Philosophiae Doctor - PhD / Violence occurs in different environments, however, it is often found in the family with family members being the perpetrators. Family violence, as an integrative concept, is defined by few researchers or theorists, let alone conceptualised as a theoretical grounding for family-centred interventions aimed at violence in the home. However, family members are all affected in the act of any violence in the family, thus any intervention should include the whole family. A family-centred approach focuses on all family members to be included in the intervention and is acknowledged as the best method when trying to create an intervention for family violence. Thus, the aim of this study was to design an intervention programme for families experiencing family violence in order to reduce violence in the family. To create such a programme, intervention mapping was the chosen design for this study. Intervention mapping has five steps, 1.) Specify the programme’s goals into proximal programme objectives. In this stage, needs are identified; 2.) Selection of theoretical and practical strategies; 3.) Design the programme, 4.) Implementation of the programme, and 5.) Focus on anticipating process and effect evaluation. However, this study only focused on the first 3 steps of intervention development, namely, Phase I, a family violence needs assessment done to identify the problem, Phase II entailed a review done to determine appropriate theoretical and practical approaches for the intervention regarding family violence, and lastly, Phase III had been a Delphi study which aided in the design and development of the intervention. This study showed promising results with proven long-term positive effects in implementing a family-centred approach, and when coupled with a collaborative network of support services, political will, and community support, and has the ability to ensure continuity of care and improved functioning for families experiencing violence in the home.

Philosophiae Doctor - PhD / Background: There is consensus internationally and among South African researchers that engagement in health risk behaviours amongst the youth is a concern from a public health perspective. It is evident that much health risk behaviours are established during adolescence, and may continue into adulthood, affecting health and wellbeing in later life, and some preventable health behaviours may be contributory causes of morbidity and mortality. Research into the development t of programmes can play a major role in reducing health risk behaviour amongst the youth and also provide a key learning opportunity should this be driven with bigger impetus by the building of research knowledge. Research knowledge needs to inform all stakeholders as to the best evidence-based possibilities that can assist in creating the behavioural change that is envisaged. This study therefore aimed to design, evaluate the feasibility of, and implement, a comprehensive youth development programme that will help to equip learners with the skills to change health risk behaviour in selected schools in the Paarl area, through input from all the stakeholders. The objectives of the study were to 1) obtain baseline information of grade 8 –10 learners about the health risk behaviours they engage in, and the extent to which learners manage personal situations; 2) explore the views of stakeholders regarding the type of health risk behaviours learners engage in, and reasons for engaging; 3) To determine the content of school-based interventions reported in literature, and its effectiveness in reducing or delaying these behaviours amongst the youth; 4) To design a youth development programme based on the views of the stakeholders and literature; 5) To evaluate the feasibility of the youth development programme designed in objective 4; 6) To implement a youth development programme. Method: This study adopted Intervention Mapping as a framework that translated into a five phase study. Each phase informed the next and the findings culminated in the proposed youth development programme for grade 8-10 learners in the Paarl area. Phase 1 used a survey to obtain baseline information about the health risk behaviours that youth engage in and the extent to which learners manage personal situations. The survey was administered using the face-face method and included a demographic questionnaire, the Youth Risk Behaviour Surveillance Survey and the Life Effectiveness Questionnaire. Descriptive statistics such as Frequencies and cross tabulations were performed, as well as inferential statistics including Multiple Regression analysis and Chi-square tests. Phase 2 entailed concept mapping using focus groups and individual interviews with stakeholders to determine their perceptions of the health risks learners engage in and the reasons for their behaviours. The sample included learners, teachers, and community representatives. Thematic analysis was conducted with transcriptions of the focus groups. Phase 3 entailed a systematic review of the literature reporting on interventions aimed at delaying and or preventing engagement in health risk behaviours amongst youth. Phase 4 entailed the triangulation of the findings from the first three phases