User-Centered Design for Citizens’ Empowerment through the Portal of the Italian Ministry of Health Tiziana Catarci1 , Maddalena D’Addario2 , Paolo Felli1 , Laura Franceschetti3 , Domenico Lembo1 , Massimo Mecella1 , Tatiana Pipan3 , Alessandro Russo1 , Annarita Vestri2 , and Paolo Villari2 1 2 SAPIENZA Università di Roma SAPIENZA Università di Roma Dip. di Informatica e Sistemistica Dip. di Sanità Pubblica e Malattie Infettive lastname@dis.uniroma1.it firstname.lastname@uniroma1.it 3 SAPIENZA Università di Roma Dip. di Scienze Sociali firstname.lastname@uniroma1.it ABSTRACT of the Web portal of the Italian Ministry of Health1 , jointly In this paper we report on a study concerning the redesign of conducted by the ministry and Sapienza Università di Roma, the Web portal of the Italian Ministry of Health, jointly con- from February 2010 to January 2011. Sapienza participated ducted by the ministry and Sapienza Università di Roma. In in the project with a multidisciplinary team involving com- this project, a multidisciplinary team consisting of computer puter scientists and engineers, sociologists and experts in scientists and engineers, sociologists and experts in commu- communication, doctors and experts in public health, in or- nication, doctors and experts in public health was involved, der to fully identify and understand citizens’ needs in terms in order to fully identify and understand citizens’ needs in of health information, on the one hand, and to apply the most terms of health information, on the one hand, and to apply innovative methodologies and techniques for user-centered the most innovative methodologies and techniques for user- design and interfaces, on the other. The main products real- centered design and interfaces, on the other. Guidelines for ized within this investigation have been: on-line communication on protection and promotion of the health, and a mock-up for the future Web portal of the Italian • Guidelines for online communication on protection and Ministry of Health have been realized during the project. promotion of the health and access to the Italian NHS [5], targeted mainly to Italian local (i.e., at the regional and Author Keywords municipal level) health administrations; such guidelines Web portal, taxonomies, guidelines, mock-up are focused on communication issues (“how to talk to cit- izens?”) and on Web design suggestions; • a mock-up for the future Web portal of the Italian Ministry ACM Classification Keywords of Health, together with its design specifications [8]. H.5.2 User Interfaces: User-centered design; J.3 Life and Medical Sciences: Health This work is part of the process of renewing the relationship between health organizations and citizens, in order to im- INTRODUCTION prove the condition of empowered citizens, repeatedly em- Current Web portals of ministries of Health, in Europe and phasized by the WHO (1978, 1986, 1998, 2005)2 . The em- all over the world, are evolving from simple information powered citizen is able to understand and choose, to define sites, mostly oriented to offer institutional and adminis- her own life-style, and to take an active role in managing trative information, to really interactive e-health systems, her well-being, and is thus able to interact rationally and re- providing citizens and operators with various services re- sponsibly with those to whom she refer, i.e., the NHS. Em- lated to health promotion and prevention, as well as facil- powerment means “giving power” to citizen. A citizen who itating the access to services of the National Health Sys- has control over her state of health is a citizen able to par- tems (NHSs) (cf. http://www.dh.gov.uk and http: ticipate in her own diagnostic, therapeutic, and rehabilitative //www.nhs.uk in the UK, and http://www.bmg. processes, but she can act in this way only because she is in- bund.de in Germany). formed. Even if a citizen is not yet a patient, provided health information could play a double role: on the one hand, it In this paper we report on a study concerning the redesign could prevent the onset of specific diseases, and, on the other hand, it could play an educational role that makes the citizen more aware of her rights and duties towards the NHS. The aim of this experience paper is to present both the partic- ular methodology adopted to produce the guidelines and the 1 http://www.salute.gov.it 2 Proceedings Pr Pro Procee ro occe cee eeedin eeed diin din ing gss ooff EEN ENGINEERING NG NGIN GIIN GININEER NEE EE EER ERRING NG INT NG IN INTERACTIVE NT N TERACTI ER E ERA RA RACT CTI C TIV TI VE E COMP C COMPUTING OM OMP O MP M MPUTI PUT UTI UTIIN T NGG S SYS- YS- Y YSS cf. the Alma Ata Declaration (1978), the Ottawa Charter (1986), TEMS T TE TEM EM EMS F FOR FOOR MEMEDICINE M EDIC DIIC D ICINE IIN NE NE A AN AND ND NDHHEALTH HEA HEEA EALTH L CARE (EICS4Med 2011), June the Jakarta Declaration (1998), the Bangkok Charter (2005). 13, 2011, Pisa, IIt aly. Italy. 