Abstract
This paper-based dissertation discusses the design of telerehabilitation (TR) projects in chronic diseases (CD), and more specifically with the complexity and rigour required in the design of TR. The major contribution of the thesis concerns the proposal of a new actionable scientific approach, based on academic knowledge crossed with Information Systems and Marketing in the sector of e-health, enabling field actors to act to promote the optimization of a TR design project. Specifically, by identifying what has been evaluated in TR and then integrating stakeholders and the patient user, we sought to find out how to promote the success of a TR design project. In order to do this, we first propose to gain an overview of the domains and processes of TR assessment in the context of CD. In the first manuscript, we conclude that there is a need for multidisciplinarity and comprehensiveness in TR assessment and confirm that little attention is paid to the TR design phase. As such, we decide to investigate further the complex nature of design projects faced by the different stakeholders. With the help of a case study on a design project of telerehabilitation device in which we are involved, we present in manuscript 2 an example of the challenges encountered when the organization is confronted with the persistence of paradoxes. We show that the different inter-organizational actors, present in the design project, make use of boundary objects when the paradox, linked to the place of the patient as a stakeholder in the design, persists over time. Following an in-depth analysis of the first results of this case study, we identify other challenges on the projects that are faced by the different stakeholders. In manuscript 3, we then expose how the organizational legitimacy of a TR design project is constructed, which is an original vision in the understanding of an IT design project. In particular, our data show that the repair of legitimacy is located at the symbolic level around a 'dormant' stakeholder, the patient, thus creating cohesion between the project actors. The fourth manuscript finally presents a new field of research, where the patient was not a stakeholder in the design because it is implemented in a health emergency situation. Within a health network helping chronic respiratory patients, this latest thesis work, currently in progress, aims to present the way in which the patient lives this post-implementation TR experience. Our focus is on the patient pathway integrating TR with a double objective: on the one hand, to deepen the understanding of this pathway by reconstructing the patient "experience" and, on the other hand, to identify the impact on the design process of a new e-health service such as TR. The discussion of the thesis addresses the conditions for the success of the interdisciplinary scientific approach proposed by the work of this thesis, the choice of situations to which it is applied and the research perspectives that result from it.