Debussche Xavier, Balcou-Debussche Maryvette
Sante Publique. 2018 May-June;30(1 Suppl):145-156. doi: 10.3917/spub.184.0145.
Health literacy refers to the competences and resources required by individuals to meet the complex demands of health in modern society. This paper describes and analyses the health literacy profiles of type 2 diabetic patients included in a 2-year long self-management education programme.
Nested in the ERMIES randomized controlled trial conducted in Reunion island, the ERMIES Ethnosocio study explored health literacy by means of two complementary approaches: description of health literacy profiles via the French version of the multidimensional "Health Literacy Questionnaire", and a socio-anthropological perspective based on 40 semi-structured interviews carried out in 2012 and then in 2015.
The results highlight the existence of 8 constitutive variables in the management of type 2 diabetes in an ordinary context: diet, physical activity, treatment and monitoring of disease (disease management), access to knowledge and skills (health knowledge), relationships with health professionals and social support (expertise, support and social network). They also emphasize the differentiated relationships of individuals to each of these variables, ranging from functional to interactive or critical "levels".
Considering the development of health literacy with patients and health professionals, and by questioning educational and therapeutic interventions as differentiating processes, this research opens up new perspectives for the approach to social inequalities in health. The combination of social sciences, medical sciences and public health is proving fruitful and potentially operative, provided that the definitions, methods, and strengths and limitations of selected prospects are clearly defined.
健康素养是指个人为满足现代社会中健康的复杂需求所需要的能力和资源。本文描述并分析了纳入一项为期两年的自我管理教育项目的2型糖尿病患者的健康素养概况。
作为在留尼汪岛进行的ERMIES随机对照试验的一部分，ERMIES民族社会学研究通过两种互补方法探究健康素养：通过法语版多维度“健康素养问卷”描述健康素养概况，以及基于2012年及之后2015年进行的40次半结构化访谈的社会人类学视角。
结果凸显了在普通在日常情境下2型糖尿病管理中8个构成变量的存在：饮食、身体活动、疾病治疗与监测（疾病管理）、知识与技能获取（健康知识）、与健康专业人员的关系及社会支持（专业知识、支持与社会网络）。结果还强调了个体与这些变量中每一个变量的不同关系，范围从功能性到互动性或批判性“水平”。
考虑到与患者及健康专业人员一起发展健康素养，并质疑教育和治疗干预作为差异化过程，本研究为处理健康方面的社会不平等问题开辟了新视角。社会科学、医学科学和公共卫生的结合已证明富有成效且可能具有操作性，前提是明确界定所选前景的定义、方法以及优势和局限性。