into a draft programme. Phase 5 included a Delphi study with life skill trainers and experts in the field of health risk programming for adolescents. The Delphi survey was conducted in two rounds. After the feedback in round one, revisions were made to the draft programme to develop the final programme. Results: The results in phase 1 resonated with the findings in the existing body of literature with regards to the health risk behaviours that learners engaged in. Smoking, drinking, sexual activity, drug use, physical inactivity, crime and violence were the most prominent HRBs reported by learners in this sample. Regression analyses indicated that the combination of the LEQ`s life skill domains (Time management, Achievement, Emotional control, Social competence, Active initiative, Self-confidence, Intellectual flexibility and Task leadership) significantly explained between 25% and 56% of the variance in the health risk behaviours (smoking, drinking, drug use, sexual activity). Gendered patterns in engagement with drinking, drug use and risky sexual behaviour was empirically supported by the results of Chi square tests. Drinking and drug use was significantly more prevalent with male learners whilst risky sexual behaviour was significantly more prevalent amongst female learners. Results from phase 2, represented by a concept map suggested that the development of programme content should start with contextual relevance achieved by understanding the range of HRBs youth engage in. This in turn allows for an exploration of the pathways in which engagement has come about. The second and third quadrants illustrate this through their focus on the reasons why youth engage in HRBs and the places where they are exposed to HRBs respectively Once the content has addressed what they do and why they do it, the process of skills development can commence to combat engagement in HRBs. The resultant concept map has four quadrants where each quadrant represents a concept map that corresponded to the themes identified was conceptualized as interacting with one another. During the systematic review process it was identified that effective interventions included the following elements: multi-theoretical approaches, multiple HRBs as targets, gender differentiation, and life skills. In phase 4 a concept map was created that assisted with the design of the programme. The findings from the Delphi study ratified the components included and determined that it was feasible. The recommendations included independent facilitators who have been trained in a specific skill set, avoiding the blurring of the boundary between teachers and facilitators, and a distinction between grades for the purposes of conceptualizing and presenting the programme. This resulted in the researcher augmenting the proposed programme to include independent facilitators; peer mentors; a staggered or tiered programme. These augmentations were substantial and made an immediate implementation not feasible. The scope of the revisions for developing a tiered or staggered programme was adopted as a recommendation, but was outside the scope of the present study in fulfilment of the requirements for a doctoral degree. Thus the final or revised programme only represents the initial level for grade 8 learners and the development process will continue using the same methodology in post-doctoral research. These include the development and accreditation of the training resources, selection and training of faciltators, and the clarification of the relative standing of facilitators in the school environment. Discussion: Health risk behaviour engagement, the factors influencing that engagement and the development of a diverse youth development programme to delay, reduce or prevent it is in itself very complex. Add to it the fact that the youth live in an ever-changing environment where negative role modelling and exposure to health risk behaviour is an everyday occurrence. Structures have been identified in this study that can play a vital role in designing a youth development programme, as well as build on existing programmes. This study incorporated intervention mapping as a participatory design using both quantitative and qualitative methodologies that speak to a high level of rigour and methodological coherence. The study yielded a rich data base with clear directives for future research that will make a significant contribution to the attempts to impact youth development programming and health risk behaviour amongst adolescents. Conclusion: The findings of this study suggest that a multi-theoretical approach to programming that includes gender differentiation and the targeting of multiple HRBs is likely to be more effective in the reduction, delay and prevention of health risk behaviour amongst learners in grade 8-10. The resultant programme is tiered or staggered and differentiates between grades in conceptualization and implementation of the programme. The study presented the programme for the first tier with grade 8 learners and made clear recommendations for the way forward. The study makes an important contribution in its use of participatory methodology that includes stakeholder participation to create a more robust and comprehensive programme.

