Issue 41

1ISSUE 41
SCIENTIFIC JOURNAL, 3 ISSUES PER YEAR JANUARY - APRIL 2015
ISSUE
41
Published by the Greek
Nursing Studies Association
(GNSA)
INDEXED IN SCOPUS, ΕΒSCO, CINAHL
ISSN 22413960
• Factors affecting collaboration between children and
parents regarding Type 1 diabetes management and
connection with treatment adherence
• Current management techniques of nausea and vomiting
in children with cancer
• Effectiveness of educational interventions for the
reduction of occupational exposure to biological hazards
• Public participation in healthcare priority setting: A
systematic review
PUBLICATIONS
οcelotos

3ISSUE 41
Scientific Journal, 3 Issues per Year
Published by the Greek Nursing Studies Association (GNSA)
Nursing
Care AND Research
EDITOR-IN-CHIEF
Chryssoula Lemonidou, RN, MSc, PhD, Professor
of Nursing, University of Athens
CO-EDITORS
Eleni Apostolopoulou, RN, PhD, Emeritus Professor of
Nursing, University of Athens
Ioannis Elefsiniotis, PhD, Assistant Professor, Faculty of
Panagiota Sourtzi, RN, MSc, PhD, Professor, Faculty of
EDITORIAL BOARD
Lambros Anthopoulos, Emeritus Professor, Faculty of
George Baltopoulos, PhD, Professor, Faculty of Nurs-
ing, University of Athens
Thalia Bellali, RN, MSc, PhD, Associate Professor of
Nursing, Technological Educational Institute of Thes-
saloniki
Konstantinos Birbas, PhD, Associate Professor, Faculty
Gerasimos Bonatsos, PhD, Professor, Faculty of Nurs-
Charalambos Economou, Associate Professor, Depart-
ment of Sociology, Panteion University,
Margarita Giannakopoulou, MSc, PhD, Associate Pro-
fessor, Faculty of Nursing, University of Athens
Leonidas Grigorakos, Associate Professor, Faculty of
Dafni Kaitelidou, MSc, PhD, Assistant Professor, Faculty
Ioannis Kaklamanos, PhD, Associate Professor, Faculty
Maria Kalafati, RN, MSc, PhD, Faculty of Nursing, Uni-
versity of Athens
Athina Kalokerinou, RN, PhD, Professor of Nursing, Fac-
ulty of Nursing, University of Athens
Evangelos Konstantinou, RN, MSc, PhD, Associate
Professor, Faculty of Nursing, University of Athens
Vassiliki Matziou, RN, PhD, Professor, Faculty of Nurs-
Pavlos Myrianthefs, PhD, Associate Professor, Faculty
Elisabeth Patiraki, RN, PhD, Professor, Faculty of
Sotiris Plakas, RN, MSc, PhD, General Hospital of At-
tika «Sismanoglion»
Olga Siskou, RN, MSc, PhD, Faculty of Nursing, Uni-
versity of Athens, President of the Greek Nursing
Studies Association
EleniTheodossopoulou, Professor, Faculty of Nurs-
INTERNATIONAL EDITORIAL BOARD
John Albarran, Principal Lecturer in Critical Care
Nursing, University of the West of England, Bris-
tol, UK
Maria Katopodi, PhD, Assistant Professor, University
of Michigan, USA
Katerina Labrinou, PhD, Assistant Professor in Nurs-
ing, Cyprus University of Technology
Anastasia Mallidou, RN, MSc, PhD, Assistant
Professor, University of Victoria, Canada
Anastasios Merkouris, RN, MSc, PhD, Associate
Professor of Nursing, Faculty of Nursing, Cyprus
University of Technology
Evridiki Papastavrou, PhD, Assistant Professor in
Nursing, Cyprus University of Technology
Elisabeth D.E. Papathanassoglou, RN, MSc, PhD,
Associate Professor, Faculty of Nursing, Cyprus
University of Technology
Julie Scholes, Professor of Nursing, University of
Brighton, Brighton, UK
Riita Suhonen, RN, PhD, Profes sor, University of
Turku, Department of Nursing Science, Turku,
Finland

5ISSUE 41
Contents
NursingCare AND Research
Published by the Greek Nursing Studies Association (GNSA)
Publisher and Editor-in-Chief: Chryssoula Lemonidou
Address: 123, Papadiamantopoulou st., 115 27 - Athens, GREECE
Tel.: +30 210-7461485
e-mail: info@nursingstudies.gr
Technical publisher: Ocelotos publishing
Annual Subscriptions 2012 for Εlectronic Version
Public Services, Libraries, Companies, Organisations: € 30,00
Individual Subscriptions: € 20,00
© Copyright 2007 - 2014: All rights reserved. The reproduction of articles (or parts of them) is
prohibited without permission of the publisher and the writers.
