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Olsen C, Lungu DA. Effectiveness of a Smartphone App (Heia Meg) in Improving Decisions About Nutrition and Physical Activity: Prospective Longitudinal Study. JMIR Form Res 2024; 8:e48185. [PMID: 38687565 PMCID: PMC11094595 DOI: 10.2196/48185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 01/15/2024] [Accepted: 01/28/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Obesity is a prevalent and serious chronic condition associated with abnormal or excessive fat buildup that poses significant health risks. The rates of overweight and obesity in adults and children continue to rise, with global rates of children with overweight or obesity aged 5-19 years growing from 4% to 18% between 1975 and 2016. Furthermore, in 2017, nearly 4 million people died due to complications arising from being overweight or obese. OBJECTIVE This study aims to investigate the potential impact of the mobile app Heia Meg on promoting healthier lifestyle choices regarding nutrition and physical activity. METHODS A prospective longitudinal study was conducted in collaboration with the Norwegian Directorate of Health. Participants were recruited through the Heia Meg app and were asked to complete a questionnaire before and after using the app. A total of 199 responses were included in the first (preintervention) questionnaire, while 99 valid responses were obtained in the second (postintervention) questionnaire. RESULTS The majority (159/199, 79.9%) of participants were female, and their age ranged from 18 years to 70 years and older. The results show a reduction in BMI after the digital intervention. However, some variables influence the BMI reduction effect: sex, age, education, and smoking. The group that obtained the most benefit from the intervention consisted of those who were male, aged 30-39 years, highly educated, and nonsmokers. Although positive, some of the findings are slightly above the statistical significance threshold and therefore should be interpreted carefully. CONCLUSIONS Our study found weak evidence to support the effectiveness of the Heia Meg app in promoting healthier lifestyle choices. However, limitations and confounding factors suggest that further research in different populations with larger sample sizes is needed to confirm or disprove our findings.
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Affiliation(s)
- Christine Olsen
- Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Daniel Adrian Lungu
- Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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Lungu DA, Røislien J, Berg SH, Smeets I, Shortt MT, Thune H, Brønnick KK. Assessing the Effect of Nonvisual Information Factors in Pandemic-Related Video Communication: Randomized Controlled Between-Subjects Experiment. J Med Internet Res 2023; 25:e42528. [PMID: 37610820 PMCID: PMC10483294 DOI: 10.2196/42528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 03/09/2023] [Accepted: 05/26/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Videos have been an important medium for providing health and risk communication to the public during the COVID-19 pandemic. Public health officials, health care professionals, and policy makers have used videos to communicate pandemic-related content to large parts of the population. Evidence regarding the outcomes of such communication, along with their determinants, is however limited. OBJECTIVE The aim of this study was to test the impact of nonvisual information factors of video communication on 4 outcomes: trust, comprehension, intentions, and behavior. METHODS Twelve short health communication videos related to pandemics were produced and shown to a large sample of participants, applying a randomized controlled between-subjects design. Three factors were included in the creation of the videos: the topic (exponential growth, handwashing, and burden of pandemics on the health care system), the source (expert and nonexpert), and a call to action (present or absent). Participants were randomly assigned to 1 video intervention, and 1194 valid replies were collected. The data were analyzed using factorial ANOVA. RESULTS The 3 pandemic-related topics did not affect trust, comprehension, intentions, or behavior. Trust was positively influenced by an expert source (2.5%), whereas a nonexpert source instead had a positive effect on the proxy for behavior (5.7%) compared with the expert source. The inclusion of a call to action had a positive effect on both trust (4.1%) and comprehension (15%). CONCLUSIONS Trust and comprehension in pandemic-related video communication can be enhanced by using expert sources and by including a call to action, irrespective of the topic being communicated. Intentions and behavior appear to be affected to a small extent by the 3 factors tested in this study. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/34275.
