The aim of the study was to determine the practice of nurses employed in integrated care projects in New Zealand from late 1999 to early 2001. Integrated care was a major health reform strategy that emphasised primary health care as a means to improve service provision between the health sectors. An investigation of nurses’ practice sought to determine the extent to which primary health care principles had been adopted in practice, as a comprehensive primary health care approach has been advocated globally in the management of chronic conditions; the leading cause of disability throughout the world and the most expensive problems faced by health care systems. The philosophical basis of the research was postpositivism. The study employed a quantitative non-experimental survey design because it allowed numeric descriptions of the characteristics of integrated care projects to be gained for the purpose of identifying nurses’ practice. The unit of inquiry was the integrated care project, and 80 comprised the study population. Data were obtained on projects from expert informants (n=27) by telephone survey using a structured interview questionnaire developed by the researcher. Data obtained from interviews were statistically analysed in two stages. First, data were produced to comprehensively describe the characteristics of integrated care projects and nurses practice. The ‘Public health interventions model’ was used as a framework to analyses the interventions (activities) and levels of population-based practice of nurses. Following this, the social values embedded in nurses’ practice were determined using ‘Beattie’s model of health promotion’ as a framework for analysis. A strong association was found between nurses’ practice in projects and strategies used in integrated care, such as information sharing, guideline development and promotion, and case management, and projects with an ethnic focus, low income focus, chronic condition focus, and well-health focus. Whilst nurses undertook interventions most frequently at the individual practice level they were also strongly ii associated with the small proportion of interventions that were undertaken at the community level. The majority of interventions by nurses reflected the health promotion value of health persuasion, indicating a paternalist and individual-oriented philosophy. Nurses were engaged in two interventions that indicated a collectiveoriented philosophy - coalition building and community development, the latter reflecting health promotion values of negotiation, partnership and empowerment. The study demonstrated that nurses’ practice in projects was predominantly centred on individual-focused population-based practice suggesting the need for a framework to assist nurses to transition their practice to include more activity at the community and systems levels. Without a reorientation of practice, nurses will remain limited in their ability to achieve health gains for populations. In response to this conclusion, and drawing on research results and reviewed literature, a new model, The ‘Primary Health Care interventions model’ was constructed. Recommendations include advocacy for the acceptance of the model by the health funder, professional nursing bodies, health organisations, educational institutions, nurses, communities, and individuals.

The aim of the study was to determine the practice of nurses employed in integrated care projects in New Zealand from late 1999 to early 2001. Integrated care was a major health reform strategy that emphasised primary health care as a means to improve service provision between the health sectors. An investigation of nurses’ practice sought to determine the extent to which primary health care principles had been adopted in practice, as a comprehensive primary health care approach has been advocated globally in the management of chronic conditions; the leading cause of disability throughout the world and the most expensive problems faced by health care systems. The philosophical basis of the research was postpositivism. The study employed a quantitative non-experimental survey design because it allowed numeric descriptions of the characteristics of integrated care projects to be gained for the purpose of identifying nurses’ practice. The unit of inquiry was the integrated care project, and 80 comprised the study population. Data were obtained on projects from expert informants (n=27) by telephone survey using a structured interview questionnaire developed by the researcher. Data obtained from interviews were statistically analysed in two stages. First, data were produced to comprehensively describe the characteristics of integrated care projects and nurses practice. The ‘Public health interventions model’ was used as a framework to analyses the interventions (activities) and levels of population-based practice of nurses. Following this, the social values embedded in nurses’ practice were determined using ‘Beattie’s model of health promotion’ as a framework for analysis. A strong association was found between nurses’ practice in projects and strategies used in integrated care, such as information sharing, guideline development and promotion, and case management, and projects with an ethnic focus, low income focus, chronic condition focus, and well-health focus. Whilst nurses undertook interventions most frequently at the individual practice level they were also strongly ii associated with the small proportion of interventions that were undertaken at the community level. The majority of interventions by nurses reflected the health promotion value of health persuasion, indicating a paternalist and individual-oriented philosophy. Nurses were engaged in two interventions that indicated a collectiveoriented philosophy - coalition building and community development, the latter reflecting health promotion values of negotiation, partnership and empowerment. The study demonstrated that nurses’ practice in projects was predominantly centred on individual-focused population-based practice suggesting the need for a framework to assist nurses to transition their practice to include more activity at the community and systems levels. Without a reorientation of practice, nurses will remain limited in their ability to achieve health gains for populations. In response to this conclusion, and drawing on research results and reviewed literature, a new model, The ‘Primary Health Care interventions model’ was constructed. Recommendations include advocacy for the acceptance of the model by the health funder, professional nursing bodies, health organisations, educational institutions, nurses, communities, and individuals.

