Healthcare System Digital Transformation across Four European Countries: A Multiple-Case Study.

Digitization has become involved in every aspect of life, including the healthcare sector with its healthcare professionals (HCPs), citizens (patients and their families), and services. This complex process is supported by policies: however, to date, no policy analysis on healthcare digitalization has been conducted in European countries to identify the main goals of digital transformation and its practical implementation. This research aimed to describe and compare the digital health policies across four European countries; namely, their priorities, their implementation in practice, and the digital competencies expected by HCPs. A multiple-case study was performed. Participants were the members of the Digital EducationaL programme invoLVing hEalth profEssionals (DELIVER), a project funded by the European Union under the Erasmus+ programme, involving three countries (Denmark, Italy, and Slovenia) and one autonomous region (Catalonia-Spain). Data were collected using two approaches: (a) a written interview with open-ended questions involving the members of the DELIVER project as key informants; and (b) a policy-document analysis. Interviews were analysed using the textual narrative synthesis and the word cloud policy analysis was conducted according to the Ready, Extract, Analyse and Distil approach. Results showed that all countries had established recent policies at the national level to address the development of digital health and specific governmental bodies were addressing the implementation of the digital transformation with specific ramifications at the regional and local levels. The words "health" and "care" characterized the policy documents of Denmark and Italy (309 and 56 times, 114 and 24 times, respectively), while "development" and "digital" (497 and 478 times, respectively) were common in the Slovenia document. The most used words in the Catalonia policy document were "data" and "system" (570 and 523 times, respectively). The HCP competencies expected are not clearly delineated among countries, and there is no formal plan for their development at the undergraduate, postgraduate, and continuing educational levels. Mutual understanding and exchange of good practices between countries may facilitate the digitalization processes; moreover, concrete actions in the context of HCP migration across Europe for employment purposes, as well as in the context of citizens' migration for healthcare-seeking purposes are needed to consider the differences emerged across the countries.

STAR-VITAL, a Four Year Comprehensive Workplace Health Promotion Program: Study Design.

Background: Premature death, chronic disease, and productivity loss can be reduced with the help of programs that promote a healthy lifestyle. Workplace health promotion programs have been shown to be an efficient way of improving employee health. These can also benefit employers by improving retention, reducing worker turnover, and lowering healthcare costs. In Slovenia, a workplace health promotion program called "STAR-VITAL-Joint Measures for the Vitality of Older Workers" targeting small- and medium-sized enterprises has been ongoing since September 2017. We hypothesize that this workplace health promotion program will yield long-term health changes for the included employees and employers. Methods/Design: The manuscript presents a workplace health promotion program design that introduces some novel approaches and solutions to workplace health promotion program implementation. It also introduces a measurement of their effects that address the problem of low participation rates and the effectiveness of workplace health promotion programs, as follows: (1) the multifaceted and individualised approach to implementation, (2) customer relationship management (CRM) -based interaction management with program participants, and (3) impact evaluation based on employee health and labour market data observing both intermediate outcomes and the final outcomes based on national micro administrative data. Discussion: Although the novel approaches introduced with the STAR-VITAL program proved to be effective during the COVID-19 pandemic, they deserve the attention of scholars and practitioners. Further research is called for to further explore the potential of CRM in health promotion contexts, the effectiveness of multifaceted and individualised workplace health promotion program interventions, and micro administrative data-based impact evaluations. Conclusions: The STAR-VITAL program introduces several new approaches addressing the problem of low participation rates and the effectiveness of WHPPs. Further research is called for to discover and explore the potential of those novel approaches.

Problematic internet use profiles and psychosocial risk among adolescents.

OBJECTIVE: Although Problematic Internet Use (PIU) is an emerging area of study in psychology, little is known about the unique features of specific subgroups of internet users and their psychosocial vulnerabilities within robust and nationwide populations. METHODS: The aim of this study was to identify distinct latent groups of internet users based on their PIU risk and to compare their psychosocial outcomes. To achieve this, a nationally representative sample of adolescents of the same grade (N = 1,066, Meanage = 13.46 years, range = 12-16) was recruited from several schools in Slovenia through stratified random sampling. RESULTS: A Latent Profile Analysis (LPA) revealed a two-class solution, with Class 1 (n = 853, 80%) featuring 'low PIU risk' participants and Class 2 (n = 213, 20%) including 'high PIU risk' participants. Behaviorally, the main feature of Class 1 denoted 'time management difficulties' while Class 2 was best characterized by 'mood and time management issues'. Further frequentist and Bayesian analyses indicated that Class 2 presented greater psychosocial risk compared to Class 1 due to significantly higher levels of PIU (generalized and across specific PIU subfactors) coupled with lower levels of subjective well-being and self-control. CONCLUSIONS: Contrary to what was initially envisaged, the two classes did not differ in terms of perceived quality in parent-child relationship. This study shows that PIU patterns and symptom-severity may be developmentally specific, further highlighting the need for clinically age-adjusted PIU screening practices within epidemiological and healthcare settings.