Instructions to Authors��12
ORIGINAL PAPER
Factors affecting collaboration between children and
parents regarding Type 1 diabetes management and
connection with treatment adherence...........................�� 23
N.Mitosi, G. Antonogeorgos, C. Bartsokas, C. Lemonidou,
E. Konstantaki, M. Giannakopoulou, A. Vazeou, V. Matziou
REVIEW
Current management techniques of nausea
and vomiting in children with cancer�� 35
A.Stamoulara, K. Papadopoulou, P. Perdikaris, V. Matziou
SYSTEMATIC REVIEW
Effectiveness of educational interventions
for the reduction of occupational exposure
to biological hazards��49
P.Copanitsanou, P. Sourtzi
SYSTEMATIC REVIEW
Public participation in healthcare priority setting:
A systematic review�� 65
Α.Farmakas, M. Theodorou, E. Papastavrou, G. Karayiannis, P. Galanis

6
GENERAL INFORMATION
1. “Nursing Care and Research” publishes, fol-
lowing peer review, articles in Greek or English,
contributing to the understanding and devel-
opment of all aspects of nursing care. The Ed-
itorial Department receives manuscripts relat-
ing to nursing practice, research, education
and management, with scientific, theoretical
or philosophical basis.
2. Papers published in the journal belong to
one of the following categories: a) research
studies, b) literature reviews and c) articles re-
lating to developments in nursing practice,
education and management. Additionally, let-
ters (no longer than 500 words), including re-
views or comments on previously published
work, are published if submitted within two (2)
months from the publication of the research
concerned.
3. Manuscripts must be submitted exclusive-
ly to the “Nursing Care and Research” journal,
they must not have been published in print or
electronic form, or undergo peer review at an-
other journal or medium at the time of sub-
mission. The Editorial Director decides time of
publication and reserves the right to change
manuscript format; however, large or substan-
tial changes are made only following author
consent.
Authors should avoid submitting two man-
uscripts from the same study without clear
justification. Also, they should not include in
new work material from background litera-
ture reviews that have already been published
(eg avoidance of self-plagiarism). In the event
that two papers emerge from the same re-
search study, presenting different aspects of
the work at hand, they must be submitted in-
dependently and not as two parts of the same
article. Each article should be autonomous
and must not include the other, although
cross - references can be made. When a com-
plete description of the research methodology
is made in the first article a brief description is
sufficient in the the second provided the first is
adequately referenced. Generally, one should
avoid publishing numerous individual papers
emanating from the same study (“salami slic-
ing”) and instead should focus on the different
aspects and research findings within a single
publication.
If the manuscript is accepted for publication,
the authors must complete and send via fax
at 00302107461485 the Non-Publication in An-
other Medium Form, which forms part of the
supporting files as required in the submission
process.
Instructions for Authors
MISSION AND AIM OF THE JOURNAL
“Nursing Care and Research” is a peer-reviewed journal accepting manuscripts from researchers
from Greece and abroad. Its mission is to contribute to the development of nursing science and
practice in Greece as well as internationally. The aim is to promote and disseminate new knowledge
and research data for eventual application in clinical practice. To this end, nurses and other affiliated
researchers are invited to submit high-calibre manuscripts in Greek or English. The journal welcomes
original research papers, reviews, theoretical or philosophical articles, interesting clinical cases and
methodological articles from experts. Nursing Care and Research is recognized at national level (FEK
issue B 1961/23-9-2008) and is indexed at the CINHAL, EBSCO and SCOPUS International Databases.

