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This thesis adds to a stream of research suggesting that healthcare can be more patient centered and efficient by redefining the role of the patient from a passive receiver to a more active and collaborative participant. This may relate to healthcare provision (Anderson and Funnell, 2005; Berry and Bendapudi, 2007; Bitner and Brown, 2008; McColl-Kennedy et al., 2012; Nordgren, 2008) and innovation (Bate and Robert, 2006; Groene et al., 2009; Longtin et al., 2010). Through research initiative containing four healthcare units and 68 patients, the present thesis combines healthcare research (e.g., Anderson and Funnell, 2005; Nelson et al., 2002) with service research (e.g., Grönroos, 2006; Vargo and Lusch, 2008, 2004) to explore three aspects of patient involvement and service innovation. Firstly, the concept of patient involvement itself is investigated through an extensive literature review of empirical research on patient involvement. A model describing the antecedents, forms and consequences of patient involvement is proposed. What value is, and how patients can co-create value is discussed from the perspectives of healthcare research and service management thought. Secondly, the thesis proposes a diary-based methodology for involving patients in service innovation. My colleagues and I developed the methodology in collaboration with the participating care providers and applied it in practice. We used the experiences we gained from the project and the contributions from the patients to examine the opportunities for user involvement in service innovation. The participants contributed with ideas and insights stemming from their experiences in their contact with healthcare and other resources. We suggest the following three ways of learning from the collected data: As ideas for improvements; through summary reports to illustrate other quantitative data; and as narratives to promote change. Thirdly, the thesis explores patients’ motivations to participate in service innovation, a hitherto unexplored field. Through an analysis of patients’ contributions and interviews with participants we found that there are a number of factors that motivate patients to participate and that participation is perceived as a social- and meaningladen event. Patients derive psychological well-being and support from participation, but disease was sometimes a barrier to participation. This thesis elaborates on how the most motivated users can be involved in service innovation, applying thinking from the lead-user methodology to a healthcare setting. Overall, the thesis explores patient involvement from new perspectives and, by doing so, adds to our collective efforts to improve healthcare. / Denna avhandling syftar till en mer patientcentrerad och effektiv sjukvård. Den bidrar till en strömning inom forskningen som menar att sjukvården kan förbättras genom en omdefiniering av patientrollen – från en roll som passiv mottagare till aktiv, samskapande aktör. Patienten kan ses som en resurs både i utförande av vården (Anderson and Funnell, 2005; Berry and Bendapudi, 2007; Bitner and Brown, 2008; McColl-Kennedy et al., 2012; Nordgren, 2008) och inom utveckling och innovation (Bate and Robert, 2006; Groene et al., 2009; Longtin et al., 2010). Avhandlingen kombinerar sjukvårdsforskning (Anderson and Funnell, 2005; Nelson et al., 2002) med tjänsteforskning (Grönroos, 2006; Vargo and Lusch, 2008, 2004) i en forskningsansats som innefattar fyra vårdenheter och 68 patienter. Den utforskar tre aspekter av patientinvolvering och tjänsteinnovation. För det första undersöks konceptet patientinvolvering genom en omfattande litteraturöversikt av den empiriska forskningen på området. Översikten leder till en konceptuell modell för att beskriva patientinvolvering: vad dess förutsättningar är, vilka former av patientinvolvering som finns och vad patientinvolvering