Nursing self-efficacy for oral anticoagulant therapy management: Development and initial validation of a theory-grounded scale.

AIM: This study aimed to develop and validate a nursing self-efficacy scale for OAC management (SE-OAM). BACKGROUND: Oral anticoagulant therapy (OAC) requires specific nursing competencies. Given that self-efficacy acts as a proxy assessment of nursing competence, its measurement is pivotal for addressing educational programs to enhance nursing competence in managing OAC. Thus far, the measurement of self-efficacy in OAC is undermined by the unavailability of valid and reliable tools. METHODS: A multi-method and multi-phase design was adopted: Phase one was a methodological study encompassing developmental tasks for generating items. Phase two comprised the validation process for determining the content validity, construct and concurrent validity, and internal consistency through two cross-sectional data collections. RESULTS: In total, 190 nurses were enrolled for determining the psychometric structure of the SE-OAM through an exploratory approach, and 345 nurses were subsequently enrolled to corroborate its most plausible factor structure derived from the exploratory analysis. The SE-OAM showed evidence of face and content validity, adequate construct, concurrent validity, good internal consistency, and stability. The final version of the scale encompassed 21 items kept by five domains: clinical management, care management, education, clinical monitoring, and care monitoring. CONCLUSIONS: The SE-OAM showed evidence of initial validity and reliability, fulfilling a current gap in the availability of tools for measuring nursing self-efficacy in managing OAC. SE-OAM could be strategic for performing research to improve the quality of OAC management by enhancing nursing self-efficacy.

Burnout syndrome and its determinants among healthcare workers during the first wave of the Covid-19 outbreak in Italy: a cross-sectional study to identify sex-related differences.

INTRODUCTION: Several studies described burnout levels of healthcare workers (HCWs) during the COVID-19 pandemic; however, sex-related differences remain poorly investigated. OBJECTIVE: To describe sex-related differences in burnout and its determinants among HCWs during the first pandemic wave of the COVID-19 in Italy. METHODS: A cross-sectional study was performed between April and May 2020. The framework given by the Job Demands Resources (JD-R) model was used to assess burnout determinants (risk and protective factors). RESULTS: Male HCWs (n=133) had higher levels of depersonalization than female HCWs (P=0,017) and female HCWs (n=399) reported greater emotional exhaustion rates (P=0,005). Female nurses were the most exposed to burnout (OR=2,47; 95%CI=1,33-4,60; P=0,004), emotional exhaustion (OR=1,89; 95% CI=1,03-3,48; P=0,041), and depersonalization (OR=1,91; 95% CI=1,03-3,53; P=0,039). Determinants of burnout differed between sexes, and some paradoxical associations were detected: the score of job demands was a protective factor in females for burnout, emotional exhaustion, and depersonalization, resilience was a risk factor for males. CONCLUSIONS: This study reveals that the stressors in male and female HCWs tended to be associated with burnout differently. Both sexes showed alarming burnout levels, even if the weights of emotional exhaustion and depersonalization acted in different ways between the sexes. The revealed paradoxical effects in this study could reflect the study's cross-sectional nature, highlighting that more resilient and empathic individuals were more consciously overwhelmed by the challenges related to the COVID-19 pandemic, thus reporting higher scores of emotional exhaustion and burnout. Future in-depth and longitudinal analyses are recommended to further explore sex-related differences in burnout among HCWs.

A multi-phase study for the development of a self-efficacy measuring scale for ostomy care nursing management.

