Attitudes and experiences towards the IMMUNI App among Sapienza university students: a pilot study

Abstract Background IMMUNI is an app that was created to help fight epidemics, starting with COVID-19. The app has a contact tracing feature but its diffusion in Italy was low. In this pilot study, we investigated university students’ attitudes and experience towards the IMMUNI app. Methods This cross-sectional study was conducted at Sapienza University of Rome between 14 April and 19 April 2021. An online survey was administrated to university students of medical area. A multivariable logistic regression model was built to identify app download's predictors. Adjusted odds ratio (aOR) and 95% confidence interval (CI) were calculated. Results We collected 247 questionnaires (response rate: 78.2%). More than half of the students (65.0%) didn't download IMMUNI app mostly because of the belief that it was useless (30.0%). By contrast, the main reason for downloading was sense of duty (40.0%). Experience with the app was limited but the process was judged as lacking for the technical difficulties. As for hypothetical incentives, feedback on how the download could help against the pandemic was considered as the most effective (3.5 out of 5). In the multivariable analysis, higher likelihood of download was associated with higher fear of contagion for family and acquaintances (aOR:1.50, 95% CI: 1.01-2.23) and higher rating to the health management of the emergency (aOR: 1.33, 95% CI:1.00-1.76). The highest odds of download were found for participants who have been advised to download the app (aOR: 3.21, 95% CI:1.80-5.73). On the other hand, greater belief that the virus came from a laboratory was negatively associated with the download (aOR: 0.75, 95% CI: 0.60-0.93). Conclusions Strategies aimed at raising students’ awareness on the importance of health technologies, restoring confidence in health authorities, and limiting disinformation around SARS-Cov-2 should be devised. In addition, the app could be enriched with positive feedbacks for users, and some technical issues should be fixed. Key messages • The spread of digital technologies for public health purposes is fostered by trust in health institutions and improving health literacy and user engagement. • An efficient and user-friendly technology is recommended.


Background:
Maternal health remains a major issue of concern in Sierra Leone. In the main referral maternity institution, Princess Christian Maternity Hospital (PCMH), up to 25% of maternal deaths occur during or shortly after transit from another health facility. There is an urgent need to improve referral systems between peripheral health units (PHUs) and PCMH. Our aim was to pilot and evaluate an eHealth tool facilitating referral of obstetric emergency cases through effective teleconsultation between PHUs and PCMH.

Methods:
A web application was designed to capture unclear or complicated delivery cases at PHUs and request respective telemedical counselling from the referral institution PCMH. The eHealth tool was piloted at 10 PHUs in Western area urban and rural in August 2021. Necessary devices were provided and delivery staff was trained to use the app. In December 2021, we conducted focus group discussion with 3-6 delivery staff at five PHUs and at PCMH to evaluate utilization and outcomes of the tool.

Results:
All participants perceived the eHealth tool as an improvement of referral procedures. Response time from PCMH after a request for counselling from a PHU was mostly <30 minutes. The main perceived advantage of the tool was the systematic documentation of obstetric complications and procedures. This relieved staff from fear of wrong treatment accusations, and recorded communication with PCMH made processes and responsibilities transparent. Another important benefit was PCMH staff being already prepared to receive a specific emergency case after use of the app, thus reducing the 'third delay' within the referral facility. As a major obstacle to smooth referral despite the eHealth tool, a lacking ambulance system was mentioned as a critical gap.

Conclusions:
Exceedingly positive user experiences with this simple tool seem to make an expansion to more PHUs worthwhile. Benefits of using the app in more remote districts in Sierra Leone should be further investigated. Key messages: Delivery staff in Sierra Leone was capable of using a web app for telemedical counselling in a useful and effective manner.
The eHealth tool was perceived as very helpful in systematically and transparently documenting emergency delivery cases and treatment procedures.

Background:
IMMUNI is an app that was created to help fight epidemics, starting with COVID-19. The app has a contact tracing feature but its diffusion in Italy was low. In this pilot study, we investigated university students' attitudes and experience towards the IMMUNI app.

Methods:
This cross-sectional study was conducted at Sapienza University of Rome between 14 April and 19 April 2021. An online survey was administrated to university students of medical area. A multivariable logistic regression model was built to identify app download's predictors. Adjusted odds ratio (aOR) and 95% confidence interval (CI) were calculated.