leder till. Avhandlingen diskuterar även begreppet värde och hur patienter kan samskapa värde, utifrån perspektiv inom vårdforskning och tjänsteforskning. För det andra föreslår avhandlingen en dagboksbaserad metod för att involvera patienter i tjänsteinnovation. Deltagande patienter skriver i denna metod ner sina ner sina idéer och upplevelser varje dag under två veckors tid. Mina kollegor och jag utvecklade metoden i samarbete med personal från de deltagande vårdenheterna och applicerade den på praktiken. Erfarenheterna från projektet och de deltagande patienternas bidrag användes för att utforska möjligheterna med patientinvolvering i utvecklingen av vården. Vi föreslår tre sätt att lära sig från det insamlade materialet: som direkta idéer till förbättringar; summerat till rapporter för att ge kvalitativ förståelse av andra kvantitativa mätningar; och enskilda patienters berättelser kan användas för att förmedla patientperspektivet i organisationen och mana till förändring. För det tredje undersöker avhandlingen patienters motivation att bidra till tjänsteinnovation, ett hittills outforskat område. Genom en analys av patienters bidrag och genom intervjuer med deltagare finner vi att patienter motiveras att delta av en rad olika anledningar, från ett behov av upprättelse till en glädje av att utföra aktiviteten. Deltagandet uppfattas som en social och meningsfull händelse. Patienter upplever psykiskt välbefinnande och stöd genom att delta, även om sjukdom kan vara ett hinder i deltagandet. Avhandlingen undersöker även hur de allra mest motiverade patienterna kan identifieras och inkluderas i tjänsteinnovation, detta inspirerat av lead  user-metoden (von Hippel, 1986). Sammantaget utforskar avhandlingen patientinvolvering och tjänsteinnovation från nya perspektiv och bidrar därmed till våra gemensamma ansträngningar för att förbättra vården och patienters välbefinnande.

Aim: The aim of the study is to explore the perceptions of the nurses’ CPD and its contribution to quality patient care in the Gauteng province of the Republic of South Africa. Significance of the study: The significance of the study is to highlight the importance of CPD as one of the contributing factors to the quality of patient care through on-going competence. The researcher hopes the recommendations from the study may serve as a motivation to health institutions that are not actively involved in continuing professional development. Method and data analysis: Quantitative descriptive explorative design was used to achieve the objectives of the study. The study involved registered professional nurses (n =105) and enrolled nurses (n=56) employed in a state health institution. Data was collected by means of a structured questionnaire.A total of 200 questionnaire were distributed and 162 completed questionnaires were returned, giving a response rate of 162/200=81%. Statistical analysis was conducted using the SAS software version 9.3.The internal and external validity was enhanced by selecting a large homogenous sample. Ethical issues: An information leaflet indicating the key elements of the study such as the research title, the purpose of the study, voluntary participation and when to withdraw from the study was distributed to all the participants. Results: The study found that nurses participate in CPD activities to maintain their professional competence, thereby contributing to quality patient care. The findings are consistent with the findings from other studies / Health Studies / M.A. (Health Studies)

