Expanded perspectives: integrating clinicians' insights for comprehensive patient-reported outcomes in value-based healthcare.

The manuscript explores value-based healthcare (VBHC) and its role in assessing healthcare quality beyond clinical metrics. It identifies four value types: personal, technical, allocative, and societal. Emphasizing the integration of diverse stakeholder perspectives, including patients, families, and clinicians, the study highlights the importance of patient- and family-reported measures (PROMs and PREMs) and clinician input. Clinicians' insights on treatment feasibility and effectiveness are crucial for a holistic understanding of healthcare quality. The manuscript advocates for combining machine learning with participatory approaches to enhance data analysis and continuous quality improvement in VBHC, driving better outcomes for patients and communities.

P.A.V.I.A. Study: Pervasiveness and Associated Factors of Video Slot Machine Use in a Large Sample of Italian Adolescents.

Video slot machines (VSM) are considered a particularly harmful gambling format; however, scant data is available on their use among underage Italian individuals. Two surveys were conducted in 2018 and 2022 involving 7,959 underage high school students (57.8% female) in Pavia, Northern Italy. We estimated adjusted odds ratios (aOR) and corresponding 95% confidence intervals (CI) for lifetime experience and current regular (at least monthly) use of VSM, according to family, educational and behavioral factors. Overall, participants reporting lifetime VSM experience were 13.2% (95% CI: 12.5 - 13.9), 15.2% (95% CI: 14.0-16.4%) in 2018, and 12.0% (95% CI: 11.1-13.0%) in 2022. Current regular VSM users were 1.4% (95% CI: 1.1-1.7) in total, 1.2% (95% CI: 0.8-1.6%) in 2018 and 1.5% (95% CI: 1.1-1.8%) in 2022. VSM lifetime experience and current regular use were significantly more frequent in males (aORs: 1.55 and 4.81, respectively), students who failed a year (aORs: 2.07 and 3.44), or with daily gambling parents/siblings (aORs: 2.83 and 4.86). Lifetime use of alcohol, tobacco, or illicit substances was significantly directly associated with lifetime VSM use (aORs between 2.64 and 4.75); monthly alcohol, tobacco, or illicit substances use was significantly directly associated with current regular VSM use (aORs between 4.47 and 18.21). Sexting and voluntary self-injury were significantly more frequent among VSM lifetime/current regular users. VSM use, which is directly associated with other risky behaviors, may be pervasive among Italian minors. Such public health concern calls for legislative enforcements and integrated multidisciplinary health promotion and prevention strategies.

Remote motivational interviewing to improve patient self-care and caregiver contribution to self-care in heart failure (REMOTIVATE-HF): Rationale, design, and methodology for a multicentre randomized controlled trial.

In patients with heart failure (HF), self-care, and caregiver contribution to self-care (i.e., the daily management of the disease by patients and caregivers) are essential for improving patient outcomes. However, patients and caregivers are often inadequate in their self-care and contribution to self-care, respectively, and struggle to perform related tasks. Face-to-face motivational interviewing (MI) effectively improves self-care and caregiver contribution to self-care, but the evidence on remote MI is scarce and inconclusive. The aims of this randomized controlled trial will be to evaluate whether remote MI performed via video call in patients with HF: (1) is effective at improving self-care maintenance in patients (primary outcome); (2) is effective for the following secondary outcomes: (a) for patients: self-care management, self-care monitoring, and self-efficacy; HF symptoms; generic and disease-specific quality of life; anxiety and depression; use of healthcare services; and mortality; and (b) for caregivers: contribution to self-care, self-efficacy, and preparedness. We will conduct a two-arm randomized controlled trial. We will enroll and randomize 432 dyads (patients and their informal caregivers) in Arm 1, in which patients and caregivers will receive MI or, in Arm 2, standard care. MI will be delivered seven times over 12 months. Outcomes will be assessed at baseline and 3 (primary outcome), 6, 9, and 12 months from enrollment. This trial will demonstrate whether an inexpensive and easily deliverable intervention can improve important HF outcomes. With the restrictions on in-person healthcare professional interventions imposed by the COVID-19 pandemic, it is essential to evaluate whether MI is also effective remotely.

