BackgroundPatient engagement (PE) is increasingly regarded as a key factor in the improvement of health behaviors and outcomes in the management of chronic disease, such as type 2 diabetes. This article explores (1) the reasons for disengagement of diabetic patients and their unique subjective attitudes from their experience and (2) the elements that may hinder PE in health management.Methods29 Type-2 uncontrolled diabetes patients were asked to keep a one-week diary related to their experience of disease management, according to the narrative inquiry qualitative approach. They were interviewed to ascertain reasons for PE. The elicited narratives were subjected to interpretive content analysis.ResultsThe findings suggest that patients give meaning to their diabetes and its management through a complex frame of subjective experiential dimensions (cognitive/thinking, behavioral/conative and emotional/feeling), which have an impact on the spheres of daily life that are considered to be crucial in the management of diabetes (diet, physical activity, therapy, doctor-patient relationship) for each patient. These results suggest that PE develops along a continuum featuring four subsequent phases (blackout, arousal, adhesion, eudaimonic project). Several unmet needs related to the different phases of the PE continuum were discovered and illuminated possible types of support.ConclusionsOur findings appear to confirm some features of PE detected by previous research, such as a behavioral component. We were also able to shed light on the synergic roles played by other subjective dimensions of patient experience (the cognitive/thinking and the emotional/feeling components) in orienting PE towards the care process. The article suggests a possible framework to deeply understand the PE process useful to orient really attuned actions to support it. These results suggest the importance of developing patient engagement assessment tools that are more firmly grounded in the individual patient experience.

ObjectiveIn approaching the study and practice of heart failure (HF) management, authors recognise that the patient–doctor relationship has a central role in engaging patients in their care. This study aims at identifying the features and the levers of HF patient engagement and suggestions for orienting clinical encounters.DesignUsing a grounded theory approach, we conducted 22 in-depth interviews (13 patients with HF, 5 physicians and 4 caregivers). Data were collected and analysed using open, axial and selective coding procedures according to the grounded theory principles.SettingsAll interviews were conducted in an office in a university hospital located in a metropolitan area of Milan, Italy.ParticipantsThe data comprised a total of 22 patient, hospital cardiologist and caregiver interviews. Patients aged ≥18 years with New York Heart Association (NYHA) Functional Class of II or III were eligible to take part. Patients were recruited primarily through their referral cardiologist.ResultsThe HF patient engagement process develops in four main phases that are characterised by different patients’ emotional, cognitive and behavioural dynamics that contribute to shape the process of a patient's meaning making towards health and illness regarding their care. The emerging model illustrates that HF patient engagement entails a meaning-making process enacted by the patient after the critical event. This implies patients’ ability to give sense to their care experience and to their disease, symptomatology and treatments, and their changes along their illness course. Doctors are recognised as crucial in fostering patients’ engagement along all the phases of the process as they contribute to providing patients with self-continuity and give new meaning to their illness experience.ConclusionsThis study identifies the core experiential domains and the main levers involved in driving patients with HF to effectively engage in their disease management. The model emerging from this study may help clinicians think in a fresh way about encounters with patients and their role in fostering their patients’ health engagement.

The authors focus their analysis in this article on online focus groups (FGs), in an attempt to describe how the setting shapes the conversational features of the discussion and influences data construction. Starting from a review of current dominant viewpoints, they compare face-to-face discussion groups with different formats of online FGs about AIDS, from a discourse analysis perspective. They conducted 2 face-to-face FGs, 2 chats, 2 forums, and 2 forums+plus+chat involving 64 participants aged 18 to 25 and living in Italy. Their findings seem not only to confirm the hypothesis of a general difference between a face-to-face discussion setting and an Internet-mediated one but also reveal differences among the forms of online FG, in terms of both the thematic articulation of discourse and the conversational and relational characteristics of group exchange, suggesting that exchanges on HIV/AIDS are characterized by the setting. This characterization seems to be important for situating the choice of tool, according to research objectives, and for better defining the technical aspects of the research project.

Research on job insecurity has traditionally focused on organizational consequences. The present study explores potential extraorganizational outcomes (employees' consumption and life projects) of job insecurity in terms of both subjective perception and objective condition. Results are based on the secondary analysis of two large data sets: a tracking study with representative samples and a survey, both conducted on Italian employees. The findings suggest that job insecurity (especially the subjective perception, rather than the objective condition) may be associated with sacrifices of daily consumption (e.g. buying groceries, apparel, or entertainment) and life projects (e.g. buying a home, marrying, or having children).

To test the hypothesis of opiate-like peptide release after transcutaneous electrotherapy we measured beta-endorphin cerebrospinal fluid (CSF) content in 13 patients without pain problems. The results indicate a time dependent increase of CSF beta-endorphin in the group of patients studied. This fact suggests that the analgesic properties of the treatment may be ascribed to an involvement of the endogenous opiates system, independently from the basal clinical conditions of the patients.