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Old age is at the core of complex constellations composed by media discourses, care and mundane activities, and affective and technological practices that involve a wide range of human and non-human actors. While during the last years concepts such as “active” and “successful” ageing have more and more emphasised the individual responsibility of older adults in managing their own health, in the context of the Covid-19 pandemic elderly have been increasingly framed as vulnerable subjects. This Crossing Boundaries will explore the different instances assumed by the “old age” as an emerging object by the enactment of discourses and materialities. In doing so, this Crossing Boundaries mobilizes different theoretical perspectives, such as STS, media studies and sociology of health. The authors will explore three main issues: 1) the public discourse about the health status of older people; 2) the collective management of Alzheimer’s disease in and outside institutions; 3) the involvement of older adults in designing information and communication technologies.

UNSTRUCTURED Background: The development of human speech recognition technologies has made increasing progress in recent years. Their role is promising in relation to health information dissemination to facilitate the role of health workers in social distancing by distributing information to the population. Some experiments were developed during the pandemic because traditional channels (e.g. telephone help desk, websites with FAQs, social media) were compromised by the large number of user accesses. For this type of situation, it is necessary to relate the technological development paths to the contexts within which the experiments were carried out. Objective: The paper highlights the text-based experience of a chatbot aimed at meeting the information needs of citizens of a northern region of Italy during the second phase of COVID-19 pandemic emergency. Since 15 April 2021, the chatbot has been accessible from every page of the website of the local Health Authority. Users can type free-form questions and obtain relevant up-to-date answers distilled from different sources of information maintained by the national and provincial authorities. Methods: The paper makes its contribution through a mix method research design. The work proposed a retrospective analysis of the engineering processes and the technicalities of setting up the chatbot and building up the wealth of information that became the basis for its responses. The accounts come directly from the working team and the interactions with the various stakeholders involved. Results: The work highlights how a technology that has arisen within bureaucratic organisational contexts cannot easily draw from the various sources of information, such as news agencies, as the chatbot should provide exclusively trusted content approved by the Health Authority so some questions cannot be answered for lack of authoritative information. Conclusions: The study is relevant for three reasons: firstly, it highlights how AI cannot disregard the contexts of use in which it is developed; secondly, it shows that, through rigorous methods, it is possible to plan a trajectory bringing organisations from providing information designed for static channels towards interactive ones. Finally, it shows that a carefully developed strategy to provide thrusted information can generate opportunities for digital transformation in healthcare organisations.

Aim In response to the SARS-CoV-2 emergency, the Competence Centre on digital health ‘TrentinoSalute4.0’ has developed TreC_Televisita, a tele visit solution that meets the needs of the Trentino healthcare system and maintains high-quality patient–doctor interactions while respecting social distancing. This paper highlights how ‘TreC_Televisita’ was integrated into the Trentino healthcare system and its potential to become a structural and durable solution for the future local healthcare service provisioning. Subject and methods This paper presents the multifactorial context that TreC_Televisita has faced for its implementation and the strategies adopted for its structural integration into the healthcare system. The analysis focuses on the main issues faced for the integration of the tele visits (e.g. privacy, payments) and how the context of TrentinoSalute4.0 permitted responding quickly to its implementation during the pandemic. It also describes how TreC_Televisita fits into the healthcare continuum from the organisational and technological standpoint, the end-user perspective and the barriers that could hamper the solution scalability. Results TreC_Televisita has demonstrated to be a technological solution that can be contextualised for different clinical domains beyond SARS-CoV-2. Moreover, it has shown its potential to scale up the solution beyond the COVID-19 emergency to the whole healthcare provisioning system in the long term. Conclusion Being a positive experience in the first months of its implementation, the long-term goal is to transform TreC_Televisita into a structural pillar of the Trentino healthcare system, setting the bases for a sustainable, win–win situation for all the stakeholders involved in healthcare service provisioning.

