Institutional language and quality of life in the French medico-social field: from discursive governance to practice-with-many framework

Background Institutional discourse shapes how care, autonomy and participation are governed within the French medico-social field for autistic people and individuals with intellectual disabilities. Although the Quality of Life (QoL) paradigm is prominent in policy documents, little is known about how its dimensions appear in the everyday language of service organisations. This study examines how institutional communication frames inclusion and support, and how these discursive patterns align with or diverge from multidimensional QoL models. Methods We analysed a national corpus of 4,813 publicly available service charters (projets de service) from French medico-social organisations. A mixed-methods design was used: (1) computational topic modelling with Latent Dirichlet Allocation to identify latent thematic structures; and (2) qualitative interpretive analysis to examine how autonomy, rights, participation and support are semantically framed. Interpretation followed the multidimensional QoL framework, focusing on material, bodily, relational and psychological domains. Results The topic model revealed a coherent discursive configuration centred on project-based care, developmental rationalities and symbolic commitments to inclusion. Across the corpus, psychological, relational and developmental dimensions of well-being dominated, while physical, material and socio-economic aspects were consistently marginalised or rendered implicit. This imbalance indicates a partial translation of the QoL model, privileging relational and developmental ideals over embodied and material conditions of daily life. Conclusions Institutional language reproduces a selective interpretation of QoL, emphasising relational and psychological components while underrepresenting bodily, material and socio-economic domains essential to everyday well-being. Drawing on institutional psychotherapy and disability studies, we propose the notion of practice-with-many (pratique-à-plusieurs) as a collective, reflective counter-model capable of reintroducing embodiment, dependence and shared vulnerability into the governance of care. QoL emerges as a situated, relational and institutional construct shaped by everyday service practices rather than solely by policy frameworks.