AIM: To develop and psychometrically test a self-efficacy scale for ostomy care nursing management. DESIGN: This study adopted a multi-method and multi-phase design. METHOD: Phase 1 of the study was comprised of the developmental tasks, where items were generated based on the emergent themes from literature. The items were then discussed with a panel of experts. Phase 2 focused on the validation process of the scale, where its content validity, construct and concurrent validity, and its internal consistency were assessed. The validation process was conducted between January 2018 - January 2019. RESULTS: The final version of the self-efficacy scale in ostomy care nursing management encompasses 24 items in three domains, namely the clinical assessment domain, the education and relationship domain, and the teamwork domain. The scale showed the evidence of face and content validity, adequate construct and concurrent validity, and adequate internal consistency. CONCLUSION: The developed scale can be used in clinical and educational research. IMPACT: This study presents the development and validation of the first valid and reliable self-reporting measurement for nurses' self-efficacy in ostomy care nursing management. Self-efficacy ostomy care nursing management encompasses 24 items and three domains, which are clinical assessment, education and relationship, and teamwork. This research will have an impact on nursing education, as it addresses the need for a specific self-efficacy assessment of ostomy care nursing management. Self-efficacy ostomy care nursing management will have an impact on nurses and patients, as it can be used to improve nurses' self-efficacy and clinical outcomes for patients in ostomy care.

Development and validation of the pressure ulcer management self-efficacy scale for nurses.

BACKGROUND: Pressure ulcers (PUs) represent a current issue for healthcare delivery. Nurse self-efficacy in managing PUs could predict patients' outcome, being a proxy assessment of their overall competency to managing PUs. However, a valid and reliable scale of this task-specific self-efficacy has not yet been developed. OBJECTIVES: To develop a valid and reliable scale to assess nurses' self-efficacy in managing PUs, that is, the pressure ulcer management self-efficacy scale for nurses (PUM-SES). METHODS: This study had a multi-method and multi-phase design, where study reporting was supported by the STROBE checklist (File S1). Phase 1 referred to the scale development, consisting in the items' generation, mainly based on themes emerged from the literature and discussed within a panel of experts. Phase 2 focused on a three-step validation process: the first step aimed to assess face and content validity of the pool of items previously generated (initial version of the PUM-SES); the second aimed to assess psychometrics properties through exploratory factorial analysis; the third step assessed construct validity through confirmative factorial analysis, while concurrent validity was evaluated describing the relationships between PUM-SES and an established general self-efficacy measurement. Reliability was assessed through the evaluation of stability and internal consistency. RESULTS: PUM-SES showed evidence of face and content validity, adequate construct and concurrent validity, internal consistency and stability. Specifically, PUM-SES had four domains, labelled as follows: assessment, planning, supervision and decision-making. These domains were predicted by the same second-order factor, labelled as PU management self-efficacy. CONCLUSION: PUM-SES is a 10-item scale to measure nurses' self-efficacy in PU management. A standardised 0-100 scoring is suggested for computing each domain and the overall scale. PUM-SES might be used in clinical and educational research. RELEVANCE TO CLINICAL PRACTICE: Optimising nurses' self-efficacy in PU management might enhance clinical assessment, determining better outcomes in patients with PUs.

'Nosce te ipsum': An Italian national survey to explore choice's differences in End of Life (EoL) care between healthcare professionals and general public.

BACKGROUND: The current debate regarding decision-making at the End-of-Life (EoL) is increasing remarkably and has spread all over the world. However, literature has paid little attention to describe choice's differences in EoL care between healthcare professionals and general public. OBJECTIVES: The aim of this study was to explore the difference between choices in EoL care made by healthcare professionals and those of the general public within the Italian context. SETTING AND PARTICIPANTS: In 2017, an Italian widespread survey was conducted using a snowball sampling. A total of 2038 participants completed the survey, 55.64% of which were the general public. RESULTS: The main differences related to specific EoL choices made by healthcare professionals and the general public. In particular, healthcare professionals were more likely to avoid cardiopulmonary resuscitation and mechanical forms of breathing in terminal-stage conditions, and they were also more likely to be favorable towards the use of opioids to avoid suffering. Overall, healthcare professionals were also more likely to make a choice rather than express a 'not sure' answer. CONCLUSION: The higher percentage of participants in the general public group that chose 'not sure' highlighted the importance of addressing and enhancing people's self-awareness. More cross-national investigation should help to frame the understanding of the choice's differences in EoL care between healthcare professionals and general public.

Ostomy Adjustment Inventory-23 (OAI-23): Development and Testing of the Italian Version.