7ISSUE 41
4. Author participation in the drafting pro-
cess
All authors cited in a manuscript must have ac-
tively contributed to the conception and de-
sign of the study and/or the analysis and in-
terpretation of data and/or in drafting the
manuscript and all should have analysed and
approved the content of the final version sub-
mitted for publication. Participation only in
the funding-seeking process or data collection
does not justify listing among the authors, and
can be acknowledged in the Acknowledge-
ment section. For this reason, when several au-
thors are cited, a separate letter is required ex-
plaining in detail the contribution of each (eg
methodological design, statistical analysis and
interpretation, drafting of final text, reviewing
and editing, literature review etc). The editori-
al department reserves the right to contact au-
thors to obtain clarifications on specific issues.
5. Submission process
Manuscriptsforpublicationaresubmittedelec-
tronically via e-mail: info@nursingstudies.gr
in Word for Windows format. Figures, tables,
graphics and images (only black white) are
to be submitted in separate files in JPEG, GIF,
TIFF, Microsoft PowerPoint and Excel formats.
Authors are advised to confirm that their work
has been received by contacting the Secre-
tariat on weekdays between 10.00-16.00, tel:
00302106512282. In addition, authors should
always maintain a copy of their work.
6. Periodicity
The journal is published three (3) times per
year (quarterly) and includes research pa-
pers submitted exclusively by its subscribers.
The author or at least one of the authors of
any manuscripts submitted must already be a
registered subscriber of the journal or a paid
member of the Nursing Studies Society for the
current year.
7. Retention of material
Authors are advised that submitted manu-
scripts are kept in record for one month af-
ter publication. If there is a request for the re-
turn of any material it should be clearly stated
when manuscripts are being submitted.
Organisation and format
8. Script: Texts should be double-spaced,
with font size 12 and 2.5 cm white margin on
all sides of each A4 page. All pages must be
numbered in the lower right corner and the
figures, tables, graphics and photos are to be
submitted in separate pages, in continuous
numbering.
9. Identification Page: The first page of each
manuscript includes the title (up to 15 words)
and the names of the authors in Greek and En-
glish. Each author name is accompanied by
qualifications, the last professional title, em-
ployer, mailing and e-mail address and tele-
phone number. In case of several authors, the
name of the author to whom inquiries regard-
ing the paper should be directed must be indi-
cated (corresponding author).
The authors of research studies cannot exceed
six (6), apart from exceptional circumstanc-
es when it comes to multi-disciplinary, large-
scale multicenter studies. The authors of oth-
er types of manuscripts cannot exceed two (2).
All authors listed in the manuscript must have
made an active contribution to the conception
and design of the study and/or the analysis
and interpretation of data and/or in the draft-
ing of the manuscript and everyone should
have studied and approved the final version
submitted for publication. Participation only
in the funding-seeking process or data collec-
tion does not justify listing among the authors,
and can be acknowledged in the Acknowledg-
ment section.
The identification page will be stored at the
journal’s Secretariat office until the comple-
tion of each anonymous peer review, receiv-
ing a code number communicated to the au-
thor via e-mail. With this number the author
can request information on the progress of
their manuscript following submission.
10. Title Page: Immediately after the identi-
fication page, follows the title page, which in-
cludes the title and the running title of the pa-
per. The running title will appear in Greek and

8
English language and cannot exceed five (5)
words. This page does not list names of au-
thors or any other item that violates their ano-
nymity during the peer-review process.
11. AbstractsandKeywords:The title page is
followed by the abstracts (up to 250 words) in
Greek and English, which will accurately sum-
marize the content of the work. The abstract
includes a) introduction, b) aim(s), c) method-
ology, d) results and e) conclusion, and must
not contain bibliographical references and ab-
breviations. Each abstract is followed by up to
six (6) keywords that indicate the content, pur-
pose and focus of the manuscript.
12. Main body of work: The area of the main
body of the manuscript should be 2,000-5,000
words (excluding abstracts, tables and bibliog-
raphy). Short manuscripts (up to 2,500 words
in the main body and up to fifteen (15) refer-
ences) are particularly welcome. This option is
recommended for the dissemination of small-
scale research studies of outstanding val-
ue, without the possibility of extrapolations
or repetition. In addition, smaller-scale man-
uscripts are more likely to reach publication
stage faster.
