This study was an investigation of the phenomenon of dementia caregiving burden and breakdown in community caregiving situations. 109 carer subjects participated in the study, with 91 current carers - 17 via face-to-face interview and 74 via the internet, and 18 past carers - two via face-to-face interview and 16 via the internet, contributing their experiences of dementia caregiving. Two new carers' assessment tools were devised to meet more fully the requirements of the 'Carers (Recognition and Services) Act 1995' (DoH, 1995), namely the 'Dementia Caregiving Problems Questionnaire (DCPQ)' and 'Dementia Caregiving Burden Questionnaire (DCBQ)'. These new assessments were tested and demonstrated to be reliable, with Cronbach Alpha scores of 0.7029 and 0.8430 respectively, and are recommended for implementation in clinical practice. The key predictive risk factors for high caregiving burden in this study were perceived stress; omission of caregiving satisfactions; carer depression; perceived impact on quality of life; perceived helpfulness of community care services; behaviour problems - especially shouting, swearing and screaming, irritability and night disturbance; poor quality carer/dependant relationship; mood problems; perceived helpfulness of informal support; perceived impact of caregiving on dependant emotional well-being and, to a lesser extent, hours spent in caregiving. The key predictive risk factors for expected relinquishment of home caregiving were DCBQ score; perceived impact on quality of life; perceived stress; carer depression and, to a lesser extent, geographical distance in caregiving; perceived helpfulness of community care services and omission of positive feelings in the carer. Based on the above risk factors, a new 'Dementia Caregiving Breakdown Risk Assessment Tool (DCBRAT)' is proposed for use by community care managers to identify 'at risk' caregiving situations so that service interventions can be targetted more towards carers who are highly burdened in their role, who are at risk of developing psychological health problems or who may be nearing breakdown in their caregiving situation. Thus the effectiveness of service interventions may be maximised and optimal health gain for carers achieved, resulting in improved outcomes for people with dementia. The DCBRAT and the similarly proposed 'Conceptual Model of Dementia Caregiving, Burden and Breakdown' will need to be further tested in post-doctoral research.

Ce travail de recherche porte sur l’intervention en prévention de la santé psychique au travail. Il s’intéresse plus particulièrement aux difficultés liées au passage entre la connaissance et l’action : c’est après le diagnostic, lorsqu’il s’agit de transformer concrètement et durablement les situations de travail et l’organisation, que les plus grandes difficultés surviennent. Pour répondre à cette ambition, un important travail théorique est réalisé afin d’identifier dans la littérature puis d’analyser, des modèles d’intervention remarquables pour leur articulation entre un cadre théorique solide autour de la dynamique santé-travail (connaissance) et un cadre méthodologique d’intervention (action). Au-travers d’une revue narrative, nous proposons ainsi trois dimensions en mesure de théoriser le passage entre la connaissance et l’action, passage que nous appréhendons comme un processus social en tant que tel et non comme conséquence méthodologique. Ces trois dimensions, que sont l’objet d’intervention, le niveau d’implication et enfin le processus cognitif de prévention implanté auprès des acteurs sont ainsi au coeur de l’ensemble de notre travail. Forts de ce travail théorique et épistémologique, notre cadre méthodologique vise l’élaboration scientifique de ce processus en cherchant à en établir l’intelligibilité et à débuter le travail de prévisibilité afin que d’autres, plus tard, parviennent au niveau de la reproductibilité. Pour ce faire, trois études ancrées dans la pratique, au sein des services de santé au travail et donc au coeur du terrain, sont présentées. Elles étudient particulièrement les effets de différentes articulations entre objet d’intervention, niveau d’implication et processus cognitif de prévention. L’ensemble de cette démarche s’inscrivant dans le cadre de la recherche fondamentale de terrain, nous aboutissons à la proposition et l’expérimentation d’un nouveau modèle d’intervention permettant de dépasser les limites observées dans la littérature. Cette nouvelle approche se distingue certes par cette articulation spécifique mais également par une méthodologie innovante, inscrivant l’intervention au sein d’un processus d’innovation organisationnelle. Fondée sur l’implantation d’une zone proximale de développement, elle permet aux acteurs de développer des activités transitionnelles, les accompagnant ainsi dans les épreuves auxquelles tout dispositif de prévention expose. Finalement, ce travail nous amène, en plus d’ouvrir vers de nouvelles orientations scientifiques et pratiques, à questionner la posture de l’intervenant agissant en prévention de la santé psychique au travail et plus encore, à une interrogation sur le cadre fondant la pratique des psychologues du travail. / This research work deals with the