1 75 mock-up, and the main technical innovations of the portal, in aspects: terms of interactivity and user interface. We therefore struc- ture the paper as follows: Section 2 outlines the methodol- • socio-demographic characteristics of the interviewees ogy and the activities carried out in the project; Sections 3– (age, sex, geographic area, education level, employment 5 describe such activities and the related outcomes; Sec- status); tion 6 presents the redesign of the portal and describe the • how they access Italian NHS Web sites; mechanisms used in the portal for semantic classification • frequency of consultation of the Web, reasons for of contents to empower information retrieval; finally, Sec- their consultations and main diseases included in their tion 7 concludes the paper. searches; • which health promotion campaigns and which data on THE METHODOLOGY ADOPTED IN THE PROJECT quality of the healthcare performances they would like to To devise the mock-up and the guidelines, we adopted a see advertised on NHS sites; User-Centered Design (UCD) approach, which, as standard- • how they evaluate the quality (i.e., completeness and use- ized in the ISO 13407, identifies four principal activities: (i) fulness) of online information currently available on the understand and specify the context of use, (ii) understand portals of the Ministry of Health and of other NHS orga- and specify the user and business requirements, (iii) design nizations. the product, in particular by creating a prototype, and (iv) evaluate the design. The questionnaire has been advertised on various sites, in- cluding the current portal of the Ministry of Health, the sites In this project, we focused on (i) – (iii), whereas activity (iv) of some local health organizations, and on Facebook. We is currently on progress. In the initial activities, the main collected 2381 responses, 2324 of which have been ana- challenge has been to understand the context and the require- lyzed, after checking the quality. 866 respondents were male ments of a portal which potentially could be visited and used (27%) and 1458 (63%) were female. 62% of the surveyed by millions of citizens. In particular, we had the need to ob- citizens use the Web especially for finding general informa- tain useful insights on the following questions: tion. Only around 30% use the Web in the first instance to search about an health problem, percentage that is rela- • which are the health needs of the Italian population, i.e., tively homogenous in different age groups; it varies from what is the epidemiological situation of the main diseases 23% for those who are 65 years old or more to 28% for and risk factors for diseases in Italy? those who are under 30. Around 58% of respondents pre- • who searches the Internet/Web for health information, fer to search online information about the protection of the which forms she adopts to surf the Web, and which kind health rather than apply directly to a doctor. This is primar- of health information is actually looked for? ily due to the fact that through the Web they can immediately • what are other information needs in terms of protection get some information. The information mainly searched in- and promotion of health that could be satisfied through cludes: (i) specific diseases, therapies/treatments, side ef- online communication? fects of therapies; (ii) hospitals or other medical facilities, • what works on Internet/Web, i.e., which types of Inter- booking systems for medical examinations, doctors or spe- net/Web health interventions are actually efficacious and cialists; (iii) lifestyle. People look for information about effective for improving health? the following diseases or health conditions: cardiovascular and/or lung diseases (23%); rheumatic and musculoskeletal To this aim, we carried out our analysis in three main stages: diseases (16%); gastrointestinal diseases (gastritis, colitis, (i) design and administration, for several months, of an on- etc.) (12%); infectious and/or sexually transmitted diseases line questionnaire, aimed at identifying the needs of the cit- (9%); cancer (7%). izens using (also) Internet/Web to access health information and health services; (ii) systematic study of the literature According to those who filled out the questionnaire, the concerning health needs and what has been discussed and health campaigns that should be promoted through the web demonstrated about the effectiveness of Internet-based in- sites of the Ministry of Health and other NHS organizations, terventions on public health; (iii) systematic analysis of a as first option, should concern blood donation (20%), organ significative number of sites/portals of local health admin- donation/transplantation (16%), workplace safety (13%), istrations, in order to derive possible best practices and to and responsible use of medicines (12%). If we consider identify the critical points to be addressed. more than one answer option for each respondent, pref- erences also include issues concerning the responsible use Then, on the basis of the outcomes, a mock-up of the portal of drugs, screening cancers (breast, cervical and colorec- has been devised. The following sections provides some in- tal), proper nutrition/obesity. About half of the respondents sights on the various activities. For the full details (including consider important to find on institutional sites information all the collected data) the reader is referred to [5]. on attitudes and actions necessary to maintain good health (49%), and indications concerning the levels of quality of health services provided by the local health organizations THE ON-LINE QUESTIONNAIRE and hospitals (50%). For the 78% of respondents, the data In order to collect data concerning the online information on levels of quality should be published on the portal of the needs of users of the Italian NHS, we have run a survey in Ministry of Health. For what concerns the quality3 of health the period ranging from April 14 to September 21, 2010, through the definition and the online administration of a 3 The quality of information is expressed in term of usefulness, ac- questionnaire. The questionnaire considered the following curacy, level of update. 