Workplace health promotion (WHP) are often depicted as an opportunity for pursuing a better and broader well-being condition under the assumption that working environments affect the physical, mental, and social well-being of individuals who spend large proportion of waking hours at work. While most empirical studies provided medical evidence to the effectiveness of WHP programs, scholars question the instrumental purposes of these programs founded on the belief that “healthy workers are better workers”. Little is known, for instance, about the design of WHP programs and their acceptance by workers. Our study addresses this gap, analyzing the co-production of a WHP program in an Italian research institute promoted by the healthcare authority, the local government and the national center for prevention and security in the workplaces. To this aim, we adopt the notion of boundary object investigate how different stakeholders reclaim to take part and being involved in this process, re-shaping their goals and their boundaries and why a WHP program or parts of it may be rejected or re-negotiated by its recipients. Our analysis reveals how each stakeholder contributes to re-shape the WHP program which emerges as the modular product of the composition of each matter of concern. Most notably, the strong rooting in a clinical perspective and the original focus on only workers at risk is gradually flanked by initiatives to involve all employees. Moreover, workers draw a line as for the legitimacy of employers’ intervention in the personal sphere of health promotion, embracing interventions addressing diet and physical activity while rejecting measures targeting smoking and alcohol consumption.

IntroductionONCO-TreC platform consists of a mobile application delivered to patients as electronic diary and a web-based dashboard managed by healthcare professionals. We aim to compare the effectiveness of ONCO-TreC electronic diary with a standard paper diary, in improving adherence to oral cancer therapy in patients with solid and haematological tumours.Methods and analysisThis is an open label, superiority, randomised controlled trial conducted in two Italian oncology units. Patients will be randomised with a 1:1 ratio to electronic or paper diary. For both groups a counsellor will be responsible for drug and diary delivery. The evaluation period will end after six cycles of therapy. The primary aim is to compare the proportion of non-adherent patients in the two arms. Adherence will be measured through pill count; anyone who takes less than 90% of the total prescribed drug dose will be considered non-adherent. Assuming a percentage of non-adherent patients to oral therapy of 40% in arm B, and a 60% reduction in this percentage in arm A, a sample of 124 patients will provide 80% power to identify an absolute difference greater than 24 percentage points using a bilateral Fisher’s exact test with a significance level of 0.05. Considering a dropout rate of 10%, approximately 136 patients will have to be enrolled. The primary analysis will be performed on the intention-to-treat population. Secondary aims are to describe the reasons for non-adherence, the level of satisfaction of patients and healthcare professionals with the paper and electronic diary, and the impact of non-adherence in terms of healthcare costs.Ethics and disseminationEthical approval was obtained from Romagna Ethics Committee (CEROM), study ID 2108, prot. n. IRST 100.28 of 10/04/2020. Informed consent will be obtained from all study participants. Findings will be disseminated through peer-reviewed journals, conferences and event presentations.Protocol versionVersion 2, 6 April 2021.Trial registration numberNCT04826458.

BACKGROUND The use of oral treatments is constantly growing in the area of onco-hematology, raising adherence and safety issues. There is an increasing body of literature highlighting the importance of patient empowerment in the self-management of cancer therapies. Within this scenario, the ONCO-TreC platform was customized and fine-tuned through a prospective multicenter training-validation study in cancer patients treated with oral anticancer drugs. OBJECTIVE This prospective randomized trial was designed to compare the effectiveness of two different strategies, ie, an electronic diary (ONCO-TreC) and a paper diary, for the management of oral cancer treatments in patients with solid and hematological tumors. METHODS Ad hoc strategies are planned to measure and monitor adherence to treatment and to assess usability and acceptability of the electronic diary. Informed consent will be obtained from all study participants. RESULTS This innovative eHealth system is expected to contribute to increasing the adherence to and safety of cancer care, promoting patient empowerment and improving patient-doctor communication. Ethical approval was obtained from the Independent Ethics Committees of the participating institutions (CEIIAV protocol no. 2982/2020; reference no. 2108). CONCLUSIONS Findings will be disseminated through peer-reviewed journals, conferences and event presentations. CLINICALTRIAL ClinicalTrials.gov NCT04826458; Institutional ID no. IRST100.28