Philosophiae Doctor - PhD / Many low- and middle-income countries are faced with a rise in the double burden of malnutrition - undernutrition and overweight/obesity. Nutrition-related factors contribute to approximately 45% of deaths in children under five years (mainly due to undernutrition) globally, while low- and middle-income countries are simultaneously witnessing a rise in childhood overweight and obesity. In 2016, an estimated 41 million children under the age of five in low- and middle-income countries were overweight or obese, while 155 million were chronically undernourished. In Africa alone, the estimated prevalence of overweight and obese children in 2010 was 8.5%, expected to reach 12.7% in 2020. In comparison, globally, one in nine people are either hungry or undernourished, while one in three people are overweight. / 2024

The aim of this study was to develop, implement and evaluate the effectiveness of a behavior based, theory driven multi-component nutrition education Intervention promoting healthy eating among two (17 to 19 year old) Lebanese adolescent samples from contrasting socioeconomic statuses. The effects of the intervention were examined in a quasi-experimental control design trial among two hundred and nine adolescent males and females from Beirut, Lebanon: one hundred and ten belonged to a high socioeconomic status (HSES) population and ninety nine belonged to a low socioeconomic status (LSES) population of adolescents. There were four study groups: two intervention and two control. The intervention groups received twelve nutrition lessons, one hour each, involving class based teaching, print materials and activities delivered by a dietitian. Intervention Mapping protocol was applied and constructs from the Social Cognitive Theory were used for the development of the intervention. At baseline and after the intervention, food frequency questionnaires (FFQ) were administered and three 24-Hour Dietary Recalls were used to examine dietary practices and nutrient intakes while semistructured interviews were conducted to gain insight to underlying determinants of food choice. Quantitative data were analyzed using Mann Whitney U Test and Chi-Square analysis. Post intervention, adolescents in both the HSES and LSES intervention groups showed a significant improvement (p<0.05) in some dietary practices and nutrient intakes; however, the impact was higher in the HSES group. In both intervention groups, positive changes were observed in some personal determinants of food choice but none were noted for external factors. These results propose that the developed nutrition education intervention is a promising instrument to promote healthy eating among similar groups of Lebanese adolescents; however, further research is needed for interventions that specifically target LSES groups.

Au Québec, près de 25 000 personnes, principalement des aînés, sont touchées par la maladie de Parkinson (MP), la majorité étant soignée par leur conjoint. Au stade modéré, la MP altère la santé et la qualité de vie de ces couples. Ce stade est propice à la mise en place d’interventions dyadiques, car les couples expérimentent des pertes croissantes, nécessitant plusieurs ajustements. Néanmoins, aucune étude n’avait encore examiné leurs besoins d’intervention lors de cette transition et peu d’interventions pour les soutenir ont fait l’objet d’études évaluatives. Avec comme cadre de référence la théorie de l’expérience de transition de Meleis et al. (2000) et l’approche systémique de Wright et Leahey (2009), cette étude visait à développer, mettre à l’essai et évaluer une intervention auprès de couples âgés vivant avec la MP au stade modéré. À cette fin, un devis qualitatif et une approche participative ont été privilégiés. L’élaboration et l’évaluation de l’intervention s’appuient sur le cadre méthodologique d’Intervention Mapping de Bartholomew et al. (2006) et sur les écrits de Miles et Huberman (2003). L’étude s’est déroulée dans une clinique ambulatoire spécialisée dans la MP. Dix couples et quatre intervenants ont collaboré à la conceptualisation de l’intervention. Trois nouveaux couples en ont fait l’expérimentation et l’évaluation. L’intervention dyadique compte sept rencontres de 90 minutes, aux deux semaines. Les principaux thèmes, les méthodes et les stratégies d’intervention sont basés sur les besoins et les objectifs des dyades ainsi que sur des théories et des écrits empiriques. L’intervention est orientée vers les préoccupations des dyades, la promotion de la santé, la résolution de problèmes, l’accès aux ressources, la communication et l’ajustement des rôles. Les résultats de l’étude ont montré la faisabilité, l’acceptabilité et l’utilité de l’intervention. Les principales améliorations notées par les dyades sont l’adoption de comportements de santé, la recherche de solutions ajustées aux situations rencontrées et profitables aux deux partenaires, la capacité de faire appel à des services et l’accroissement des sentiments de maîtrise, de soutien mutuel, de plaisir et d’espoir. Cette étude fournit des pistes aux infirmières, engagées dans différents champs de pratique, pour développer et évaluer des interventions dyadiques écologiquement et théoriquement fondées. / In Quebec, nearly 25 000 people are affected by Parkinson’s disease (PD). They are, for the most part, elders cared for by their spouse. At the moderate stage, PD alters the couples health and quality of life. This stage of the illness offers opportunities for dyadic interventions, as these couples experiment growing losses requiring numerous adjustments. Nevertheless, no study had yet explored their intervention needs during this transition and few interventions to support them have been the object of evaluative studies. Based on transition theory by Meleis and colleagues (2000) and on family systems approach by Wright and Leahey (2009), the purpose of this study was to develop, implement and evaluate a dyadic intervention oriented towards elderly couples living with PD at the moderate stage. To achieve this goal, a qualitative design and a participative approach were privileged. The Intervention Mapping framework by Bartholomew and colleagues (2006) and the analytic methods developed by Miles and Huberman (2003) were used to conceptualize and evaluate the intervention. The study took place in an ambulatory clinic specialized in PD. Ten couples and four health professionals collaborated to the intervention development. Three new couples tested and evaluated the intervention. The dyadic intervention consists of seven sessions of 90 minutes, held every second week. The themes of the sessions and the intervention methods and strategies are based on the couples needs and goals, as well as on specific theories and empirical findings. The intervention is oriented towards dyads concerns, health promotion, problem solving, access to resources, communication, and role adjustments. The study results showed the feasibility, the acceptability and the utility of the intervention. The main benefits observed by the dyads are the adoption of health behaviors, the finding of solutions adapted to various situations and favorable to both partners, the skills to get help and services, and the increased feelings of mastery, mutual support, pleasure and hope. This study can illuminate nurses involved in different domains of practice and interested in developing and evaluating dyadic interventions that are ecologically and theoretically based.