Submitted by Micheli Abreu (mabreu@fiocruz.br) on 2016-04-15T14:40:15Z No. of bitstreams: 1 Ariélly_Fidelis_EPSJV_Mestrado_2015.pdf: 4030638 bytes, checksum: 1cac5141946d0e14060659dcc3956e36 (MD5) / Approved for entry into archive by Mario Mesquita (mbarroso@fiocruz.br) on 2016-04-15T18:19:44Z (GMT) No. of bitstreams: 1 Ariélly_Fidelis_EPSJV_Mestrado_2015.pdf: 4030638 bytes, checksum: 1cac5141946d0e14060659dcc3956e36 (MD5) / Made available in DSpace on 2016-04-15T18:19:44Z (GMT). No. of bitstreams: 1 Ariélly_Fidelis_EPSJV_Mestrado_2015.pdf: 4030638 bytes, checksum: 1cac5141946d0e14060659dcc3956e36 (MD5) Previous issue date: 2016 / Fundação Oswaldo Cruz. Escola Politécnica de Saúde Joaquim Venâncio. Programa de Pós Graduação em Educação Profissional em Saúde / Diferentes concepções de cuidado permeiam o setor da saúde e influenciam as práticas adotadas em todos os campos, inclusive o da saúde mental. Cada local de atendimento em saúde adota um perfil de cuidado, que nem sempre atende às reais necessidades da população. Este estudo buscou sentido para o cuidado em saúde mental na Rede de Atenção Psicossocial do Sistema Único de Saúde (SUS). O estudo configura-se metodologicamente como qualitativo de cunho fenomenológico, a partir do referencial hermenêutico de Heidegger. Para trilhar o caminho analítico tomou-se por inspiração, também, o referencial da Antropologia Visual e o seu fazer etnográfico. O esforço empreendido nesta pesquisa se deu a partir da seleção de 21 imagens fotográficas que retratam distintas vivências que apontam para o cuidado exercido no interior de diferentes dispositivos de saúde mental do Sistema Único de Saúde do Brasil. Cinco imagens retratam cenas de Centros de Atenção Psicossocial (CAPS), oito de Hospitais Psiquiátricos e oito de Residências Terapêuticas. A partir destas imagens, o sentido do cuidado exercido nos dispositivos da RAPS emergiu como ainda atrelado à noção de cuidado baseado nos procedimentos e ações efetivas, ao funcionamento considerado adequado exclusivamente desde o cumprimento de protocolos, critérios e atividades assistenciais preconizadas nos manuais. O cuidado considerado necessário para o âmbito da saúde mental é o que, certamente, contribui para a progressão da Reforma Psiquiátrica Brasileira, valoriza as pessoas, reconhece seus contextos de vida, se interessa por seus sentimentos e expectativas quanto ao que os profissionais podem vir a colaborar para a satisfação das necessidades, para a redução do seu sofrimento e para a reconfiguração dos dispositivos de saúde. / Different conceptions of care permeat the health sector, playing important role in the practices adopted in all fields, including mental health. Each health device adopts a care profile, which does not always achieve the real needs of the population. This study sought meaning for mental health care in Psychosocial Care Network of the Brazilian Unified Health System (Rede de Atenção Psicossocial - RAPS of the Sistema Único de Saúde - SUS). The study has methodological and qualitative phenomenological nature, with the referential of heideggerian hermeneutics. To tread this analytical path took as an inspiration, also, referential of the Visual Anthropology and its ethnographic approach. The efforts undertaken in this research come up from the selection of 21 photographic images that depict different experiences about to the care exercised inside of some devices of SUS. Five images show scenes of Psychosocial Care Centers (Centros de Atenção Psicossocial - CAPS), eight are to looking for experiencies in psychiatric hospitals and eight are set up inside therapeutic residences (Programa de Residências Terapêuticas). From these images, the meaning of care exercised in the RAPS devices emerged as still linked to the notion of care based on procedures and effective action, operation considered appropriate only from compliance protocols, welfare criteria and activities recommended by manuals. The care deemed necessary for the scope of mental health is what certainly contributes to the progression of the Brazilian Psychiatric Reform, values people, recognizing their life contexts, their feelings and expectations as to what professionals can come to collaborate to meet the needs, to reduce their suffering and to the reconfiguration of health devices.