Type 1 diabetes mellitus (T1DM) is an auto-immune disease that requires an important effort in self-management. The onset of T1DM in a child places a significant burden on parents, requiring careful management of blood glucose levels through insulin injections, diet and exercise. The main aim of our study is to synthesise what is known about the consequences of T1DM onset for families and, in particular, how parents share the emotional, practical and educational burden of care connected with diabetes management. To accomplish this goal, we conducted an integrative review of 29 studies concerned with the ways in which disease management permeates the daily lives of families. Based on our findings, we offer suggestions for future research. For this study, PubMed, SAGE Journals, Google Scholar, ERIC, Web of Science, Embase and Scopus databases from 2000 to 2017 were searched using keywords related to T1DM management in families, parental roles and learning processes. Our sample included qualitative, quantitative and mixed-method studies which assessed the consequences of T1DM onset for the family and, in particular, the ways through which disease management permeates the daily lives of mothers and fathers of children with T1DM (3–18 years of age). The initial literature search returned 113 papers and 29 studies that met all the inclusion criteria. Through a content analysis, we identified three conceptual categories: (i) ‘managing emotions after diagnosis’, (ii) ‘reconstructing routines around new needs’ and (iii) ‘educating young patients to enhance autonomy’. The review results strongly support that diabetes is a family illness in which patients and parents are at the centre of emotions, routines and knowledge strictly connected to diabetes. Strong emotions, new routines and educational processes arise after T1DM onset, changing family life definitively.

BACKGROUND A platform designed to support the home management of oral anticancer treatments and provide a secure web-based patient–health care professional communication modality, ONCO-TreC, was tested in 3 cancer centers in Italy. OBJECTIVE The overall aims of the trial are to customize the platform; assess the system’s ability to facilitate the shared management of oral anticancer therapies by patients and health professionals; and evaluate system usability and acceptability by patients, caregivers, and health care professionals. METHODS Patients aged ≥18 years who were candidates for oral anticancer treatment as monotherapy with an Eastern Cooperative Oncology Group performance status score of 0 to 1 and a sufficient level of familiarity with mobile devices were eligible. ONCO-TreC consisted of a mobile app for patients and a web-based dashboard for health care professionals. Adherence to treatment (pill count) and toxicities reported by patients through the app were compared with those reported by physicians in medical records. Usability and acceptability were evaluated using questionnaires. RESULTS A total of 40 patients were enrolled, 38 (95%) of whom were evaluable for adherence to treatment. The ability of the system to measure adherence to treatment was high, with a concordance of 97.3% (95% CI 86.1%-99.9%) between the investigator and system pill count. Only 60% (3/5) of grade 3, 54% (13/24) of grade 2, and 19% (7/36) of grade 1 adverse events reported by physicians in the case report forms were also reported in the app directly by patients. In total, 94% (33/35) of patients had ≥1 app launch each week, and the median number of daily accesses per patient was 2. Approximately 71% (27/38) and 68% (26/38) of patients used the app for messages and vital sign entering, respectively, at least once during the study period. CONCLUSIONS ONCO-TreC is an important tool for measuring and monitoring adherence to oral anticancer drugs. System usability and acceptability were very high, whereas its reliability in registering toxicity could be improved. CLINICALTRIAL ClinicalTrials.gov NCT02921724; https://www.clinicaltrials.gov/ct2/show/NCT02921724

