Exploration of the situated acceptability of a territorial health pathway

In the face of an aging population and the prevalence of chronic diseases, the World Health Organization (WHO 2022b) promotes the development of patient-centered, multi-professional, and multi-organizational care approaches, such as health pathways. While this integrative approach is being promoted in France, its deployment represents a major challenge, marking a break with the compartmentalised city/hospital approach. In aging rural areas like the Haut Cantal, which is landlocked and sparsely populated, the stakes are crucial to ensure access to quality healthcare. Our study delves into the local deployment of a territorial health pathway in this region, shedding light on the obstacles and levers to its successful acceptability. We employ the situated acceptance model (Bobillier Chaumon 2016; Lai et al. 2020), a comprehensive framework for analysing the acceptability of a management dispositive by examining users' relationships with the dispositive (personal dimension), with the work organization (organizational dimension), with other users (interpersonal dimension), and with their job (professional dimension). This model is particularly well-suited for our research, as it allows us to capture the multifaceted nature of the implementation process. The analysis of the qualitative data collected was conducted using a thematic approach, combining both a priori and a posteriori coding. This methodology was chosen to deepen our understanding of the modalities of acceptability in a specific rural context, taking into account the nuances and particularities unique to each interviewed actor. Our results show that the level of knowledge of this system varies significantly among professionals, leading to a fragmented acceptability of the health pathway. Several barriers to acceptability were identified, including cognitive overload, perceived loss of autonomy, and the reconfiguration of work collectives. Nevertheless, actions such as training and clear communication are promising avenues for improvement. This research contributes to knowledge on fostering successful public collaborations (Cristofoli, Meneguzzo, and Riccucci 2017) and expands the application of the situated acceptance model to a new context. Our findings proved valuable insights for effectively implementing territorial health pathways and promoting their acceptability by stakeholders, ultimately contributing to improving healthcare delivery in rural areas.