PURPOSE: The purpose of this study was to evaluate the validity and reliability of the Italian version of the Ostomy Adjustment Inventory-23 (OAI-23). DESIGN: This is a methodological study evaluated psychometric properties of the OAI-23. SUBJECTS AND SETTING: A sample of 230 patients with an ostomy was enrolled in an Italian university hospital from May to September 2017. METHODS: This study comprised two phases; during phase 1, the cultural-linguistic translation of the OAI-23 into Italian was completed. In addition, content and face validity were tested. In phase 2, psychometric testing of the OAI-23 was conducted in a cross-section sample of 258 Italian patients with a fecal ostomy. RESULTS: The Italian version of the OAI-23 presents 23 items giving a 3-dimensional structure: acceptance, negative feelings, and social engagement. Accordingly, this 3-dimensional structure arise from an exploratory factorial analysis with the maximum likelihood robust estimator (RMSEA = 0.089 [95% CI = 0.063-0.113; P = .05], and CFI = 0.901, explaining 44% of the total variance). The internal consistency of the OAI-23 was good (Cronbach α for acceptance = 0.91; for negative feelings = 0.87; for social engagement = 0.93; for overall scale = 0.91). CONCLUSIONS: The OAI-23 provides a valid and reliable assessment of patients' psychosocial adjustment to an ostomy. It provides important resource for clinical decision-making; for example, it may be used to design or tailor educational strategies to enhance psychosocial adjustment following creation of an ostomy.

International Nursing: GSD International Nursing Academy: An Italian Case of Practical Disruption Highlighting the Worth of Nursing Within Health Care Organizations.

It is strategic to describe and disseminate available examples of how nurses find the modus operandi to being fully integrated in their organizations, including the nurse role in determining improvements in clinical practice, management, education, and/or research. This article describes the recent experiences of Gruppo San Donato International Nursing Academy. The disruptive case shared here underlines the worth of nursing within health care organizations. The Gruppo San Donato International Nursing Academy aims to be a striking model to innovate health care delivery through the optimal utilization of the nursing workforce, uniting the areas of nursing management, nursing education, and research into a unique organizational platform.

[Mixed method sequential study on the barriers underpinning a new patient centred care model implementation: the nurses' perspectives]. / Studio con metodo misto sequenziale sulle barriere che ostacolano l'implementazione di un nuovo modello organizzativo patient centred care: la prospettiva infermieristica.

INTRODUCTION: Comparison of the state of nursing in Italy with other countries has shown that theory development in Italian nursing remains quite undeveloped. Theory development in Italian nursing will need to consider local cultural and professional aspects, specific to the Italian practice context, by drawing on known health needs, experiences and nursing approa- ches. The aim of this investigation was to map current knowledge related to nursing in Italy, based on the experiences of patients, families and communities, to provide a basis on which nursing theories could be developed. METHODS: Scoping Review was selected as the best method for this knowledge mapping. Fawcett's nursing metaparadigm was chosen as a broad guide and means by which the litera- ture analysis could be structured. RESULTS: Twenty-two studies were retained and examined in this analysis, including contexts relating to acute care, chronic conditions, as well as emergency and home care services. We defined themes in line with the nursing metaparadigm. Although these definitions are partial, referring only to certain contexts specific to some aspects of nursing care, the original contributions of this investigation provides an important starting point for theory development in Italian nursing, based on the Italian context. CONCLUSION: Strong and credible theory development, that can be readily adapted to practice, requires a rigorous analysis of the points of view of all actors involved in the nursing care process.

The Italian Version of the Opening Minds Stigma Scale for Healthcare Providers: Validation and Study on a Sample of Bachelor Students.