Background A platform designed to support the home management of oral anticancer treatments and provide a secure web-based patient–health care professional communication modality, ONCO-TreC, was tested in 3 cancer centers in Italy. Objective The overall aims of the trial are to customize the platform; assess the system’s ability to facilitate the shared management of oral anticancer therapies by patients and health professionals; and evaluate system usability and acceptability by patients, caregivers, and health care professionals. Methods Patients aged ≥18 years who were candidates for oral anticancer treatment as monotherapy with an Eastern Cooperative Oncology Group performance status score of 0 to 1 and a sufficient level of familiarity with mobile devices were eligible. ONCO-TreC consisted of a mobile app for patients and a web-based dashboard for health care professionals. Adherence to treatment (pill count) and toxicities reported by patients through the app were compared with those reported by physicians in medical records. Usability and acceptability were evaluated using questionnaires. Results A total of 40 patients were enrolled, 38 (95%) of whom were evaluable for adherence to treatment. The ability of the system to measure adherence to treatment was high, with a concordance of 97.3% (95% CI 86.1%-99.9%) between the investigator and system pill count. Only 60% (3/5) of grade 3, 54% (13/24) of grade 2, and 19% (7/36) of grade 1 adverse events reported by physicians in the case report forms were also reported in the app directly by patients. In total, 94% (33/35) of patients had ≥1 app launch each week, and the median number of daily accesses per patient was 2. Approximately 71% (27/38) and 68% (26/38) of patients used the app for messages and vital sign entering, respectively, at least once during the study period. Conclusions ONCO-TreC is an important tool for measuring and monitoring adherence to oral anticancer drugs. System usability and acceptability were very high, whereas its reliability in registering toxicity could be improved. Trial Registration ClinicalTrials.gov NCT02921724; https://www.clinicaltrials.gov/ct2/show/NCT02921724

PURPOSE: The COVID-19 outbreak rapidly became a public health emergency and led to radical changes in patient management. From the start of the pandemic, we used electronic medical record–assisted telephone follow-up (E-TFU) of cancer survivors (CS) to minimize hospital exposure. The aim of this prospective study was to assess how breast cancer survivors (bCSs) perceived E-TFU. MATERIALS AND METHODS: A 15-item survey was e-mailed to bCSs who had been managed with E-TFU. The responses were measured using Likert-like scales and were correlated with the main characteristics of the bCS using Pearson's test. RESULTS: One hundred thirty-seven of 343 bCSs (40%) completed the survey between March 9 and June 2, 2020. Their median age was 59 years. Although 80.3% of bCSs were satisfied with E-TFU, only 43.8% would like to have E-TFU in the future. A low educational level was correlated with higher COVID-19–related anxiety ( P = .025). An older age ( P = .002) and a low educational level ( P < .0001) were correlated with the need to be accompanied to reach the hospital. A personal history of second cancer was inversely correlated with understanding medical advice ( P = .015) and the expectation of feeling relief after a follow-up visit ( P = .0027). Furthermore, pandemic phase II was correlated with satisfaction with E-TFU ( P = .010). CONCLUSION: E-TFU was an important means of avoiding hospital contacts during the COVID-19 pandemic, and the majority of bCSs in the survey were satisfied with this procedure. Further studies are needed to investigate the implementation of telemedicine even outside an emergency situation.

Remote monitoring has often been thought to lead to a highly structured and standardised care process. Several studies have stressed that patient-provider communication could be hindered if mediated by technologies, leading to an impoverished relationship. We argue that while remote monitoring leads to a redefinition of the patient-provider relationship, it could also offer the opportunity to develop a more intimate acquaintance not possible via only routine visits. The study is part of a clinical trial aimed at assessing the acceptability of a remote monitoring platform for type 1 diabetes. Drawing on practice-based studies, we focused our analysis on the practice of text message exchange between patients and providers. The 396 conversations were coded with a template analysis, leading to the identification of two main categories: 'knowing the patient' and 'knowing about the patient'. The analysis reveals that the practice of messaging led to the development of a 'digital intimacy', a relationship characterised by a thorough familiarity made possible by electronic devices that extends to face-to-face encounters. Drawing on our case, we argue that remote monitoring can foster greater intimacy between patients and providers, which is made possible by the overall increase in the quantity and quality of communication between patients and providers.