Au Québec, près de 25 000 personnes, principalement des aînés, sont touchées par la maladie de Parkinson (MP), la majorité étant soignée par leur conjoint. Au stade modéré, la MP altère la santé et la qualité de vie de ces couples. Ce stade est propice à la mise en place d’interventions dyadiques, car les couples expérimentent des pertes croissantes, nécessitant plusieurs ajustements. Néanmoins, aucune étude n’avait encore examiné leurs besoins d’intervention lors de cette transition et peu d’interventions pour les soutenir ont fait l’objet d’études évaluatives. Avec comme cadre de référence la théorie de l’expérience de transition de Meleis et al. (2000) et l’approche systémique de Wright et Leahey (2009), cette étude visait à développer, mettre à l’essai et évaluer une intervention auprès de couples âgés vivant avec la MP au stade modéré. À cette fin, un devis qualitatif et une approche participative ont été privilégiés. L’élaboration et l’évaluation de l’intervention s’appuient sur le cadre méthodologique d’Intervention Mapping de Bartholomew et al. (2006) et sur les écrits de Miles et Huberman (2003). L’étude s’est déroulée dans une clinique ambulatoire spécialisée dans la MP. Dix couples et quatre intervenants ont collaboré à la conceptualisation de l’intervention. Trois nouveaux couples en ont fait l’expérimentation et l’évaluation. L’intervention dyadique compte sept rencontres de 90 minutes, aux deux semaines. Les principaux thèmes, les méthodes et les stratégies d’intervention sont basés sur les besoins et les objectifs des dyades ainsi que sur des théories et des écrits empiriques. L’intervention est orientée vers les préoccupations des dyades, la promotion de la santé, la résolution de problèmes, l’accès aux ressources, la communication et l’ajustement des rôles. Les résultats de l’étude ont montré la faisabilité, l’acceptabilité et l’utilité de l’intervention. Les principales améliorations notées par les dyades sont l’adoption de comportements de santé, la recherche de solutions ajustées aux situations rencontrées et profitables aux deux partenaires, la capacité de faire appel à des services et l’accroissement des sentiments de maîtrise, de soutien mutuel, de plaisir et d’espoir. Cette étude fournit des pistes aux infirmières, engagées dans différents champs de pratique, pour développer et évaluer des interventions dyadiques écologiquement et théoriquement fondées. / In Quebec, nearly 25 000 people are affected by Parkinson’s disease (PD). They are, for the most part, elders cared for by their spouse. At the moderate stage, PD alters the couples health and quality of life. This stage of the illness offers opportunities for dyadic interventions, as these couples experiment growing losses requiring numerous adjustments. Nevertheless, no study had yet explored their intervention needs during this transition and few interventions to support them have been the object of evaluative studies. Based on transition theory by Meleis and colleagues (2000) and on family systems approach by Wright and Leahey (2009), the purpose of this study was to develop, implement and evaluate a dyadic intervention oriented towards elderly couples living with PD at the moderate stage. To achieve this goal, a qualitative design and a participative approach were privileged. The Intervention Mapping framework by Bartholomew and colleagues (2006) and the analytic methods developed by Miles and Huberman (2003) were used to conceptualize and evaluate the intervention. The study took place in an ambulatory clinic specialized in PD. Ten couples and four health professionals collaborated to the intervention development. Three new couples tested and evaluated the intervention. The dyadic intervention consists of seven sessions of 90 minutes, held every second week. The themes of the sessions and the intervention methods and strategies are based on the couples needs and goals, as well as on specific theories and empirical findings. The intervention is oriented towards dyads concerns, health promotion, problem solving, access to resources, communication, and role adjustments. The study results showed the feasibility, the acceptability and the utility of the intervention. The main benefits observed by the dyads are the adoption of health behaviors, the finding of solutions adapted to various situations and favorable to both partners, the skills to get help and services, and the increased feelings of mastery, mutual support, pleasure and hope. This study can illuminate nurses involved in different domains of practice and interested in developing and evaluating dyadic interventions that are ecologically and theoretically based.

