L’agir-en-contexte : comprendre l’action des individus en situation de vulnérabilité

One of the challenges in health promotion is to design theoretical tools and interventions that take into consideration the way structures influence individuals’ life paths, while also recognizing individuals’ ability to make choices that shape their life and, in turn, have an effect on the world in which they live. The exclusionary mechanisms framework makes it possible to assimilate these two occurrences, particularly with regards to the notion of access (Adam & Potvin, 2016). This analytical framework conceives of exclusion mechanisms as a set of elements at various levels that, during interaction, limit access to rights, resources, and capacities for a healthy life and lead to situations of vulnerability. The framework proposes to look at issues of access as a relevant opportunity for addressing the interaction between individuals and structures. With this analytical framework as a starting point, the goal of this thesis is to understand how limited access to rights, resources, and possibilities for developing capacities interact with the context in which individuals evolve and their ability to act. In order to examine certain contexts that have been influenced by exclusionary mechanisms, as well as how individuals carry out their actions within these contexts, we postulated that: 1) Food insecurity is the result of exclusionary mechanisms that limit access to the financial resources necessary to feed oneself in sufficient quantity and quality, or that provoke anxiety that one will not be able to feed oneself in sufficient quantity and quality; and 2) Going to a community organization reflects individuals’ ability to act in the face of such adversities. Based on these postulates, and using life story interviews, we studied the paths of 12 individuals participating in a food insecurity community organization. The concept of acting-in-context has been developed based on the qualitative analysis of the life stories collected. This concept is composed of a five-part system: agency, resources, capacities, threats, and opportunities. These components make it possible to understand how exclusion mechanisms shape context and adjust individuals’ ability to act. More particularly, the concept of “acting-in-context” suggests that exclusionary mechanisms modify the context’s configuration by increasing threats, decreasing opportunities, and acting on individuals’ capacities, resources, and, by extension, agency. Based on this concept, three types of “acting-in-context” were developed: 1) motivated “acting-in-context”, in which individuals act according to their wishes, desires, aspirations, values, and principles while being faced with few threats, but many opportunities; 2) constrained “acting-in-context”, in which acting is essentially turned toward managing threats, leaving little or no room for wishes, desires, aspirations, values, and principles; and 3) synchronic “acting-in-context,” in which individuals attempt to act according to their wishes, desires, aspirations, values, and principles, but must also act otherwise in the face of threats limiting the possibility for them to realize their desires, hopes, aspirations, values and principles. This thesis therefore provides a new way of conceptualizing context and new analytical tools to understand individuals’ actions. In the end, our results suggest that a health promotion intervention that tries to strengthen individuals’ capacities needs to analyze the configuration of “acting-in-context” in order to reduce the density of threats. In this way, the intervention will increase opportunities, capacities, and resources, as well as enable individuals to act according to their wishes, desires, aspirations, values, and principles.

Keyphrases: Health promotion, Vulnerability, Poverty, Social exclusion, Food insecurity, Social inequalities in health