BACKGROUND: Health mediation practices are multiform-as they constantly adapt to the context-and multilevel, making any study of health mediation complex. Given this background, some authors in interventional health research working on the complexity of interventions highlighted the need for a solid conceptual framework-upstream of any evaluation-that considers all the specificities of the intervention and the context. The present realist qualitative study aimed to deepen our understanding of how health mediation could foster healthcare utilization. METHODS: We conducted a realist qualitative study from May 2021 to September 2022 in France using eighteen semi-structured interviews of professionals implementing health mediation. The themes investigated were their professional framework, activities, and perception of factors facilitating and limiting the effect of health mediation on the fostering of healthcare utilization by underserved populations. Data was analyzed to develop a taxonomy of health mediation activities and to hypothesize initial middle-range theories necessary to explain the effect of health mediation on healthcare utilization. Results were amended and adjusted at four consensus seminars in February 2023. RESULTS: The taxonomy comprised 59 activities grouped into standardized categories into three dimensions: the territorial structuring of health mediation, the coordination and steering of response actions, and healthcare system navigation. We identified three initial middle-range theories that could explain how health mediation might foster healthcare utilization among underserved populations. Specifically, these theories suggested two prerequisites for effective health mediation. The first would be the need for a community of practice to help the healthcare system adapt to the problems and needs of underserved populations. The second would be the need to foster the intention to use the healthcare system, based on the targeted populations" perceived and unperceived health needs. In turn, this could encourage effective healthcare utilization for these populations. DISCUSSION: Health mediators might complement the work of all other healthcare and social workers to respond proportionately to the needs and different vulnerabilities of underserved populations. In this way, health mediation promotes the right to good health and fosters healthcare utilization.
Auteur : Richard Elodie, Ramiz Leila, Oltean Mara, Troussier Vanina, Ulracher Caroline, Speed Olivia, Conort Muriele, Coutant Cécile, Chaves Quirino Fréderique, Martin Fernandez Judith, Vandentorren Stéphanie, Cambon Linda
BMC public health, 2025, vol. 25, n°. 1, p. 1917