The aim of the study was to determine the practice of nurses employed in integrated care projects in New Zealand from late 1999 to early 2001. Integrated care was a major health reform strategy that emphasised primary health care as a means to improve service provision between the health sectors. An investigation of nurses’ practice sought to determine the extent to which primary health care principles had been adopted in practice, as a comprehensive primary health care approach has been advocated globally in the management of chronic conditions; the leading cause of disability throughout the world and the most expensive problems faced by health care systems. The philosophical basis of the research was postpositivism. The study employed a quantitative non-experimental survey design because it allowed numeric descriptions of the characteristics of integrated care projects to be gained for the purpose of identifying nurses’ practice. The unit of inquiry was the integrated care project, and 80 comprised the study population. Data were obtained on projects from expert informants (n=27) by telephone survey using a structured interview questionnaire developed by the researcher. Data obtained from interviews were statistically analysed in two stages. First, data were produced to comprehensively describe the characteristics of integrated care projects and nurses practice. The ‘Public health interventions model’ was used as a framework to analyses the interventions (activities) and levels of population-based practice of nurses. Following this, the social values embedded in nurses’ practice were determined using ‘Beattie’s model of health promotion’ as a framework for analysis. A strong association was found between nurses’ practice in projects and strategies used in integrated care, such as information sharing, guideline development and promotion, and case management, and projects with an ethnic focus, low income focus, chronic condition focus, and well-health focus. Whilst nurses undertook interventions most frequently at the individual practice level they were also strongly ii associated with the small proportion of interventions that were undertaken at the community level. The majority of interventions by nurses reflected the health promotion value of health persuasion, indicating a paternalist and individual-oriented philosophy. Nurses were engaged in two interventions that indicated a collectiveoriented philosophy - coalition building and community development, the latter reflecting health promotion values of negotiation, partnership and empowerment. The study demonstrated that nurses’ practice in projects was predominantly centred on individual-focused population-based practice suggesting the need for a framework to assist nurses to transition their practice to include more activity at the community and systems levels. Without a reorientation of practice, nurses will remain limited in their ability to achieve health gains for populations. In response to this conclusion, and drawing on research results and reviewed literature, a new model, The ‘Primary Health Care interventions model’ was constructed. Recommendations include advocacy for the acceptance of the model by the health funder, professional nursing bodies, health organisations, educational institutions, nurses, communities, and individuals.

