Papers by Sabina De Rosis
Behavioural Public Policy
Evidence on the effectiveness of health promotion interventions is mixed, especially in terms of ... more Evidence on the effectiveness of health promotion interventions is mixed, especially in terms of the magnitude of their impact and long-term adherence. This paper proposes a comprehensive approach informed by behavioural economics of developing behavioural change programmes, which is designed to educate, activate, engage and empower people by taking into consideration individual and social mechanisms. Three applied pilots and their results are presented in order to illustrate the approach using cognitive and social mechanisms to lead to better health outcomes, individually and community-wide. More research is needed to explore levers and barriers for the systemic adoption of this framework in implementing health promotion interventions.
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Politiche Sanitarie, 2018
Abitudini e preferenze alimentari, così come attività fisica e sportiva, sono temi fondamentali n... more Abitudini e preferenze alimentari, così come attività fisica e sportiva, sono temi fondamentali nell’ambito della prevenzione della salute, che oggi risulta sempre più centrale per l’implementazione di politiche pubbliche mirate alla riduzione di fenomeni quali l’obesità e la sedentarietà e delle patologie conseguenti. Il paradigma adottato nelle politiche di prevenzione e promozione della salute è stato caratterizzato per lo più da azioni verticali e unidirezionali, basate su processi di informazione spesso con impatto assai limitato sui comportamenti dell’utenza. Processi di comunicazione-azione efficaci sono invece quelli che permettono un percorso di apprendimento tale da determinare cambiamenti nei comportamenti e l’assunzione di responsabilità individuali e collettive rispetto agli obiettivi di salute. ‘beFood’ è un progetto di ricerca-azione implementato in Toscana per testare un nuovo modello educativo-partecipativo con l’obiettivo di mettere gli stessi adolescenti in condizione di diventare fruitori e divulgatori del messaggio di salute e non semplici destinatari di un intervento di promozione. Il progetto ha visto partecipare un gruppo di studenti liceali (n = 49) di 10 scuole secondarie toscane coinvolti in un percorso di Alternanza scuola-lavoro avviato a novembre 2016 e conclusosi a maggio 2017. Le modalità innovative nel promuovere il messaggio di salute sono state caratterizzate dal coinvolgimento degli studenti per la progettazione e conduzione di un’iniziativa di promozione della salute che includeva un’indagine campionaria volta a rilevare abitudini e preferenze in ambito alimentare e di attività fisica dei loro coetanei. Durante la rilevazione, gli studenti stessi hanno promosso l’adozione di corretti stili di vita nei confronti di più di 5000 persone. Questa esperienza ha permesso così di indagare le potenzialità dei processi di influenza peer-to-peer e l’utilizzo di linguaggi e tecnologie digitali nel diffondere contenuti di salute alla popolazione di riferimento, ottenendo dei risultati preliminari sulle potenzialità di questo approccio nelle politiche di promozione della salute. Inoltre l’indagine campionaria ha permesso di rilevare le abitudini degli adolescenti toscani evidenziando aspetti su cui impostare il lavoro futuro. Daily choices and personal preferences regarding food habits and physical activity are critical topics in health prevention. Health prevention is the first place for the implementation of public policies that aim at tackling obesity and physical inactivity that are some of the most relevant risk factors for chronic diseases, such as diabetes or complex mental diseases related to eating disorders. Generally, health promotion interventions are delivered in a top-down process with targets seen as passive receivers with a limited impact on their behaviors. Active communication processes are instead more effective to foster a learning path that lead to a behavioral change and stimulate people in taking on individual and collective responsibility towards health outcomes. ‘beFood’ is an action research project implemented in Tuscany as a new training and communication method with the aim of making adolescents receivers and messengers of the health contents. A group of Tuscan students (n = 49) from ten high school institutes was involved in this initiative as a part of their mandatory work-related learning pathway called Alternanza scuola-lavoro (a young apprenticeship program) from November 2016 to May 2017. The main objective of the project was to test the effectiveness of innovative strategies in promoting healthy lifestyles. In particular, the project aimed at shifting the participants’ role from passive receivers to active messengers by engaging them in the design phase and the conduction of a digital technology-based survey. They collected data on the habits and the preferences of their peers about food and physical activity by spreading a questionnaire including the healthy message to more than 5,000 respondents. During the whole process, it was possible to investigate the potential influence of peer-to-peer processes and the impact of customized languages and new technologies in spreading health promotional messages to the population target.
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The routine deployment of tele-healthcare solutions in healthcare systems and at the system-level... more The routine deployment of tele-healthcare solutions in healthcare systems and at the system-level is challenging and often problematic. This article reports the results of a case study in Tuscany (Italy), aimed at investigating the factors that may affect these processes. A multi-level and multi-stakeholder sample of 32 informants were interviewed in-depth about topics based on a previous literature analysis. Crucial determinant factors in the management of tele-healthcare services were identified in relation to technological, individual, organisational and contextual aspects. A reorganisation of healthcare in line with more participatory dynamics of teamwork, and more collaborative relationships within and among healthcare organisations, as well as with other stakeholders could contribute to integrate tele-healthcare into practice. Leadership and a strategic vision could also strongly influence the implementation and deployment of tele-healthcare.