Protective factors of ethical conflict during a pandemic-Quali-Ethics-COVID-19 research part 2: An international qualitative study.

AIMS AND OBJECTIVES: To determine which factors can be considered protective of ethical conflicts in intensive care unit healthcare professionals during a pandemic. BACKGROUND: The COVID-19 pandemic gave rise to new ethical concerns in relation to the management of public health and the limitations on personal freedom. Continued exposure to ethical conflict can have a range of psychological consequences. DESIGN: A qualitative design based on phenomenological approach. METHODS: A total of 38 nurses and physicians who were regular staff members of Barcelona and Milan's public tertiary university hospitals and working in intensive care units during the first wave of the COVID-19 pandemic. Semi-structured online in-depth interviews were conducted. A thematic analysis was performed by two independent researchers following the seven steps of Colaizzi's methods. We adhere COREQ guidelines. RESULTS: One theme 'Protective factors of ethical conflict in sanitary crisis' and four subthemes emerged from the data: (1) knowledge of the infectious disease, (2) good communication environment, (3) psychological support and (4) keeping the same work team together. CONCLUSIONS: Four elements can be considered protective factors of ethical conflict for healthcare professionals during a sanitary crisis. While some of these factors have already been described, the joint identification of this set of four factors as a single element is, in itself, novel. This should help in ensuring the right mechanisms are in place to face future pandemics and should serve to improve institutional organisation and guarantee safe and high-quality patient care in times of healthcare crisis. RELEVANCE TO CLINICAL PRACTICE: Future strategies for the prevention of ethical conflict during sanitary crises, pandemics or other catastrophes need to consider a set of four factors as a single element. These factors are the knowledge of the infectious disease, a good communication environment, psychological support and keeping the same work team together into joint consideration.

Development and validation of the parents' healthcare needs scale for adolescents with congenital heart disease.

PURPOSE: The healthcare needs of parents of adolescents with congenital heart disease (CHD) have been under-investigated as no valid and reliable tools have been developed for assessing their needs. Therefore, this study aims to develop and validate the Parents' Healthcare Needs Scale for adolescents with CHD (PHNS-CHD). DESIGN AND METHODS: A multi-method approach and multi-phase design were employed. Phase one referred to generating scale items based on emerging themes in the literature, and phase two showed the validation process, divided into three steps. Step one tested the content and face validity of the first version of the PHNS-CHD. After that, step two described the initial psychometric validation process of scale using an exploratory factorial analysis (EFA). Then, step three confirmed the PHNS-CHD factorial structure and assessed its internal consistency. RESULTS: The PHNS-CHD showed evidence of face and content validity, adequate construct, and internal consistency and stability. Specifically, it had 22 items grouped into five domains, labeled as follows: Healthcare education to the child; to be supported as a parent, clinical support to the child, the continuum of care to the child; emotional support to the child. CONCLUSIONS: The PHNS-CHD is a psychometrically robust measure for assessing the healthcare needs of parents of adolescents with CHD. PRACTICE IMPLICATIONS: The PHNS-CHD might help clinicians, especially pediatric nurses, assess the healthcare needs of parents of adolescents with CHD and design adequate care plans for the whole family.

Public views on the Covid-19 immunity certificate: A scoping review.