The aim of the study was to determine the practice of nurses employed in integrated care projects in New Zealand from late 1999 to early 2001. Integrated care was a major health reform strategy that emphasised primary health care as a means to improve service provision between the health sectors. An investigation of nurses’ practice sought to determine the extent to which primary health care principles had been adopted in practice, as a comprehensive primary health care approach has been advocated globally in the management of chronic conditions; the leading cause of disability throughout the world and the most expensive problems faced by health care systems. The philosophical basis of the research was postpositivism. The study employed a quantitative non-experimental survey design because it allowed numeric descriptions of the characteristics of integrated care projects to be gained for the purpose of identifying nurses’ practice. The unit of inquiry was the integrated care project, and 80 comprised the study population. Data were obtained on projects from expert informants (n=27) by telephone survey using a structured interview questionnaire developed by the researcher. Data obtained from interviews were statistically analysed in two stages. First, data were produced to comprehensively describe the characteristics of integrated care projects and nurses practice. The ‘Public health interventions model’ was used as a framework to analyses the interventions (activities) and levels of population-based practice of nurses. Following this, the social values embedded in nurses’ practice were determined using ‘Beattie’s model of health promotion’ as a framework for analysis. A strong association was found between nurses’ practice in projects and strategies used in integrated care, such as information sharing, guideline development and promotion, and case management, and projects with an ethnic focus, low income focus, chronic condition focus, and well-health focus. Whilst nurses undertook interventions most frequently at the individual practice level they were also strongly ii associated with the small proportion of interventions that were undertaken at the community level. The majority of interventions by nurses reflected the health promotion value of health persuasion, indicating a paternalist and individual-oriented philosophy. Nurses were engaged in two interventions that indicated a collectiveoriented philosophy - coalition building and community development, the latter reflecting health promotion values of negotiation, partnership and empowerment. The study demonstrated that nurses’ practice in projects was predominantly centred on individual-focused population-based practice suggesting the need for a framework to assist nurses to transition their practice to include more activity at the community and systems levels. Without a reorientation of practice, nurses will remain limited in their ability to achieve health gains for populations. In response to this conclusion, and drawing on research results and reviewed literature, a new model, The ‘Primary Health Care interventions model’ was constructed. Recommendations include advocacy for the acceptance of the model by the health funder, professional nursing bodies, health organisations, educational institutions, nurses, communities, and individuals.