The manuscript should include headings to
further clarify text sections. Proposed head-
ings include: a) introduction, b) literature re-
view, c) aims, d) research questions and
assumptions, e) sample f) data collection pro-
cess, g) reliability and validity, h) ethical issues,
i) data analysis, j) results, k) discussion, l) lim-
itations of the study,m) conclusions and rel-
evance to nursing practice, n) acknowledg-
ments etc. Headings must be selected and
adapted to content needs and their hierarchi-
cal order should be clearly distinguishable; for
example first level headings should appear in
upper case and bold fonts, second level head-
ings in lower case and bold fonts, third level
headings in italics and so on and so forth.
Study population anonymity and informed
consent
In order to ensure anonymity, the manuscript
should not include the names of specific in-
dividuals, hospitals or other entities, without
their explicit consent. Furthermore, patients
retain a fundamental right in regards to re-
specting their privacy which should not be in-
fringed without their informed consent. How-
ever, in those cases where the authors consider
that certain personal patient data are essen-
tial for scientific purposes (such as patient ini-
tials or photographs or names of hospitals) in-
formed consent is necessary. This means that
authors are required to show the final version
of their work (with the accompanying files: Im-
ages and Annexes) prior to submission to the
journal and receive written consent from the
patients.
In each case, the authors should make an ef-
fort to ensure the greatest possible degree of
patient anonymity. For example, covering the
eye area in photos does not fully ensure the
anonymity of the depicted. Changes in some
patient characteristics is the technique rec-
ommended to authors, provided that these
changes do not distort/misinterpret the re-
search results. Such changes should always be
communicated to the publisher along with as-
surances that these changes will not result in
any “alteration” of a scientific nature. Obtain-
ing of the written informed consent should be
stated in the methodology section, in the final
text of the submitted manuscript.
ADHERING TO THE HUMAN RIGHTS CODE OF
CONDUCT
Should authors publish results of studies con-
ducted on humans, the methodology section
should indicate whether they were conducted
according to the principles of the Declaration
of Human Rights, (Helsinki 1975) as revised in
2004. Should certain processes deviate from
these principles, these must be methodolog-
ically outlined and justified.
Specifically, concerning clinical studies (in-
vasive or not), authors should indicate, in the
methodology section whether they were con-
ducted upon approval of the National Agency

9ISSUE 41
for Medicines (EOF) in accordance with Minis-
terial Decision DYG 3/89292 Gazette V1973/31-
12-2003 (aligned with Directive 2001/20/EC).
It should also be indicated that data is histori-
cal and should be referred to in the past tense.
The time of data collection should be reported
in both the abstract and the main text. For ex-
ample, in the case of empirical studies, this can
be stated thus: “Data collection was carriedout
during 2007” or “Data collection was performed
over 18 months, in the 2006-2007 period.” Note
that the “Nursing Care and Research” journal
does not publish studies citing data older than
five (5) years, unless current relevance is suffi-
ciently justified. In qualitative studies, individu-
als should refer to numbers or aliases (in quotes)
and mentions should be balanced equally across
the full range of responses.
In the case of reviews, the year of the review
should be reported and the range of publica-
tion years of the studies reviewed should be
reported. Such details should be mentioned
in historical studies. The statistical tests used,
ought to be defined and, where necessary,
documented with references.
Abbreviations and symbols should be used
rarely and only in the case of names or expres-
sions of extensive length. The full names or ex-
pressions will be referred to during first use,
followed by the abbreviation in parentheses.
In any case, abbreviations will follow the rules
set out by the Royal Society of Medicine Press.
13. Conficts of interest
Public confidence in the peer-review process
depends partly on the management of any
conflicting interests arising in the writing, eval-
uation and final publication decision as artic-
ulated by the editorial department. Conflicts
of interest arise when an author (or the institu-
tion to which the author belongs to), a review-
er or the Managing Editor maintain financial or
personal relationships that can in a negative
way affect their actions/judgment regarding
the manuscript submitted to the journal. More
specifically, according to the requirements for
manuscripts submitted to biomedical journals
(as issued in February 2006 by the Internation-
al Committee of Medical Journals Publishers)
conflicting interests arise when financial rela-
tionships exist (eg employer – employee, own-
ership of property, financial honorary prizes,
and paid expert opinions) and these are the
most easily identifiable cases and those that
most often undermine the credibility of the
journal, the publishers, the authors and the sci-
entific endeavours in general. However, con-
flicting interests may arise for other reasons as
well such as poor interpersonal relationships,
academic competition etc.
