Aspects of ethics and ethos in the Italian pilot
Cocreation in health promotion and prevention has some unique features
The main difference between public health services and other public services is that the former demands scientific evidence of the efficacy of any intervention before it can be provided. Therefore, the national health system should decide which interventions are better suited to a given context, more acceptable to a given population, sustainable given the available resources, and thus recommended by the National Prevention Plan. Having a short list of recommended interventions, limits the opportunity to implement a thorough co-creation process and can create an asymmetry in knowledge between the preventive medicine scientific community and the other actors and users involve. On the other hand, the need to apply some criteria to prioritize interventions and adapt the best intervention for a given community among those recommended is a process that can obtain enormous benefits from the application of a co-creation process.
Prevention and health promotion interventions raise another issue: interventions aiming at changing risky behaviors and promoting healthy lifestyles, can not be perceived as needed by the target population. The target population often considers these interventions unwelcome intrusions in their lives. Furthermore, in prevention, the target population may attribute a value to the possible health benefits of an intervention that is substantially different from that attributed by society (or by public health care professionals). When the service provided is a prevention intervention targeting childhood obesity, the definition of users and beneficiaries is also challenging; while the beneficiaries are the children themselves, we are interested in changing the entire family’s behaviors (diet and physical activity are both determined by family habits).
More details here [Giorgi Rossi P, Ferrari F, Amarri S, Bassi A, Bonvicini L, et Al; Describing the Process and Tools Adopted to Cocreate a Smartphone App for Obesity Prevention in Childhood: Mixed Method Study. JMIR Mhealth Uhealth. 2020 Jun 8;8(6):e16165. doi: 10.2196/16165. PMID: 32357123; PMCID: PMC7308901]