Οι Άμεσες Ξένες Επενδύσεις (Α.Ξ.Ε.) θεωρούνται ως ένα σημαντικό εργαλείο στη διαδικασία της παγκοσμιοποίησης και διαδραματίζουν έναν κρίσιμο ρόλο στην ανάπτυξη των οικονομιών πολλών χωρών, μέσω της βελτίωσης της υποδομής τους, των τεχνικών τους δεξιοτήτων, των ικανοτήτων των επιχειρηματιών και των οικονομικών πόρων, αναφορικά με τα έσοδα της κυβέρνησης και το ξένο συνάλλαγμα. Η παρούσα εργασία εκπονείται με απώτερο σκοπό να εξετάσει κατά πόσο α) ο πραγματικός κατά κεφαλήν ρυθμός ανάπτυξης του Α.Ε.Π., β) ο ετήσιος ρυθμός πληθωρισμού, γ) το ποσοστό ανεργίας, δ) ο υφιστάμενος αριθμός των τηλεφωνικών γραμμών ανά 100 κατοίκους, ε) το εργατικό δυναμικό που κατέχει δευτεροβάθμια εκπαίδευση καθώς και στ) το ονομαστικό κόστος εργασίας, επηρεάζουν τις εισροές Άμεσων Ξένων Επενδύσεων στις χώρες που βρίσκονται α) στην Ε.Ε. – 27, β) στην Ευρωζώνη καθώς και γ) στην Ευρωπαϊκή Ένωση αλλά εκτός Ευρώ, αναφορικά με τα έτη 2002 – 2010. Αναλυτικότερα, η τρέχουσα μελέτη αποτελείται από πέντε κεφάλαια καθώς και από ένα παράρτημα. Κατ’ αρχάς, το πρώτο (1ο) κεφάλαιο εξετάζει ορισμένες βασικές έννοιες της διεθνούς επιχειρηματικής δραστηριότητας. Εν συνεχεία, στο δεύτερο (2ο) κεφάλαιο, παρουσιάζονται οι έξι προαναφερθέντες προσδιοριστικοί παράγοντες, οι οποίοι είναι ικανοί να εξηγήσουν την επένδυση των Πολυεθνικών Επιχειρήσεων σε μια δεδομένη τοποθεσία. Επιπροσθέτως, στο τρίτο (3ο) κεφάλαιο, αναλύονται τα υποδείγματα εκείνα που στηρίζονται σε πάνελ δεδομένα. Στο τέταρτο (4ο) κεφάλαιο, δε, πραγματοποιείται η εμπειρική ανάλυση με τη βοήθεια του στατιστικού πακέτου, STATA και ταυτόχρονα, διαφαίνονται τα αντίστοιχα αποτελέσματα αυτής, αναφορικά με τη σχέση των εισροών Α.Ξ.Ε. και των εξεταστέων παραγόντων, σε κάθε μια ομάδα χωρών (Ε.Ε. – 27, χώρες Ευρωζώνης και χώρες εκτός Ευρώ) ξεχωριστά, κατά τα έτη 2002 – 2010. Στη συνέχεια, στο πέμπτο (5ο) κεφάλαιο της παρούσας εργασίας, παρουσιάζονται τα συμπεράσματα που εκπίπτουν από τη συγκεκριμένη ανάλυση και παράλληλα, δίδονται ορισμένες ενδιαφέρουσες προτάσεις για μελλοντική έρευνα. Εν κατακλείδι, η τρέχουσα μελέτη ολοκληρώνεται με την εισαγωγή ενός παραρτήματος, το οποίο αποτελεί ένα συνοπτικά χρήσιμο εγχειρίδιο εντολών του πακέτου STATA και ίσως συμβάλλει στην κατανόηση και εξυπηρέτηση του εκάστοτε χρήστη αυτού. / Foreign Direct Investment (F.D.I.) is considered as an important tool in the process of globalization and plays a crucial role in the development of economies of many countries, by improving the quality of their infrastructure, their technical skills, entrepreneur capabilities and financial resources, in terms of government revenues and foreign exchange. This dissertation takes part in order to examine whether a) Real G.D.P. Growth Rate per Capita, b) Annual Inflation Rate (Inflation is measured by the Annual Growth Rate of the G.D.P. Deflator), c) Unemployment Rate (Total Unemployment as a percentage of Total Labor Force), d) Telephone Lines per 100 people, e) Labor Force with Secondary Education and f) Nominal Labor Cost (Labor Cost Index, Nominal Value – Annual Data), affect F.D.I. inflows a) in the 27 European Union member countries, b) in the Eurozone countries and c) in the Non – Eurozone countries, during the period 2002 – 2010. Specifically, this study consists of five chapters and an appendix. First of all, the first (1st) chapter examines concepts relevant to the international business activity. Moreover, the second (2nd) chapter presents the above six determinants of Foreign Direct Investment, which is able to explain the establishment of MNEs in a specific location. Furthermore, the third (3rd) chapter concerns those models based on panel data. Τhe fourth (4th) chapter incorporates the empirical analysis, using the statistical package, STATA, and simultaneously, its corresponding results, regarding the relationship between F.D.I. inflows and their possible six determinants, in each group of countries separately (E.U. – 27 member countries, Eurozone and Non – Eurozone countries), during the period 2002 – 2010. Moreover, the fifth (5th) chapter shows the final results, which are extracted from the specific analysis and at the same time, it provides some interesting proposals for further research. Finally, this study is completed with the introduction of an annex, which is a useful manual of STATA commands and perhaps, make users become more convenient and confident with this package.