La promozione della salute sui luoghi di lavoro è oggetto di riflessione e analisi di discipline che vanno dalla medicina preventiva fino alle scienze aziendali, passando per la dietologia e le scienze motorie. Il nostro articolo si propone invece di contribuire al dibattito sulla promozione della salute sui luoghi di lavoro da una prospettiva organizzativista, indagandone gli aspetti processuali e la significazione simbolica nei contesti organizzativi. A questo scopo, il lavoro documenta e analizza la progettazione di Key to Health, un’iniziativa di Workplace Health Promotion condotta presso un grande istituto di ricerca con sede nella Provincia Autonoma di Trento. Tramite l’analisi dello studio di caso del progetto Key to Health, l’articolo intende riflettere sui processi di co-costruzione di un intervento di Workplace Health Promotion, soffermandosi sulle tensioni emergenti dai diversi modi di concepire e rappresentare la gestione della salute all’interno di un’organizzazione.

Why data work in healthcare? Healthcare organizations across the globe are currently grappling to implement tools and practices to transform data from “refuse to riches,” a movement propelled by mass adoption of electronic health records (EHRs), sensors, and servers that can hold an ever-expanding volume of digital data. Allegedly, “By digitizing, combining and effectively using big data, healthcare organizations ranging from single-physician offices and multi-provider groups to large hospital networks and accountable care organizations stand to realize significant benefits.” The potential is “. . . to improve care, save lives and lower costs.” As a consequence, organizations are struggling under massive institutional pressures to make healthcare “data-driven” against the messy reality of creating, managing, analyzing, and using data for management, decision-making, accountability, and medical research.

In recent decades, longer life expectancy, the consequent greater number of patients with often concurrent diseases, and the need of healthcare institutions to reduce the costs of services, have engendered changes in all European healthcare systems. On one side, healthcare systems increasingly rely on the self-management skills of patients, who undertake a growing amount of ‘sickness work’ from which they are relieved only in the case of severe illness. On the other, the inability of public healthcare systems to satisfy the increased demand for care has led to the growth of private healthcare organizations as well as cooperatives of health professionals who offer their services privately. The care of citizens, therefore, is increasingly distributed across networks of actors with very different objectives, logics of action and professional backgrounds (public and private healthcare organizations, community medical services, voluntary organizations). Despite the attention devoted by social studies of medicine to the work done by citizens in supporting the work of clinicians and nurses, the work performed in connection to the management of care networks have been only marginally investigated. Drawing on a qualitative research carried out in the Province of Trento (Italy) and focused on the different ways in which elderly people with chronic conditions manage their conditions outside the healthcare and welfare institutions, in this paper we are interested in deepening the understanding of the invisible work citizens perform in connection to the management of care services and professionals. That is, the work needed in order to activate, mend and coordinate complex networks of care.

BACKGROUND The diffusion of information and communication technologies (ICTs) in type 1 diabetes (T1D) management has generated a debate on the ways in which ICTs can support the patient-provider relationship. Several studies have focused on text messages. Most of the literature proposes quantitative analysis of the impact of text messaging on the clinical conditions of patients and/or their satisfaction with the technology, while the qualitative studies have focused mainly on patients’ perceptions about strengths and weaknesses of this technology. OBJECTIVE In contrast to past studies, we adopted a qualitative approach for the in-depth examination of patient-health care professionals’ interactions in text messaging. METHODS The study focused on the use of the Trento Cartella Clinica del Cittadino Diabetes System (TreC-DS), a digital platform with a built-in messaging system, in two diabetes centers, integrating message analysis with interviews with patients and health care professionals. Each center focused on a specific patient profile: the first one focused on pregnant women with T1D and the second one focused on adult patients with poorly controlled diabetes. RESULTS The main results of the study were as follows: (1) Health care professionals and patients perceived the messaging system as useful for sharing information (ie, pregnant women for prescriptions and adults with poorly controlled diabetes for advice); (2) The content and communication styles of the two centers differed: in the case of pregnant women, interactions via text messaging were markedly prescriptive, while in the case of adult patients with poorly controlled diabetes, they were conceived as open dialogues; and (3) Conversations were initiated mainly by professionals; in the cases considered, it was mainly the diabetes center that decided whether a messaging conversation was needed. CONCLUSIONS The results show how the features of interactions of text messaging changed based on the patient profiles in two different centers. In addition, in both diabetes centers that were involved, the system seems to have laid a foundation for a closer relationship between patients and health care professionals.

