Practice variations in French public psychiatry and associated factors (PRAVA-PSY) Background As in other countries, mental disorders in France represent a significant epidemiologic and economic burden that is expected to increase dramatically. Practice variations across public psychiatric services are a source of inequity and inefficiency and thus challenge the quality of care. While the need for evidence-based policy has been emphasized, research on practice variations in French public psychiatry, which represents two-thirds of mental health care delivered to patients in terms of expenditure, does not exist. Objectives The objectives of our study are threefold: 1/ To produce evidence on practice variations in French adult public psychiatry; 2/ To have a better understanding of the factors associated with mental health care practice variations; a. To identify characteristics of the providers of public psychiatric care that are associated with practice variations b. To identify patient characteristics that are associated with practice variations c. To identify the characteristics of the environments of the providers that are associated with practice variations; 3/ To develop recommendations on how to develop and implement policies to reduce unwarranted practice variations and to direct future research. Methods First, we will use descriptive analysis to describe practice variations and assess their ranges across French adult public psychiatric organizational units (PPOUs) using data from the Summary of medical information for psychiatry (RIM-Psy). A set of variables will be used to describe practice (e.g. average length of stay, annual re-hospitalization rate, etc.). Second, we will investigate factors associated with practice variations for mental disorders by using multivariate modeling. Three steps will be successively undertaken: 1) Hypotheses on predictors of practice variations, including characteristics of providers (PPOUs), their patients and their environments, will be developed to construct an explanatory model for each variable describing practice. 2) Database on predictors will be prepared. 3) Models will be run. Third, on the basis of the results, conclusions will be drawn with experts through a workshop bringing together decision makers, mental health care professionals and patient representatives to issue recommendations to address unwarranted practice variations and thus improve equity and efficiency in the system. Skills in health research services, statistical analysis, workfield psychiatry and health geography are needed for the completion of this project, and a multidisciplinary team has therefore been built. Prospects This project will enable a better understanding of the factors associated with practice variations in French public psychiatric care. These findings will be published in peer-reviewed journals and will have implications for policy-makers as they will provide evidence to improve the organization of public psychiatric care in France. Recommendations will be issued and further work will be developed based on the results of the project.

Since Covid-19 was first discovered in China and the WHO confirmed its human-to-human transmission, the French population has been kept informed by the media regarding the progression of the epidemy ‘til its arrival and development in France. Messages on the nature of individual prevention measures and good practices to put in place to stop the progression of the disease were communicated multiple times per day. Despite the fact that this disease is creating an unprecedented health crisis, it appears that the general population has, overall, not fully embraced the prevention measures against Covid-19. This could be due to a lower risk aversion related to this specific disease, a misunderstanding of the prevention measures, or the messages themselves which may have been unclear or contradictory. Many hypotheses are possible and it is therefore important to understand the mechanisms underlying people’s behaviours during this public health crisis. That is why the objective of this study will be to provide information on the general population’s representations of the epidemy and of the disease, as well as their perceptions of the risk and of the prevention measures for themselves and others, and understand the factors that influenced them. Many humanities and social sciences studies have shown that risk is a social construct. Because there are multiple risks, it is difficult to apprehend them all at the same time. Individuals rank those risks not through a simple calculation but based on criteria that involve their own values, norms and beliefs which, in turn, allow them to apprehend the risk and act accordingly. However, our cultural and social background determines these values, norms and beliefs and thus orient representations and behaviours. Elements of belief persist in our collective psyche, even in so-called rationalistic societies. Anthropology and sociology help us go beyond the mere observation of individuals’ irrationality to better understand the foundations on which they rely to act. The field work that we are doing is made up of two phases. The first is taking place during the epidemy and the second at a later time. The first phase is divided into two tasks: a survey using a questionnaire administered to the Constances cohort, and a longitudinal qualitative study using exploratory phone interviews carried out throughout the confinement period. Phase 2 will construct a questionnaire based on the results of Phase 1, which will be administered to the Constances cohort. Our results will provide scientific inputs for the authorities’ reflections on actions and argumentations for prevention measures and how to implement them in future crisis situations. The study method which includes both socio-anthropological and epidemiological approaches as well as the creation of a qualitative cohort, is largely transferable to other crisis situations. Our findings, in particular the identification of mechanisms of erosion or reinforcement of adequate behaviours regarding prevention measures, will have a scope that goes beyond the Covid-19 epidemy. They will serve as a basis transferable to other epidemic situations.

The World Health Organization (WHO) recommends interactive and participatory sexuality education. At the French level, the main focus of the national sexual health strategy is to promote sexual health, particularly among young people, particularly by using new communication tools. To do this, online health communities offer individuals the opportunity to receive information, advice and support from their peers. However, previous research has not yet established strong evidence on the health benefits of virtual communities and peer-to-peer online support (across multiple health topics). The effect of online support groups on health outcomes remains unclear, including a lack of methodological construction. Research must observe the conditions and factors (collective or individual) influencing the results. For this, randomized controlled trials can help evaluate which components of a complex intervention contribute to an effect The Sexpairs project is a Population Health Intervention Research, aiming at promoting positive long-term health behaviors on a young audience (general population). This project is the result of a common reflection on the state of the art and the advent of digital social media, given the lack of evidence-based data on health promotion interventions among peers and on the Internet. Our Intervention Research project aims to evaluate among an online cohort the effectiveness of a participatory online community intervention for the promotion of sexual and reproductive health (SRH) of adolescents and young adults (AYA), and how a new conceptual model makes it possible to change their practices beyond attitudes and improve positive behaviors. We would like to test an innovative youth peer intervention model by: 1) observing how peers can help build and animate a community that helps change behavior (peer-led); 2) observing how young people can interact with each other to educate themselves and further develop their level of information which determines positive behaviors (peer education) (peer-led ? peer education) ? Two steps to understand the effect of "participation" To do so, we will build a web-based cohort of AYA among whom we will test (at 4 months of longitudinal follow-up) the peer-led participatory online community intervention (intervention n°1). After these first 4 months, the entirety of the cohort (including the control group) will be enrolled in the participatory online community. We will then test within the whole participatory online community cohort an additional specific interactive peer education intervention, namely a "shared construction of knowledge in subgroups" for AYA (intervention n ° 2). This online community cohort could be the ground for other specific interventions implementing new interactive models for youth empowerment. Our project has an original approach mobilizing youth participation on several levels. At the level of research, we want to solicit young people in a Community-Based Research Participatory Model (CBPR) and include them in the different stages of our project, from conception to evaluation. We will then be able to build an intervention that is as close as possible to the concerns and expectations of young people.