Results:
We collected 247 questionnaires (response rate: 78.2%). More than half of the students (65.0%) didn't download IMMUNI app mostly because of the belief that it was useless (30.0%). By contrast, the main reason for downloading was sense of duty (40.0%). Experience with the app was limited but the process was judged as lacking for the technical difficulties. As for hypothetical incentives, feedback on how the download could help against the pandemic was considered as the most effective (3.5 out of 5). In the multivariable analysis, higher likelihood of download was associated with higher fear of contagion for family and acquaintances (aOR:1.50, 95% CI: 1.01-2.23) and higher rating to the health management of the emergency (aOR: 1.33, 95% CI:1.00-1.76). The highest odds of download were found for participants who have been advised to download the app (aOR: 3.21, 95% CI:1.80-5.73). On the other hand, greater belief that the virus came from a laboratory was negatively associated with the download (aOR: 0.75, 95% CI: 0.60-0.93).

Conclusions:
Strategies aimed at raising students' awareness on the importance of health technologies, restoring confidence in health authorities, and limiting disinformation around SARS-Cov-2 should be devised. In addition, the app could be enriched with positive feedbacks for users, and some technical issues should be fixed.

Issue/Problem:
Aging populations, worsening burden of chronic disease and recent pandemic has accelerated awareness and the importance of telemedicine in providing continuity of healthcare.
Description of the problem: AGENAS is the public body responsible for the implementation of telemedicine investment (E1 billion) in the context of the NextGenerationEU plan. AGENAS has built up a working group expert panel to define the technical and informatics features of the investment. The project consists of the realization of the national telemedicine platform and the regional telemedicine services. Italian regions will implement telemedicine services based on the national guidelines defined by AGENAS, that will also monitor it through key performance indicators outlined on the basis of best practices and scientific evidence of multidimensional evaluation.

Results:
National telemedicine platform will improve, optimise and standardise telemedicine services throughout the Country, considering what may already be available in regional and local healthcare contexts. Regarding telemedicine services in regional context, that will be implemented within the NextGenerationEU, they will be focused on the telemonitoring of high prevalence conditions (i.e. cardiological, respiratory, diabetes, neurological and oncological) as well as other services such as televisit, teleconsultation and teleassistance. Connecting patient's home with healthcare system provide benefits for patients and their families, who will be able to interact with healthcare professionals, obtaining consultation and monitoring of their health.

Lessons:
The implementation of the investment, aiming at improving equity and integration of care, will contribute to provide real world evidence about usage, benefits and potential risk of the telemedicine in primary care for the management of chronic diseases.

Key messages:
The investment under the Next Generation EU plan it is the lifetime chance to transform Italian healthcare service and draw a new framework to cope with the high demand in telemedicine. Improving telemedicine services will determine a breakthrough in management of patient with chronic diseases in the Italian primary care sector.

Background:
Digital media is an important part in the everyday lives of young people. However, hate, threats, and harassment on social media is becoming a global public mental health issue among youth.
To promote mental health in this age group, this issue needs to be addressed, and community-based health promotion, in particular participatory interventions, are needed to make measures taken meaningful for youth. The aim of the study was twofold; to teach participatory mobile phone filmmaking to Youth Community Center (YCC) staff; and to investigate how they assess this method regarding feasibility, relevance, costs, resources needed, and time considerations. Methods: YCC staff participated in a two-day mobile phone filmmaking training. Group interviews that were recorded and transcribed verbatim were conducted and field notes were taken. Data was deductively analyzed in accordance with Elo and Kyngäs (2008). Results: YCC staff found the technology was easily accessible and the method needs limited extra resources. It has the potential to promote creativity and can be used as a means to involve young people in describing the issue in their own words, and to find a solution to the issue at hand. The method also has the potential to reach and engage the whole community as organizing a mobile phone film event is part of the process. Time consumption was not perceived as an issue, as staff is free to plan activities as they see fit.

Conclusions:
According to YCC staff, participatory mobile phone filmmaking has the potential to promote positive interactions on social media among youth. This in turn has the potential to promote wellbeing of young people. Recommendations are that this method is tested among young people and investigate if it is a helpful intervention to promote mental health in this age group. Key messages: Participatory mobile phone filmmaking may be useful in youth mental health promotion. The method is cheap, easily accessible, and have the potential to involve the whole community.

Background:
Barriers in accessing healthcare services are a common issue that contributes to the disproportionately poor health outcomes in people who experience homelessness. A possible way to overcome these barriers and meaningfully engage with this under-served population is through the implementation of the so called patient navigation (PN) models. We conducted a systematic scoping review to gain a better understanding on how PN models are utilized with people experiencing homelessness and other comparable populations and to identify their features, barriers and facilitators to their implementation and their outcomes.

Methods:
A systematic scoping review was done based on a predetermined protocol. We conducted a search of Web of Science, PubMed/ Medline and Scopus databases on the 15th of June 2021. A narrative analysis of the included studies was conducted.

Results:
Our search yielded 1203 hits, and after removing 475 duplicates, we were left with 728 publications of interest.
15th European Public Health Conference 2022