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Affiliation(s)
- Daniel Adrian Lungu
- SHARE - Centre for Resilience in Healthcare, Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Jo Røislien
- SHARE - Centre for Resilience in Healthcare, Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Siv Hilde Berg
- SHARE - Centre for Resilience in Healthcare, Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Ionica Smeets
- Science Communication and Society, Institute of Biology, Leiden University, Leiden, Netherlands
| | - Marie Therese Shortt
- SHARE - Centre for Resilience in Healthcare, Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Henriette Thune
- SHARE - Centre for Resilience in Healthcare, Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Kolbjørn Kallesten Brønnick
- SHARE - Centre for Resilience in Healthcare, Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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Berg SH, Shortt MT, Røislien J, Lungu DA, Thune H, Wiig S. Key topics in pandemic health risk communication: A qualitative study of expert opinions and knowledge. PLoS One 2022; 17:e0275316. [PMID: 36178941 PMCID: PMC9524709 DOI: 10.1371/journal.pone.0275316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 09/14/2022] [Indexed: 11/24/2022] Open
Abstract
Background Science communication can provide people with more accurate information on pandemic health risks by translating complex scientific topics into language that helps people make more informed choices on how to protect themselves and others. During pandemics, experts in medicine, science, public health, and communication are important sources of knowledge for science communication. This study uses the COVID-19 pandemic to explore these experts’ opinions and knowledge of what to communicate to the public during a pandemic. The research question is: What are the key topics to communicate to the public about health risks during a pandemic? Method We purposively sampled 13 experts in medicine, science, public health, and communication for individual interviews, with a range of different types of knowledge of COVID-19 risk and communication at the national, regional and hospital levels in Norway. The interview transcripts were coded and analysed inductively in a qualitative thematic analysis. Results The study’s findings emphasise three central topics pertaining to communication about pandemic health risk during the first year of the COVID-19 pandemic in Norway: 1) how the virus enters the human body and generates disease; 2) how to protect oneself and others from being infected; and 3) pandemic health risk for the individual and the society. Conclusion The key topics emerging from the expert interviews relate to concepts originating from multiple disciplinary fields, and can inform frameworks for interprofessional communication about health risks during a pandemic. The study highlights the complexity of communicating pandemic messages, due to scientific uncertainty, fear of risk amplification, and heterogeneity in public health and scientific literacy. The study contributes with insight into the complex communication processes of pandemic health risk communication.
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Affiliation(s)
- Siv Hilde Berg
- Faculty of Health Sciences, Department of Quality and Health Technology, Centre for Resilience in Healthcare, University of Stavanger, Stavanger, Norway
- * E-mail:
| | - Marie Therese Shortt
- Faculty of Health Sciences, Department of Quality and Health Technology, Centre for Resilience in Healthcare, University of Stavanger, Stavanger, Norway
| | - Jo Røislien
- Faculty of Health Sciences, Department of Quality and Health Technology, Centre for Resilience in Healthcare, University of Stavanger, Stavanger, Norway
| | - Daniel Adrian Lungu
- Faculty of Health Sciences, Department of Quality and Health Technology, Centre for Resilience in Healthcare, University of Stavanger, Stavanger, Norway
| | - Henriette Thune
- Faculty of Health Sciences, Department of Quality and Health Technology, Centre for Resilience in Healthcare, University of Stavanger, Stavanger, Norway
| | - Siri Wiig
- Faculty of Health Sciences, Department of Quality and Health Technology, Centre for Resilience in Healthcare, University of Stavanger, Stavanger, Norway
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Berg SH, Shortt MT, Thune H, Røislien J, O'Hara JK, Lungu DA, Wiig S. Differences in comprehending and acting on pandemic health risk information: a qualitative study using mental models. BMC Public Health 2022; 22:1440. [PMID: 35902839 PMCID: PMC9334540 DOI: 10.1186/s12889-022-13853-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 07/20/2022] [Indexed: 11/27/2022] Open
Abstract
Background A worldwide pandemic of a new and unknown virus is characterised by scientific uncertainty. However, despite this uncertainty, health authorities must still communicate complex health risk information to the public. The mental models approach to risk communication describes how people perceive and make decisions about complex risks, with the aim of identifying decision-relevant information that can be incorporated into risk communication interventions. This study explored how people use mental models to make sense of scientific information and apply it to their lives and behaviour in the context of COVID-19. Methods This qualitative study enrolled 15 male and female participants of different ages, with different levels of education and occupational backgrounds and from different geographical regions of Norway. The participants were interviewed individually, and the interview data were subjected to thematic analysis. The interview data were compared to a expert model of COVID-19 health risk communication based on online information from the Norwegian Institute of Public Health. Materials in the interview data not represented by expert model codes were coded inductively. The participants’ perceptions of and behaviours related to health risk information were analysed across three themes: virus transmission, risk mitigation and consequences of COVID-19. Results The results indicate that people placed different meanings on the medical and scientific words used by experts to explain the pandemic (e.g., virus transmission and the reproduction number). While some people wanted to understand why certain behaviour and activities were considered high risk, others preferred simple, clear messages explaining what to do and how to protect themselves. Similarly, information about health consequences produced panic in some interviewees and awareness in others. Conclusion There is no one-size-fits-all approach to public health risk communication. Empowering people with decision-relevant information necessitates targeted and balanced risk communication. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13853-y.