Justificativa: Internações por Condições Sensíveis à Atenção Primária (ICSAP) são utilizadas como medida da efetividade da atenção à saúde e menores taxas estão associadas ao maior acesso à Atenção Primária à Saúde (APS). Poucos estudos utilizam instrumentos que medem a qualidade da APS e seu efeito nas taxas de internações. Esse estudo buscou identificar fatores individuais, contextuais e dos atributos da APS, medidos nas Equipes de Saúde da Família (ESF), associados com a variação das ICSAP. Métodos: Estudo ecológico das taxas de ICSAP e sua associação com as variáveis preditoras na população de Belo Horizonte, Minas Gerais, entre 2010 e 2013, analisadas por um modelo multinível. Resultados: Do total de 447.500 internações, excluídos os partos, 85.211 foram ICSAP, correspondendo a 19% do total de Internações. Dessas, 50,8% ocorreram em mulheres, 33% em menores de 18 anos, 32% em adultos e 35% em maiores de 60 anos. As taxas padronizadas anuais de ICSAP entre 2010 e 2013, foram maior nos homens (114,5/10.000) que nas mulheres (107,1/10.000). A vulnerabilidade socioeconômica da população está fortemente associada com o comportamento das taxas de internação. O aumento de 10% na população de alto risco ampliou em 4 ICSAP por 10.000 mulheres e em 3 ICSAP por 10.000 homens. Enquanto um aumento de 10% na população de baixo risco, uma redução de 6 ICSAP em mulheres e 5 nos homens, em cada Unidade Básica de Saúde. Nas análises realizadas na população adulta e idosa, para os grupos de doenças agudas e crônicas mais prevalentes nessa faixa etária, o aumento de uma unidade a mais no escore de qualidade da APS, reduz a taxa de ICSAP em 4% ao ano nas mulheres idosas com doenças crônicas. Conclusão: A utilização das ICSAP como medida da efetividade da APS/SF deve ter seu escopo ampliado, incluindo, além das características individuais e dos serviços, as socioeconômicas. Os melhores escores de qualidade da APS tem efeito significativo na redução das taxas de internações por condições crônicas, em mulheres idosas, ao longo dos anos. Como a vulnerabilidade socioeconômica esteve fortemente relacionada ao comportamento das taxas de ICSAP, esses achados reforçam a importância da APS na redução das iniquidades, ao atender uma população idosa e vulnerável, em um contexto de grandes desigualdades, como é o caso dessa metrópole brasileira. / Introduction. Ambulatory Care Sensitive Conditions (ACSC) have been used as a measure of the effectiveness of Primary Health Care (PHC). Few studies have, however, analysed changes in the rates of these hospitalizations using instruments that measure the quality of PHC and its effect on admission rates. This study aimed to identify individual factors, with the variation of ACSC. Methods. Ecological study of ACSC rates and their association with the predictor variables in the population of Belo Horizonte, Minas Gerais, between 2010 and 2013, analyzed by a multilevel model. Results. Of the total 447,500 admissions, excluding births, 85,211 were ICSAP, corresponding to 19% of total admissions. Of these, 50.8% occurred in women, 33% under 18, 32% in adults and 35% over 60 years. The annual standardized rates ACSC between 2010 and 2013 were higher in men (114.5 /10,000) than in women (107.1/10,000). The socio-economic vulnerability of the population is strongly associated with the trends of hospitalization rates. The 10% increase in high-risk population expanded by 4 and 3 ACSC per 10,000 women and men, respectively. While an increase of 10% in low-risk population, a reduction of 6 and 5 ACSC per 10.000 in women and men in each Basic Health Unit. In the analyzes in adults and the elderly, for most prevalent acute and chronic diseases in this age group, the increase of one more unit in the APS quality score, reduces ICSAP rate of 4% per year in older women with chronic diseases. Conclusion. The PHC best quality scores have significant effect in reducing hospitalization rates for chronic conditions in elderly women over the years. As the socioeconomic vulnerability was strongly related to the behavior of ACSC rates, these findings reinforce the importance of PHC in reducing inequities, particularly in large inequalities contexts, as in the case of a Brazilian metropolis. And reinforce the need to expand the assessment of the scope to use ACSC as a mesure of effectiveness of PHC, considering the individual, services and socio-economic characteristics.