Internet Gaming Disorder in adolescence: investigating profiles and associated risk factors.

BACKGROUND: Electronic gaming is a popular free-time activity and its deleterious effects have been considered by the American Psychiatric Association and World Health Organization. More recently 'Gaming Disorder' (GD) has been added to the 11th revision of the International Classification of Diseases, while 'Internet Gaming Disorder' (IGD) remains as a tentative disorder in the 5th revision of the Diagnostic and Statistical Manual of Mental Disorders. This study aimed to explore the characteristics of young gamers at risk for developing IGD. METHODS: To achieve this, a quantitative and nationally representative study was conducted in primary schools in Slovenia with eighth grade as the primary sampling unit (N = 1071, Meanage = 13.44 years, SDage = 0.59). Psychometric testing assessing IGD was conducted to identify participants' IGD risk levels and to compare 'high risk gamers', 'low risk gamers', and 'non-gamers' in relation to free-time activities, self-control, and parent-child relationship. A one-way ANOVA analysis was conducted with Games-Howell post-hoc test to compare the three groups of participants. Statistically significant IGD factors were then included in a multinomial logistic regression analysis to identify the most relevant predictors of IGD. RESULTS: About 4.7% (n = 48) [95% CI: 3.4-6.0%] of Slovenian adolescents were found to be 'high risk gamers' when considering risk of IGD. These were mostly males (n = 42, 87.5%), and their preferred leisure activities involved more screen time activities (e.g., watching TV, playing video games, using social media). Moreover, 'high risk gamers' showed significantly lower levels of self-control compared to 'low risk gamers', and poorer understanding with their parents. Perceived satisfaction with life and mental health did not differ significantly between the three groups. The multinomial logistic regression identified four key predictors of IGD: male gender, gaming as a frequent free-time activity, attending music school or a choir and self-control. CONCLUSION: Public health measures should target adolescents at increased risk of developing IGD in early age because they are particularly drawn to excessive gaming behaviors and present greater IGD vulnerability.

Prevalence of problematic internet use in Slovenia.

BACKGROUND: Internet use is an integral part of our everyday activities; however, Internet use may become problematic and harmful in a minority of cases. The majority of reported prevalence rates of problematic Internet use refer to adolescent samples, whereas epidemiological studies on representative adult populations are lacking. This study aimed to reveal the prevalence and characteristics of problematic Internet use in Slovenia. METHODS: Problematic Internet Use Questionnaire (PIUQ) was included in European Health Interview Study (EHIS) on representative Slovenian sample. The frequency of Internet use and problematic Internet use were both assessed. RESULTS: 59.9% of Slovenian adult population uses the Internet daily, and 3.1% are at risk of becoming problematic Internet users, 11% in the age group from 20 to 24 years. Those being at risk for becoming problematic Internet users are younger (mean age 31.3 vs. 48.3 for non-problematic users), more likely to be males (3.6% of males, whereas 2.6% of females are affected), students (12.0%), unemployed (6.3%) or unable to work (8.7%), single (6.5%), with high education (4.5%). Regression analysis revealed that the strongest predictor of being at risk for problematic Internet use is age (ß=-0.338, p<0.001); followed by high educational level (ß=0.145; p<0.001) and student status (ß=0.136; p<0.001). CONCLUSION: 3.1% of Slovenian adult population are at risk of becoming problematic Internet users, whereas 3 out of 20 Slovenian adolescents aged from 18 to 19 years are at risk (14.6%). Prevention programs and treatment for those affected are paramount, especially for the young generation.

Internet Gaming Disorder Among Slovenian Primary Schoolchildren: Findings From a Nationally Representative Sample of Adolescents.

Background and aims Since the inclusion of Internet Gaming Disorder (IGD) in the latest (fifth) edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a tentative disorder, a few psychometric screening instruments have been developed to assess IGD, including the 9-item Internet Gaming Disorder Scale - Short-Form (IGDS9-SF) - a short, valid, and reliable instrument. Methods Due to the lack of research on IGD in Slovenia, this study aimed to examine the psychometric properties of the IGDS9-SF in addition to investigating the prevalence rates of IGD in a nationally representative sample of eighth graders from Slovenia (N = 1,071). Results The IGDS9-SF underwent rigorous psychometric scrutiny in terms of validity and reliability. Construct validation was investigated with confirmatory factor analysis to examine the factorial structure of the IGDS9-SF and a unidimensional structure appeared to fit the data well. Concurrent and criterion validation were also investigated by examining the association between IGD and relevant psychosocial and game-related measures, which warranted these forms of validity. In terms of reliability, the Slovenian version IGDS9-SF obtained excellent results regarding its internal consistency at different levels, and the test appears to be a valid and reliable instrument to assess IGD among Slovenian youth. Finally, the prevalence rates of IGD were found to be around 2.5% in the whole sample and 3.1% among gamers. Discussion and conclusion Taken together, these results illustrate the suitability of the IGDS9-SF and warrants further research on IGD in Slovenia.