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Affiliation(s)
- Siv Hilde Berg
- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Kjell Arholmsgate 43, 4021, Stavanger, Norway.
| | - Marie Therese Shortt
- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Kjell Arholmsgate 43, 4021, Stavanger, Norway
| | - Henriette Thune
- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Kjell Arholmsgate 43, 4021, Stavanger, Norway
| | - Jo Røislien
- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Kjell Arholmsgate 43, 4021, Stavanger, Norway
| | - Jane K O'Hara
- School of Healthcare, University of Leeds, Leeds, UK
| | - Daniel Adrian Lungu
- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Kjell Arholmsgate 43, 4021, Stavanger, Norway
| | - Siri Wiig
- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Kjell Arholmsgate 43, 4021, Stavanger, Norway
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Berg SH, Lungu DA, Brønnick K, Harthug S, Røislien J. Exponential growth bias of infectious diseases: a systematic review protocol (Preprint). JMIR Res Protoc 2022; 11:e37441. [DOI: 10.2196/37441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 07/26/2022] [Accepted: 08/04/2022] [Indexed: 11/13/2022] Open
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Lungu DA, Røislien J, Wiig S, Shortt MT, Ferrè F, Berg SH, Thune H, Brønnick KK. The Role of Recipient Characteristics in Health Video Communication Outcomes: Scoping Review. J Med Internet Res 2021; 23:e30962. [PMID: 34967758 PMCID: PMC8759013 DOI: 10.2196/30962] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/21/2021] [Accepted: 10/29/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The importance of effective communication during public health emergencies has been highlighted by the World Health Organization, and it has published guidelines for effective communication in such situations. With video being a popular medium, video communication has been a growing area of study over the past decades and is increasingly used across different sectors and disciplines, including health. Health-related video communication gained momentum during the SARS-CoV-2 pandemic, and video was among the most frequently used modes of communication worldwide. However, although much research has been done regarding different characteristics of video content (the message) and its delivery (the messenger), there is a lack of knowledge about the role played by the characteristics of the recipients for the creation of effective communication. OBJECTIVE The aim of this review is to identify how health video communication outcomes are shaped by recipient characteristics, as such characteristics might affect the effectiveness of communication. The main research question of the study is as follows: do the characteristics of the recipients of health videos affect the outcomes of the communication? METHODS A scoping review describing the existing knowledge within the field was conducted. We searched for literature in 3 databases (PubMed, Scopus, and Embase) and defined eligibility criteria based on the relevance to the research question. Recipient characteristics and health video communication outcomes were identified and classified. RESULTS Of the 1040 documents initially identified, 128 (12.31%) met the criteria for full-text assessment, and 39 (3.75%) met the inclusion criteria. The included studies reported 56 recipient characteristics and 42 communication outcomes. The reported associations between characteristics and outcomes were identified, and the potential research opportunities were discussed. Contributions were made to theory development by amending the existing framework of the Integrated-Change model, which is an integrated model of motivational and behavioral change. CONCLUSIONS Although several recipient characteristics and health video communication outcomes were identified, there is a lack of robust empirical evidence on the association between them. Further research is needed to understand how the preceding characteristics of the recipients might affect the various outcomes of health video communication.