Submitted by Izabel Franco (izabel-franco@ufscar.br) on 2016-10-10T14:50:02Z No. of bitstreams: 1 DissAAS.pdf: 1435150 bytes, checksum: 7abcf360d540c17a74c711194318bbda (MD5) / Approved for entry into archive by Marina Freitas (marinapf@ufscar.br) on 2016-10-20T19:59:08Z (GMT) No. of bitstreams: 1 DissAAS.pdf: 1435150 bytes, checksum: 7abcf360d540c17a74c711194318bbda (MD5) / Approved for entry into archive by Marina Freitas (marinapf@ufscar.br) on 2016-10-20T19:59:13Z (GMT) No. of bitstreams: 1 DissAAS.pdf: 1435150 bytes, checksum: 7abcf360d540c17a74c711194318bbda (MD5) / Made available in DSpace on 2016-10-20T19:59:19Z (GMT). No. of bitstreams: 1 DissAAS.pdf: 1435150 bytes, checksum: 7abcf360d540c17a74c711194318bbda (MD5) Previous issue date: 2016-03-31 / Não recebi financiamento / The biopsychosocial phenomenon of drug use becomes a challenge to the health promotion because of the multitude of factors involved; among them, the subject's autonomy. Aiming to identify and understand a set of aspects related to personal autonomy for the use and search for treatment because of disorders related to use of illicit drugs, we used the clinicalqualitative Method and interpretive interactionism to investigate the people's autonomy in the beginning of the treatment at CAPS- AD São Carlos, SP. The data obtained through nondirected interviews done with ten of these subjects were organized into thematic categories, which the content analysis showed that some people had a voluntary action, both for the drug use and for the search for treatment. However, others did not recognize their volitional intention for drug or had their self-care autonomy impaired. On the other hand, it was observed that the reflection about the use condition itself seems to move people to search for treatment. Therefore, it is important to consider that the subject's autonomy is crucial for both the determination by the use of drugs and for seeking treatment and self-care, although it may be impaired in some circumstances. This implies that the treatment project for the care of people who use illegal drugs need to consider the reflections and decisions of the subject itself about their living conditions and the maintenance of the use factors, as well as the possibility of choice and improved quality of life. / O fenômeno biopsicossocial do uso de drogas torna-se um desafio à promoção de saúde diante da multiplicidade de fatores envolvidos; entre eles, a autonomia do sujeito. Com o objetivo de identificar e compreender um conjunto de aspectos ligados à autonomia pessoal para o uso e para busca pelo tratamento por transtornos relacionados ao uso drogas ilícitas, utilizou-se o Método clínico-qualitativo e o interacionismo interpretativo para investigar a autonomia de pessoas em início do acompanhamento para cuidados no CAPS-AD de São Carlos, SP. Os dados obtidos por meio de entrevistas não-dirigidas feitas com dez desses sujeitos foram organizados em categorias temáticas, cuja análise do conteúdo mostrou que algumas pessoas apresentaram uma ação voluntária, tanto para o uso da droga, quanto para a busca por tratamento. Contudo, outras não reconheceram sua intenção volitiva para o uso da droga ou tinham sua autonomia para o autocuidado prejudicada. Por outro lado, observou-se que a reflexão sobre a própria condição de uso parece mobilizar as pessoas a buscar por tratamento. Portanto, é importante considerar que a autonomia do sujeito é decisiva tanto para a determinação pelo uso de drogas quanto para a busca do tratamento e para o autocuidado, ainda que possa estar prejudicada em algumas circunstâncias. Isso implica que o projeto terapêutico destinado ao cuidado às pessoas que fazem uso de drogas ilícitas precisa considerar as reflexões e decisões do próprio sujeito a respeito de sua condição de vida e dos fatores da manutenção do uso, bem como das possibilidades de escolha e melhoria da qualidade de vida.