2 76 information currently available on the Web, the best over- systematic reviews and/or meta-analysis published in the all score has been obtained by the sites of associations of literature. A total of 52 systematic reviews/meta-analyses patients with specific diseases. Interestingly, the most use- fulfilled our predetermined inclusion criteria and were in- ful information currently available on the portal of the Min- cluded for analysis. The methodological quality of the stud- istry of Health has been considered the one on transplan- ies evaluating the effectiveness of Internet health interven- tation, statistical data and materials on contests, announce- tion is not high, and the possibility of some conflict of in- ments and legislation. terests cannot be ruled out in some situations. Despite these limitations, considering the most comprehensive reviews on THE REVIEW OF THE LITERATURE the topic [14, 12, 11], it is possible to draw different con- clusions: (i) the most effective Internet health interven- The epidemiological analysis of the health status of the Ital- tions are the tailored interventions, with adaptation to the ian population was made through consultation of official user, personalization and feedback; (ii) the sizes of these data and reports of the Italian Ministry of Health, the Na- interventions could be categorized as small to medium for tional Observatory of Health of the Italian Regions and the population-based interventions; (iii) however, the potential National Institute of Statistics [4, 2, 3, 10]. impact of these interventions on population health is high, and the cost-effectiveness ratio potentially highly favorable To understand the Internet health information needs of the compared to other health interventions; (iv) however, com- population, also in order to validate the online questionnaire, mon sense advices to implement hybrid models, which could a systematic review of the literature was performed. A to- combine applications or tailored interventions, user naviga- tal of 52 cross-sectional surveys were retrieved, carried out tion, collaborative filtering, as well as human-to-human in- mainly in the USA and Europe. The analysis of the three teractions, considering the high popularity of the latter ones main surveys performed in USA, Europe and Italy [9, 7, 1] among the Internet users. allowed us to identify the main determinants of Internet use for health purposes, the type of health information most fre- The results of the review of the literature allow us to draw quently searched on the Web and other useful information. a set of recommendations for the construction of a national Gender, age and socioeconomic status are the major determi- evidence-based health website. In summary it should: nants of Internet use for health purposes. Women search the Internet for information about health more than men, even if 1. contain information concerning the physiopathology of they are penalized by the fact that they sometimes have less the human body, the most frequent diseases, risk behav- access to the Web. Younger people and people with high iors, and health interventions of proven effectiveness, in socio-economic level search more frequently the Internet for order to improve the health literacy of citizens (cf. Salute obtaining health information, but the quote of elderly and A–Z in Figure 1); disadvantaged people using Internet for health is increasing. 2. include tailored interventions, with adaptation, personal- Specific diseases and specific treatments are the most popu- ization and feedback, aimed to promote healthy behaviors lar topics searched through Internet. However, it is important for disease prevention and compliance to secondary pre- to note that people searching the Internet for having informa- vention programs of proven effectiveness (cf. the avail- tion about health promotion activities and interventions for ability of applications on the portal, see Section 6); disease prevention are increasing, as well as people seek- 3. give accurate information on the organizational structure ing information about access to health services and the per- of the national NHS, in order to facilitate the access to the formance of health care organizations. Although the main health care organizations and, at the same time, to pro- health related activity on the Internet is information seeking, mote the appropriate use of them (cf. Esplora SSN in Fig- a considerably increasing number of people use the Internet ure 1); as a communication channel, participating in forums, self- 4. contain information about the performance of the different help groups, etc. The increasing use of Internet to tackle health care organizations (hospitals, etc.) and, possibly, of isolation, to access experiential knowledge and for gaining physicians; social support should definitively taken in proper considera- 5. include systems and tools able to endorse the participation tion when defining the Internet health information needs of of citizens, as well as the human-to-human interactions the population. (cf. the use of Web 2.0 tools, as discussed in Section 6). The evaluation of the effectiveness of health interventions