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Affiliation(s)
- Daniel Adrian Lungu
- SHARE - Centre for Resilience in Healthcare, Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Jo Røislien
- SHARE - Centre for Resilience in Healthcare, Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Siri Wiig
- SHARE - Centre for Resilience in Healthcare, Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Marie Therese Shortt
- SHARE - Centre for Resilience in Healthcare, Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Francesca Ferrè
- Management and Health Laboratory, Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Siv Hilde Berg
- SHARE - Centre for Resilience in Healthcare, Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Henriette Thune
- SHARE - Centre for Resilience in Healthcare, Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Kolbjørn Kallesten Brønnick
- SHARE - Centre for Resilience in Healthcare, Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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Røislien J, O'Hara JK, Smeets I, Brønnick K, Berg SH, Shortt MT, Lungu DA, Thune H, Wiig S. Creating effective, evidence-based video communication of public health science (the COVCOM study): Protocol for a sequential mixed methods effect study (Preprint). JMIR Res Protoc 2021; 11:e34275. [PMID: 35147500 PMCID: PMC8919988 DOI: 10.2196/34275] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/21/2022] [Accepted: 02/06/2022] [Indexed: 12/04/2022] Open
Abstract
Background The nonlinear nature of contagious diseases and the potential for exponential growth can be difficult to grasp for the general public. This has strong implications for public health communication, which needs to be both easily accessible and efficient. A pandemic is an extreme situation, and the accompanying strict societal measures are generally easier to accept if one understands the underlying reasoning behind them. Bringing about informed attitude change and achieving compliance to strict restrictions requires explanations of scientific concepts and terminologies that laypersons can understand. Objective The aim of the project is to develop effective, evidence-based modes of video communication for translating complex, but important, health messages about pandemics to both the general population and decision makers. The study uses COVID-19 as a case to learn and prepare society for handling the ongoing and future pandemics, as well as to provide evidence-based tools for the science communication toolbox. Methods The project applies a mixed methods design, combining qualitative methods (eg, interviews, observational studies, literature reviews) and quantitative methods (eg, randomized controlled trials [RCTs]). The project brings together researchers from a wide range of academic fields, as well as communication industry professionals. Results This study has received funding from the Trond Mohn Foundation through the Research Council of Norway’s “COVID-19 Emergency Call for Proposals” March 2020. Recruitment and data collection for the exploratory first phase of the project ran from February 2021 to March 2021. Creative communication work started in May 2021, and the production of videos for use in the RCTs in the final phase of the project started in September 2021. Conclusions The COVCOM project will take on several grand challenges within the field of communicating science and provide evidence-based tools to the science communication toolbox. A long-term goal of the project is to contribute to the creation of a more resilient health care system by developing communication responses tailormade for different audiences, preparing society for any future pandemic. International Registered Report Identifier (IRRID) DERR1-10.2196/34275
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Affiliation(s)
- Jo Røislien
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Jane K O'Hara
- School of Healthcare, Faculty of Medicine & Health, University of Leeds, Leeds, United Kingdom
| | - Ionica Smeets
- Science Communication and Society, Institute of Biology, Leiden University, Leiden, Netherlands
| | - Kolbjørn Brønnick
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Siv Hilde Berg
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Marie Therese Shortt
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Daniel Adrian Lungu
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Henriette Thune
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Siri Wiig
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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Abstract
INTRODUCTION Scholars, healthcare practitioners and policymakers have increasingly focused their attention on patient-centredness. Patient-reported metrics support patient-driven improvement actions in healthcare systems. Despite the great interest, patient-reported outcome measures (PROMs) are still not extensively collected in many countries and not integrated with the collection of patient-reported experience measures (PREMs). This protocol describes the methodology behind an innovative observatory implemented in Tuscany, Italy, aiming at continuously and longitudinally collecting PROMs and PREMs for elective hip and knee total replacement. METHODS AND ANALYSIS The Observatory is digital. Enrolled patients are invited via SMS or email to online questionnaires, which include the Oxford Hip Score or the Oxford Knee Score. Data are real-time reported to healthcare professionals and managers in a raw format, anonymised and aggregated on a web platform. The data will be used to investigate the relationship between the PROMs trend and patients' characteristics, surgical procedure, hospital characteristics, and PREMs. Indicators using patient data will be computed, and they will integrate the healthcare performance evaluation system adopted in Tuscany. ETHICS AND DISSEMINATION The data protection officers of local healthcare organisations and the regional privacy office framed the initiative referring to the national and regional guidelines that regulate patient surveys. The findings will be reported both in real time and for publication in peer-reviewed journals.
