The question of trust is crucial in the field of health because health is indicative of particularly strong issues, be it societal, regulatory, institutional or individual as well as because the boundaries between specialized information validated by legitimate bodies such as institutions or professionals of the sector and information that has not been validated have become permeable. The final reason is that trust appears to be central within relationships between actors in the field, whether they are professionals, patients, public authorities, companies or health organizations. The issue of trust is most often dealt with from the viewpoint of the relationship between patients and health professionals or between users and their health system [JAU 03, SAO 09].

In this book, we propose a method of addressing trust in terms of information and communication phenomena that are at work in the health sector and consider the process of building the legitimacy of information in the health sector.

The forms of production, editorialization and mediation of specialized information in the field of medicine have undergone a large number of changes in recent years, particularly under the influence of information and communication technologies. These developments have affected the health information sector, considered here as information for the general public, especially through the development of discussion forums and websites for generalists and most often from private players. Specialized medical information, which is part of the field of professional information and intended for industry players (especially health professionals), has also undergone profound changes. Traditionally produced by the public sector or specialized publishers, it has seen the multiplication of production bodies: pharmaceutical laboratories, patient associations, doctors, etc.; information validation circuits, where they exist, have also diversified.

These transformations accompany other developments in the field of medicine. The development of the medical Internet, the setting up of patient files and telemedicine have led us to reexamine the question of confidence in the field of health, whether it is in the relationships between actors, compared to the information found on the Internet, disseminated by institutions or obtained from professionals, or in relationships that are formed with information-communication devices, including medical information systems. Finally, discourses on patient empowerment, whether they come from public authorities or health institutions, lead us to consider this movement by questioning the notions associated with it, such as autonomy, understanding, participation or even trust.

The Trésor de la Langue Française defines trust as the “spontaneous or acquired belief in the moral, emotional, professional value … of another person”. According to the philosopher Michela Marzano, trust refers to the idea that one can trust someone or something. In particular, she wrote, “the verb confide (from the Latin confidere: cum, with and fidere, proud) means, indeed, that something precious is given to someone, trusting him and thus abandoning yourself to his goodness and his good faith” [MAR 10]. Thus, we trust a person or device that we consider reliable based on our own criteria. Confidence also refers to a sense of security: a “climate of trust” evoking a situation that appears reassuring. In the presentation of one of the Réseaux editions published in 2001 about trust, Louis Quéré was interested in its other aspects, such as the inter-organizational trust mentioned by Edward Lorenz and the conditions favoring it.

Here, we connect trust and legitimacy by proposing to question the way in which the legitimacy of information is built, particularly in information-communication devices in the field of health. Certifying health information sites by the Health On the Net (HON) Foundation, accredited by the Haute Autorité de Santé (HAS), is an example of the legitimization of health information intended to give reliability that provides guarantees and, therefore, trust to users. However, the conventional criteria of peer evaluation as practiced in the context of scientific publication activity cannot be applied during mass dissemination of medical information, since health professionals cannot respond to a large number of requests. Validation of content is lacking [REN 09]; legitimacy is exercised in the field of information quality, certified or labeled, which can be identified by a logo said to be “of quality”. In this context, the legitimacy conferred by the attribution of a quality logo appears above all as a guarantee of credibility for site publishers, which does not necessarily result in a higher visitor rate. This raises the question of the criteria used by Internet users to trust health information sites, as well as the question of the different forms of certification put in place by producers of health information services.

Sociology highlights the confidence crisis that has affected medicine and its impact on professional territories [AÏA 94, BRO 94]: an increase or decrease in medical power, leading to a loss of influence of physicians on public policy decisions [HAS 99]; a change in the relationship between physicians and patients due to widespread access to information on the Web; a judicialization of medicine [LAN 04] and, finally, the development of self-medication practices [FAI 12]. This loss of confidence has various consequences for the information practices of patients and health professionals alike, which need to be studied carefully. The motivations that lead players in situations of distrust to use information are questioned here.

This book is composed of 12 chapters and several theoretical reflections, case studies and much feedback considering trust and the process of legitimizing information and communication in the field of health. In these chapters, the issue is addressed either in a professional context, within institutions, in companies and in healthcare organizations, where trust is most often considered in relation to internal information-communication devices, public health policies and actors in the field of health; or in an individual approach, where trust is generally addressed in the context of relationships between citizens and public authorities or medical professions.

Four chapters situate their investigations in a personal and familial context. Confidence is envisioned especially when citizens are asked to inform themselves in order to make a decision related to their health or that of their relatives.

Vaccination is discussed in Chapters 1, 2 and 3, first by Mylène Costes, who questions the information sources that parents use to vaccinate their children; then by Maryline Vivion, who discusses the hesitation of young parents to vaccinate, considering this approach as favoring the development of an informational habitus allowing us to apprehend a large amount of contradictory information on the subject and finally by Ève Dubé and Dominique Gagnon, who specifically address the impact of information sources on decision-making in the event of vaccination.

In Chapter 4, Clément and Denis Dussarps focus on the information-communication practices of parents of autistic children on the Web.

Eight chapters in this book consider the question of trust in a professional and organizational context.

The study presented in Chapter 5, written by Anna Lezon-Rivière and Madjid Ihadjadène, is associated with the French Army and analyzes the relationship between confidence and information practices of flight nurses in emergency situations.

Chapters 6 and 7 focus on trust in the prism of public health and health communication policies. In Chapter 6, Omrane Dorsaf and Pierre Mignot address online communication practices in the face of the confidence crisis in the prevention of breast cancer. Nathalie Verdier, in Chapter 7, analyzes, through the case of music therapy, the role of information activity in the process of building trust between players centered on a care practice that is not well recognized on the public policy scene and in the French health system.

In Chapters 8 and 9, the authors discuss trust between players in the field of health. Pamela Baillette and Michel Mannarini, in Chapter 8, are interested in the interrelations between the players involved in the process of care and processing of information in hospitals, and wonder more specifically about the role played in the matter by internal medicine, in charge of coordinating and integrating care. In Chapter 9, Aurélia Dumas questions the obstacles encountered when establishing a relationship of trust within a health service at work.

Connected health is dealt with in Chapter 10 by Adrian Staii. The author is interested in devices, the uses that are made of them and the political and societal issues they reveal.

Finally, Chapters 11 and 12 propose a reflection on trust in relation to information-communication devices. Géraldine Goulinet-Fité and Didier Paquelin, in Chapter 11, analyze the co-use of an information-communication device among elderly patients, close caregivers and nursing staff, centered around the functions of help, support and assistance inherent in “caring” at home. In Chapter 12, Roxana Ologeanu and David Morquin study the place of the computerized patient file in doctoral practices and show, in particular, the difficulties in organizing the information contained in the CPF with regard to the very large number of players and their diversity.

Introduction written by Céline PAGANELLI.