title: Using the evaluation process as a lever for improving health and healthcare accessibility: The case of HCV services organization in Quebec.
abstract: BACKGROUND
  The evaluation process can be a lever to improve pathways of access to healthcare. The objective of this article is to show how an evaluation strategy can both contribute to knowledge development and have direct impacts on health services provision. We use the case of hepatitis C (HCV) services organization to illustrate the use and the value of this evaluative approach.
  
  
  METHODS
  Inspired by empowerment evaluation, the transformative-participatory approach involved overlapping phases of knowledge development and discussion with stakeholders. We conducted several knowledge development activities to discern the needs of people with HCV, the resources available, and the facilitators and impediments along the care pathway, starting from prevention and screening, all the way through to treatment. Using an overlapping approach allowed us to regularly transfer acquired knowledge back to the participants in the study settings and also to gather their impressions, interpretations, and suggestions during periods of deliberation.
  
  
  RESULTS
  The knowledge development activities made it possible to document the needs, resources, and experiences of people affected by HCV. In the discussion sessions, viable solutions were identified to improve health and healthcare access for people with HCV and to prioritize certain actions. This project demonstrated that using the evaluation process can enable an instrumental, conceptual use of results and, in fact, can have a transformative impact on services organization.
authors: Canada Research Chair in Evaluation and Health System Improvement, Department of Community Health Sciences, Charles-LeMoyne Hospital Research Centre, Université de Sherbrooke, Sherbrooke, Quebec, Canada. Electronic address: astrid.brousselle@usherbrooke.ca.
authors: Astrid
authors: A
authors: Brousselle
authors: Estrie Regional Public Health Departement, Department of Community Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
authors: Geneviève
authors: G
authors: Petit
authors: Centre intégré de santé et de services sociaux de l'Estrie-Centre hospitalier universitaire de Sherbrooke -Installation Centre de réadaptation en Dépendance, Canada.
authors: Marie-Josée
authors: MJ
authors: Giraud
authors: Charles-LeMoyne Hospital Research Centre, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
authors: Michèle
authors: M
authors: Rietmann
authors: Psychoeducation, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
authors: Krystel
authors: K
authors: Boisvert
authors: Clinical Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
authors: Véronique
authors: V
authors: Foley
mesh_terms: D017144:Focus Groups; D006297:Health Services Accessibility; D006526:Hepatitis C / Q000517:prevention & control*; D006801:Humans; D018671:Needle-Exchange Programs; D017064:Process Assessment, Health Care; D011792:Quebec; D015819:Substance Abuse, Intravenous / Q000150:complications*
keywords: Access to care; Empowerment evaluation; Evaluation; Hepatitis C; Use