delivered through Internet is a difficult task. The field has AN ANALYSIS OF ITALIAN HEALTH WEBSITES suffered from a lack of clarity and consistency. The absence An analysis of Italian health organizations’ websites has of professional leadership and of accepting governing ap- been carried out in order to obtain useful indications in plan- proaches, terminology, professional standards, and method- ning for an effective online communication strategy. Its ob- ologies has caused the field of the evaluation of these in- jective was to respond to the following questions: tervention to be diffused and unstructured. Only recently some categorizations have been proposed, as the classifica- • what kind of health information is available on the web- tion proposed by Strecher [14], considering the ways that sites of such organizations (aims, logical information Internet can interact with the user: (i) user navigation; (ii) structure, content, online services, technologies, etc.)? collaborative filters; (iii) applications; (iv) human-to-human • do the websites satisfy the health information needs of the interactions. Given the number of original studies evaluat- population concerning the available healthcare services, ing the effectiveness of Internet health intervention, in this the promotion of public health and the prevention of dis- case the systematic search of the literature was limited to eases? 3 77 3. availability and quality of the online services, concerning not only the quality of the website content and the use of Internet healthcare interventions, but also the quality (interactivity) of electronic forms and of facilities for on line booking of such services 4. accessibility and ICT quality, referring to the different so- lutions for presenting and organising the website content, regarding both accessibility for Internet users and techno- logical criteria. The analysis has considered the websites of all the Re- gional Governments (in fact, 19 regions and 2 autonomous provinces) and the websites of a sample of 84 Local Health Authorities (out of 195 in total). The main results of the analysis highlight that Regional Government health websites show: • a strong institutional identity, because they present the lo- cal health policy as an outcome of the approach taken by Regional Governments and have a low international per- spective; • a weak attitude to networking with other public health ad- ministrations or private associations working in the local health service; • a satisfactory level of administrative transparency, even though citizen protection mechanisms/tools are mainly normative statements; • an high level of attention to the promotion of public health, even though they rarely make use of the commu- nication campaigns offered by the Ministry of Health; • a good level of ICT quality. (a) Homepage Instead, the websites of the Local Health Authorities are characterized by: • a significant institutional identity, with frequent refer- ences to their respective Regional Government rather than to the Ministry; • a good level of administrative transparency, even though the citizen protection mechanisms are mainly normative (b) Menu statements; • a satisfactory level of availability of information regard- Figure 1. The mock-up ing online services, even though electronic forms and fa- cilities for online booking of health services are not very frequent; • a good level of ICT quality. • do they observe the standards set by the Italian e- government policy? Therefore, analyzing the websites of the Regional Govern- ments and of the Local Health Authorities we can see a sce- We have identified a set of indices and organised them in nario revealing different online health communication strate- 4 dimensions, that explain the concept of “quality of online gies, with a strong local identity and with weak coordina- health information supply”: tion by and towards the central institutional level (Ministry). In order to improve on line health communication, we sug- 1. institutional identity and networking attitude: the possibil- gested the following strategies: ity to easily identify the site with a specific authority, and also its attitude towards the development of thematic and • to recognize the centrality of citizens/patients, both in the operative networks with other public health administra- phase of identifying and structuring the content of web- tions or professional associations or patients’ associations sites, and during the editing of the website and the orga- working in the health service; nization of health services via the Internet; 2. administrative transparency, based on the availability of • to strengthen the orientation and coordination role that the online information regarding the organizational structure Ministry of Health should play in respect of other health- of the NHS, tasks and performance, and the availability of care administrations as regards information and commu- citizen protection mechanisms/tools; 4 78 nication activities; To provide users with powerful and effective means to re- • to view online health information as the result of coop- trieve the information they are looking for on the portal, erative networking between the Ministry of Health and its contents are being classified according to a taxonomy, the other healthcare administrations (at national and local i.e., a classification scheme which organizes in a hierarchi- level); cal structure the main categories of