La Survie globale (SG) est le critère de jugement de référence dans les essais cliniques en oncologie mais les critères de jugement dit intennédiaires centrés sur la tumeur qui sont évalués plus précocement sont de plus en plus utilisés comme critères substitutifs de la survie globale La qualité de vie (QdV) constitue un critère de jugement pour évaluer un bénéfice clinique direct pour le patient. Nos résultats ont montré que 32% des critères de jugement dans les essais de phase III de CBNPC avancés étaient pas du tout définis et seulement 43% était clairement défini et qu'aucun critère intermédiaire n'a démontré sa substitutivité sur la SG. Nous avons montré que la mesure, l'analyse et le report des données de QdV étaient hétérogènes entre les essais de phase III de CBNPC avancés d'où la nécessité de recommandations. Nous avons comparé longitudinalement la QdV chez 451 patients âgés de 70-89 ans atteints de CBNPC avancés randomisés entre une bichimiothérapie et une monochimiothérapie selon la technique du temps jusqu'à détérioration définitive (TJD) d'un score de QdV. Cette étude a montré : sur le plan clinique, le bénéfice du doublet de chimiothérapie pour les patients est renforcé par les données de QdV; sur le plan méthodologique: le TJD est une technique d'analyse faisable dans les essais de phase III de CBNPC et fournit des résultats faciles d'interprétation. Nous avons proposé l'utilisation de co-critères de jugement principaux associant QdV et critère centré sur la tumeur. Enfin, nous avons démontré la valeur pronostique de la dimension santé globale de QdV à baseline du questionnaire sur la SG chez les patients âgés atteints de CBNPC avancés. / Overall survival (OS) is the gold standard endpoint in oncology clinical trials. Nevertheless, intermediate tumor-centered endpoints which are assessed earlier are more and more used as surrogate of OS. Health-related quality of life is an endpoint which assesses a direct benefit for the patient. We demonstrated that 32% of endpoints in advanced non-small-cell lung phase III clinical trials were not defined at all, 43% were not clearly defined and none ofthem has demonstrated its surrogacy on OS. We demonstrated the weakness and the heterogeneity of the measurement, analysis, and reporting of HRQoL in phase III advanced NSCLC trials. Precise and uniform recommendations are needed. We longitudinally compared HRQoL using tüne until definitive deterioration (TUDD) method in 451 patients aged 70-89 years with advanced NSCLC randomly assigned to receive a doublet of chemotherapy or a monochemotherapy. We demonstrated the benefit of the doublet chemotherapy in terms ofHRQoL. On a methodological point ofview TUDD method is feasible and provide clinically meaningful results. We proposed another approach which would be to combine intermediate endpoint• with HRQoL as co-primary endpoints. Finally, we demonstrated the additional prognostic value of HRQoL data at baseline to identify vulnerable subpopulations in elderly NSCLC patients.

In South Africa, the quality of health care is directly related to the concept of patient-centred care and the enactment of the Batho Pele Principles and the Patients’ Rights Charter. The quality of health care delivery has dropped drastically, and reports in the media indicate that public hospitals in the Eastern Cape Province are on the brink of collapse, with thousands of patients being treated in condemned hospitals. Receiving and rendering health care in the face of such challenges, the question arose: “Are patients receiving patient-centred care in public hospitals?” The answer to this rhetorical inquiry appeared to be obvious, but this research study explored and described professional nurses’ perceptions of patient-centred care in public hospitals and their understanding of evidence-based practice and best practice guidelines. The proposed study followed a qualitative, exploratory, descriptive and contextual design. The research population included professional nurses who are employed in public hospitals in Nelson Mandela Bay, and consisted of nurse managers and nurses who work in the wards. The research study consisted of three phases. In Phase 1, semi-structured interviews and focus groups were conducted with nurse managers and professional nurses working in the wards in order to collect data about their perceptions of patient-centred care and their understanding of evidence-based practice and best practice guidelines. The interviews were transcribed and Tesch’s eight steps of data analysis were followed to create meaning from the data collected. Themes were identified and grouped together to form new categories. The researcher ensured the validity of the study by conforming to Lincoln and Guba’s model of trustworthiness, which consists of the following four constructs: credibility, transferability, dependability and confirmability. An independent coder assisted with the coding process. In Phase 2, an integrative literature review was conducted in order to identify previous guidelines regarding best practice for patient-centred care. Relevant guidelines were selected, critically appraised, data was extracted and synthesised for the development of a best practice guideline for patient-centred care. An independent appraiser critically appraised the guidelines, thereby ensuring trustworthiness. In Phase 3, the data in Phase 1 and Phase 2 were integrated to formulate a draft best practice guideline for patient-centred care. The guideline was submitted to an expert panel for review and was modified according to the recommendations of the panel, whereby the best practice guideline for patient-centred care in public hospitals in Nelson Mandela Bay was finalized.