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Affiliation(s)
- Sabina De Rosis
- Management and Healthcare Laboratory, Institute of Management and Department EMbeDS, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Francesca Pennucci
- Management and Healthcare Laboratory, Institute of Management and Department EMbeDS, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Daniel Adrian Lungu
- Management and Healthcare Laboratory, Institute of Management and Department EMbeDS, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Mario Manca
- Department of Orthopaedic Surgery, Versilia Hospital, Lido di Camaiore, Italy
| | - Sabina Nuti
- Management and Healthcare Laboratory, Institute of Management and Department EMbeDS, Scuola Superiore Sant'Anna, Pisa, Italy
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Berg SH, O'Hara JK, Shortt MT, Thune H, Brønnick KK, Lungu DA, Røislien J, Wiig S. Health authorities' health risk communication with the public during pandemics: a rapid scoping review. BMC Public Health 2021; 21:1401. [PMID: 34266403 PMCID: PMC8280576 DOI: 10.1186/s12889-021-11468-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 06/30/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Responses from the H1N1 swine flu pandemic and the recent COVID-19 coronavirus pandemic provide an opportunity for insight into the role of health authorities' ways of communicating health risk information to the public. We aimed to synthesise the existing evidence regarding different modes of communication used by health authorities in health risk communication with the public during a pandemic. METHODS We conducted a rapid scoping review. MEDLINE and EMBASE were searched for publications in English from January 2009 through October 2020, covering both the full H1N1 pandemic and the response phase during the COVID-19 pandemic. The search resulted in 1440 records, of which 48 studies met our eligibility criteria. RESULTS The present review identified studies across a broad interdisciplinary field of health risk communication. The majority focused on the H1N1 pandemic and the COVID-19 pandemic. A content analysis of the studies identified three categories for modes of communication: i) communication channels, ii) source credibility and iii) how the message is communicated. The identified studies on social media focused mainly on content and engagement, while studies on the effect of the use of social media and self-protective behaviour were lacking. Studies on the modes of communication that take the diversity of receivers in the field into account are lacking. A limited number of studies of health authorities' use of graphic and audio-visual means were identified, yet these did not consider/evaluate creative communication choices. CONCLUSION Experimental studies that investigate the effect of health authorities' videos and messages on social media platforms and self-protective behaviour are needed. More studies are needed across the fields of health risk communication and media studies, including visual communication, web design, video and digital marketing, at a time when online digital communication is central to reaching the public.
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Affiliation(s)
- Siv Hilde Berg
- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Kjell Arholmsgate 43, 4021, Stavanger, Norway.
| | - Jane K O'Hara
- Faculty of Medicine & Health, School of Healthcare, University of Leeds, Leeds, England
| | - Marie Therese Shortt
- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Kjell Arholmsgate 43, 4021, Stavanger, Norway
| | - Henriette Thune
- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Kjell Arholmsgate 43, 4021, Stavanger, Norway
| | - Kolbjørn Kallesten Brønnick
- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Kjell Arholmsgate 43, 4021, Stavanger, Norway
- Centre for Age-Related Medicine (SESAM), Helse Stavanger, Stavanger, Norway
| | - Daniel Adrian Lungu
- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Kjell Arholmsgate 43, 4021, Stavanger, Norway
| | - Jo Røislien
- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Kjell Arholmsgate 43, 4021, Stavanger, Norway
| | - Siri Wiig
- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Kjell Arholmsgate 43, 4021, Stavanger, Norway
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Lungu DA, Foresi E, Belardi P, Nuti S, Giannini A, Simoncini T. The Impact of New Surgical Techniques on Geographical Unwarranted Variation: The Case of Benign Hysterectomy. Int J Environ Res Public Health 2021; 18:ijerph18136722. [PMID: 34206452 PMCID: PMC8297008 DOI: 10.3390/ijerph18136722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/18/2021] [Accepted: 06/19/2021] [Indexed: 11/16/2022]
Abstract
Since the 1980s, the international literature has reported variations for healthcare services, especially for elective ones. Variations are positive if they reflect patient preferences, while if they do not, they are unwarranted, and thus avoidable. Benign hysterectomy is among the most frequent elective surgical procedures in developed countries, and, in recent years, it has been increasingly delivered through minimally invasive surgical techniques, namely laparoscopic or robotic. The question therefore arises over what the impact of these new surgical techniques on avoidable variation is. In this study we analyze the extent of unwarranted geographical variation of treatment rates and of the adoption of minimally invasive procedures for benign hysterectomy in an Italian regional healthcare system. We assess the impact of the surgical approach on the provision of benign hysterectomy, in terms of efficiency (by measuring the average length of stay) and efficacy (by measuring the post-operative complications). Geographical variation was observed among regional health districts for treatment rates and waiting times. At a provider level, we found differences for the minimally invasive approach. We found a positive and significant association between rates and the percentage of minimally invasive procedures. Providers that frequently adopt minimally invasive procedures have shorter average length of stay, and when they also perform open hysterectomies, fewer complications.
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Affiliation(s)
- Daniel Adrian Lungu
- Management and Healthcare Laboratory, Institute of Management and Department EMbeDS, Scuola Superiore Sant’Anna, 56127 Pisa, Italy; (E.F.); (P.B.); (S.N.)