interest in the domain. • to build a network of health public administrations and By virtue of this classification, the user can query the por- professional associations and patients’ associations work- tal by referring to the categories of the taxonomy, and get ing in the health services, aimed at exchanging informa- as reply those documents that belong to the same or related tion and strengthening mutual legitimacy, in order to re- categories. Notably, the reference to the categories does not duce the fragmentation of information and to promote need to be explicit, i.e., the user is not required to a priori wider communication. know the taxonomy to pose queries to the portal (see also below). THE PORTAL In order to simplify the process of definition, validation, and Figure 1 shows the homepage of the proposed mock-up. The maintenance of the taxonomy, and to ease the possible inte- four main pillars of the proposal are (i) a navigation inter- gration in the portal of contents coming from external infor- face, on the top of the page, based on ”buttons” instead of mation sources, to realize our taxonomy we analyzed exist- the classical links, (ii) a large number of interactive applica- ing (de-facto) standards. Among various proposals for con- tions, either accessible on the portal or downloadable on mo- tent classification and terminological representation in the bile devices, (iii) the possibility to customize the home page biomedical domain (e.g., UMLS4 , ICD5 , SNOMED CT6 , through the MyPage application (a-la iGoogle) and (iv) ad- GALEN7 ), in our project we referred to MeSH (Medical Sub- vanced search functionalities and page-to-page correlations ject Headings)8 a taxonomy developed by the National Li- based on taxonomies. In terms of contents, the (mock-up of brary of Medicine (NLM) of the United States. This choice the) portal respects the suggestions previously described. has been motivated by the fact that MeSH is specifically tai- lored to information retrieval (and thus suited to our aims), The navigation menu based on buttons has the twofold aim contains also non-biomedical or clinical categories, and with of being aesthetically more catchy than the classical one, respect to other proposals has more compact dimensions (it and ready for visualization on touch devices (e.g., iPads, includes around 22000 terms), which makes it simpler to touchpads, etc.), which represent the future of Web surf- use. ing. In order to enforce the citizen-oriented vocation of pro- moting good life habits, a lot of applications will be made In fact, to make easier the process of content classifica- available, e.g., for dietary calculation, alcohol abuse control, tion, we operated a simplification of the MeSH, aimed at pregnancy check schedule, etc.; such applications, which en- both reducing the number of categories and eliminating the hance the level of interactivity of the portal and therefore at- most technical ones. However, to not loose the advantages tract users, can be mobile apps to be downloaded on devices, of adopting a (de-facto) standard, we simply “cut” some or Web applications accessible through the portal. branches of the “MeSH tree” so as to exclude too detailed categories. In this process, we have been helped by do- The possibility of customizing the page of the portal is an ab- main experts. The resulting taxonomy contains around 3500 solute novelty wrt existing public administrations/agencies, MeSH terms. not only in Italy but, at the best of our knowledge, all over Europe. This has been obtained by including a MyPage ap- Despite MeSH includes general purpose categories (e.g., the plication, which allows each registered user to personalize ones of the Disciplines and Occupations or Phenomena and the information she wants to access. Processes branches), we found out cases in which MeSH re- sults insufficient in order to satisfactory classify some doc- The portal provides four main “channels”, i.e., sections uments included in the portal. To overcome this problem, specifically tailored to particular categories of information we decided to include in our taxonomy some of the cate- and possible interested users: citizens (corresponding to La gories used for article classification in (the Italian version nostra salute), health and administrative operators (Attività of) Wikipedia9 , and in particular we selected the categories e professioni), users interested in institutional and organiza- included in the Human Activities branch of the Wikipedia tional information (Ministro e Ministero), and users inter- classification schema10 , which in fact substitutes in our tax- ested in News e Media. Each section, which is managed onomy the (more limited) Humanities branch of MeSH. We by a specific editorial board, has its own space in the home choose the Wikipedia classification for two main reasons: page, even if, in compliance with the user-centered approach previously described, the section dedicated to citizens is pre- 4 dominant. http://www.nlm.nih.gov/research/umls/index. html 5 http://www.who.int/classifications/icd/en/ Moreover, in order to satisfy the suggestion 4 of Section 4, 6 http://www.ihtsdo.org/snomed-ct/ a specific information system, collecting quality and perfor- 7 http://www.opengalen.org mance data of healthcare organizations, will be developed 8 http://www.nlm.nih.gov/mesh/meshhome.html and made accessible through the portal. It is also worth re- 9 http://www.wikipedia.org/ marking that Web 2.0 tools are used throughout the portal 10 http://it.wikipedia.org/w/index.php?title= (e.g., tag clouds, wiki and blogs, correlations with Facebook, Speciale:AlberoCategorie&target=attivitá+ Twitter, etc.), in order to promote user interaction. umane&mode=categories&dotree=Vai 5 79 (i) Wikipedia is one of the most popular portal on the In- Italian). Franco Angeli, Milano, 2007. ternet, and its contents are widely shared among several mil- lions of users; (ii) its category tree is designed through a col- 2. Rapporto OsservaSalute 2008. Stato di salute e qualità laborative process aiming at including categories proposed dell’assistenza nelle regioni italiane (in Italian), 2008. by the users, and therefore particularly suited for informa- 3. Rapporto OsservaSalute 2009. Stato di salute e qualità tion retrieval activities. dell’assistenza nelle regioni italiane (in Italian), 2009. We finally observe that, to further support the process of con- 4. Relazione sullo stato sanitario del paese 2007-2008 (in tent classification in the portal, we foreseen the development Italian). http://www.salute.gov.it/ of tools helping the research of the categories in the taxon- pubblicazioni/ppRisultatiRSSP.jsp., omy. In this respect several directions can be followed: (i) 2009. realization of keyword-based search mechanisms to directly access the categories of interest in the taxonomy (thus avoid- 5. Linee guida per la comunicazione on line in tema di ing to manually navigate the taxonomy); (ii) use of a dic- tutela e promozione della salute (in Italian). http: tionary (extending the one already available with MeSH) to //www.salute.gov.it/pubblicazioni/ include in the taxonomy also synonyms of categories, thus ppRisultato.jsp?id=1473, 2011. both expanding the lexicon of the taxonomy and including 6. Ananiadou, S., and McNaught, J. Text mining for more terms in it, in a way transparent to the user; (iii) def- biology and biomedicine. Artech House Books, 2006. inition of techniques for automatic keyword extraction from text documents, in such a way that document classification 7. Andreassen, H., Bujnowska-Fedak, M., Chronaki, C., could be done according to extracted terms, in the spirit Dumitru, R., Pudule, I., Santana, S., Voss, H., and of [6, 13]. More details on the taxonomy and the classifi- Wynn, R. European citizens’ use of e-health services: a cation process in the portal of the Italian Ministry of Health study of seven countries. BMC Public Health 7, 53 can be found in [8]. (2007). 8. Ausiello, S., De Angelis, A., Felli, P., Lembo, D., CONCLUSIONS Mecella, M., and Russo, A. Ministero della Salute: In this experience paper we have presented a project, car- Ipotesi di progettazione e mock-up del nuovo portale ried out during 2010, focused on the definition of guidelines orientato al cittadino e del relativo canale (in Italian), for online communication on protection and promotion of 2010. the health in the Italian NHS (including regional health web portals, local health authorities websites, hospital websites, 9. Fox, S., and Jones, S. The social life of health etc.), and the realization of a mock-up to serve as input for information. Online: a redesign of the web portal of the Ministry of Health. The www.pewinternet.org/Reports/2009/ guidelines, as well as the mock-up, were successfully pre- 8-The-Social-Life-of-Health-Information. sented in a workshop on February 17, 2011. They are pub- aspx. lished online and are currently in the process of being for- 10. ISTAT. Indagine multiscopo. Condizioni di salute, mally adopted by all the interested administrations. fattori di rischio e ricorso ai servizi sanitari 2005 (in Italian). www.istat.it/salastampa/ In a scenario in which all websites of the NHS organizations comunicati/non_calendario/20070302_ are realized in accordance with the guidelines, the portal of 00/testointegrale.pdf, 2007. the Ministry of Health can be also able to act as a broker, in order to offer a centralized access to information and ser- 11. Krebs, P., Prochaska, J., and Rossi, J. A meta-analysis vices of the NHS. An interesting future issue will be to con- of computer-tailored interventions for health behavior sider how users will react, with respect to trust and privacy change. Prev. Med. 51, (3–4) (2010), 214–221. concerns, about the personalization features of the portal of- fered through the MyPage, as they may feel as their infor- 12. Portnoy, D., Scott-Sheldon, L., Johnson, B., and Carey, mation access requests on the portal might be logged and M. Computer-delivered interventions for health analysed for potential medical information. promotion and behavioral risk reduction: a meta-analysis of 75 randomized controlled trials, Acknowledgements. 1988-2007. Prev. Med. 47 (2008), 3–16. The authors would like to thanks the team of the Italian Ministry of Health 13. Rullo, P., Policicchio, V., Cumbo, C., and Iiritano, S. for the fruitful and active collaboration during the project, in particu- Olex: effective rule learning for text categorization. lar Daniela Rodorigo, Massimo Aquili, Claudia Biffoli, Claudia Spicola, IEEE Transaction on Knowledge and Data Daniela Cricenti, Cristina Giordani. Moreover, they would like to thank Engineering 21, 8 (2009), 1118–1132. all the Sapienza people collaborating in the project, namely Sara Ausiello, Andrea De Angelis, Priscilla Carcione, Eliana Ferroni, Emanuele Leoncini, 14. 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