Le discours sur l'Autre s'ancre dans le discours médical. Mais de quel Autre s'agit-il ? De quelle identité parlons nous dès lors qu'il s'agit d'altérité, de reconnaissances et de vulnérabilités du sujet de soin ? Qui reconnaît-on ? Nous explorons ici les équilibres relationnels au sein de la relation soignant-soigné en Orthopédie dento-faciale hospitalière. A travers une l'approche structurale des représentations sociales, via l'utilisation de cartes conceptuelles, est interrogé le rapport des partenaires thérapeutiques à l'objet prendre soin, notion symbolique et indicible de l'activité soignante. Introduire le prendre soin revient à souligner ce que la relation contient de dimension à la fois éthique, technique et politique. Avec la notion d'accueillance du sujet, élément matriciel central révélé par l'analyse de la représentation, lors des questionnaires réalisés, se dessinent les enjeux identitaires de la reconfiguration contemporaine de la relation de soin, modèle hybride entre une forme atténuée de paternalisme médical et une libéralisation relative. Cette perspective novatrice nous autorise à interroger ces différents registres de valeurs, qui sont autant de témoignages et d'illustrations de la notion de personne. Cette dialectique du même et de l'Autre, de l'identité et de la reconnaissance des acteurs, ouvre ainsi un débat de nature à la fois théorique, éthique et politique autour de l'espace relationnel du soin. / A discourse focused on the Other is firmly anchored in medical discourse. But what Other is being spoken about? What identity are we talking about when considering the otherness, recognition and vulnerability of the recipient of care? Whom are we recognising? Here, we will be exploring the relational balance within the patient-carer relationship in the field of dentofacial orthopedics. A structural approach to social representations, using concept maps, will be adopted in order to examine the relationship of the therapeutic partners to the concept of care provision - a symbolic component of the treatment process which is difficult to define explicitly. Introducing the notion of care provision means placing an emphasis on the ethical, technical and political content of the care relationship. The notion of the favourable reception of the patient, a central element of the relationship which is revealed by an analysis of representations based on questionnaires, highlights the role of identity in the contemporary reconfiguration of the care relationship - a hybrid model which combines a modulated form of medical paternalism and comparative emancipation. This original perspective enables us to examine these various value registers, which illustrate and testify to the notion of the individual. This dialectic of sameness and the Other, of the identity and the recognition of the participants, thus gives rise to a debate, simultaneously theoretical, ethical and political, focused on the relational space associated with care.

Les médecines complémentaires sont nombreuses et variées, leur recours est largement répandu et en hausse. Selon les pratiques, les données d’évaluation sont plus ou moins riches, mais il y a peu de conclusions consensuelles quant à leur efficacité, même en cas de littérature abondante. Nous commencerons par un état des lieux de l’adéquation des méthodes conventionnelles utilisées pour l’évaluation du médicament, à savoir de l’essai contrôlé randomisé (ECR) et des méta-analyses, pour l’évaluation des médecines complémentaires.A travers trois applications pratiques, nous réfléchirons ensuite à l’apport d’autres méthodes, moins reconnues à ce jour dans le champ de l’evidence based medecine mais pouvant apporter d’autres éclairages. En particulier, nous discuterons de l’intérêt des méthodes mixtes, des études qualitatives et de l’exploitation des grandes bases de données médico-administratives. Nous réaliserons une revue mixte sur l’évaluation de l’hypnose pour le travail et l’accouchement, une étude qualitative sur l’expérience du qi gong par des patientes hospitalisées pour anorexie mentale sévère, et nous étudierons le potentiel d’exploitation du Système National d'Information Inter Régimes de l'Assurance Maladie (SNIIRAM) pour évaluer les médecines complémentaires. Les deux premiers axes nous amèneront à questionner le choix des critères de jugement et des instruments de mesure utilisés dans les ECR et nous inciteront à accorder davantage de place et de légitimité à la perspective du patient. Plus largement, cela nous invitera à remettre en cause la suprématie traditionnellement accordée aux études