The diffusion of e-health tools and services by users: the example of “Mon espace santé” in France[La diffusion des outils et services e-santé auprès de leurs utilisateurs : l’exemple de « Mon espace santé » en France]

Government authorities aim to capitalize on the opportunities offered by digital technology in healthcare to improve patient information and care while addressing health disparities across regions. However, in France, while the digital transformation of the healthcare sector has advanced significantly over the past fifteen years, its outcomes have been highly variable and, at times, still quite disappointing. To strengthen and accelerate this digital transformation, numerous studies have detailed the mechanisms and factors that promote the adoption and use of digital health tools and services. In contrast, far fewer studies have focused on the phase of disseminating these tools and services to users, even though this phase significantly determines their adoption and use. To address this gap, drawing on the theory of diffusion of innovations, we propose to analyze the methods of dissemination to users of the "Mon espace santé" tool proposed and implemented by the French National Health Insurance Fund. Based on participant observation within the teams responsible for disseminating this tool, we describe the elements of dissemination for this digital innovation (social system, innovation, communication channels, time). The results of this analysis allow us, initially on a theoretical level, to propose an initial framework for analyzing the diffusion of digital innovations in healthcare. Applying this analytical framework then enables us to characterize the modes of diffusion of "user-centered" digital innovation in healthcare alongside those related to its design, which are already well-documented in the literature. These modalities are described through the main components of the diffusion of "Mon espace santé" (different user roles, communication channels used, and stages of diffusion) and three of its guiding principles (user-as-actor, State-as-platform, and user-centered incentive-based deployment). On a practical level, these dissemination components and principles offer avenues for improving the dissemination of digital health innovations in the public sector.