- Correspondence:
| | - Elisa Foresi
- Management and Healthcare Laboratory, Institute of Management and Department EMbeDS, Scuola Superiore Sant’Anna, 56127 Pisa, Italy; (E.F.); (P.B.); (S.N.)
| | - Paolo Belardi
- Management and Healthcare Laboratory, Institute of Management and Department EMbeDS, Scuola Superiore Sant’Anna, 56127 Pisa, Italy; (E.F.); (P.B.); (S.N.)
| | - Sabina Nuti
- Management and Healthcare Laboratory, Institute of Management and Department EMbeDS, Scuola Superiore Sant’Anna, 56127 Pisa, Italy; (E.F.); (P.B.); (S.N.)
| | - Andrea Giannini
- Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (A.G.); (T.S.)
| | - Tommaso Simoncini
- Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (A.G.); (T.S.)
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Hoxha I, Zhubi E, Grezda K, Kryeziu B, Bunjaku J, Sadiku F, Agahi R, Lungu DA, Bonciani M, Little G. Caesarean sections in teaching hospitals: systematic review and meta-analysis of hospitals in 22 countries. BMJ Open 2021; 11:e042076. [PMID: 33509847 PMCID: PMC7845681 DOI: 10.1136/bmjopen-2020-042076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 12/26/2020] [Accepted: 01/08/2021] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE The aim of this study is to determine the odds of caesarean section in all births in teaching hospitals as compared with non-teaching hospitals. SETTING Over 3600 teaching and non-teaching hospitals in 22 countries. We searched CINAHL, The Cochrane Library, PubMed, sciELO, Scopus and Web of Science from the beginning of records until May 2020. PARTICIPANTS Women at birth. Over 18.5 million births. INTERVENTION Caesarean section. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measures are the adjusted OR of caesarean section in a variety of teaching hospital comparisons. The secondary outcome is the crude OR of caesarean section in a variety of teaching hospital comparisons. RESULTS In adjusted analyses, we found that university hospitals have lower odds than non-teaching hospitals (OR=0.66, 95% CI 0.56 to 0.78) and other teaching hospitals (OR=0.46, 95% CI 0.24 to 0.89), and no significant difference with unspecified teaching status hospitals (OR=0.92, 95% CI 0.80 to 1.05, τ2=0.009). Other teaching hospitals had higher odds than non-teaching hospitals (OR=1.23, 95% CI 1.12 to 1.35). Comparison between unspecified teaching hospitals and non-teaching hospitals (OR=0.91, 95% CI 0.50 to 1.65, τ2=1.007) and unspecified hospitals (OR=0.95, 95% CI 0.76 to 1.20), τ2<0.001) showed no significant difference. While the main analysis in larger sized groups of analysed studies reveals no effect between hospitals, subgroup analyses show that teaching hospitals carry out fewer caesarean sections in several countries, for several study populations and population characteristics. CONCLUSIONS With smaller sample of participants and studies, in clearly defined hospitals categories under comparison, we see that university hospitals have lower odds for caesarean. With larger sample size and number of studies, as well as less clearly defined categories of hospitals, we see no significant difference in the likelihood of caesarean sections between teaching and non-teaching hospitals. Nevertheless, even in groups with no significant effect, teaching hospitals have a lower or higher likelihood of caesarean sections in several analysed subgroups. Therefore, we recommend a more precise examination of forces sustaining these trends. PROSPERO REGISTRATION NUMBER CRD42020158437.
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Affiliation(s)
- Ilir Hoxha
- Department of Community & Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
- Research Unit, Heimerer College, Prishtina, Kosovo
- LifestylediagnostiX, Prishtina, Kosovo
| | | | | | | | | | | | - Riaz Agahi
- Research Unit, Heimerer College, Prishtina, Kosovo
| | - Daniel Adrian Lungu
- Health and Management Laboratory (MeS Lab), Institute of Management and Department EMbeDS, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Manila Bonciani
- Health and Management Laboratory (MeS Lab), Institute of Management and Department EMbeDS, Scuola Superiore Sant'Anna, Pisa, Italy
| | - George Little
- Department of Pediatrics and of Obstetrics and Gynecology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
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Horenberg F, Lungu DA, Nuti S. Measuring research in the big data era: The evolution of performance measurement systems in the Italian teaching hospitals. Health Policy 2020; 124:1387-1394. [PMID: 33153801 DOI: 10.1016/j.healthpol.2020.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/21/2020] [Accepted: 10/04/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND In the healthcare system, Teaching Hospitals(THs) not only provide care, but also train healthcare professionals and carry out research activities. Research is a fundamental pillar of THs' mission and relevant for the healthcare system monitored by Performance Evaluation Systems. Research activities can be measured using citation index services and this paper highlights differences between two services based on bibliometrics, describes opportunities and risks when performance indicators rely on data collected, controlled and validated by external services and discusses the possible impact on health policy at a system and provider level. METHODS A bibliometric analysis was done on data between 2014-2016 from ISI Web of Science and Scopus of 18.255 physicians working in 26 Italian THs. Quantity was defined as the number of publications and quality as Impact Factor or Field-Weighted Citation Impact. RESULTS Overall, 41.233 and 66.409 documents were extracted from respectively ISI Web of Science and Scopus. While benchmarking results, significant differences in ranked position both in metrics emerged. DISCUSSION Utilizing secondary data sources to measure research activities of THs allows benchmarking at an (inter)national level and overcoming self-referment. To utilize indicators for multiple governance purposes at the system and provider level, indicators need to be profoundly understood, require formalizations in data validation, internal analysis and a sharing process among health professionals, management and policymakers.