quantitatives pour la remplacer par une vision non hiérarchique mais synergique des approches qualitatives et quantitatives. Le troisième axe nous permettra d’identifier les limites actuelles à l’exploitation du SNIIRAM pour l’évaluation des médecines complémentaires, à la fois sur le plan technique et sur le plan de la représentativité. Nous proposerons des mesures concrètes pour rendre possible et pertinente son exploitation dans le champ de l'évaluation des médecines complémentaires.Enfin, dans la discussion générale, nous tiendrons compte du fait que l’évaluation des médecines complémentaires n’a pas pour but d’autoriser ou non une mise sur le marché. Ainsi, contrairement à l'évaluation des médicaments, l'évaluation des médecines complémentaires ne s'inscrit pas toujours dans une visée de prise de décision. Nous soulignerons l’importance de tenir compte de la visée (visée de connaissance ou visée de décision) dans l’élaboration d’une stratégie de recherche et nous proposerons deux stratégies différentes en nous appuyant sur la littérature et les résultats issus de nos trois exemples d'application. Concernant la stratégie de recherche à visée de prise de décision, nous montrerons l’importance des étapes de définition de l’intervention, d’identification des critères de jugement pertinents, et d’optimisation de l’intervention, avant la réalisation d’essais pragmatiques visant à évaluer l’efficacité en vie réelle. Nous verrons comment la volonté d’évaluer ces pratiques nous renvoie à des défis en terme de réglementation et nous soulignerons par ailleurs la nécessité d’évaluer la sécurité de ces pratiques en développant des systèmes de surveillance adaptés. / Complementary medicines are numerous and varied, their use is widespread and increasing.Quality and quantity of evaluation data depend on the type of complementary medicines, but there are few consensual conclusions about their effectiveness, even in the case of abundant literature. We will start with an inventory of the adequacy of the conventional methods used for drug evaluation, namely randomized controlled trials (RCT) and meta-analyzes, for the evaluation of complementary medicines. Through three practical applications, we will then consider the contribution of other methods, less recognized to date in the field of evidence-based medicine but potentially contributive to shed light on other perspectives. In particular, we will discuss the advantages of mixed methods, qualitative studies and the exploitation of large health administrative databases. We will conduct a mixed-method review of the assessment of hypnosis for labor and childbirth, a qualitative study on the experience of qi gong by patients hospitalized for severe anorexia nervosa and we will study the potential of the French national health insurance database (SNIIRAM) to evaluate complementary medicines. The first two axis will lead us to question the choice of outcomes and measurement tools used in RCTs and to value and legitimate the patient's perspective. More broadly, it will invite us to question the hierarchical vision of qualitative and quantitative research that traditionally attributes supremacy to quantitative studies. It will encourage us to replace it with a synergistic vision of qualitative and quantitative approaches. The third axis will enable us to identify the current limits to the use of SNIIRAM for the evaluation of complementary medicines, both technically and in terms of representativeness. We will propose concrete measures to make its exploitation possible and relevant in the field of evaluation of complementary medicines.Finally, in the general discussion, we shall take account of the fact that the evaluation of complementary medicines is not part of a marketing authorization process. Thus, contrary to drug evaluation, complementary medicines evaluation does not always imply decision making. We will emphasize the importance of considering the aim (aim of knowledge or aim of decision) in the development of a research strategy. We will propose two different strategies based on the literature and the results from our three examples. Concerning the research strategy aimed at decision-making, we will show the importance of defining the intervention, identifying the relevant outcomes, and optimizing the intervention first, before carrying out pragmatic clinical trials to evaluate its effectiveness. We will discuss the regulatory challenges complementary medicine evaluation confronts us to, and stress the need to assess the safety of these practices by developing appropriate monitoring systems.