Although WhatsApp is used by teenagers as one major channel of cyberbullying, such interactions remain invisible due to the app privacy policies that do not allow ex-post data collection. Indeed, most of the information on these phenomena rely on surveys regarding self-reported data. In order to overcome this limitation, we describe in this paper the activities that led to the creation of a WhatsApp dataset to study cyberbullying among Italian students aged 12-13. We present not only the collected chats with annotations about user role and type of offense, but also the living lab created in a collaboration between researchers and schools to monitor and analyse cyberbullying. Finally, we discuss some open issues, dealing with ethical, operational and epistemic aspects.

In recent decades, Western Health Systems have been at the centre of many changes such as, for example, the rise in chronic illnesses and demand for treatment, the decline in public re-sources available to public welfare, the increasing importance of pharmaceutical companies and private health care facilities and, finally, the spread of Information Communication Technologies (ICT) to support care processes. The work shows the procedure between health practice and the use of existing IT infrastruc-tures. This has required a change in working practices and involved new complex socio-material practices and specific know-how. The safety of the system, which should be guaran-teed by standardized formal protocols, is supported by informal practices, from the experi-ences gained in the workplace and from the organization, which allow coordination between heterogeneous players. The study also revealed how, despite the micro-policies that the intro-duction of the new system would impose through the control of managers on staff, the safety of the process is ensured mainly by the work organization and mutual supervision between the different professional figures.

Purpose– Personal Health Record (PHR) systems make possible to integrate data from different sources and circulate them within the illness care and management network. The new arrangements prefigure a redefinition of the relations among healthcare practitioners, patients, and caregivers. The purpose of this paper is to consider the role and the meanings attributed to information when a technical artifact enables new forms of communication within the healthcare management network.Design/methodology/approach– The authors adopted a qualitative research design, conducting a pre-post analysis on a theoretical sample of patients and of a paediatrics department. The authors selected 12 patients (six females and six males) aged between four and 20 years old.Findings– The patients were willing to act as “stewards of their own information” (Halamkaet al., 2008), but they interpreted this role in terms of restricting access to their information, rather than facilitating its dissemination. In fact, the PHR was symbolized as an instrument to support personal diabetes management but the patients want to preserve their own competence and independent management on the information regarding their “Personal” diseases.Originality/value– This work highlights two connotation of “Personal” information. The first is the dimension of the right to the privacy of information when it is believed that it may be used to pass judgement on the patient. The second connotation of “Personal” is the assertion by patients of their competence and autonomy in interpreting the information on the basis of personal knowledge about their diabetes.

This paper discusses mediation in the patient–provider relationship arising from the introduction of digital technology for a specific form of monitoring: ‘clinical self-tracking’. Focusing on the management of type 1 diabetes, a condition that requires significant self-management by patients, we describe how the actors negotiated a new ICT-mediated relationship in three hospital departments. The analysis followed a qualitative design and was carried out by interviewing patients, clinicians and technology developers and by analysing messages exchanged through the ICT tool. We first show how each department customised the system by drawing on already existing care practices, organisational goals and representations of the department’s desired relationship with the patients. We then focus on patient–provider relationships, showing that, while the clinical self-tracking sometimes followed the path desired by the providers, at other times, it developed in unexpected ways. We distinguish among three emerging categories of self-tracking: self-tracking for remote management, self-tracking for e-learning and self-tracking as boundary setting. The analysis reveals how the new patient–provider relationship arises from an open-ended process. Providers can push self-tracking practices but cannot steer them; and patients, through an unexpected use of the self-tracking technologies, are able to negotiate a desired relationship with providers.

