Développement et application d’un modèle conceptuel de l’implantation de programmes de promotion de la santé offerts par des pairs

Peer education is increasingly being used in health promotion. In this strategy, peer leaders deliver health promotion programs (HPPs) to their peers. Peer leaders usually attend training before delivering HPPs. Few studies have examined the implementation of peer-led HPPs, along with their determinants and mechanisms of action. This thesis was undertaken as part of a quasi-experimental study aiming to evaluate the effectiveness of Vivre en Équilibre (VEE), a peer-led HPP targeting fear of falling and its consequences on older adults’ social participation. The purpose of this thesis is to develop and apply the implementation framework of peer-led HPPs. More specifically, the objectives are to: 1) develop a conceptual framework of peer-led HPPs; 2) document the implementation of VEE; and 3) identify the factors associated with its implementation. Following a literature review, a conceptual framework of peer-led HPPs was developed based on existing conceptual work and on complex systems theory concepts. This framework postulates that factors related to individuals, to the program and to the context influence implementation. It further suggests three mechanisms (interactions, self-organization, adaptation process) through which these factors may act. A multiple case study analyzed the implementation of VEE among six independent-living residences for older adults in Quebec. Program reach, fidelity of implementation, adaptations, responsiveness, and factors associated with implementation of the program were documented. Observation grids, peer leaders’ logbooks, attendance sheets, phone questionnaires and interviews (with peer leaders, activity coordinators of the residences, and a subgroup of program participants) were used to collect the data. Content analysis and case comparisons helped identify factors associated with implementation of VEE and compare them with the conceptual framework developed. Overall, 71 older adults participated in the program. Most participants corresponded to the program’s target population (i.e. older adults with fear of falling). Peers delivered all program content but adapted some elements. The participation rate (91%) and the satisfaction level of participants, peers and activity coordinators were high. The analysis revealed that some factors related to individuals (e.g., participants’ attitudes, peer leaders’ experience), to the program (e.g., materials and content quality, training) and to the organizational context (e.g., implementation climate) facilitated VEE implementation through mechanisms identified in the framework. This thesis shows that VEE can be successfully delivered by peer leaders in independent-living residences. The results also support the conceptual framework and shed light on factors associated with the implementation of VEE. These results can guide researchers and practitioners interested in implementing peer-led HPPs.

Keyphrases: Recherche qualitative, Peer education, Implementation analysis, Older adults, Health promotion, Conceptual framework, Complex system theory, Multiple case-study, Qualitative research