Background Diabetes self-management education (DSME) is an effective intervention for patients with type 2 diabetes mellitus (T2DM); nevertheless, patient participation in this type of programme is low. Implementation of DSME programmes in primary care practices by the local multi-professional team is a potential strategy to improve access to DSME for T2DM patients. The aim of this study was to identify perceived facilitators and barriers by patients to participation in local DSME delivered by primary care professionals in France. Method T2DM patients, informed and recruited during consulting with their usual care provider, who had attended a structured and validated DSME programme delivered by 13 primary care providers within a multi-professional primary care practice in a deprived area of 20,000 inhabitants, were invited to participate in this study. A qualitative study with semi-structured, in-depth interviews was conducted with study participants, between July 2017 and February 2018. A reflexive thematic analysis of the interviews was carried out. Coding schemes were developed to generate thematic trends in patient descriptions of facilitators and barriers to DSME participation. Results Nineteen interviews (mean length 31 min; [20–44 min]) were completed with T2DM patients. Four themes on facilitators for programme participation emerged from the data: geographical proximity of a DSME programme held in the local multi-professional primary care practice; effective promotion of the DSME programme by the local multi-professional team; pre-existing relationship between patients and their healthcare providers; and potential to establish new social interactions within the neighbourhood by participating in the programme. Three themes on barriers to attendance emerged: integrating the DSME programme into their own schedules; difficulties in expressing themselves in front of a group; and keeping the motivation for self-managing their T2DM. Conclusions From the patient perspective, the programme geographical proximity and the pre-existing patient-healthcare provider relationship were important factors that contributed to participation. Healthcare providers should consider these factors to improve access to DSME programmes and diabetes self-management in deprived populations. Longitudinal studies should be performed to measure the impact of these programmes.

Résumé -Contexte : La prise en charge des maladies chroniques impose aux professionnels de travailler ensemble, dans un souci de qualité des soins. L'éducation interprofessionnelle vise à préparer à ces pratiques collaboratives. Une formation interprofessionnelle a été mise en place auprès de 110 étudiants de 8 professions de santé à Rennes. Objectif : Notre étude vise à analyser la perception des étudiants concernant cette formation et l'impact éventuel dans leur pratique professionnelle. Méthode : Une méthode qualitative par entretiens semi-directifs a été conduite par deux chercheurs, auprès d'étudiants deux ans après leur participation à la formation. Une analyse thématique manuelle avec double codage a été réalisée en identifiant les unités de sens puis en catégorisant les thèmes retrouvés. Résultats : Seize entretiens semidirectifs ont été réalisés auprès d'étudiants issus de sept filières de formation. Cette formation est novatrice. Elle est une occasion unique de rencontrer les autres professionnels de santé. Elle permet de s'interroger sur les notions d'identité professionnelle et de représentations. La décou-verte des compétences de chacun mais aussi le développement de relations plus égalitaires entre les différents acteurs de santé sont des éléments essentiels. Si l'impact d'une telle formation est difficile à évaluer, les discours des étudiants mettent en exergue une nette volonté de déve-lopper le travail collaboratif. Les étudiants veulent s'engager et construire des modes d'exercice collaboratifs dans leur milieu professionnel ambulatoire ou hospitalier. Un changement de regard sur la pratique est souligné. Conclusion : Les formations interprofessionnelles apparaissent indispensables pour rencontrer les autres professionnels de santé, déconstruire les représentations et travailler dans une logique de collaboration interprofessionnelle. RECHERCHE ET PERSPECTIVES

Aim: Our objective was to explore the difficulties experienced by transgender people in accessing primary health-care services and their expectations towards primary care providers to improve their health-care access. Background: Because transgender people are exposed to many discriminations, their health-care access is particularly poor. Guidelines recommend greater involvement of primary care providers in the processes because of the accessibility feature of primary care services. Methods: A qualitative study using semi-directed interviews was conducted among 27 transgender people (February 2018 – August 2018). These voluntary participants were recruited through different means: local trans or LGBTI (lesbian, gay, bisexual, trans, and/or intersex) associations, primary care providers, and social networks. The data analysis was based on reflexive thematic analysis in an inductive approach. Findings: Difficulties in accessing health-care occurred at all the levels of the primary health-care system: primary care providers – transgender people interaction, access to the primary care team facility (starting with the secretariat), access to secondary care specialists, and continuity of care. Transgender people report ill-adapted health-care services as a result of gender-based identification in health-care settings. Their main expectation was depsychiatrization and self-determination. They supported mixed health network comprising primary care providers and transgender people with a coordinating role for the general practitioner. These expectations should be priorities to consider in our primary health-care system to improve access to health-care for transgender people.