intervention in prevention of occupational psychological health problems. It highlights the difficulties between knowing and doing: the biggest difficulties occur after diagnosis, when work situations and the organisation have to be substantially and permanently transformed. To reach this goal, a great deal of theoretical work has been carried out in order to identify in literature and analyse significant models of intervention for their coordination between a sound theoretical framework around the dynamics of occupational health (knowing) and a methodological framework of intervention (doing). We propose thus, through a literature review, three dimensions able to theorize the transition from knowledge to action, a transition which is understood as a social process as such and not as a methodological consequence. Those 3 dimensions, namely the object of the intervention, the level of involvement and the cognitive prevention process implemented with the actors, are at the heart of our work. Thanks to this theoretical and epistemological work, the designed methodological framework aims at developing scientifically this process, seeking its comprehensibility and the beginning of a work of predictability, and enabling reproducibility by other actors in the future. To that end, we present 3 studies, each firmly rooted in practice, within occupational health departments, and thus in the field. They study the effects of different linkages between the object of intervention, the level of involvement and the cognitive prevention process. The whole process fits into fundamental applied research and results in the proposal and the testing of a new model of prevention, which enables to go beyond the limits observed in literature. This new approach is characterised by this specific coordination and also by an innovative methodology that puts the intervention within a process of organisational innovation. Based on the implementation of a proximal zone of development, it allows the actors to develop transitional activities and is helpful in the difficulties they face in any prevention system. Eventually, this work opens new practical and scientific orientations, questions the stance of the occupational health professionals as well as the framework of practice of occupational psychologists.

Background: One of society's most pressing social challenges is the state of people's psychological health. Healthcare institutions have adopted e-health due to the noticeable rise in psychological health issues and growing societal reliance on digital technologies. Internet based Cognitive behavioural therapy (iCBT) is essential for those with psychological health issues. Since 2012, the Department of Swedish Municipalities and Regions (SKR) has coordinated the 1177 healthcare programme, a digitisation initiative. By 2025, the Swedish Government hopes to be a global leader in digitising social services and health care. This ehealth system must promote the welfare and good health, which are founded on the idea of equality between individuals. It must increase patient engagement and confidence while bridging the gap between patient needs and what the healthcare system can supply.  Aim: To describe the access to e-health within Swedish healthcare programs for psychological health problems.  Method: Summative qualitative content analysis of data from websites regarding access to e-health services or iCBT in the Swedish local authorities and regions through an inductive approach.  Findings: The results show that e-health services and resources are unequally distributed among local authorities and regions in Sweden.  Conclusion: Results of the study show that unequal e-health service and resource distribution might result in stigmatization and a decline in patient's willingness to seek care. / Bakgrund: Psykisk ohälsa är en av de stora samhällsutmaningarna idag. Hälso- och sjukvården har implementerat e-hälsa på grund av den märkbara ökningen av psykiska hälsoproblem och samhällets växande beroende av digital teknik. Internet baserad kognitiv beteende terapi (iKBT) som levereras online är viktig för dem med psykiska hälsoproblem. Sedan 2012 har Sveriges kommuner och regioner (SKR) samordnat digital vårdprogram 1177. Svenska regeringen syftar till att vara världsledande inom digitalisering av socialtjänst och hälso- och sjukvård. Detta e-hälsosystem måste främja välfärden och den goda hälsan, som bygger på idén om jämlikhet mellan individer. Det måste öka patienternas engagemang och förtroende samtidigt som den måste överbrygga klyftan mellan patienternas behov och vad hälso- och sjukvården kan tillhandahålla. Syfte: Att beskriva tillgången till e-hälsa i svenska vårdprogram för psykisk ohälsa. Metod: Summativ kvalitativ innehållsanalys av data från webbplatser om tillgänglighet till e-hälsa tjänster eller iKBT i de svenska kommuner och regioner genom en induktiv ansats. Resultat: Resultaten visar att tillhandahållandet av e-hälsa tjänster och resurser är ojämnt fördelat mellan olika kommuner och regioner i Sverige. Konklusion: Studie visar att ojämn fördelning av e-hälsa tjänster och resurser kan orsaka stigmatisering och minskad motivation bland de patienter som tänker söka vård och hjälp.