Héloïze Rouze, PharmD, Praticien Contractuel, Service Recherche et Epidémiologie Cliniques, Pôle de Santé Publique, HCL
Etude Eval-Xailes :
Evaluation of a health autonomy support program for obese people
The X-ailes program, an experiment to support autonomy in health (article 92), aims to support overweight or obese people by means of Référents Parcours de Santé (RPS) and the mobilization of a network of socio-medical-associative partners in two territories (Puy-de-Dôme and Lyon-Métropole). The aim of our study was to evaluate the implementation of this innovative system.
A mixed methodology guided by the REAIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework was used to measure the reach of the target population, the effectiveness and the implementation of the program, using indicators, questionnaires and semi-directed interviews with users, partners and RPS. The effect on users' goals, quality of life and autonomy was assessed at baseline and at 6 months.
From December 2018 to July 2022, X-ailes accompanied 318 users, including 68 with reinforced follow-up including 89.7% women, 58.8% with massive obesity, 61.7% unemployed, and 95.5% in a situation of precariousness according to the EPICES score. At the start of follow-up, only 34.6% declared a satisfactory state of health, and 75% were severely restricted in their daily lives. At 6 months, 69% of users had achieved their individual goals thanks to the support provided, and 58% had improved their quality of life. X-ailes has built up a network of 194 partners in both areas. Partner involvement varied according to their understanding of the role of RPS and their confidence in the complementarity of actions. Profiles and needs varied from one region to another, with older people in the Puy-de-Dôme, more likely to live in rural areas, with greater social and healthcare access needs than in Lyon-Métropole: young urban dwellers in need of adapted physical activity. In Puy-de-Dôme, 31% of RPS interactions targeted social or emotional support, while in Lyon-Métropole 33% targeted individualized action.
Personalized health mediation, provided by a Référent Parcours de Santé, meets a need for primary, secondary and tertiary prevention, and produces favorable effects on people's health and life paths. Our results underline the need for support tailored to the specific characteristics of each territory, to empower users and reduce territorial inequalities in health.