L’évaluation des projets d’accompagnement à l’autonomie en santé : pourquoi privilégier une approche pragmatiste ?

Abstract

In connection with article 92 of the last Health Act, twenty-eight projects are being tested nationwide with a view to demonstrate the value of support to gain autonomy in health. These projects will be assessed on a case-by-case basis according to their specific situations. However, with the possible generalization of this type of programs, it was also necessary to assess them against the same frame of reference. To this end, a participatory approach was conducted with their coordinators to identify a single evaluation framework, even though these projects were very heterogeneous. This development process led to the identification of a common intervention logic that made it possible, in the aftermath, to define support for autonomy in health, i.e. to set out the conditions under which a health intervention may be used. A pragmatic vision guided the production of the evaluation framework which articulates four dimensions (individual empowerment, enabling environment, collective empowerment, organizational empowerment) composed of 21 criteria and presented as inseparable. According to this logic, the process of empowering individuals, as an objective of interventions, cannot be pursued if it is not embedded in practices that are consistent with the values inherent to the original intention. This also calls for the effects of the empowerment of supported persons to be granted as much importance as the processes of the interventions and the learning processes of individuals and organizations.