Prejudices on psychiatric disorders frequently turn into stigmatizating attitudes, also among health care providers. The Opening Minds Stigma Scale for Health Care Providers (OMS-HC) was introduced in 2012 to measure stigma. No Italian versions of this tool exist so far. We wanted to investigate stigma among healthcare students in Italy, and to prepare an Italian version of the scale. A multicentric, cross-sectional study was conducted on a sample of Nursing, Physiotherapy, Occupational therapy, and Dietistics students. The Italian version of the scale was obtained through back-translation.561 students were enrolled, median age 21 years, IQR [20;23], 62.22% females (n = 349). 262 students declared having met subjetcs affected by psychiatric disorders during their training; 50 had one or more psychiatric disorders in their lives. The Italian version proved valid and reliable. Older students had lower stigma scores. No differences existed between stigma scores according to gender and personal experience of mental illness.

Highlights from 2013 Consociazione Nazionale Associazioni Infermieri (CNAI) Conference: reflections and addresses for Italian nursing.

This conference intends to boost the reflection on the state of nursing in Italy, which began with the XV National Congress of National Consociation of Nurses Associations and Other Health Social Workers (CNAIOSS) held in Naples in 1996. Today the name of the association is National Consociation of Italian Nurses (CNAI) (Desimio et al, 1998). After 17 years, it seems urgent to re-read the stretch of progress made in nursing science and identify future directions for the Italian nursing, in this period of rationalization of resources and economic crisis. The congress activities intend to deepen Italian debate within the profession on the state of the art and discipline, starting from the changing of many elements such as: healthcare setting, diffusion information technology, contents of education and especially the care needs of the population. The conference is designed to answer to some stated aims: - to set the nursing science within the wide context of the health sciences with particular reference to Italy; - to reflect on the state of the art and culture of nursing in Italy; - to acquire theoretical and methodological elements useful to strengthen and redefine their identity as nurse practitioners; - to identify the reasons why it is urgent to choose and use a common language in nursing clinical education, training and organization; - to learn from the sharing of the care planning experience and from the knowledge of different languages acquired by Italian realities. The conference follows the tradition of CNAI and intends to continue its contribution to the evolution of the theoretical and methodological aspects that found nursing practice in Italy.

A stepwise methodological approach to develop and validate the digital and technological self-efficacy scale for healthcare workers among nurses and nursing students.

AIMS: To develop and validate the Digital and Technological Self-Efficacy Scale (Digitech-S) for healthcare workers among nurses and nursing students. BACKGROUND: Digital and technological solutions (DTS) significantly impact working life in healthcare and educational settings. DTS-related self-efficacy might be defined the individual's confidence in proficiently performing digital and technological tasks, even when faced with challenges. Its assessment might guide educators in orienting focused interventions to enhance the self-efficacy of nurses and nursing students. Thus far, the assessment of DTS-related self-efficacy is currently undermined by the lack of valid and reliable measurements. DESIGN: A stepwise methodological approach was employed in two main phases. Phase one focused on tasks guided by literature for generating items reflecting DTS. Phase two encompassed three steps: A content validity step, a first cross-sectional data collection for Mokken scaling analysis (MSA) performed to reduce the number of items toward a unidimensional structure and with a hierarchical approach, and a confirmatory factor analysis including the group (nurses vs. nursing students) as a covariate (MIMIC) to cross-validate the unidimensional structure and assess the measurement invariance using a second cross-sectional data collection round. A Multi-Group Confirmatory Factor Analysis (MG-CFA) was also conducted to test for configural, metric, scalar, and strict invariance across the two groups. RESULTS: Phase one resulted in 36 items derived from a literature review, which was reduced to 33 after the content validity process. 660 responders (nurses = 388; nursing students = 272) were included in the sample analyzed with MSA, and 13 items were hierarchically selected for the subsequent data collection (Rho reliability = 0.95; Hs = 0.67; Hi ranging from 0.55 to 0.72). MIMIC models were performed on 421 responders (nurses = 268; nursing students = 153), and three items that caused non-invariance between nurses and nursing students were identified and removed from the final version (Cronbach's alpha = 0.928). The MG-CFA demonstrated configural and metric invariance, suggesting a consistent factor structure and factor loadings across both groups, but scalar and strict invariance were not fully achieved. CONCLUSIONS: The Digitech-S is a 10-item scale showing a unidimensional and stable structure, which could be used for educational and research purposes.