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Affiliation(s)
- Frank Horenberg
- Health and Management Laboratory (MeS Lab), Institute of Management and Department EMbeDS, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà, 33, Pisa, Italy; Sant'Anna School of Advanced Studies, Health and Management Laboratory (MeS Lab), Piazza Martiri della Libertà, 33, 56127 Pisa PI, Italy.
| | - Daniel Adrian Lungu
- Health and Management Laboratory (MeS Lab), Institute of Management and Department EMbeDS, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà, 33, Pisa, Italy; Sant'Anna School of Advanced Studies, Health and Management Laboratory (MeS Lab), Piazza Martiri della Libertà, 33, 56127 Pisa PI, Italy.
| | - Sabina Nuti
- Health and Management Laboratory (MeS Lab), Institute of Management and Department EMbeDS, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà, 33, Pisa, Italy; Sant'Anna School of Advanced Studies, Health and Management Laboratory (MeS Lab), Piazza Martiri della Libertà, 33, 56127 Pisa PI, Italy.
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Lungu DA, Pennucci F, De Rosis S, Romano G, Melfi F. Implementing successful systematic Patient Reported Outcome and Experience Measures (PROMs and PREMs) in robotic oncological surgery-The role of physicians. Int J Health Plann Manage 2019; 35:773-787. [PMID: 31793689 DOI: 10.1002/hpm.2959] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 10/25/2019] [Accepted: 10/28/2019] [Indexed: 01/04/2023] Open
Abstract
Patient Reported Outcome and Experience Measures (PROMs and PREMs) play an increasingly important role in monitoring the quality of the oncological pathway. The aim of this study is to describe the case of five hospitals a year after the adoption of PROMs and PREMs for robotic oncological colorectal surgery in Tuscany and to investigate how the clinicians can impact the process of implementation and the efficacy of such measures. We used 14 months of data from the five robotic centers in Tuscany. Above all, the physician's personal motivation to improve the treatment of patients, the teamwork, and the possibility to use data for research purposes proved to be the essential factors for their engagement and the successful implementation of patient reported measures. Physicians play a key role in the adoption of systematic PROMs and PREMs. The higher their level of engagement, the higher the collection success, both in terms of number of patients enrolled and response rates. Moreover, the collection of patient reported measures may become part of physicians' daily practice and may lead to a change in their relationship and communication with patients, as clinicians accept to have their job reviewed and are not afraid to be evaluated by their patients.
