PUBLI : Marwân-al-Qays Bousmah, Anne Gosselin, Karna Coulibaly, Andrainolo Ravalihasy, Corinne Taéron, Jean-Noël Senne , Flore Gubert et Annabel Desgrées du Loû, « Immigrants’ health empowerment and access to health coverage in France : A stepped wedge randomised controlled trial », Social Science & Medicine, vol. 339, 2023


Throu­ghout Europe, migra­tion-related health inequa­li­ties are mirrored by large inequa­li­ties in health cove­rage. There is a need to develop novel stra­te­gies to secure access to health insu­rance for immi­grants in Europe, in order to meet the shared Sustai­nable Deve­lop­ment Goal of universal health cove­rage. We evaluated the impact of an original health-related empo­werment inter­ven­tion on access to health cove­rage among vulne­rable, mostly undo­cu­mented immi­grants in France.As part of the MAKASI study, we adopted an outreach approach and deve­loped a commu­nity-based inter­ven­tion with and for immi­grants from sub-Saharan Africa living in preca­rious condi­tions in the Greater Paris area. This parti­ci­pa­tory inter­ven­tion was grounded in the theory of indi­vi­dual empo­werment. Using a stepped wedge rando­mised design, we first conducted a robust evalua­tion of the effect of the inter­ven­tion on access to health cove­rage at three and six months post-inter­ven­tion. We then inves­ti­gated whether the inter­ven­tion effect was mediated by a health empo­werment process.Between 2018 and 2021, a total of 821 parti­ci­pants – 77% of whom were men – were recruited in public spaces and followed up for six months. Parti­ci­pants had been living in France for four years on average, 75% of them had no resi­dence permit, and 44% had no health cove­rage at the time of inclu­sion. The proba­bi­lity of acces­sing health cove­rage increased by 29 percen­tage points at six months post-inter­ven­tion (p < 0.01). This impro­ve­ment was partially mediated by a health empo­werment process, namely a rein­for­ce­ment of parti­ci­pants’ know­ledge of and capa­city to access avai­lable social and health resources.A health empo­werment inter­ven­tion largely improved access to health insu­rance among vulne­rable immi­grants in France. Our findings may be trans­ferred to other settings where immi­grants are entitled to health insu­rance. This study offers promi­sing pers­pec­tives – beyond infor­ma­tion provi­sion and direct referral – to reduce migra­tion-related inequa­li­ties in health coverage.

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