INTRODUCTION: Already in its first implementation, the introduction of the Covid-19 immunity certificate has generated some debate among the public. This debate might be a hindrance to the effective realization of this policy. This study aimed to systematically review published research evaluating public feeling of the Covid-19 immunity certificate policy measure and to find which factors might influence its acceptance. METHODS: We followed the scoping review methods manual by the Joanna Briggs Institute. We included studies with no time limits that presented novel data, and no exclusions have been made based on study design. We excluded articles that presented just expert opinions. RESULTS: We found and reviewed 17 articles. The included studies were conducted in two main countries (the United Kingdom and Switzerland), with the rest from Israel, Italy, Spain, Germany, Australia, Taiwan and China. Both qualitative and quantitative studies were included, and nonrepresentative samples were mostly used to explore the public feeling about the Covid-19 immunity certification. The included studies showed that public views on immunity certification are quite contradictory and influenced by age, gender, ethnicity, political orientation and attitudes towards Covid-19 vaccination. The topic more often addressed by the included studies was the public's views on the positive and negative implications of the Covid-19 immunity certificate in terms of ethical, legal and behavioural consequences of this measure. CONCLUSION: The varying acceptance rates are notable and may partly be linked to differences in demographics, Covid-19 concerns and ideological beliefs, as seen in other health-related tracking policies. Moreover, dominant factors behind the (un)success of this policy are complex and entangled with the cultural and political dimensions rather than being just technical. For this reason, it is important to expand psychosocial research to better understand the concerns behind health certifications and allow planning of culturally based and ethically sound suitable strategies. This would be very relevant to increasing public approval and compliance with this public health measure. PATIENT OR PUBLIC CONTRIBUTION: This does not apply to our work as it was a review paper.

Lived experience of patients in ICU after cardiac surgery: A phenomenological study.

BACKGROUND: Cardiac surgery (CS) patients spend a significant amount of time in the intensive care unit (ICU). This event can be very overwhelming, with an intense emotional impact, causing vulnerability and a sense of helplessness in patients. Currently, the in-depth description of the ICU stay experience from a patient's own perspective is little studied, especially in the CS setting and using a qualitative approach in Italy. AIMS: This study aimed to describe CS patients' lived experiences. METHODS: A qualitative phenomenological study was conducted between October 2018 and December 2019 using the interpretative phenomenological analysis approach. RESULTS: Eleven patients were interviewed during the months after discharge from the ICU. Four main themes emerged from the analysis of the interviews: (a) will not wake up anymore; (b) endless time in ICU; (c) something keeps me from breathing; and (d) "anchor in the storm." Results confirm the negative experience of patients in the ICU, mainly because of the extubating procedure. Nurses were found to play a key role in decisions, supporting and protecting patients from the psychological stress related to the ICU stay. CONCLUSION: This is the first study capturing ICU patients' lived experiences after a CS intervention with the use of interpretative phenomenology in Italy. Further investigations are warranted to systematically identify which approaches or strategies are essential to support these patients in the Italian context. RELEVANCE TO CLINICAL PRACTICE: Our study's results could be useful for tailored care delivery to meet the real needs of Italian patients in the ICU after CS and, consequently, improve the quality of nursing care and patients' outcomes.

Effects of the COVID-19 Emergency and National Lockdown on Italian Citizens' Economic Concerns, Government Trust, and Health Engagement: Evidence From a Two-Wave Panel Study.

Policy Points Preventive measures such as the national lockdown in Italy have been effective in slowing the spread of COVID-19. However, they also had psychological and economic impacts on people's lives, which should not be neglected as they may reduce citizens' trust and compliance with future health mandates. Engaging citizens in their own health management and in the collaboration with health care professionals and authorities via the adoption of a collaborative approach to health policy development is fundamental to fostering such measures' effectiveness. Psychosocial analysis of citizens' concerns and emotional reactions to preventive policies is important in order to plan personalized health communication campaigns. CONTEXT: Because of the COVID-19 pandemic, between February 23 and March 8, 2020, some areas of Italy were declared "red zones," with citizens asked to stay home and avoid unnecessary interpersonal contacts. Such measures were then extended, between March 10 and May 4, 2020, to the whole country. However, compliance with such behaviors had an important impact on citizens' personal, psychological, and economic well-being. This could result in reduced trust in authorities and lowered compliance. Keeping citizens engaged in their own health and in preventive behaviors is thus a key strategy for the success of such measures. This paper presents the results from a study conducted in Italy to monitor levels of people's health engagement, sentiment, trust in authorities, and perception of risk at two different time points. METHODS: Two independent samples (n = 968 and n = 1,004), weighted to be representative of the adult Italian population, were recruited in two waves corresponding to crucial moments of the Italian COVID-19 epidemic: between February 28 and March 4 (beginning of "phase 1," after the first regional lockdowns), and between May 12 and May 18 (beginning of "phase 2," after the national lockdown was partially dismissed). Respondents were asked to complete an online survey with a series of both validated measures and ad hoc items. A series of t-tests, general linear models, and contingency tables were carried out to assess if and how our measures changed over time in different social groups. FINDINGS: Although sense of self and social responsibility increased between the two waves, and trust toward authorities remained substantially the same, trust in science, consumer sentiment, and health engagement decreased. Our results showed that while both the level of general concern for the emergency and the perceived risk of infection increased between the two waves, in the second wave our participants reported being more concerned for the economic consequences of the pandemic than the health risk. CONCLUSIONS: The potentially disruptive psychological impact of lockdown may hamper citizens' compliance with, and hence the effectiveness of, behavioral preventive measures. This suggests that preventive measures should be accompanied by collaborative educational plans aimed at promoting people's health engagement by making citizens feel they are partners in the health preventive endeavor and involved in the development of health policies.