Introduction : Un accident vasculaire cérébral (AVC) peut entraîner de multiples conséquences sur la participation des personnes dans leurs activités de la vie quotidienne, incluant celles qui sont liées à la sexualité. Toutefois, rares sont les individus ayant subi un AVC qui ont l’opportunité d’aborder la sexualité dans le cadre de leur réadaptation, en lien avec de multiples facteurs liés aux clients (ex., gêne), aux cliniciens (ex., manque perçu de connaissances et d’habiletés) et à l’environnement de réadaptation (ex., surcharge, manque d’outils cliniques). Une revue systématique de la littérature a fait ressortir l’effet prometteur des interventions en réadaptation sexuelle de par les huit études interventionnelles qui y ont été incluses. Toutefois, à notre connaissance, peu d’études ont porté sur la création d’une intervention abordant les multiples barrières à l’offre de services en réadaptation sexuelle post-AVC pouvant être implantée dans un contexte réel de réadaptation. Objectifs : L’objectif général de cette thèse était de cocréer un programme multifactoriel pour améliorer les services de réadaptation sexuelle post-AVC au Québec avec des cliniciens, des gestionnaires, des individus ayant subi un AVC, ainsi que de leurs partenaires (si applicable). Méthodes : Cette thèse comprenant trois études a été menée selon une approche de transfert de connaissances intégrée et guidée par les quatre premières étapes de la cartographie des interventions de Bartholomew et al. (2016) en partenariat avec cinq centres de réadaptation post-AVC au Québec. Des méthodes qualitatives et de codesign (ex., adaptation de la méthode LEGO® Serious Play®) ont été utilisées pour répondre aux objectifs. Au total, 20 intervenants, une gestionnaire ainsi que dix individus ayant subi un AVC et partenaires de différentes régions administratives du Québec ont participé à au moins l’une des 11 activités de codesign en ligne qui ont eu lieu d’octobre 2021 à décembre 2022. L’ensemble des activités ont été coanimées, enregistrées et leur contenu a été analysé par thématiques selon le Theoretical Domains Framework (TDF), le système Capability, Motivation, Opportunities and Behaviour (COM-B) et la Roue du changement de comportement (Behaviour Change Wheel (BCW)). Résultats : La première étude qualitative décrit 12 grands facteurs interreliés influençant l’offre de services en réadaptation sexuelle, situés au niveau des cliniciens et de l’organisation dans laquelle ils travaillent, ainsi que 11 stratégies visant à outiller les intervenants ou à structurer et enrichir l’environnement de réadaptation pour améliorer les services de réadaptation sexuelle (étape 1 de la cartographie des interventions). La deuxième étude présente une revue de la portée sur les méthodes d’évaluation en réadaptation sexuelle post-AVC qui a fait ressortir de nombreuses méthodes pouvant être utilisées par les professionnels de la réadaptation. La troisième étude qualitative présente la démarche de co-création et le programme, son modèle logique, la matrice de changement anticipé ainsi que des suggestions d’indicateurs de retombées, puis des considérations pour son implantation future dans les programmes de réadaptation post-AVC. Conclusion : Les travaux de recherche composant cette thèse ont permis de faire une synthèse des connaissances sur le sujet de la réadaptation sexuelle post-AVC, de mieux comprendre les facteurs expliquant le manque d’offre de services associés, ainsi que de créer avec les parties prenantes un programme multifactoriel prêt à être implanté dans le futur dans les milieux de réadaptation post-AVC au Québec. / Introduction: A stroke can have multiple consequences on people's participation in their activities of daily living, including those related to sexuality. However, few individuals who have suffered a stroke address sexuality as part of their rehabilitation, in connection with multiple factors related to clients (e.g., embarrassment), clinicians (e.g., lack of perceived knowledge and skills) and the rehabilitation environment (e.g., overload, lack of clinical tools). A systematic review of the literature highlighted the promising effect of sexual rehabilitation interventions through a total of eight intervention studies included in it. However, to our knowledge, few studies have focused on the creation of an intervention addressing the multiple barriers to the offer of post-stroke sexual rehabilitation services that can be implemented in a real rehabilitation