DIGITAL HEALTHCARE: RETHINKING THE PATIENT ROLE IN TELEMEDICINE

In the recent decades, the healthcare system has undergone several transformations driven by digitalization and technological innovation. The advent of healthcare technologies has changed the way patients are cared for by healthcare professionals, offering new opportunities for continuity of care and for the role assumed by patients in managing their health. The COVID-19 pandemic has accelerated the transition to telemedicine interventions, ensuring the provision of adequate remote care to reduce infection risks and travel. However, this rapid spread has raised some critical issues such as long-term sustainability, accessibility (e.g., health and digital literacy), and the psychological implications for patients involved through digital tools. Within this context, this thesis aims to explore digital healthcare from a psychosocial perspective, with the intention of understanding how this innovation changes social representation and the experience of care by patients. The first study investigates the evolution of the patient role in telemedicine. By comparing the fields of psychology and medicine, different conceptualizations of patient participation were explored. Constructs such as adherence, engagement and activation lead to a representation of the patient along a continuum ranging from passivity to active involvement. Through a bibliometric analysis of scientific production from 1990 to 2023, the study showed that the medical field tends to use terms such as compliance and adherence, while psychology is gradually shifting toward engagement, indicating a more collaborative role for patients in their own care pathway. The second study explores how telemedicine is represented in the Italian press, since it entered public discourse, to identify different representations of digital healthcare among laypeople. The findings showed that telemedicine is predominantly represented as an innovative and efficient tool for facilitating access to and delivery of care. However, alongside an optimistic narrative of this innovation, it was possible to identify elements of ambivalence and resistance that highlight several difficulties in the large-scale implementation of telemedicine tools. Finally, the third study focused on patients diagnosed with heart failure, in a healthcare setting where a telemonitoring tool was proposed. In the early stages of the research project, the psychological mechanisms underlying the relationship between self-care behaviors, patient activation and perceived quality of life were explored. The findings revealed that the level of patient activation plays a mediating role between self-care and well-being, suggesting that behaviors aimed at disease management and improving quality of life are not sufficient if patients are not aware and actively involved in their own care pathway. This thesis considers telemedicine from a perspective that goes beyond its purely technological and innovative aspects, viewing it instead as a process that involves psychological dimensions, transforming patient care and management in the healthcare context and redefining the boundaries between technology, medicine and patient experience. Integrating a health and social psychology perspective, this work emphasizes the need for a person-centered approach when proposing and implementing a telemedicine service. Technology thus becomes a support for the clinician-patient relationship and to foster patients’ self-management.