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De la motivation à l’implication : application de l’entretien motivationnel et de la communication engageante au dépistage du cancer colorectal. Études randomisées contrôlées

Abstract : Context of the thesis: The present thesis is part of an Industrial Convention of Formation by Research (CIFRE) between the laboratory of Psychology EA-4139 Santé et Qualité de Vie of Bordeaux and the Association pour le Dépistage du Cancer Colorectal en Alsace (ADECA Alsace) in Colmar.Aims of the study: The main objective of the thesis was to improve the involvement of the 50-75 years old segment of the population of Alsace in the organized colorectal cancer screening, whilst respecting their personal decision. The thesis was also the opportunity to get a better understanding of the adherence factors to health recommendations. Structure of the thesis: The thesis is made up of two main parts. In a first theoretical part, we looked into the place of the prevention in our hypermodern societies (Aubert, 2006) while proposing an integrative reading of adherence through the concept of motivation (Carré & Fenouillet, 2009). The model underlines especially the contribution of self-regulation (Hall & Fong, 2007), self-determination (Ryan & Deci, 2000) and dissonance (Festinger, 1957). It provides health professionals with a wide range of recommendations to help them optimize their communication on prevention. In a second empirical part, we have put to the test the components of the articulator model by the randomized controlled studies and, in this way, tested two motivational strategies both related to organized colorectal cancer screening program in Alsace. The first study (N=48 413) resulted in an article published in the Gastroenterology medical review and two conferences, one of which in the international Disease Digestive Week in San Diego. It evaluates the contribution of an adjusted phone counselling guided by a transtheoric approach of motivation (Weinstein, 1988), amongst other things motivational interviewing (Miller & Rollnick, 2006). The second randomized controlled study (N=22397) is a postal motivational intervention focused on self-reliance and involvement inspired by the informed choice (Gøtzsche et al., 2008) and the engaging communication (Girandola & Joule, 2008). Main outcomes: The results of the first study demonstrate that an individualized phone counselling enables to get a tenfold increase in the return of medical exclusions (19,2%>1,8%) χ2 (1, N=26425) = 2,603E3 ; p=.000 and to double or even triple the participation compared to mail (30,4%> 9,2%) χ2 (1, N=22535) = 1,140E3; p=.000 whatever the type of advice χ2 (1, N=2 182) =1,195; p=.274. However, the procedure encounters barriers with regard to its feasibility compared to mail (3,8%< 9,2%) χ2 (1, N=46773) = 5,781E2; p.000. The second study shows a benefit of the informed choice on the satisfaction of the subject related to the information process F (4, N=63) = 8,570 ; p=.000 but no effects of the type of mail on the participation in the course of the phase of first invitation χ2 (4, N=11470) = 3,012 ; p=.556 and even in the relaunching process χ2 (4, N=10610) = 4,352 ; p=.360. Discussion: The results are discussed and interpreted with the support of the theoretical consideration of the articulator model. Recommendations for health professionals and further research projects are submitted at the end of the thesis.
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Guillaume Broc. De la motivation à l’implication : application de l’entretien motivationnel et de la communication engageante au dépistage du cancer colorectal. Études randomisées contrôlées. Psychologie. Université de Bordeaux, 2014. Français. ⟨NNT : 2014BORD0020⟩. ⟨tel-01172497⟩

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