context. Objectives: The general objective of this thesis was to co-create a multifactorial program to improve post-stroke sexual rehabilitation services in Quebec with clinicians, managers, individuals who have suffered a stroke, as well as their partners (if applicable). Methods: This thesis comprising three studies was conducted according to an integrated knowledge transfer approach and guided by the first four steps of Bartholomew et al. (2016) in partnership with five post-stroke rehabilitation centers in Quebec. Qualitative and codesign methods (e.g., adaptation of the LEGO® Serious Play ® method) were used to meet the objectives. A total of 20 workers, a manager as well as ten individuals who have suffered a stroke and partners from different administrative regions of Quebec participated in at least one of the 11 online codesign activities that took place from October 2021 to December 2022. All the activities were co-facilitated, recorded and their content analyzed by theme according to the Theoretical Domains Framework (TDF), the Capability, Motivation, Opportunities and Behaviour (COM-B) system and the Behavior Change Wheel (Behaviour Change Wheel (BCW)). Results: The first qualitative study describes 12 major interrelated factors influencing the offer of sexual rehabilitation services, located at the level of clinicians and the organization in which they work, as well as 11 strategies aimed at equipping interveners or at structuring and enriching rehabilitation environment to improve sexual rehabilitation services (step 1 of intervention mapping). The second study presents a scoping review of assessment methods in post-stroke sexual rehabilitation that highlighted many methods that can be used by rehabilitation professionals. The third qualitative study presents the co-creation process and the program, its logic model, the matrix of anticipated change as well as suggestions for impact indicators, then considerations for its future implementation in post-stroke rehabilitation programs. Conclusion: The research work making up this thesis has made it possible to synthesize knowledge on the subject of post-stroke sexual rehabilitation, to better understand the factors explaining the lack of supply of associated services, as well as to create with the parties stakeholders a multifactorial program ready to be implemented in the future in post-stroke rehabilitation settings in Quebec.

La prise optimale d’un traitement antirétroviral est la clé du succès de ces traitements. Cette prise devrait être d’au moins 95 % des médicaments antirétroviraux prescrits afin de supprimer à long terme la réplication virale et donc de restaurer et de préserver la fonction immunologique. Cependant, les personnes vivant avec le virus de l’immunodéficience humaine (PVVIH) éprouvent des difficultés à adopter et à maintenir ce niveau de prise dans le temps. Bien que certaines interventions aient démontré leur capacité à faciliter ce comportement, au Québec il n’y a pas d’intervention systématique pour soutenir ces personnes dans la prise quotidienne de ces traitements. Le but de cette étude était donc de développer et d’évaluer une intervention pour faciliter le comportement de prise optimale d’un traitement antirétroviral chez des personnes vivant avec le VIH. Pour guider le développement de l’intervention, la démarche appelée « intervention mapping » a été suivie. Le cadre théorique proposé par Godin et ses collègues (2005) qui inclut le sentiment d’efficacité personnelle et les attitudes positives face à la prise optimale d’un traitement antirétroviral a été ainsi utilisé non seulement pour prédire et expliquer le comportement de prise, mais aussi pour élaborer l’intervention. Selon ce modèle, le soutien social, la satisfaction envers les professionnels et le fait de ne pas ressentir d’effets indésirables sont autant de facteurs modifiables associés au sentiment d’efficacité personnelle et aux attitudes positives. L’intervention développée visait l’acquisition et la mobilisation des habiletés nécessaires pour influencer ces facteurs en vue de rehausser le sentiment d’efficacité personnelle et les attitudes positives ainsi que pour faciliter ce comportement. Cette intervention comportait quatre rencontres d’une durée de 45 à 75 minutes, s’échelonnant sur 12 semaines, avec une infirmière iii possédant une expertise en VIH. L’évaluation de l’effet de cette intervention sur le comportement et les variables explicatives a été effectuée à l’aide d’un essai clinique avec