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eHealth is expected to contribute in tackling challenges for health care systems. However, it als... more eHealth is expected to contribute in tackling challenges for health care systems. However, it also imposes challenges. Financing strategies adopted at national as well regional levels widely affect eHealth long‐term sustainability. In a public health care system, the public actor is among the main “buyers” eHealth. However, public interventions have been increasingly focused on cost containment. How to match these 2 aspects? This article explores some central issues, mainly related to financial aspects, in the development of effective and valuable eHealth strategies in a public health care system: How can the public health care system (as a “buyer”) improve long‐term success and sustainability of eHealth solutions? What levers are available to match in the long period different interests of different stakeholders in the eHealth field? A case study was performed in the Region of Tuscany, Italy. According to our results, win‐win strategies should be followed. Investments should take into account the need to long‐term finance solutions, for sustaining changes in health care organizations for obtaining benefits. To solve the interoperability issues, the concept of the “platform approach” emerged, based on collaboration within and between organizations. Private sector as well as beneficiaries and final users of the eHealth solutions should participate in their design, provision, and monitor- ing. For creating value for all, the evidence gap and the financial needs could be addressed with a pull mechanism of funding, aimed at paying according to the outcomes produced by the eHealth solution, on the base of an ongoing monitoring, measurement, and evaluation of the outcomes.
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PROMs è l'acronimo di Patient-Reported Outcome Measures, ovvero misure di esito riportate dal paz... more PROMs è l'acronimo di Patient-Reported Outcome Measures, ovvero misure di esito riportate dal paziente. Le prime misure di outcome riportate dal paziente risalgono agli anni '70, quando sono stati sviluppati ed utilizzati strumenti per la raccolta routinaria delle misure di dolore provato dai pazienti e riportate direttamente dagli stessi, nell'ambito di trial clinici e valuta-zioni di efficacia di trattamenti 1. L'uso dei PROMs nell'ambito di questo tipo di studi si è molto diffuso, diventando l'ambito principale di applicazione degli stessi 2. Queste misure consentono infatti di integrare gli indicatori di esito basati su valutazioni cliniche prodotte dai profes-sionisti sanitari con le valutazioni che lo stesso paziente esprime in modo diretto del proprio stato di salute. In tal senso, i PROMs permettono di comprendere se un trattamento o in intervento specifici abbiano fatto la differenza per paziente, tanto in termini di condizioni di salute specifiche e generali, quanto di qualità della vita. I PROMs, infatti, sono questionari in grado di raccogliere informazioni di diverso tipo. La multidimensionalità dei PROMs con-sente di cogliere una serie ampia di aspetti; infatti, i questionari investigano generalmente una rosa di costrutti o dimensioni diversi che includono: sintomi, funzionalità, salute mentale/disagio psichico, percezione della propria salute, health-related quality of life. Ognuno dei costrutti è misurato mediante metriche che associano un valore alle risposte dei pazienti, al fine di produrre uno score. Più nel dettaglio, i questionari utilizzati per la raccolta dei PROMS includono strumenti standardizzati disease/condition-specific , cioè studiati per indagare gli esiti di un intervento o una patologia specifici, e strumenti generici, in grado di misurare la qualità della vita e lo stato di salute percepito dal paziente. Negli ultimi anni, il numero di misure specifiche è cresciuto esponenzialmente, permettendo l'utilizzo dei PROMs per la valutazione degli outcome prodotti in diversi percorsi assistenziali e da numerosi trattamenti, siano essi chirurgici, farmacologici, psicoterapeutici, riabilitativi, etc.. A questi si affiancano normalmente questionari generici, come l'EuroQol five dimensions questionnaire (EQ-5D) 3 e lo Short Form Health Survey (SF-36) 4. Si tratta di PROMs che misurano il benessere, la qualità della vita e lo stato di salute percepiti dai pazienti a prescindere dalla loro condizione specifica, dalla loro patologia e dalle loro caratteristiche individuali. Sono strumenti particolarmente utili per effettuare comparazioni tra gruppi o a livello aggregato, come nel caso dei trial clinici. Le modalità di somministrazione dei PROMs sono oggi oggetto di linee guida volte a standardizzare le procedure di raccolta dei dati e il loro uso, a massimizzare la comparabilità dei dati tra diversi trial clinici o studi osservazionali, così come tra diverse organizzazioni sanitarie o sistemi sanitari nell'ambito di sistemi continui di raccolta dei PROMs 5,6 .