Development and Psychometric Validation of the Nursing Self-Efficacy Scale for Managing Cancer Treatment-Induced Cardiotoxicity: An Exploratory Mixed-Method Study.

OBJECTIVE: Assessing nursing self-efficacy could be strategic to sustain nursing competence. This study aimed to develop and validate the nursing self-efficacy scale for managing cancer treatment-induced cardiotoxicity (NSS-CTC). DATA SOURCES: An exploratory mixed-method study was performed by including two main phases. The first comprised the developmental tasks to generate the initial pool of items, including a literature review and a consensus meeting based on a nominal group technique. The second phase initially involved an external panel of experts in assessing the content validity of the novel scale, followed by a cross-sectional data collection to perform exploratory factor analysis by employing a multicenter and convenience sampling approach. The most plausible psychometric structure derived from the exploratory factor analysis was tested with a confirmatory factor analysis using a second data collection round on another sample enrolled with a multicenter and convenience sampling approach. Internal consistency was assessed using Cronbach's alfa. CONCLUSION: The NSS-CTS is a novel 15-item self-report measure for assessing nurse self-efficacy in dealing with cancer treatment-related cardiotoxicity. Its two plausible domains were labeled knowledge-related self-efficacy (Cronbach's α = 0.924) and practice-related self-efficacy (Cronbach's α = 0.937); the factor analyses in both samples showed adequate fit to sample statistics. Future studies are necessary to corroborate its construct validity and assess its measurement invariance across various country contexts. IMPLICATIONS FOR NURSING PRACTICE: Assessing nursing self-efficacy for managing cancer treatment-induced cardiotoxicity is a promising approach for identifying educational gaps and promoting nursing competency in this particular area of cancer care.

Does the Synergy Model Implementation Improve the Transition from In-Hospital to Primary Care? The Experience from an Italian Cardiac Surgery Unit, Perspectives, and Future Implications.

The demand for care services in the healthcare system has changed and is triggering a smooth transition from in-hospital to primary care. In this regard, patient-centered-care models of care delivery might provide a framework to follow patients' journeys throughout their transition between different levels of care. Accordingly, an Italian research group at a cardiac hospital in Northern Italy implemented the Synergy Model in a Cardiac Surgery Unit, a patient-centered-care model, and is using the framework of the model to guide a smooth transition of patients towards rehabilitation and primary care after their hospitalization. This discursive paper is focused on the experience, perspectives, and future implications of adopting the Synergy Model to facilitate the transition from in-hospital to primary care. The presented experience and discussion might be helpful to the international debate regarding the strategies to boost a smooth transition from in-hospital to primary care.

From classroom training to e-learning: a journey through the quality of learning life of nurse students in post-graduate education - A longitudinal qualitative study.

BACKGROUND AND AIM: recent studies regarding COVID-19 experiences of nursing students highlighted the effect of the transition from face-to-face to online education, rather than the complexity of the overall quality of educational life. This study aim investigating of how the students perceive the quality of educational life in the forced online training, searching for any shift of meanings concerning the students learning experience, from the first phase of the sudden transition to online and the online stabilization phase. METHODS: a longitudinal qualitative study, carried during two moments of the online teaching activity forced by COVID-19, the first one in May-June 2020 and the second six months later in January -February 2021. A convenience sample of 24 students attending post-graduate courses for health professions recruited at University of Parma, answered in-depth interviews, videotaped, verbatim transcribed and analyzed using the Braun and Clarke model. RESULTS: five themes emerged from meaning shift of data collection: reactions to change in educational life; factors favoring a new quality of educational life; factors hindering the perception of the quality of educational life; adaptation strategies to the new educational life; tools and strategies to facilitate communication and the absence of the classroom. CONCLUSIONS: participants perceive advantages of online teaching, on quality of their educational life. The issue of how to create opportunities for internship period remains open. Further research to understand online internship and exploring what extent it is essential to propose it in face-to-face modality.

Burnout and post-traumatic stress disorder in frontline nurses during the COVID-19 pandemic: a systematic literature review and meta-analysis of studies published in 2020.

