Barriers and facilitators to health technology adoption by older adults with chronic diseases: an integrative systematic review.

BACKGROUND: In recent years, healthcare systems have progressively adopted several technologies enhancing access to healthcare for older adults and support the delivery of efficient and effective care for this specific population. These technologies include both assistive technologies designed to maintain or improve the independence, social participation and functionality of older people at home, as well as health information technology developed to manage long-term conditions. Examples of such technologies include telehealth, wearable devices and mobile health. However, despite the great promise that health technology holds for promoting independent living among older people, its actual implementation remains challenging. METHODS: This study aimed to conduct an integrative systematic review of the research evidence on the factors that facilitate or hinder the adoption of different types of technology by older individuals with chronic diseases. For this purpose, four electronic databases (PsycArticles, Scopus, Web of Science and PubMed) were queried to search for indexed published studies. The methodological quality of the selected papers has been assessed using the Mixed Methods Appraisal Tool (MMAT). RESULTS: Twenty-nine articles were selected, including 6.213 adults aged 60 or older. The studies have been synthesised considering the types of technological interventions and chronic diseases, as well as the main barriers and facilitators in technology acceptance. The results revealed that the majority of the selected articles focused on comorbid conditions and the utilisation of telemedicine tools. With regard to hindering and facilitating factors, five main domains were identified: demographic and socioeconomic, health-related, dispositional, technology-related and social factors. CONCLUSION: The study results have practical implications not only for technology developers but also for all the social actors involved in the design and implementation of healthcare technologies, including formal and informal caregivers and policy stakeholders. These actors could use this work to enhance their understanding of the utilisation of technology by the ageing population. This review emphasises the factors that facilitate technology adoption and identifies barriers that impede it, with the ultimate goal of promoting health and independent living.

Health Risk Communication During COVID-19 Emergency in Italy: The Impact of Medical Experts' Debate on Twitter.

The COVID-19 emergency underlined the importance of an effective public health communication to limit the spread of the outbreak. Physicians as "public experts" can play a crucial part in health risk communication, even if their role is challenged by transformations into the information system. Therefore, the major objective of this study was to investigate public perception of medical experts' opinions regarding the COVID-19 emergency. The Italian public debate involving medical experts in the Twitter sphere during the SARS-CoV-2 pandemic has particularly been examined. A content analysis was performed on 2,040 randomly selected tweets. The results of content analysis show that the medical experts who tend to mitigate the risk received a higher number of tweets supporting their positions when compared to the experts whose statements were aimed at intensifying the risk. Since a public expert is a communicator, but also an advisor who can affect how laypersons perceive and react to risk events, this study can provide more knowledge about the public perception of different communication strategies incorporated by medical experts.

Italian validation of the situational Brief Cope Scale (I-Brief Cope).

The Brief COPE (Coping Orientation to Problems Experienced) inventory is 14 faced scales used to assess coping strategies. It has been administered on different population samples and translated into several languages. Nonetheless, the Italian validation of its situational format is missing, and the present study aimed to fill this gap. To this end, the original English version of the scale was translated into Italian and administered to a sample of 682 Italian healthcare workers (HCWs), during the first wave of COVID-19. The Exploratory and Confirmatory Factor Analysis (EFA and CFA) were performed and led to the validation of the Italian Brief COPE (I-Brief COPE) scale, consisting of 21 items, loading properly on 6 factors, which range from activation (F1) to deactivation (F2), via social support (F3), humorous reframing (F4), religious/spiritual reliance (F5), substances use (F6). The six factors identified represent, according to our analyses, the relevant dimensions of coping in a stressful situation such as COVID-19. The results of this study reveal that the I-Brief Cope can be considered as a valid tool for measuring coping strategies in facing stressful, unpredictable, and damaging events.

The Robust Italian Validation of the Coping Humor Scale (RI-CHS) for Adult Health Care Workers.

The Coping Humor Scale (CHS) is a seven-item tool widely used to assess the use of humor in coping with stressful situations. The beneficial effect of humor in buffering the impact of negative experiences has been investigated in several contexts and populations; for this reason, the CHS has been used in many languages, but its solid validation in Italian is still missing. Our study aimed at building a robust instrument to measure coping humor strategies among Italian health care workers, a category which has been particularly exposed to stressful situations in the last two years. The CHS translated into Italian was administered to a sample of 735 health care workers during the first wave of the COVID-19 pandemic in Italy. Confirmatory factor analysis and Rasch analysis were performed. As a result, a six-item Robust Italian Coping Humor Scale (RI-CHS) was validated and ready to use for future studies on Italian health care workers' samples. This study gives evidence that our six-item solution works as a ruler (i.e., an instrument that meets the conditions of fundamental measurement in the context of the human sciences) to measure the degree to which Italian health care workers rely on humor to cope with stress.