Authors must indicate at the end of the text
and prior to the references section if they con-
sider that the peer review of their work may be
affected or not by the existence of any conflict
of interest as described above.
14. Sources of funding
Authors should indicate details (entity name,
contact information, amount awarded) of all
funding sources from which their research
benefitted. Examples of such sources in-
clude: medical or non-medical interest com-
pany funds, scholarships, national or Europe-
an Community grants, support from scientific
bodies (eg scientific societies, non -profit insti-
tutions etc.). It should also be indicated if the
work was carried out as part of a national or
transnational program, financed by nation-
al or international sources. In this case, full de-
tails of the program (awarding body, duration,
amount of funding, etc.) must be disclosed.
This information should be listed in a separate
section following the conflicts of interest sec-
tion.
15. Acknowledgements
The funding sources section is followed by
the optional Acknowledgements section, stat-
ing the names and affiliations of all those who
contributed (eg through the provision of pri-
mary data, or by reviewing the text or provid-
ing their opinion) to the drafting of the man-
uscript (apart from the authors). This section

10
should acknowledge any sponsors donating
materials and tools required for the research.
16. Bibliographic References: Bibliograph-
ic references in the text should indicate the
names of the authors followed by the date in
chronological order, eg. (Lewis 1975, Barnett
1992, Chalmers 1994). When there are more
than two authors, the name of the first author
followed by et al., eg. (Barder et al. 1994), is ref-
erenced in the text but all authors should be
listed in the bibliography. When quotes are
used in the text, the page should be referred
to eg. (Chalmers 1994, p.7). All references must
be from primary sources.
The literature list follows the Harvard system,
written in alphabetical order based on the sur-
name of the first author. The list should in-
clude authors’ surnames and initials, the date
of publication, article title, full name of journal,
volume number (and issue number if the vol-
ume pages are not consecutive) and the first
and last page of the article. When the refer-
ence applies to a book, the author, the date,
the title, followed by the publisher and the city
must be stated. When the reference applies to
a chapter in a book, details on the author(s) of
the book, the date, place of publication and
publisher must be provided. These references
that are said to be “in press”, shall be accepted
only if accompanied by a letter of acceptance
from the journal in question.
Examples:
Williams N. (2001). Patient resuscitation follow-
ing major thermal trauma. Nursing in Critical
Care: 6: 115-121
Muller D, Harns P, Watley L. (1986). Nursing
Children: Psychology Research and Practice.
London: Harper Row.
Lewis T, Hell J. (1992). Rhabdomyolysis and
Myoglobinuria. In: Hall J, Schmidt G, Wood L.
(eds), Principles of Critical Care, Volume 2. New
York: McGraw Hill.
Websites are refencees as follows:
National Institute for Clinical Excellence (2000)
Final appraisal determination: Drugs for early
thrombolysis in the treatment of acute myo-
cardial infarction, NICE, www.nice.org.uk/ar-
ticle.asp?a =36672. Last access on 7 October
2006.
17. Figures , Tables , Graphics , Photos :
Tables must be referred to herein as Tables,
numbered in the order they are presented, eg
as Table 1, Table 2, etc. and incorporated in the
correct place in the body of the text. All imag-
es, including photos, must be referred to here-
in as Figures and numbered in the order they
are presented, eg Figure 1, Figure 2 etc. They
must also be captioned and may be accom-
panied by a legend not exceeding thirty (30)
words. Figures of all forms will cover a single
column (width 86mm) or two columns when
needed (width 177mm). The journal reserves
the right to adjust the size of figures for tech-
nical reasons.
When material (including figures, tables, etc.)
that has already been published elsewhere ap-
pears in the manuscript, the written permis-
sion of the original authors (or those who own
the copyright of said material) must be ob-
tained. The authors of published papers are
fully liable for any copyright infringement.
Peer-review process
18. All submitted work is reviewed (anony-
mously) by two (2) independent referees/re-
viewers and, if they contain complex statistical
methodologies by a statistician as well. Re-
viewers decide whether an article is a) accept-
ed, b) requires modifications or c) rejected. In
case of disagreement among the reviewers,
the Managing Editor will reach a final decision,
taking into account all reviewer comments.