Does patient engagement affect IBD patients' health-related quality of life? Findings from a cross-sectional study among people with inflammatory bowel diseases.

BACKGROUND: Patients diagnosed with inflammatory bowel disease (IBD) are required to deal with the unpredictability of this clinical condition, which is associated with poorer health-related quality of life (HRQoL) compared to other clinical conditions. Patient engagement is currently demonstrated to relate with chronic patients' HRQoL, but few studies have been conducted among this population. METHODS: A cross-sectional study was conducted among 1176 IBD patients. Data were collected on participants' HRQoL (SIBD-Q) and patient engagement (PHE-s®). Regression analysis was used to examine the effects of patient engagement on HRQoL. RESULTS: About the half of the sample (47%) reported a low patient engagement level. 30% of the sample reported a low level of HRQoL. Psycho-emotional functioning resulted to be the aspect of HRQoL most impacted in the 37% of the sample. The regression model showed that PHE-s® is significantly related to the SIBD-Q total score (B = .585; p < .001; R squared = .343) and to the subscales' scores-systemic symptoms (B = .572; p < .001; R squared = .327), bowel symptoms (B = .482; p < .001; R squared = .232), social (B = .485; p < .001; R squared = .234) and psycho-emotional (B = .607; p < .001; R squared = .369) functioning. CONCLUSIONS: Patients who are engaged in their IBD care pathway are more likely to report higher level of HRQoL, thus offering clues to potential therapeutic approaches to ameliorating IBD patients' wellbeing. As this is a modifiable factor, screening for patient  health engagement levels, coupled with appropriate interventions, could improve care, and ultimately improve HRQoL outcomes among IBD patients.

Factors associated with emotional exhaustion in healthcare professionals involved in the COVID-19 pandemic: an application of the job demands-resources model.

PURPOSE: The purpose of the present cross-sectional study is to investigate the role of perceived COVID-19-related organizational demands and threats in predicting emotional exhaustion, and the role of organizational support in reducing the negative influence of perceived COVID-19 work-related stressors on burnout. Moreover, the present study aims to add to the understanding of the role of personal resources in the Job Demands-Resources model (JD-R) by examining whether personal resources-such as the professionals' orientation towards patient engagement-may also strengthen the impact of job resources and mitigate the impact of job demands. METHODS: This cross-sectional study involved 532 healthcare professionals working during the COVID-19 pandemic in Italy. It adopted the Job-Demands-Resource Model to study the determinants of professional's burnout. An integrative model describing how increasing job demands experienced by this specific population are related to burnout and in particular to emotional exhaustion symptoms was developed. RESULTS: The results of the logistic regression models provided strong support for the proposed model, as both Job Demands and Resources are significant predictors (OR = 2.359 and 0.563 respectively, with p < 0.001). Moreover, healthcare professionals' orientation towards patient engagement appears as a significant moderator of this relationship, as it reduces Demands' effect (OR = 1.188) and increases Resources' effect (OR = 0.501). CONCLUSIONS: These findings integrate previous findings on the JD-R Model and suggest the relevance of personal resources and of relational factors in affecting professionals' experience of burnout.

