Maria Grazia Rossi

Fertilizing a patient engagement ecosystem to innovate healthcare: Toward the first Italian Consensus conference on patient engagement

Currently we observe a gap between theory and practices of patient engagement. If both scholars and health practitioners do agree on the urgency to realize patient engagement, no shared guidelines exist so far to orient clinical practice. Despite a supportive policy context, progress to achieve greater patient engagement is patchy and slow and often concentrated at the level of policy regulation without dialoguing with practitioners from the clinical field as well as patients and families. Though individual clinicians, care teams and health organizations may be interested and deeply committed to engage patients and family members in the medical course, they may lack clarity about how to achieve this goal. This contributes to a wide “system” inertia—really difficult to be overcome—and put at risk any form of innovation in this filed. As a result, patient engagement risk today to be a buzz words, rather than a real guidance for practice. To make the field clearer, we promoted an Italian Consensus Conference on Patient Engagement (ICCPE) in order to set the ground for drafting recommendations for the provision of effective patient engagement interventions. The ICCPE will conclude in June 2017. This document reports on the preliminary phases of this process. In the paper, we advise the importance of “fertilizing a patient engagement ecosystem”: an oversimplifying approach to patient engagement promotion appears the result of a common illusion. Patient “disengagement” is a symptom that needs a more holistic and complex approach to solve its underlined causes. Preliminary principles to promote a patient engagement ecosystem are provided in the paper.

Weak Educational Components in mHealth Devices for Diabetes Support Available on the Italian Market

On the frontier between technology, psychology, and the behavioral sciences, the research field of positive technology studies the kinds of technological devices that can impact individuals’ well-being and the way they do so. In a way, mHealth can be considered as a subset of positive technology in that it aims at supporting “individuals in reaching engaging and self-actualizing experiences.” In spite of this potential, there remain a few open questions as to the effectiveness of the mHealth devices currently on offer. We report the results of a review of apps for diabetes patients on offer for the Italian-speaking public. Apps were identified by conducting a search in the Google Play Store (for the Android mobile operating system) and Apple App Store (for the IOS mobile operating system) during October 2015. We have considered 140 apps on the Google Play Store (GPS) and 73 apps on the Apple App Store (AAS). The smaller number of apps considered for IOS users probably depends on different inclusion criteria adopted by the 2 stores. Of the 180 rejected apps, 53.5% do not have an Italian-language user interface (67% for Android category and 25% for IOS category), 21.7% are paid apps (15% for Android category and 35% for IOS category), and 13.9% are not apps designed for the task of diabetes self-management (12.5% for Android category and 16.7% for IOS category). The total number of eligible apps is 20 for the GPS and 13 for the AAS, of which 16 are duplicate apps and have thus been left out. Overall, the final selection is of 17 apps (of which just 3 apps are available on both stores). The 17 selected apps resulting from our selection have been analyzed by looking at how they are structured as regards the educational level. International reviews have already underlined the lack of educational contents in the majority of mobile applications worldwide. Our review confirms this result also for Italy. In considering which of the apps’ functionalities to include in the category “educational,” we have decided to include those functions designated to offer information aimed at improving self-awareness and autonomy of patients regarding their disease. In particular, we have regarded education as a composite category and we have analyzed apps with reference to 6 subcategories: decision support (8 apps feature this function; 47%), messages (8 apps feature this function; 47%), contents (2 apps feature this function; 11.8%), visual aids (16 apps feature this function; 94.1%), goal setting (3 apps feature this function; 17.6%), social sharing (3 apps feature this function; 17.6%). Our analysis of the educational functionalities reveals an underlying idea of education that is mostly limited to the transmission of information. For example, when we paid attention to the linguistic structure of the messages used by the apps we observed that all messages evaluated are used to provide alerts or reminders. We never found messages used as instruments for critical thinking to foster self-awareness and autonomy. This exemplification suggests that the educational functionalities included in the reviewed apps did not take into account more comprehensive conceptions of education, which include the ability to process and interpret information, allowing users to then act on it. Based on these observations, we are planning to design and test a new mobile app for diabetes support for the Italian market. By working in particular on the visual aids, goal setting functions and messages functions included in the app, we are designing messages encouraging critical thinking that are based on the theoretical assumptions derived from the use of a cognitive-argumentative model of verbal communication. To verify the efficacy of our assumptions regarding the effectiveness of the messages featured in this application, we will test a prototype with type 2 diabetes patients in 2 hospitals in Italy. Further interventions devoted to assessing the role of different educational functions to improve diabetes self-management are necessary.