répartition aléatoire. La principale variable résultat a été mesurée à l’aide d’un questionnaire autoadministré, de la charge virale et du nombre de CD4. Autant la variable résultat principale que les variables explicatives ont été mesurées avant l’intervention et après celle-ci, soit à 12 et 24 semaines. L’échantillon était constitué de 51, personnes vivant avec le VIH et suivies dans une clinique à Montréal : 23 dans le groupe contrôle et 28 dans le groupe expérimental. Des analyses de variance (ANOVA) à mesures répétées ont été réalisées afin d’analyser l’effet de l’intervention sur la prise optimale d’un traitement antirétroviral et les autres variables intermédiaires dans le temps. Les résultats montrent une tendance positive (p = 0,056) quant à l’obtention d’une charge virale indétectable dans le groupe intervention. Ainsi, 43,8 % plus de personnes du groupe expérimental comparativement au groupe contrôle (78,6 % versus 34,8 %) avaient une charge virale indétectable à 12 semaines et 32,8 % de plus à 24 semaines (89,3 % versus 56,5 %). Bien qu’aucun effet significatif ait été trouvé en regard des variables explicatives, probablement à cause d’un manque de puissance statistique, les légères augmentations observées dans le groupe expérimental sont cohérentes avec le modèle théorique utilisé (Godin & al., 2005). Cette étude contribue à l’avancement des connaissances en proposant une intervention pour faciliter la prise optimale d’un traitement antirétroviral chez des personnes vivant avec le VIH. / The key to the success of antiretroviral treatment is optimal treatment taking. At least 95% of prescribed antiretroviral treatments (ARV) have to be taken to achieve long-term suppression of viral replication and so restore and preserve immunologic functioning. However, people living with acquired immunodeficiency virus (PLHIV) have problems adopting and sustaining this level of medication taking over time. Although some interventions have demonstrated they can facilitate this behaviour, in Quebec there are no systematic interventions to support PLHIV in daily treatment taking. The goal of this study was to develop and evaluate an intervention to facilitate optimal antiretroviral-treatment-taking behaviour among people living with HIV. Development of the intervention was guided by an approach known as “intervention mapping.” Accordingly, the theoretical framework put forward by Godin and his colleagues (2005), which includes the factors of self-efficacy and attitudes, was used not only to predict and explain treatment-taking behaviour but also to develop the intervention. In the model, self-efficacy and attitudes are associated with a number of modifiable factors: social support, satisfaction with health professionals and not feeling adverse effects. The goal of the intervention was therefore the acquisition and mobilization of skills in order to affect these factors and, consequently, enhance self-efficacy and positive attitudes towards taking one’s ARV treatment, thus facilitating the desired behaviour. The individualized intervention was structured as four 45- to 75-minute meetings held over a 12-week period with a nurse who had expertise in HIV. A randomized trial was conducted to evaluate the effect of the intervention on behaviour and on the explanatory variables. A self-administered questionnaire, viral load and CD4 count were used to measure the principal outcome variable. vi Measurements of the principal outcome and the explanatory variables were made before the intervention and at 12 weeks and at 24 weeks post-intervention. The sample comprised 51 people living with HIV who were being followed at a clinic in Montreal: 23 in the control group and 28 in the experimental group. Data were subjected to repeated measures analysis of variance (ANOVA). The intervention was found to have a positively trend (p = 0.056) in terms of achieving an undetectable viral load : 43.8 % more persons of the experimental group compared with the group control (78.6 % versus 34.8 %) had an undetectable viral load at 12 weeks and 32.8 % more at 24 weeks (89.3 % versus 56.5 %). Probably the lack of statistical power meant no significant effect was found on the explanatory variables, but the small increases observed in the experimental group are consistent with the theoretical model (Godin et al., 2005). This study contributes to knowledge by proposing an intervention to facilitate optimal antiretroviral-treatment taking among PLHIV.

No description available.