Pierron Annabelle, Fond-Harmant Laurence, Alla François
Bordeaux Population Health Research Center, UMR 1219, Méthodes pour la recherche interventionnelle en santé des populations, Université de Bordeaux, 33000, , 1 rue Jean Burguet, Bordeaux, France.
Directrice de Recherche. ACSAL Agence pour la Coopération Scientifique, LEPS UR 3412-Université Sorbonne Paris Nord, Afrique, Luxembourg.
BMC Public Health. 2021 Jun 29;21(1):1252. doi: 10.1186/s12889-021-11237-2.
To reduce social inequities in health, the World Health Organization's Commission on Social Determinants of Health recommends acting as soon as life begins. In this context, parenting support is promoted as a major lever. The objective of the present research was to develop an intervention theory establishing the conditions for the success of interventions, policies, and organizations supporting parenting in terms of reducing or preventing social inequalities in health for both mother and child in the perinatal period.
To meet these objectives, we conducted a realist evaluation based on a multiple-case study. The study evaluated two border towns in Europe. We collected data from three sources: documentary reviews, focus groups and interviews with professionals, and parental questionnaires.
The main results concerning the fight against social inequalities in health show a true willingness on the part of those involved to carry out universal actions, coordinated between professionals and institutions, in response to the demands of parents; however, the reality on the ground shows the complexity of their implementation and the multiplicity of results. Our middle-range theory showed that to be effective in tackling social inequalities in health, actions must address structural determinants at the macro-systemic level. However, the field of realist evaluation shows that it is first and foremost the actions focused on individual behavior that are implemented. While there is a general political desire to combat social inequalities in health in early childhood, the results show that the strategies in place are potentially not the most effective. Effective support actions would respond to individual strategies; however, current approaches target parents' behavior, aiming to empower them but without giving them the means to do so.
This research constitutes a body of knowledge gathered for reflection and action. In particular, any perinatal policy should clearly state among its objectives the intention to reduce social inequalities in health. The policy should also state that it will be evaluated according to the criteria of proportionate universalism, interprofessional coordination, and actions based on the diversity of parents' needs.
为减少健康方面的社会不平等现象，世界卫生组织健康问题社会决定因素委员会建议从生命伊始就采取行动。在此背景下，育儿支持被视为一项主要手段。本研究的目的是构建一种干预理论，确定在围产期减少或预防母婴健康方面的社会不平等现象的干预措施、政策及组织取得成功的条件。
为实现这些目标，我们基于多案例研究进行了一项实在论评价。该研究对欧洲的两个边境城镇进行了评估。我们从三个来源收集数据：文献综述、与专业人员的焦点小组讨论和访谈，以及家长问卷。
关于消除健康方面社会不平等现象的主要结果表明，相关各方确实愿意开展普遍行动，专业人员和机构之间进行协调，以回应家长的需求；然而，实际情况显示这些行动实施起来很复杂，结果也多种多样。我们的中程理论表明，要有效解决健康方面的社会不平等问题，行动必须在宏观系统层面解决结构性决定因素。然而，实在论评价领域表明，首先实施的是关注个体行为的行动。虽然在幼儿期消除健康方面社会不平等现象有总体的政治意愿，但结果表明现有的策略可能并非最有效。有效的支持行动应回应个体策略；然而，当前的方法针对家长的行为，旨在增强他们的权能，但却没有给予他们这样做的手段。
本研究构成了供思考和行动的知识体系。特别是，任何围产期政策都应在其目标中明确表明减少健康方面社会不平等现象的意图。该政策还应表明将根据相称普遍主义、跨专业协调以及基于家长需求多样性的行动等标准进行评估。
