This study was undertaken to analyze how the way young, recently immigrated, families utilize health services evolves over time. Twenty families participated in the study. They all included at least one child of preschool age, had immigrated less than 8 years previously, and had used primary healthcare services since their arrival. A triphasic pattern of utilization was observed, consisting of contact with one or more health services, selection of specific services from those available, and consolidation of choices. Families relied upon a variety of information sources in each of these phases. The primary attributes upon which the families based their evaluation, selection, and adoption of health services were geographical and temporal accessibility, interpersonal and technical quality of services, and language spoken by health professionals and staff. Perception of health services' attributes is influenced by the families' sociocultural referents and preemigration experience. Results indicate that utilization of primary healthcare services progressively changes over time, evolving from the ad hoc use of walk-in services to the adoption of regular sources of care.

This pilot project aims to test and see the relevance of the direct observation method to collect data on the barriers and facilitators to attending public places by seniors with TBI. The study is based on the conceptual framework VADA WHO which focuses on the development of friendly built and technological environments for seniors. Three elderly people participated in the study, recruited from an ongoing project, The Citizen Intervention in Community Living (APIC), in the presence of their personalized attendant. The study shows the feasibility of the method in terms of its acceptability and resources mobilized. It shows its relevance to access additional data that would have been difficult to obtain using others methods (e.g., semi-structured interview), such as the identification of the strategies used by the participants to address the obstacles encountered (avoidance, travel planning, use of physical and preventative support of the personalized attendant).

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Résumé Université de Montréal.Le contexte actuel des systèmes de santé occidentaux réclame que des transformations soient opérées dans les modes d’organisation et de dispensation des soins de santé. Pour faire face à ces nouveaux défis, de nombreux établissements ont introduit de nouveaux rôles infirmiers ayant le potentiel de transformer l’offre de services. Cet article a comme but de mieux comprendre le déploiement de ces nouveaux rôles infirmiers en contexte québécois et d’identifier les facteurs qui favorisent ou entravent leur mise en oeuvre, en portant un intérêt particulier à la dimension du pouvoir médical. Notre analyse montre que l’introduction de nouveaux rôles nécessite que soient redéfinis les espaces d’autorité exercés par la profession médicale sur la prestation de l’ensemble des services de santé, incluant les services infirmiers. La question du pouvoir médical, aussi délicate soit-elle, est d’autant plus importante que la négociation des frontières entre la profession infirmière et la profession médicale se présente comme un incontournable pour maximiser le plein potentiel de ces rôles et atteindre les objectifs poursuivis en termes d’accessibilité, de globalité et de qualité des services.