Bakgrund: Statistik och forskningsrapporter från bland annat Världshälsoorganisationen visar att hälsan världen över är ojämlikt fördelad och att socioekonomisk status, socialt kapital och health literacy är bidragande faktorer. Föräldrars utbildningsnivå och inkomst kan påverka barns hälsa och uppväxtvillkor och barn tillhörande riskgrupper har sämre förutsättningar till hälsa. Samhället har möjlighet att genom politiska insatser på olika nivåer och i olika sektorer påverka individers möjligheter att i sin tur vidta hälsofrämjande åtgärder. Syfte: Syftet med studien var att undersöka föräldrars syn på kopplingen mellan ekonomi och hälsa, och hur det påverkar familjen att leva ett gott liv. Metod: En kvalitativ ansats valdes och sju föräldrar från tre olika kommuner i Värmland intervjuades i enskilda semistrukturerade intervjuer. Samtliga intervjuer spelades in, transkriberades och analyserades därefter enligt kvalitativ innehållsanalys. Resultat: Analysen resulterade i två kategorier: ”Hinder och möjligheter” som består av subkategorierna: Socialt kapital och Tid och utrymme, och vidare av ”Prioritering och investering” som består av subkategorierna: Samhällets roll, Levnadsvanor och livsstil och Uppväxtvillkor. Slutsats: Det framkom att hälsa är ett komplext begrepp som handlar om både fysiskt och psykiskt välbefinnande. Enligt informanterna har individer möjlighet att påverka sin hälsa genom prioriteringar och investeringar. Vidare beskrevs att förutsättningarna för hälsa är ojämlikt fördelade i samhället och de ekonomiskt svagare kan ha svårare att vidta hälsofrämjande åtgärder. Informanterna ansåg att det finns en koppling mellan ekonomi och hälsa och att god ekonomi förbättrar individers möjligheter till hälsa och ett gott liv. Individers kunskap, intressen och vilja styr individers val i livet. Tidsbrist och för lite utrymme för återhämtning och tid med familjen har beskrivits kunna utgöra en begränsande faktor för bättre hälsa. Hälsa beskrevs också vara en resurs för ett produktivt liv. Barns hälsa påverkas bara till viss del av familjens ekonomi samtidigt som en trygg miljö och god föräldrarelation ansågs vara betydelsefulla. / Background: Statistics and reports from among others the World Health Organization show that inequity in health exists all over the world and that socioeconomic status, social capital and health literacy are contributing factors. Parental education and income have an effect on children’s health and development and children in risk groups have lower chances to develop good health. The society has the opportunity to affect individuals to take actions to promote their own health by political actions on different levels and in different sectors. Aim: The aim of this study was to examine parental view on the connection between economics and health, and its effects on living a good family life. Method: A qualitative approach was used to collect data. Seven parents from three different municipalities in Wermland were interviewed using a semi-structured interview guide. The interviews were recorded and transcribed. The data was analyzed using qualitative content analysis. Results: The analysis of the material resulted in two categories: ”Obstacles and opportunities” which further consists of two subcategories: Social capital and Time and capacity. The other category “Priority and investment” consists of three subcategories: Society’s role, Lifestyle factors and Childhood conditions. Conclusion: This study showed that health is a complex concept about physical and psychological well-being. According to the informants individuals have the opportunity to affect their health by their priorities and investments. Furthermore, the opportunities for reaching good health are being described as unequal throughout the society and it seems to be harder to take health promoting actions for those who are economically weaker. The informants felt that there is a connection between economics and health and that good economy improves individuals’ possibilities to be healthy and live a good life. Individuals’ interests, knowledge and will affect their choices in life. Lack of time and capacity for recovery and to spent time with their families is thought to be a limiting factor for better health. Health is also being described as a resource for a productive life. Children’s health is only partly being affected by families’ economy. A safe environment and good parental relationship seems to be important.

