Toward a community-centred approach to healthcare

Abstract In the face of growing medical scepticism and institutional distrust, this article sketches an integrated framework to examine the interplay between public health controversies and clinical interactions. Situated within Community-Centred Approaches (CCA) and participatory public health, the framework employs tools from medical argumentation to show how doubt in healthcare interactions marks a crucial site where communicative and interpretive expertise are essential and trust is actively negotiated — a site that requires participatory practices capable of responding to and repairing it through dialogical engagement and reason-giving. Building on the concept of argumentative potential , it analyses clinical dialogue as the core community in which institutional legitimacy and interpersonal trust are negotiated. A case study on vaccine hesitancy illustrates how expressions of doubt can activate different argumentative potentials — ambivalent, sceptical, or denialist — each opening or closing discursive trajectories that either foster or erode trust. The paper advances the notion of argumentative participation as a key condition for discursive trust, illustrating how clinical dialogue can serve as a site of participatory repair, understood as the active rebuilding of trust through dialogue and shared reasoning, within broader public health controversies.