Place4Carers: a multi-method participatory study to co-design, piloting, and transferring a novel psycho-social service for engaging family caregivers in remote rural settings.

BACKGROUND: Family caregivers are key actors in the ageing society. They are mediators between practitioners and patients and usually provide also essential daily services for the elders. However, till now, few services have been deployed to help caregivers in their care tasks as in improving their mental health which can experience sever burden due to caregiving duties. The purpose of the study is to implement a community-based participatory research project to co-design an innovative organizational model of social services for family caregivers of elderly health consumers living in remote rural areas in Italy. METHODS: This is a community-based participatory research project in the remote area of Vallecamonica involving four main phases. These included a quantitative analysis of caregiver needs, a scoping review on existing services for caregivers, co-design workshops with local stakeholders and caregivers to create a novel service the piloting and a first implementation of the service and the assessment of project transferability to other contexts. RESULTS: As the hours dedicated to elder care increases, both objective and developmental caregiver's burden significantly increases. Conversely, higher levels of engagement were associated with lower physical and emotional burden, and caregiver engagement was positively correlated with their perceived self-efficacy in managing disruptive patient behaviours. Based on these preliminary results, four co-design workshops with caregivers were conducted and led to the definition of the SOS caregivers service, built on four pillars structured upon the previous need analysis: a citizens' management board, training courses, peer-to-peer meetings, and project and service information. We found that co-design is an effective means of creating new services for family caregivers, whose experiential knowledge proved to be a key resource for the project team in delivering and managing services. Less positively, the transferability analysis indicated that local municipalities remain reluctant to acknowledge caregivers' pivotal role. CONCLUSIONS: A dedicated support service for caregivers can ameliorate caregiving conditions and engagement levels. The service has resulted a successful co-productive initiative for a psycho-social intervention for family caregivers. For the future, we suggest that family caregiver should be considered an active partner in the process of designing novel psycho-social services and not just as recipients to enhance a better aging-in-place process.

"Invisible Voices": A Critical Incident Study of Family Caregivers' Experience of Nursing Homes After Their Elder Relative's Death.

PURPOSE: The literature provides few examples of family caregivers' retrospective evaluation of nursing home services. This study aimed at analyzing narratives of Italian family caregivers of elders who experienced nursing home placement. DESIGN AND METHODS: Data were gathered through in-depth interviews with family members after their relatives' death. The interviews were based on the Critical Incident Technique, which allowed the categorization of the most memorable positive and negative events from the perspective of family members of elders deceased in nursing homes. Interviews were interpreted with a phenomenologically inspired thematic analysis approach. Participants were screened for complicated grief disorder as a confounding variable in relatives' accounts of the treatment. RESULTS: Results suggested that positive long-term recollection of the nursing home was associated with different themes emerging from the interviews: medical reliability and expertise, active demonstrations of care that extend beyond the contract with the facility, individualized attention, responsiveness, openness to dialog with family members about routines, management of the first impression, and family engagement. Lack of professionals' expertise and medical failures, lack of care for patients' personal goods, lack of family involvement, lack of individualized attention, lack of responsiveness, poor patient surveillance, and structural limits of the facilities were the themes that were more frequently negatively associated with the nursing home experience. IMPLICATIONS FOR PRACTICE: Focusing on the key dimensions connected to the quality of the experience of family members can enrich the quality of existing nursing home services and allow healthcare policymakers and managers to design better facilities for the patients.

Taking care of dying patients through an 'interprofessional ecosystem': a grounded theory study on the experience of an interprofessional team in palliative care.

