While numerous tools are available to better incorporate equity into population health actions, they are limited mainly by their lack of adaptation to professional practices and organizational realities. A study was conducted in Québec to identify and understand, from the perspective of future users, conditions that would facilitate use of a tool (Reflex-ISS) targeted at supporting collaborative action to improve consideration of social inequalities in health (SIH) within population health actions. Concept mapping and focus groups were implemented as complementary methods for investigating the conditions. Significant results that emerged were strong participant interest in the tool and the need for resources to better take SIH into account. The conditions for use that were identified referred to the tool itself (user-friendliness and literacy) and to resources for appropriating the tool, competency development, as well as the role and responsibilities of organizations and policies in promoting use of the tool in daily activities and more fundamentally in acting against SIH in general. Models for organizational innovation give an idea of the dimensions that need to be considered to strengthen the integration of equity into organizations and to support the changes in practice that result from using the tool. They provide a reminder that a health equity tool cannot be the cornerstone of an organizational strategy to fight against SIH; rather, it must be incorporated as part of a systemic strategy of professional and organizational development.
Correspondance : A. Guichard anne.guichard@fsi.ulaval.ca 2 2 Résumé : Si la lutte contre les inégalités sociales de santé ne devrait pas uniquement incomber aux acteurs de santé publique, ces derniers doivent au moins s'assurer que leurs interventions en tiennent compte. Or, les acteurs concernés par ces interventions ne disposent que de peu d'outils, pour les soutenir dans cette démarche. Ainsi, sur la base d'une recherche réalisée en France, nous avons adapté, testé et développé au Québec, un outil visant à aider les acteurs à mieux considérer les inégalités sociales de santé. L'article vise à présenter la démarche ayant mené à l'adaptation de l'outil au contexte québécois, à décrire l'outil, puis à discuter des enjeux de son intégration dans les pratiques professionnelles. Le Abstract : Although actions to reduce inequalities in health cannot be considered the exclusive responsibility of public health actors, they should at least make sure their interventions account for these inequalities. However, the actors involved in these interventions have few tools to support them in this process. Therefore, building on a study conducted in France, we have adapted, tested, and developed in Quebec a tool intended to help actors take into account social inequalities in health. The article presents the approach that led to the adaptation of the tool to the Quebec context, to describe the tool, and then to discuss some issues for inclusion in professional practices. A participatory and constructive process between researchers, managers and practitioners led to a useful and useable tool. It is composed of five aspects of intervention (planning, implementation, evaluation, sustainability, and empowerment) and of 44 items for discussion presented as questions. A user guide, a glossary, and some practical examples accompany the tool. It follows a reflexive and constructive process wherein a third party facilitator can assist actors involved in an intervention in analyzing how they are taking into account social inequalities in health. This assessment can help generate collective recommendations for improvements, which can be followed up on over time, to improve consideration of equity in public health interventions. The article concludes on some issues related to its integration into professional practices.
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