’ feedback assessment included 7 patients and 3 rheumatologists. The number of app installations, current users, users’ requests and functionalities used were collected. Results Preliminary studies indicated numerous safety issues and needs for counselling, leading to the 6 functionalities of the app HIBOOT (OWL in English): a safety checklist before treatment administration, aid in daily life situations related to self-management and safety, treatment reminders, global well-being self-assessment, periodic counselling messages, and a diary to note comments and appointments. The app is free, with no personal data collection. The presentation is a friendly companion that interacts with the user. The content was based on the French recommendations for DMARD management, drug leaflets and public national health websites. HIBOOT was installed 20,500 times from 2017 to 2020, with 4300 regular current users and still increasing usage curves. The checklist, diary and queries on daily life situations were the most used functionalities. Overall, 18,000 requests were identified for information on safety or other patient matters over a 8-month period in 2020. Scores were 4.4/5 stars at Android and iOS stores. Conclusion HIBOOT is a free app for patients with inflammatory arthritis that was developed with a preliminary qualitative–quantitative study including patients during the process and has scientifically validated content. The number of current users is substantial. Future evaluation of the HIBOOT benefit is needed.

International audience

La reconfiguration du système de santé chilien depuis 1979 est paradigmatique quant aux réformes de libéralisation et aux ré-articulations des relations entre État, marché et société civile dans un régime néolibéral. Le but de cet article est d’analyser la relation entre la protection sociale et l’actuel système de santé au Chili, en questionnant la place des droits sociaux dans la gestion de la sécurité sociale. Il s’agit de réfléchir aux enjeux sociologiques de la conception de l’État mise en place par la restructuration économique et politique de la dictature et consolidée sous les régimes démocratiques. Pour cela, nous exposons une lecture des processus de réforme du système de santé et du débat actuel sur l’idée de droit à la santé. Du point de vue des dimensions socio-politiques et normatives de la société chilienne, l’article retrace les principales tensions qui traversent ce débat au niveau institutionnel et de la sociabilité quotidienne, tout en mettant en évidence une économie morale qui justifie certaines formes d’inégalité et une difficulté à parler le langage des droits sociaux.

ABSTRACT Background: The treatment of alcohol abusers in different cultural contexts does not depend only on the methods used but also on the ways in which treatment providers perceive the problem and relate to their clients. Objectives: This study compares treatment professionals' basic beliefs about alcohol use disorders in two culturally different European countries to find out to what extent these ideas are shaped by the respondents' socio-cultural context, profession, and other background variables. Methods: Similar postal surveys were conducted among professionals working in specialized addiction treatment units in Finland (n = 520) and France (n = 472). The data were analyzed by descriptive statistical methods and logistic regression analysis. Results: Consistent cultural differences were found in almost all the questions asked and they remained significant even after controlling for the other background factors. The French professionals emphasized the addictiveness of alcohol more than their Finnish colleagues. They also believed less in the chances of recovery and attributed more responsibility for the problem to external factors, while the Finns emphasized individual responsibility. Profession, gender and some other background variables also modified beliefs about specific questions. Conclusions: Cultural factors shape the ways in which alcohol use disorders are perceived more pervasively than the other background variables. The French professionals' low trust in treatment and the Finnish professionals' lack of concern for the addiction potential of alcohol and stronger tendency to regard the person as responsible for the problem could be seen as potential impediments to effective ways of helping alcohol abusers in these countries.

L’exemple de l’autisme a ete choisi pour aborder la question du decalage entre les rapports officiels qui decrivent un systeme de soins integres au Quebec et les observations de terrains. L’analyse des rapports officiels, des observations ethnographiques dans un hopital de Montreal, des entretiens avec les professionnels, les familles et les representants d’associations de parents ont permis d’identifier de grandes transformations au debut des annees 2000, dans le sens d’une volonte d’offrir plus de services aux familles. Cependant, des changements de direction, de personnels et d’objectifs ont eu pour consequence une diminution d’offres de services moins de dix ans plus tard. Cet article a pour objectif d’analyser les politiques et les pratiques d’intervention en autisme et de les replacer dans le contexte plus general des reformes du systeme de sante quebecois.