Associations between Personality Traits, Intolerance of Uncertainty, Coping Strategies, and Stress in Italian Frontline and Non-Frontline HCWs during the COVID-19 Pandemic-A Multi-Group Path-Analysis.

The COVID-19 pandemic represented a very difficult physical and psychological challenge for the general population and even more for healthcare workers (HCWs). The main aim of the present study is to test whether there were significant differences between frontline and non-frontline Italian HCWs concerning (a) personality traits, intolerance of uncertainty, coping strategies and perceived stress, and (b) the models of their associations. A total of 682 Italian HCWs completed a self-report questionnaire: 280 employed in COVID-19 wards and 402 in other wards. The analysis of variance omnibus test revealed significant differences between the two groups only for perceived stress, which was higher among the frontline. The multi-group path analysis revealed significant differences in the structure of the associations between the two groups of HCWs, specifically concerning the relations between: personality traits and intolerance of uncertainty; intolerance of uncertainty and coping strategies. Regarding the relation between coping strategies and stress no difference was identified between the two groups. In both of them, emotionally focused coping was negatively related with perceived stress, whereas dysfunctional coping was positively related with stress. These results could be useful in planning actions aiming to reduce stress and improve the effectiveness of HCWs' interventions. Training programs aimed to provide HCWs with a skillset to tackle uncertain and stressful circumstances could represent an appropriate support to develop a preventive approach during outbreaks.

Italian onco-haematological patients' preferences in bad news communication: a preliminary investigation.

BACKGROUND: The manner in which bad news is communicated in oncological contexts can affect patients' engagement, their coping strategies and therapeutic compliance. Although this topic has been broadly investigated since the nineties, to the best of our knowledge, little has been written about Italian patients' experiences and preferences concerning what the oncologists should disclose and how they should intimate patients about their health conditions in different stages of oncological disease. METHODS: In an attempt to fill this gap, an online self-report questionnaire was administered to a sample of Italian onco-haematological patients. Data were analysed both qualitatively (by a content analysis) and quantitatively (by descriptive analysis and Generalized Linear Mixed Model). RESULTS: While the majority of patients elected to know the truth during their clinical course, a polarisation between those arguing that the truth be fully disclosed and those claiming that the truth be communicated in a personalised way was observed at the attitude level. Among demographic variables accounted for, age seems to most affect patients' preferences. Indeed, younger Italian patients decidedly reject concealment of the truth, even when justified by the beneficence principle. This result could be a reaction to some protective and paternalistic behaviours, but it could even reflect a relation according to which the more the age increases the more the fear of knowing rises, or an intergenerational change due to different ways of accessing the information. The qualitative analysis of the final open-ended question revealed three main sources of problems in doctor-patient encounters: scarcity of time, absence of empathy and use of not-understandable language that makes it difficult for patients to assume a more active role. CONCLUSIONS: The results of the present study, which represents a preliminary step in the subject investigation, will be deployed for the construction and validation of a more sophisticated questionnaire. Better awareness of the Italian onco-haematological patients' preferences concerning bad news communication and truth-telling could be useful in adopting more suitable medical practices and improving doctor-patient relationships.

Coronavirus Disease Stress Among Italian Healthcare Workers: The Role of Coping Humor.

The study aimed to understand how coping strategies in general and humor-based coping strategies in particular modulate the perception of pandemic-related stress in a sample of Italian healthcare workers during the coronavirus disease (COVID-19) outbreak in Italy. A total of 625 healthcare workers anonymously and voluntarily completed a 10-min questionnaire, which included psychometrically valid measurements preceded by a set of questions aimed at determining workers' exposure to COVID-19. The Perceived Stress Scale was used to measure healthcare workers' stress levels, and the Brief COPE Scale and Coping Humor Scale were used to assess participants' avoidant or approach coping style and verify the degree to which they relied on humor to cope with stress. The results show that (1) levels of perceived stress were higher in healthcare workers who were more exposed to COVID-19 (i.e., who came into contact with COVID-19 patients or worked in wards dedicated to COVID-19) in comparison to less-exposed workers; (2) participants who reported a higher use of avoidant coping strategies perceived the situation as more stressful than those who used them less; and (3) healthcare workers who reported higher use of humor-based coping strategies perceived the situation as less stressful in comparison with those who reported less use of coping humor. Such findings expanded other research studies by including coping humor as a potential factor to mitigate the perceived stress related to COVID-19. The paper concludes with a discussion of implications for future research and limitations of the study.