If the reviewers suggest modifications, the
manuscript is returned by the journal secretar-
iat to the corresponding author for redrafting
and resubmission within six weeks from the
date the comments were made (the review
process spans usually 6-8 weeks and in some
cases can reach up to 10 weeks). During resub-
mission, authors are required to indicate the
modifications they have carried out in accor-
dance to reviewer instructions in a letter to the
Managing Editor. The modified manuscript is
forwarded to the reviewers if deemed neces-

11ISSUE 41
sary, and they confirm whether or not modi-
fications comply with their recommendations.
At that point the Managing Editor reaches the
final decision to publish the article.
19. Electronic Reprint: Following publica-
tion, the corresponding author will receive an
electronic reprint of the article in PDF format.
Electronic reprints will be distributed by him/
her to the other authors. The journal does not
issue printed reprints of published work.
COPYRIGHT
20. In order to publish any article in the “Nurs-
ing Care and Research” journal, the authors are
asked to grant this exclusive right to the Soci-
ety for Nursing Studies. Along with the draft
for modifications the authors receive an Au-
thorization for Exclusive Publication form
which must be filled, signed and returned by
mail (or by email as a pdf file) to the journal,
along with the modified manuscript.
When a paper is derived from an extensive re-
search study and the same or other authors
have prepared additional papers, which have
been published or submitted for publication
in this or other journals, the corresponding
author must notify the Managing Editor so as
to ensure that third party copyright is not in-
fringed. Any impact emanating from copyright
infringement lies exclusively with the authors
of published articles and the journal will pro-
ceed with all necessary actions.
FINAL NOTE
Subscribers preparing manuscripts for publi-
cation in the “Nursing Care and Research” jour-
nal are requested to adhere to these Instruc-
tions for Authors carefully in order to avoid
delays in the publication of their work and the
publication of new volumes of the journal.

12
Abstract
INTRODUCTION: Effective management of
type 1 diabetes has been associated with the
collaborative involvement of parents at the
treatment of the disease.
PURPOSE: The purpose of this study was to
evaluate the collaboration between children/
adolescents with T1D and their parents as well
as factors affecting it. Moreover, this study aimed
to investigate the relation between parental
collaborative involvement and treatment
adherence.
METHODS: Patients with T1D (N = 108) aged
8-18 years, completed the questionnaires
“Collaborative Parent Involvement Scale” and
“Self-Care Inventory Scale”. Demographic
characteristics of the participants and information
associated with diabetes therapy were also
recorded.
RESULTS: The mean age of the sample was 12.9
years (± 3.01) with mean disease duration 5.5
years (± 3.08). 89.8 % of children (n = 97) reported
high levels of collaboration with their parents
(score ≥ 38) and the majority of the children (81.5
%) presented satisfactory levels of treatment
adherence (score ≥ 3.7) with mean HbA1c 7.9
%. The age (p = 0.09) and sex of the patient (p
= 0.374), the educational level of the father (p =
0.345) and mother (p = 0.618), the marital status
of parents (p = 0.982), the employment status
father (p = 0.494) and mother (p = 0.566) were
not statistically significant factors of collaboration
between parents and children. Collaborative
parental involvement (p = 0.029) found to
statistically correlate with better treatment
adherence levels. More precisely, the children
who reported effective collaboration with their
parents, were four times more likely to have better
treatment adherence (p = 0.001).
CONCLUSIONS: Findings of the present study
indicate that children with T1D collaborate
satisfactorily with their parents and achieve high
levels of treatment adherence.
KEYWORDS: Adherence, parental collaborative
involvement, factors, diabetes management,
T1DM.
ORIGINAL PAPER
Factors affecting collaboration between
children and parents regarding Type 1 di-
abetes management and connection with
treatment adherence
N. Mitosi, Nurse RN, MSc, “Mitera” Children’s Hospital, Athens.
G. Antonogeorgos, Pediatrician, MD, MSc, PhD, Biostatistician-Epidemiologist Research Fellow,
Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
C. Bartsokas, Emeritus Professor of Pediatrics, Director of Medical Service “Mitera” Children’s Hospital of
Athens.
C. Lemonidou, Professor, Faculty of Nursing, National Kapodistrian University of Athens
E. Konstantaki, Nurse RN, MSc, PhD(c), Head Nurse at “Mitera” Children’s Hospital of Athens
M.Giannakopoulou,AssociateProfessorFacultyofNursingNationalKapodistrianUniversityofAthens
A. Vazeou, Pediatrician MD, Director of A’ Pediatric Clinic, Head at Diabetes Centre at PA Kyriakou
Children’s Hospital.
