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L’institutionnalisation des programmes communautaires : revue des modèles théoriques et proposition d’un modèle

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Résumé

Les programmes communautaires en promotion de la santé doivent durer longtemps pour obtenir un impact significatif sur les statistiques sociosanitaires liées à ces habitudes et conditions de vie. Leur efficacité réside notamment dans l’institutionnalisation de ces programmes.

Ces programmes souvent nouveaux pour l’organisation hôte devraient survivre au-delà des ressources formelles de santé publique investies. Cependant, il s’avère que certains programmes disparaissent avec le retrait du financement extérieur, ce qui coûte cher à l’organisation puisque le programme aura mobilisé et créé des attentes auprès des acteurs locaux générant parfois de la résistance face à l’implantation d’autres programmes de promotion de la santé. C’est pourquoi il devient pertinent de comprendre les principes et les processus impliqués dans le maintien ou l’institutionnalisation des programmes.

À partir d’une revue de littérature de 28 articles, le présent article examine différents modèles théoriques (environnemental, organisationnel, communautaire ou de marketing) qui mettent en relief diverses variables explicatives ou prédictrices du maintien d’un programme de promotion de la santé dans une organisation. Puis, l’article propose un modèle qui tente d’amalgamer plusieurs de ces variables sous diverses catégories: caractéristiques liées au programme, caractéristiques liées à la ciblehôte, caractéristiques liées à l’adoption, à l’implantation, à l’appropriation et à l’incorporation, enfin caractéristiques liées à l’ajustement mutuel.

Abstract

Community-based health promotion programs to change lifestyle habits must remain in their host organizations for extended periods of time in order to have impact. Their effectiveness can be closely linked to their long term viability or institutionalization.

To remain viable, these programs must survive beyond initial investment and support by external organizations. However, some programs disappear when external investment is withdrawn. This can be costly and in addition can generate resistance to the implementation of other health promotion programs in the future. Recently, interest in the processes involved in the institutionalization of these programs has increased.

Based on 28 publications, this article reviews selected conceptual models that highlight environmental, organizational, community and marketing-related variables possibly related to the institutionalization process. A new model is proposed to link these diverse models according to: characteristics of the program, characteristics of the host organization, characteristics related to the adoption, implementation and incorporation of the program, and finally characteristics related to the fit (mutual adjustment) between the host and the program.

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Authors and Affiliations

  1. Habitudes de vie/Santé du coeur, Direction de la santé publique, Régie régionale de Montréal-Centre, 4835 avenue Christophe-Colomb, Montréal, Québec, H2J 3G8, Canada

    Lise Renaud PhD (Boursière senior du Conseil québécois de la recherche sociale (CQRS) et chercheur), Sylvie Chevalier MSc (Agente de recherche) & Jennifer O’Loughlin PhD (Boursière du Programme national de recherche et développement en santé (PNRDS)

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  1. Lise Renaud PhD
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  2. Sylvie Chevalier MSc
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  3. Jennifer O’Loughlin PhD
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Correspondence to Lise Renaud PhD.

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Renaud, L., Chevalier, S. & O’Loughlin, J. L’institutionnalisation des programmes communautaires : revue des modèles théoriques et proposition d’un modèle. Can J Public Health 88, 109–113 (1997). https://doi.org/10.1007/BF03403872

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