BACKGROUND: The interprofessional approach is part of the philosophy in palliative care, and its benefits are already documented. However, there are no evidence regarding the process through which the interprofessional team faces the process of the patient's end-of-life and how this experience might be of value for the team's development itself. The aim of this study was to analyse and understand the psychosocial processes that occurs when an interprofessional team accompanies patients and their families to death in palliative care, with the ultimate aim to develop a substantive theory to describe this phenomenon. METHODS: A Grounded Theory method, as theorized by Strauss and Corbin, was adopted for this study. Data were collected through semi-structured interviews and then independently analysed using constant comparison analysis. Fourteen healthcare professionals - belonging to different disciplines (doctor, nurse coordinator, nurse, nurse assistant, psychologist) - were interviewed in a Northern Italy palliative care facility. FINDINGS: The core category of this study was identified to be the process of accompaniment of the dying patient as an interprofessional ecosystem. Moreover, the results showed four main factors determining the development of the core psychosocial process: from professionals' 'Hidden Amazement' to 'Onerous Happiness' where 'Weaving of Professional Resources' and 'Work Meaning' are the underlying conditions to catalyse the process itself. CONCLUSION: Interprofessional care appears an essential value, which becomes the source of the team's strength when facing end-of-life experiences. Health policies and organisations should take the importance of the characteristics of the work environment more carefully. The meaning that professionals attribute to their work and to the team itself, indeed, it may have impact on the overall quality of care and contribute to sustain work engagement, even in stressful situations like end-of-life care.

The Experience of Child Neuropsychiatry Residents who Volunteered in Italian COVID-19-Designated Hospitals.

OBJECTIVE: During the first months of 2020, the coronavirus disease of 2019 (COVID-19) spread rapidly and soon reached a pandemic level. With the increasing number of hospitalizations, medical and nursing personnel resources were soon inadequate. As a consequence, medical volunteers became a key human resource and young medical residents in any specialty were hired on a voluntary basis to contribute to take care of patients with COVID-19. This study reports on the lived experience of residents in child neuropsychiatry who volunteered in Italian hotspot COVID-19-designated hospitals during the epidemic outbreak. METHODS: A phenomenological, qualitative approach using semi-structured interviews with open-ended questions was used to obtain in-depth narratives of the experience of residents in child neuropsychiatry volunteering in North Italy COVID-19-designated hospitals. All residents (n = 8) participated in the study. Interviews were conducted by an expert researcher trained in qualitative methods. Data analysis was performed by independent coders. RESULTS: Five core themes could be identified from the interviews: acting as mediators on two fronts, facing the shock of COVID-19 reality, capitalizing from specialty education, growing as persons and professionals, and humanizing medical care. CONCLUSIONS: This study is unique in providing an in-depth understanding of the experience of young residents in child neuropsychiatry volunteering in general hospitals during the COVID-19 pandemic in Northern Italy. The findings suggest that this experience may be highly beneficial for both the residents and the hospital quality of care. Insights for an accurate planning of residents' engagement in future healthcare emergencies are provided.

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.

Mistrust in biomedical research and vaccine hesitancy: the forefront challenge in the battle against COVID-19 in Italy.

Researchers have been working quickly and collaboratively for the development of vaccines against the COVID-19 virus. The effort of the scientific community in searching a vaccine for COVID-19 may be hampered by a diffused vaccine hesitancy. Two waves of data collection on representative samples of the Italian population (during the "first" and "second" phase of the Italian Covid-19 mitigation strategy) were conducted to understand citizens' perceptions and behaviors about preventive behaviors willingness to vaccine for COVID-19. Our study shows that willingness to COVID-19 vaccine is correlated to trust in research and in vaccines, which decreased between phase 1 and phase 2 of the Italian pandemic. According to the results of our study, the proportion of citizens that seem to be intentioned to get the Covid-19 vaccine is probably too small to effectively stop the spreading of the disease. This requires to foster a climate of respectful mutual trust between science and society, where scientific knowledge is not only preached but also cultivated and sustained thanks to the emphatic understanding of citizens worries, needs of reassurance and health expectations.

'Vaccine hesitancy' among university students in Italy during the COVID-19 pandemic.