V. Matziou, Professor, Faculty of Nursing National Kapodistrian University of Athens
Corresponding Author:
Nikoli Mitosi, 14 Stefanou Perri str. 19 009 Rafina, Athens, Greece. Tel: + 30 6982738688,
email: nmitosi@gmail.com.

13ISSUE 41
Abstract
BACKGROUND: Nausea and vomiting are the
most frequent and most undesirable side – ef-
fects of chemotherapy for children and adoles-
cents with cancer.
AIM: To review the current techniques which are
used to manage nausea and vomiting in children
with cancer, who are under chemotherapy.
METHOD: Literature review of studies published
during the years 2002 - 2012 in the electronic da-
tabases Pubmed, Medline and Cochrane, using
the key – words: «children with cancer», «chemo-
therapy», «nausea», «vomiting», «prevention» and
«management». Among the retrieved articles,
1818 articles appeared to be relevant to the topic,
but only 12 of them were fully informed.
RESULTS: According to the electronic review, the
methods that are used to prevent and manage
the nausea and vomiting – side effects of chemo-
therapy – in children and adolescents have been
significantly improved the latest years. Nine stud-
ies refer to the use of antiemetic drugs in order to
manage those side effects in children with cancer.
Also, three studies are referred to the use of non
– pharmacological methods of managing nausea
and vomiting, such as acupuncture, progressive
muscle relaxation (PMR), guided imagery and
children’s training about how to plan their meals
before and after chemotherapy. Those methods,
combined with antiemetic drugs have proved to
be extremely effective.
CONCLUSIONS: According to the review, the suc-
cessful management of nausea and vomiting in
children with cancer can be achieved if the appro-
priate antiemetic drugs and non – pharmacologi-
cal methods are combined.
KEY WORDS: «children with cancer», «chemo-
therapy», «nausea», «vomiting», «prevention» and
«management».
REVIEW
Current management techniques of nau-
sea and vomiting in children with cancer
A. Stamoulara, RN, M.Sc., Pediatric Clinic, “MITERA” Children’s Hospital, Athens
K. Papadopoulou, RN, M.Sc., Pediatric Clinic, “MITERA” Children’s Hospital, Athens
P. Perdikaris, RN, M.Sc., Ph.D., Pediatric Oncology Department, “ A. P. KYRIAKOY ” Children’s Hospital,
Athens
V. Matziou, Professor of Pediatric Nursing, National and Kapodistrian University of Athens, Athens
CorrespondingAuthor:
A. Stamoulara, 5 Thaleias street, GR – 12135, Peristeri, Greece, Tel: +30 210 5734139, +30 6974648160,
E – mail: a.stamoulara@windowslive.com

14
Abstract
INTRODUCTION: Professionals working in
healthcare settings are often exposed to possi-
bly contagious biological hazards due to the na-
ture of their work.
PURPOSE: The investigation of the effects of ed-
ucational interventions regarding the biological
risk factors on professionals’knowledge, compli-
ance with the appropriate precautionary meas-
ures, and on the frequency of sharp injuries.
MATERIAL AND METHODS: A search about
research studies was carried out in electronic
databases (Pubmed, Cinahl, Scopus, Cochrane)
using the keywords “education”, “educational in-
terventions”, “healthcare professionals”, “knowl-
edge”,“occupational safety”,“personal protective
equipment”, “bloodborne pathogens”, “needle-
stick injuries”, “exposure”. The studies should be
published in the Greek or English language, be-
tween the years 1995 and 2014, and with possi-
bility of access to the full article. In total, 22 stud-
ies were included in the review.
RESULTS: The studies included mainly prior to
and after the educational intervention measure-
ments. The educational methods differed be-
tween the studies, with lecture being the most
commonly used method. A number of findings
were observed in the studies, such as the profes-
sionals’increasedknowledgeaftertheeducation,
the reduction of sharp injuries’incidence, the im-
provement of handling of infectious materials,
improved compliance with general health and
safety measures, and the professionals’ satisfac-
tion from participation in educational programs.