Negli ultimi anni le istituzioni locali e nazionali hanno implementato politiche volte ad integrare interventi sociali e sanitari. Allo stesso tempo, il dibattito scientifico ha posto sempre piu attenzione sulle strategie di integrazione socio-sanitaria, trascurando pero il piu delle volte il ruolo dei pazienti e dei loro caregiver. Il contributo proposto mira a colmare questo gap, presentando alcuni risultati di una ricerca qualitativa svolta nella Provincia di Trento e focalizzata sul caso degli anziani con patologie croniche. In particolare, muovendo da un approccio practice based, si mostrera come la famiglia giochi un ruolo centrale nell’integrazione socio-sanitaria, arruolando professionisti e caregivers informali, coordinando la loro azione e rammendando "i buchi" dei network di cura emergenti.

Il lavoro presenta una riflessione sull’educazione terapeutica svolta dal personale sanitario fuori dal contesto ospedaliero. Lo scopo del contributo è analizzare gli effetti di un periodo prolungato di educazione all’auto-gestione sulla alleanza terapeutica. A partire da una etnografia condotta su campi scuola per bambini e adolescenti con diabete di Tipo 1 la ricerca si concentra su quattro dimensioni specifiche dei campi scuola: i campi scuola come spazi inter- organizzativi, la relazione tra il reparto e il campo scuola, l’ottenimento di obiettivi clinici tramite le relazioni tra i partecipanti al campo e l’apprendimento dei medici riguardo ai pazienti e la conseguente ridefinizione del rapporto medico-paziente. La ricerca permette di considerare il periodo al campo scuola come un “incontro clinico prolungato”, un momento fondativo e centrale nella ridefinizione della relazione tra medico e paziente.

Background: The diffusion of information and communication technologies (ICTs) in type 1 diabetes (T1D) management has generated a debate on the ways in which ICTs can support the patient-provider relationship. Several studies have focused on text messages. Most of the literature proposes quantitative analysis of the impact of text messaging on the clinical conditions of patients and/or their satisfaction with the technology, while the qualitative studies have focused mainly on patients’ perceptions about strengths and weaknesses of this technology. Objective: In contrast to past studies, we adopted a qualitative approach for the in-depth examination of patient-health care professionals’ interactions in text messaging. Methods: The study focused on the use of the Trento Cartella Clinica del Cittadino Diabetes System (TreC-DS), a digital platform with a built-in messaging system, in two diabetes centers, integrating message analysis with interviews with patients and health care professionals. Each center focused on a specific patient profile: the first one focused on pregnant women with T1D and the second one focused on adult patients with poorly controlled diabetes. Results: The main results of the study were as follows: (1) Health care professionals and patients perceived the messaging system as useful for sharing information (ie, pregnant women for prescriptions and adults with poorly controlled diabetes for advice); (2) The content and communication styles of the two centers differed: in the case of pregnant women, interactions via text messaging were markedly prescriptive, while in the case of adult patients with poorly controlled diabetes, they were conceived as open dialogues; and (3) Conversations were initiated mainly by professionals; in the cases considered, it was mainly the diabetes center that decided whether a messaging conversation was needed. Conclusions: The results show how the features of interactions of text messaging changed based on the patient profiles in two different centers. In addition, in both diabetes centers that were involved, the system seems to have laid a foundation for a closer relationship between patients and health care professionals.

Introduction of healthcare infrastructures is often accompanied by workarounds, persistence of paper-based documents and of technologies that the innovation was intended to replace, raising the question as to whether they are by-products or intrinsic to infrastructure innovation processes. This work, through a longitudinal case study of a hospital information system long in use, investigates their origin, their role in enabling the system’s affirmation, and the difficulty of eliminating them. Through a qualitative methodology, semi-structured interviews and ethnography, we reconstruct the history of the system and the information management practices around it. Our analysis reveals that the effectiveness of the tool implemented derived largely from ‘junction work’ performed by the nurses, which ensured the flow of data among different electronic and paper-based information systems. Moreover, in carrying out their junction work the nurses intervened to modify, enrich and complete the information contained in the different systems.

by Emilio F. Moran, Malden, MA, Wiley-Blackwell, 2010, 232 pp., US$37.95 (paperback), ISBN 9781405105743 Studies that address the human dimensions of global environmental change face the stark real...