This study aimed to systematically synthesize evidence regarding burnout and post-traumatic stress disorder (PTSD) among nurses engaged in the frontline during the COVID-19 pandemic, highlighting their risk and protective factors. The specific literature on nurses' mental health outcomes still remains not synthesized. A systematic review was performed (PROSPERO: CRD42021227939), searching literature published in 2020 on Pubmed, Scopus, CINAHL, and PsycInfo. We quantitatively pooled means of included studies measuring burnout and PTSD with the same tools. Twenty-five studies were included in this review. Seven (3766 nurses) were included in the meta-analysis for estimating means of depersonalization and emotional exhaustion assessed using the Maslach Burnout Inventory, respectively: 7,40 (95%CI=6,00-8,80) and 22,82 (95%CI=19,24-26,41). Likely, 12 studies were used to estimate two pooled means for PTSD, one for six studies adopting the Impact of Event Scale-Revised (1551 nurses), and six adopting the PTSD Scale for DSM-5 (8547 nurses). The main risk and protective factors of both outcomes were female sex and younger age, work-related variables, and physical and mental factors, such as concerns, skin lesions from wearing personal protective equipment. This systematic review portrayed the situation described in literature during 2020 on nurses' burnout and PTSD during the COVID-19 pandemic. Although the outcomes' levels described in the included studies are diverse, the broad situation appears alarming, and supportive multi-level strategies, considering individual and system-level, should be planned to decrease the described worsening scenario within the clinical settings avoid middle and long-term negative consequences.

Effects of Mutuality, Anxiety, and Depression on Quality of Life of Patients With Heart Failure: A Cross-Sectional Study.

This study aimed to describe the impact of mutuality, anxiety, and depression on quality of life (QoL) in patients with heart failure (HF) using cross-sectional, convenient, and consecutive sampling. A total of 97 patients were recruited. Socio-demographic and clinical variables and self-report measures of anxiety, depression, mutuality, and QoL were collected. The results highlighted the pivotal role of mutuality (specifically the domain of shared values between patients and their caregivers) in determining perceptions of physical health. Conversely, depression was a negative determinant of perceptions of both physical and mental health. Future research is needed to describe in-depth and longitudinally the associations between mutuality and QoL in patients with HF.

Modified Research Utilization Questionnaire: Development and Validation Study among Italian Nurses.

PURPOSE: The purpose of this study was to develop the modified research utilization questionnaire (M-RUQ) and to establish its content and face validity, construct validity, and reliability. METHODS: This study has a multiphase (three phases), methodological, and cross-sectional design. First, research utilization questionnaire (RUQ) was translated into Italian, which is the target language to develop the M-RUQ. Second, the RUQ psychometric proprieties were assessed using exploratory factorial analysis to identify ambiguous or problematic items (e.g., cross-loadings) (cross-sectional sampling A). The RUQ modification (i.e., item deleting, wording modification, and scoring procedure) represented the development of the M-RUQ among Italian nurses. The third phase was aimed to confirm the construct validity of the M-RUQ and to test its stability and internal consistency (cross-sectional sampling B). RESULTS: This study's findings show that M-RUQ has a three-dimensional structure and a total of 22 items. The M-RUQ shows evidence of validity and reliability. Precisely, the factorial structure coming from an exploratory factorial analysis on the first sample (n = 504) was confirmed by a final model of confirmatory factorial analysis (CFA) on a second sample (n = 362). The final CFA model showed adequate goodness of fit, where all the factor loadings showed values higher than .40. Cronbach's α was satisfactory for each domain and for the overall scale. Furthermore, the M-RUQ showed good stability described by the test-retest. CONCLUSION: The M-RUQ should be used to assess research utilization among nurses for educational or research purposes to address the practice. Further research about its validity and reliability is suggested.

Paradox of self-care gender differences among Italian patients with chronic heart failure: findings from a real-world cross-sectional study.