The debate around vaccines has been in the spotlight over the last few years in Europe, both within the scientific community and the general public debate. In this regard, the case of the Italian vaccination debate is particularly worrying given that Italy has been one of the European countries with the highest number of measles cases in the recent past. According to this scenario, we conducted a cross-sectional study on a convenience sample of Italian university students aimed at: (1) exploring their attitudes towards a future vaccine to prevent COVID-19 and; (2) evaluating the impact of the university curricula (healthcare vs. non-healthcare curricula) on the intention to vaccinate. Descriptive analysis on the 735 students that answered to the question on the intention to vaccinate showed that 633 (86.1%) students reported that they would choose to have a vaccination for the COVID-19 coronavirus; on the other side, 102 (13.9%) students reported that they would not or be not sure to vaccine (low intention to vaccinate). This means that in our sample more than one student out of 10 shows low intention to vaccinate (vaccine hesitancy). Furthermore, when running analysis comparing healthcare students versus non-healthcare students we found no significant differences in responses' percentage distribution (p = .097). Understanding the student's perspective about the future COVID-19 vaccine and supporting their health engagement and consciousness may be useful in planning adequate response and multidisciplinary educational strategies-including the psychological perspective on vaccine hesitancy underlying factors - in the post-pandemic period.

The Caregiving Health Engagement Scale (CHE-s): development and initial validation of a new questionnaire for measuring family caregiver engagement in healthcare.

BACKGROUND: This study was aimed to preliminary validate a cross-disease psychometric measure to assess the psycho-social experience of family caregiver engagement in healthcare (Caregiving Health Engagement Scale, CHE-s), which refers to the caregiver's psychological attitude to be an active, skilled and motivated player in the care process of their loved ones. METHOD: The study consisted of a mixed methods, multi-stage research. First, a preliminary qualitative stage was aimed at investigating - in the caregivers' perspective - the engagement process in providing care to a ill relative (stage 1). The second stage of the research was aimed at developing a psychometric scale to assess this concept (i.e. the Caregiving Health Engagement Scale - CHE-s) and to preliminary test its psychometric properties (stage 2). RESULTS: Overall, 230 caregivers (32 in stage 1, and 198 in stage 2) participated to the study. The first qualitative stage, conducted by qualitative interviews on 32 family caregivers, highlighted four main experiential positions of caregiver engagement (namely, denial, hyper-activation, drawing, and balance), showing that "full engagement" occurs when caregivers become able to reach balance between their caring tasks and their broad life goals. In the second quantitative stage, we used the qualitative evidences emerged from stage one as a basis for developing the items of the Caregiving Health Engagement scale (CHE-s). We preliminary tested its psychometric properties through a cross-sectional study on 198 caregivers, which demonstrated CHE-s to be a reliable measure to capture the dynamic nature of caregiver engagement. The CATPCA results, together with the ordinal alpha of 0.88, suggests a mono-dimensional latent structure and a very good internal consistency and CFA showed adequate goodness of fit indices. (CFI = 0.96, RMR = 0.03, RMSEA = 0.05). CONCLUSIONS: Health care systems that prioritize person-led care may benefit from using the Caregiving Health Engagement Model and the CHE scale (CHE-s) to assess the engagement level of family caregivers in order to better tailor the supportive and educational intervention addressing them.

[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 quest for engaging AmI: Patient engagement and experience design tools to promote effective assisted living.

Recent research highlights that patient engagement, conceived as a patient's behavioral, cognitive and emotional commitment to his own care management, is a key issue while implementing new technologies in the healthcare process. Indeed, eHealth interventions may systematically fail when the patient's subjective experience has not been taken into consideration since the first steps of the technology design. In the present contribution, we argue that such an issue is more and more crucial as regarded to the field of Ambient Intelligence (AmI). Specifically, the exact concept of technologies embedded in the patients' surrounding environment implies a strong impact on their everyday life, which can be perceived as a limitation to autonomy and privacy, and therefore refused or even openly opposed by the final users. The present contribution tackles this issue directly, highlighting: (1) a theoretical framework to include patient engagement in the design of AmI technologies; (2) assessment measures for patient engagement while developing and testing the effectiveness of AmI prototypes for healthcare. Finally (3) this contribution provides an overview of the main issues emerging while implementing AmI technologies and suggests specific design solutions to address them.