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Affiliation(s)
- Daniel Adrian Lungu
- Health and Management Laboratory (MeS Lab), Institute of Management and Department EMbeDS, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Francesca Pennucci
- Health and Management Laboratory (MeS Lab), Institute of Management and Department EMbeDS, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Sabina De Rosis
- Health and Management Laboratory (MeS Lab), Institute of Management and Department EMbeDS, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Gaetano Romano
- Minimally Invasive and Robotic Thoracic Surgery, Robotic Multispecialty Center of Surgery, University Hospital of Pisa, Pisa, Italy
| | - Franca Melfi
- Minimally Invasive and Robotic Thoracic Surgery, Robotic Multispecialty Center of Surgery, University Hospital of Pisa, Pisa, Italy
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Lungu DA, Grillo Ruggieri T, Nuti S. Decision making tools for managing waiting times and treatment rates in elective surgery. BMC Health Serv Res 2019; 19:369. [PMID: 31185989 PMCID: PMC6560774 DOI: 10.1186/s12913-019-4199-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 05/30/2019] [Indexed: 12/24/2022] Open
Abstract
Background Waiting times for elective treatments, including elective surgery, are a source of public concern and therefore are on policy makers’ agenda. The long waiting times have often been tackled through the allocation of additional resources, in an attempt to reduce them, but results are not straightforward. At the same time, researchers have reported wide geographical variations in the provision of elective care not driven by patient needs or preferences but by other factors. The paper analyses the relationship between waiting times and treatment rates for nine high-volume elective surgical procedures in order to support decision making regarding the availability of these services for the citizens. Using the framework already proposed for the diagnostic services, we identify different patterns that can be followed to align the supply with patient needs in the Italian context. Methods After measuring the waiting times and the treatment rates for nine procedures in the 34 districts in Tuscany, we performed correlation analyses. Then, we plotted the results in a matrix cross-checking waiting times and rates. By doing so, we identified four different contexts that require a second step analysis to tackle unwarranted geographical variations and ensure timely care to patients. Finally, for each district and elective surgical procedure, we measured the economic impact of the different treatment rates in order to evaluate whether there are any supply criticalities and eventually some room for maneuver. We also included active and passive mobility of patients. Results The results show a high degree of variation both in treatment rates and waiting times, especially for the orthopaedic procedures: knee replacement, knee arthroscopy and hip replacement. The analysis performed for the nine interventions shows that the 34 districts are in varying positions in the waiting time-treatment rate matrix, suggesting that there is no straightforward relationship between rates and waiting times. Each combination in the matrix may have different determinants that require healthcare managers to adopt diversified strategies. The decision making process needs to be supported by a two-level analysis: the first one to put in place the matrix that cross-checks waiting times and treatment rates, the second one to analyse the characteristics of each quadrant and the improvement actions that can be proposed. Conclusions In Italy, waiting times in elective surgical services are a main policy issue with a relevant geographical variation. Our analysis reveals that this variation is due to multiple elements. In order to avoid simplistic approaches that do not solve the problem but often lead to increased expenditure, policy makers and healthcare managers should follow a two-step strategy firstly identifying the type of context and secondly analysing the impact of elements such as resource productivity, resource availability, patients’ preferences and care appropriateness. Only in some cases it is required to increase the service supply. Electronic supplementary material The online version of this article (10.1186/s12913-019-4199-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Daniel Adrian Lungu
- Healthcare Management Laboratory, Institute of Management and Department EMbeDS, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà, 33, Pisa, Italy.
| | - Tommaso Grillo Ruggieri
- Healthcare Management Laboratory, Institute of Management and Department EMbeDS, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà, 33, Pisa, Italy
| | - Sabina Nuti
- Healthcare Management Laboratory, Institute of Management and Department EMbeDS, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà, 33, Pisa, Italy
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Vainieri M, Lungu DA, Nuti S. Insights on the effectiveness of reward schemes from 10-year longitudinal case studies in 2 Italian regions. Int J Health Plann Manage 2018; 33:e474-e484. [PMID: 29380905 PMCID: PMC6032864 DOI: 10.1002/hpm.2496] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 01/09/2018] [Accepted: 01/09/2018] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Pay for performance (P4P) programs have been widely analysed in literature, and the results regarding their impact on performance are mixed. Moreover, in the real-life setting, reward schemes are designed combining multiple elements altogether, yet, it is not clear what happens when they are applied using different combinations. OBJECTIVES To provide insights on how P4P programs are influenced by 5 key elements: whom, what, how, how many targets, and how much to reward. METHODS A qualitative longitudinal analysis of 10 years of P4P reward schemes adopted by the regional administrations of Tuscany and Lombardy (Italy) was conducted. The effects of the P4P features on performance are discussed considering both overall and specific indicators. RESULTS Both regions applied financial reward schemes for General Managers by linking the variable pay to performance. While Tuscany maintained a relatively stable financial incentive design and governance tools, Lombardy changed some elements of the design and introduced, in 2012, a P4P program aimed to reward the providers. The main differences between the 2 cases regard the number of targets (how many), the type (what), and the method applied to set targets (how). CONCLUSION Considering the overall performance obtained by the 2 regions, it seems that whom, how, and how much to reward are not relevant in the success of P4P programs; instead, the number (how many) and the type (what) of targets set may influence the performance improvement processes driven by financial reward schemes.
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Affiliation(s)
- Milena Vainieri
- Laboratorio Management e Sanità―Institute of ManagementScuola Superiore Sant'Anna of PisaPisaItaly
| | - Daniel Adrian Lungu
- Laboratorio Management e Sanità―Institute of ManagementScuola Superiore Sant'Anna of PisaPisaItaly
| | - Sabina Nuti
- Laboratorio Management e Sanità―Institute of ManagementScuola Superiore Sant'Anna of PisaPisaItaly
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