The Master's Thesis deals with an analysis of regional differentiation in micro-regions of Moravian-Silesian Region. However, the analysis focuses on period of industrialization, periods before and after industrialization are also included. Development of population has been under the influence of several factors such as railway transport and both hierarchical and administrative position. A brief comparison with other regions of the Czech Republic is also embraced. The main focus is on the analysis on the level of micro-regions of individual municipalities. Historical development determined creation of special relationship between Core and Periphery. The part of the Thesis is devoted to a synthesis which divides micro-regions into categories according to the developing tendencies. Succinct comment is dedicated to the analysis of developing trends, key determinants and prediction of further population development. The hypothesis are held in the Introduction and confirmed or disproved in the Conclusion.

La loi du 04 mars 2002 relative aux droits des malades et à la qualité et à la qualité du système de santé et la loi HPST (Hôpital, Patients, Santé et Territoires) de 2009 qui accorde un cadre légal à l’éducation thérapeutique ont promu l’autonomie du patient en favorisant sa participation aux décisions médicales. L’autogestion de la maladie chronique voulue par les pouvoirs publics en fournissant ces outils juridiques pour améliorer la qualité de soins, a suscité notre intérêt pour programme d’éducation thérapeutique destiné à des patients insuffisants rénaux en pré-dialyse. L’un des objectifs est de favoriser la liberté des patients à choisir une méthode de dialyse. Dans notre travail de thèse, nous avons voulu montrer comment les déterminants sociaux des décisions médicales et ceux liés aux choix d’une méthode de dialyse sont construits. Si en France, les patients semblent davantage se tourner vers une prise en charge à l’hôpital, dans certains pays, c’est le pluralisme médical qui est de mise. L’exercice de l’auto-analyse a montré le poids de l’économique, de la culture, de la famille dans les choix de santé.Par ailleurs, la place de l’éducation thérapeutique dans le processus décisionnel n’est pas figée : l’éducation thérapeutique peut être complémentaire à la pratique médicale, être un outil d’aide à la décision pour certains patients insuffisants rénaux ou être utilisée par les médecins pour favoriser l’observance décisionnelle des patients. Nous avons montré que les patients et les médecins se basent sur plusieurs facteurs qui peuvent influencer la nature de la délibération.Cette étude a montré que le choix est réseauté et que les décisions sont construites car elles sont basées sur des interactions et des stratégies médicales. Ces déterminants permettent également de comprendre comment la confiance est construite dans le processus décisionnel. Tantôt distribuée, tantôt déplacée, la confiance est explicative du type d’information que le patient priorise. Le choix réseauté du patient amène finalement à la relativisation du modèle de décision médicale partagée qui semble de plus en plus avoir un caractère normatif dans la relation entre professionnels de santé et patients. / The law of March 04th, 2002 on the rights of patients and the quality of the health system and the law HPST (Hôpital, Patients, Santé et Territoires) of 2009 that grants legal framework for patients’ education, have promoted the patient’s autonomy by encouraging his participation in medical decisions. Self-management of chronic illness as favoured by public authorities in providing the legal tools to improve the quality of care has aroused our interest in patient education programs for patients with renal failure in pre-dialysis. One of the objectives of this program is to allow patients free choice when deciding on the method of dialysis.Our thesis aims to underline how the social determinants at work in medical decisions and those involved in the choice of a dialysis method are constructed.In France, patients seem to favor hospital patient care, but in some countries, medical pluralism is more frequent. The exercise of self-analysis has revealed the significant part played by economy, culture and family in health choices.Moreover, the part played by patient education in the decision-making process is neither fixed nor pre-determined: patient education can complement medical practice, can be a decision support tool for some kidney patients or be used by doctors to promote patient decision-making compliance.We have shown that patients and physicians rely on several factors that may influence the nature of the discussion.This study reveals that the choice is networked and that the decisions that are made are the outcome of several interactions and medical strategies. These determinants also help to understand how trust develops and leads to decision-making.Sometimes distributed, sometimes shifted, trust accounts for the type of information prioritized by the patient. The networked choice of the patient finally puts the shared decision-making model into perspective as it increasingly seems to have a normative character in the relationship between health professionals and patients.

No description available.