Argumentation as a Bridge Between Metaphor and Reasoning

The aim of this chapter is to explore the relationship between metaphor and reasoning, by claiming that argumentation might act as a bridge between metaphor and reasoning. Firstly, the chapter introduces metaphor as a framing strategy through which some relevant properties of a (generally more concrete and known) source domain are selected to understand a (generally less concrete and known) target domain. The mapping of properties from the source to the target domain implicitly forces the interpreter to consider the target from a specific perspective. Secondly, the chapter presents metaphor as an implicit argument where some inferences can be drawn from the comparison between the source and the target domain. In particular, this chapter aims to understand whether and to what extent such an argument might be linked to analogical reasoning. The chapter argues that, in case of faulty analogy, this kind of argument might have the form of a quaternio terminorum, where metaphor is the middle term. Finally, the chapter presents the results of an experimental study, aiming to test the effect of the linguistic nature of the middle term on the detection of such faulty analogy. The chapter concludes that a wider context is needed to make sense of an analogical argument with novel metaphors, whilst in a narrow context, a lexicalised metaphor might be extended and the overall argument might be interpreted as metaphoric.

Argomenti metaforici: come integrare persuasione e argomentazione / Metaphor in Arguments: How to Integrate Persuasion and Argumetation

The persuasive power of metaphor is often seen in opposition to rational procedures in argumentation, which should guarantee deliberative democracy in the public sphere. Against this view, referable to the classic theory of argumentation, we adopt the argumentative theory of reasoning (MERCIER, SPERBER 2011) and present the results of an experimental study on the role of metaphors in a specific argumentative fallacy, the quaternio terminorum (ERVAS, LEDDA 2014; ERVAS, GOLA, LEDDA, SERGIOLI 2015). In light of the experimental evidence, we argue that (1) it is no longer possible to evaluate the role of metaphors in argumentation without distinguishing different kinds of metaphors (in the experimental study the distinction between dead and live metaphors is analysed); (2) it is possible to identify different argumentative styles (i.e. argumentative persuasion and reflective argumentation). Connecting different kinds of metaphors with different argumentative styles, we propose an interpretative framework able to integrate persuasion and argumentation.

Come affinare le armi della seduzione: emozioni e vigilanza epistemica / How to Sharpen the Seduction Weapons: Emotions and Epistemic Vigilance

Seduction is often seen as a deceptive strategic game, which hampers deliberation. However, in case of seduction, emotions play a central role in modulating communicated contents. In this sense, seduction is not a form of deception, but an impulse to know. How to provide a cognitive account of seduction able to distinguish it from deception? Within philosophical Western tradition, emotions have a negative role in deliberation as they are automatic, unconscious and obliged. In contrast with this tradition, Mascaro and Sperber have recently argued that the capacity for epistemic vigilance enables people to filter misinformation, based not only on epistemic but also on affective knowledge. Some of the cognitive mechanisms presupposed by epistemic vigilance are targeted at the source of information, others at its content. Within the framework of the argumentative theory of reasoning, we propose a cognitive account of seduction able to distinguish it from deception, by focusing on the affective component of epistemic vigilance. We argue that in seduction emotions, far from being totally automatic, unconscious and obliged, contribute to the appreciation of both the source and content of information. Diversely from deception, seduction presupposes a positive role of emotions which induces a creative style of argumentation.