AIM: The aim of this study was to critically analyse and describe gender differences related to self-care among patients with chronic heart failure (HF). METHODS AND RESULTS: A monocentric real-world cohort of 346 patients with chronic HF in follow-up was used for this cross-sectional study. We report data related to the cohort's demographic and clinical characteristics. Self-care was assessed using the Self-Care of Heart Failure Index before patients' discharge. After bivariate analysis, logistical regression models were used to describe the relationship between gender, self-care behaviours and self-care confidence. While men were found to have more than quadruple the risk of poor self-care than women (OR 4.596; 95% CI 1.075 to 19.650), men were also found to be approximately 60% more likely to have adequate self-care confidence than women (OR 0.412; 95% CI 0.104 to 0.962). Considering that self-care confidence is described as a positive predictor of behaviours, our results suggest a paradox. It is possible that the patient-caregiver relationship mediates the effect of confidence on behaviours. Overall, adequate levels of self-care behaviours are a current issue, ranging 7.6%-18.0%. CONCLUSION: This study sets the stage for future research where elements of the patient-caregiver relationship ought to be considered to inform the planning of appropriate educational interventions. We recommend routinely measuring patients' self-care behaviours to guide their follow-up and as a basis for any changes in their daily life behaviours.

Italian version of Dyspnoea-12: cultural-linguistic validation, quantitative and qualitative content validity study.

BACKGROUND: Dyspnoea-12 is a valid and reliable scale to assess dyspneic symptom, considering its severity, physical and emotional components. However, it is not available in Italian version due to it was not yet translated and validated. For this reason, the aim of this study was to develop an Italian version Dyspnoea-12, providing a cultural and linguistic validation, supported by the quantitative and qualitative content validity. METHODS: This was a methodological study, divided into two phases: phase one is related to the cultural and linguistic validation, phase two is related to test the quantitative and qualitative content validity. Linguistic validation followed a standardized translation process. Quantitative content validity was assessed computing content validity ratio (CVR) and index (I-CVIs and S-CVI) from expert panellists response. Qualitative content validity was assessed by the narrative analysis on the answers of three open-ended questions to the expert panellists, aimed to investigate the clarity and the pertinence of the Italian items. RESULTS: The translation process found a good agreement in considering clear the items in both the six involved bilingual expert translators and among the ten voluntary involved patients. CVR, I-CVIs and S-CVI were satisfactory for all the translated items. CONCLUSIONS: This study has represented a pivotal step to use Dyspnoea-12 amongst Italian patients. Future researches are needed to deeply investigate the Italian version of  Dyspnoea-12 construct validity and its reliability, and to describe how dyspnoea components (i.e. physical and emotional) impact the life of patients with cardiorespiratory diseases.

Health literacy in type 2 diabetes patients: a systematic review of systematic reviews.

Aim To summarize, critically review, and interpret the evidence related to the systematic reviews on health literacy (HL) amongst type 2 diabetes mellitus (T2DM). Methods The methodology for this study consisted of a systematic review of systematic reviews, using the PRISMA statement and flowchart to select studies, and searching on PubMed, CINAHL, Scopus, and Cochrane. The search covered the period between January 2006 and June 2016. Results From the 115 identified record by the queries, only six systematic reviews were included, following a quality evaluation using AMSTAR. The included systematic reviews content was analyzed by the independent work of two authors, using a narrative synthesis approach. The findings of this study (i.e., main themes) are areas of consensus and gaps in knowledge. Areas of consensus are HL definition, HL measurement tools, and the relationship between T2DM patient knowledge (or literacy) and his/her HL. The gaps in knowledge were the assessment of the relations between HL and health outcomes and self-efficacy, the gender differences, the effectiveness of interventions to improve HL, the cost-effectiveness study of interventions to improve HL, and the understanding of the influence of organizational environment on HL. Conclusion This review provides a current state of knowledge to address clinical practice and research proposals. HL could be useful to personalize patients' follow-up and it should be routinely assessed in its three dimensions (i.e. functional, interactive and critical) to enhance patients' ability to cope with clinical recommendations. Future research should be mainly aimed to test the effectiveness of evidence-based interventions to improve HL amongst T2DM patients.