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Irpps Working Papers, Sep 9, 2014
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BMC Medical Informatics and Decision Making, 2015
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Epidemiology, 2012
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Background: The use of Information and Communication Technologies (ICTs) in healthcare has been p... more Background: The use of Information and Communication Technologies (ICTs) in healthcare has been presented as a potential solution to the current challenges that healthcare systems have to face. The introduction of ICTs may need initial investments and, moreover, may produce changes in the routine practice of the healthcare system. Financial incentives are expected to be an effective managerial tool to communicate a strategic vision and a mandate, to improve the adherence to the strategy and to promote a consistent individual behaviour. In this perspective, financial incentives are assumed to accelerate the ICTs adoption and use in healthcare. The aim of this study was to investigate whether and how Italian Regional healthcare systems use the Chief Executive Officers' (CEOs) reward scheme to stimuli the implementation of ICT in healthcare.
Materials and methods: A content analysis was conducted on the Italian Regional acts on healthcare CEOs incentive schemes, that were approved in the period 2010–2012 and with a legal validity that ranged from 1 to 4 years (until 2014). The acts cover around 60% of the Italian Regions. ICT goals were identified, categorized, and compared using descriptive statistics.
Results: This study identified two areas on which financial incentives related to ICTs were mainly focused: (i) ICT infrastructure and architecture; (ii) flows and processing of economic and financial data. The use of technology to better store and process medical data (i.e. EHR-like systems) were only marginally present. Use of e-Health and m-Health solutions for providing healthcare services, valorization of ‘health big data’ in a community care perspective, more advanced applications of technology for monitoring or preventing diseases were not incentivized for CEOs in Italy.
Conclusion: The use of ICTs in healthcare appears to be of general interest in Italy: a great number of Italian Regions introduced specific goals into CEOs financial schemes. Efforts in this field seem to be not linked to the objectives of better care at sustainable cost, while it appears important to ensure a better and wider presence of enabling environments and to implement ICT-based control systems.
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Background: Scientific and public interest in the use of the Internet for health-related purposes... more Background: Scientific and public interest in the use of the Internet for health-related purposes has grown considerably. Concerns regarding its impact on patient–doctor relationship and risks for patients have inflamed the debate. Literature provides scarce evidence in this field. This paper investigates whether a patient's decision to use the web also depends on previous experience and satisfaction with healthcare. Method: Statistical analyses were conducted using data from a survey of more than 1700 citizens in Tuscany (Italy). The Andersen behavioural model was adopted as framework for investigating two patient behaviours: Internet use for health-related purposes; discussion of online findings with the physician. Two separate multivariate logistic models were performed to verify whether satisfaction and experience with healthcare system and general practitioners were associated with the e-health behaviours. Results: Age, education and dissatisfaction with the healthcare system are the main determinant factors of e-health use. The behaviour of sharing the e-health experience with general practitioners is more diffused among those patients who are more satisfied with physicians for the involvement in the decision-making process and suggestions on lifestyle. Implications: Whether patients choice to share information found online with the doctor depends on the ability of the doctor to engage patients in decision-making, e-health can produce a 'double-empowerment' process: experienced by the patient on the Internet, and legitimated by the doctor during encounters.
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Books by Sabina De Rosis
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Papers by Sabina De Rosis
Materials and methods: A content analysis was conducted on the Italian Regional acts on healthcare CEOs incentive schemes, that were approved in the period 2010–2012 and with a legal validity that ranged from 1 to 4 years (until 2014). The acts cover around 60% of the Italian Regions. ICT goals were identified, categorized, and compared using descriptive statistics.
Results: This study identified two areas on which financial incentives related to ICTs were mainly focused: (i) ICT infrastructure and architecture; (ii) flows and processing of economic and financial data. The use of technology to better store and process medical data (i.e. EHR-like systems) were only marginally present. Use of e-Health and m-Health solutions for providing healthcare services, valorization of ‘health big data’ in a community care perspective, more advanced applications of technology for monitoring or preventing diseases were not incentivized for CEOs in Italy.
Conclusion: The use of ICTs in healthcare appears to be of general interest in Italy: a great number of Italian Regions introduced specific goals into CEOs financial schemes. Efforts in this field seem to be not linked to the objectives of better care at sustainable cost, while it appears important to ensure a better and wider presence of enabling environments and to implement ICT-based control systems.
Books by Sabina De Rosis
Materials and methods: A content analysis was conducted on the Italian Regional acts on healthcare CEOs incentive schemes, that were approved in the period 2010–2012 and with a legal validity that ranged from 1 to 4 years (until 2014). The acts cover around 60% of the Italian Regions. ICT goals were identified, categorized, and compared using descriptive statistics.
Results: This study identified two areas on which financial incentives related to ICTs were mainly focused: (i) ICT infrastructure and architecture; (ii) flows and processing of economic and financial data. The use of technology to better store and process medical data (i.e. EHR-like systems) were only marginally present. Use of e-Health and m-Health solutions for providing healthcare services, valorization of ‘health big data’ in a community care perspective, more advanced applications of technology for monitoring or preventing diseases were not incentivized for CEOs in Italy.
Conclusion: The use of ICTs in healthcare appears to be of general interest in Italy: a great number of Italian Regions introduced specific goals into CEOs financial schemes. Efforts in this field seem to be not linked to the objectives of better care at sustainable cost, while it appears important to ensure a better and wider presence of enabling environments and to implement ICT-based control systems.