CONCLUSIONS: The implementation of appro-
priate health and safety measures for preventing
occupational exposure to biological risk factors
is not sufficient and other measures, such as
professionals’ training, are required addition-
ally. Published studies demonstrate the neces-
sity of education, but the long-term effects of
education as well as the effectiveness of differ-
ent educational methods on the knowledge and
practice of professionals working in healthcare
settings are required.
KEY-WORDS:“education”,“educational interven-
tions”, “healthcare professionals”, “occupational
health and safety”, “use of personal protective
equipment”.
SYSTEMATIC REVIEW
Effectiveness of educational interventions
for the reduction of occupational exposure
to biological hazards
P. Copanitsanou, General Hospital of Piraeus “Tzaneio”, Piraeus, Greece
P. Sourtzi, Professor, National and Kapodistrian University of Athens, Greece
CorrespondingAuthor:
Copanitsanou Panagiota, Petropoulaki 19, 10445 Athens, Greece, Email: giwta_c@hotmail.com,
Telephone number: 6979838784

15ISSUE 41
Abstract
INTRODUCTION: Public participation in health-
care priority setting is one of the hot discussion
topics especially in the developedWestern coun-
tries. Evidently, public opinion on healthcare pri-
orities and methods to explore those opinions
are important research areas.
OBJECTIVE: To explore public opinion concern-
ing participation of the public in healthcare pri-
ority setting, as well as identify methods used
when conducting these types of research.
METHODS: A review of the available literature
published between January 1, 1994 and Febru-
ary 1, 2014. We used the following key-words:
public health participation, participation meth-
ods, health practices, health priorities, lay/public
participation. Initial search gave 212 papers, 19
of which were included in the review.
RESULTS: Results lead to more positive attitudes
towards the active public participation, which
can take various forms, such as discussions, ex-
change of views and consultation, also high-
lighting the importance of providing thorough
information to the public (n=4). In relation to
healthcare priority setting, there was evidence
of variation in views and opinions expressed by
the general population, patients and healthcare
professionals as far as prioritization is concerned,
with patients placing emphasis on treatment for
acute conditions and diseases, while the medi-
cal and nursing staff highlighting treatment for
chronic diseases. Focusing on studies conducted
in various countries investigating public involve-
ment and participation in healthcare priority
setting, results show lack of meaningful and in-
formed public participation (N=4).
CONCLUSION: Health benefits and health dete-
rioration caused by the lack of treatment were
the two most important issues that citizens take
into consideration to decide on healthcare prior-
ity setting.
KEYWORDS: healthcare priority, public health
participation, participation methods, participa-
tion
Public participation in healthcare priority
setting: A systematic review
Α. Farmakas., Psychotherapist CBT, RN, RMN, PhD(c)
M.Theodorou., Associate Professor, Open University of Cyprus
E.Papastavrou, Assistant Professor, School of Health Sciences, Department of Nursing, Cyprus University
of Technology
G. Karayiannis, RN, MSc, Special Scientific Educational Personnel, Nursing Program, Department of
Health Sciences, School of Sciences, European University, Nicosia, Cyprus
P. Galanis., RN, MPH, PhD, Center for Health Services Management and Evaluation, Department of
SYSTEMATIC REVIEW

16
INTRODUCTION
Over the past few decades, the topic of public
participation and the role citizens may or should
have in healthcare priority setting is gaining an
ever-growing importance and has raised the in-
terest not only of the academic community, but
also to some extent, health policy itself. Even so,
since the results of several research studies have
indicated that, invariably, health services are not
aware of people’s views and expectations (Mos-
sialos King, 1999), thus priorities set in various
western European countries do not conform to
patients’ or citizens’ needs and preferences (Hon-
ingsbaum et al., 1999). Moreover, priorities of-
ten set lead to solutions that typically limit ac-
cess to healthcare and citizens end up assessing
them negatively, especially when applied with-
out public participation in the decision-making
(Diederich et al., 2012).
Those who decide on health policy in principle
may have a positive approach to public partici-
pation in healthcare priority setting, while at the
same time, it is a desired goal of the World Health
Organisation,(WHO,1996; Council of EE, 2000) but
in practice, difficulties, questions and specula-
tions arise. Main topic of concern is how to de-
fine the level and promote public participation in
healthcare propriety setting. Scanning the litera-
ture efficiently, one can identify views and ideas
that support active public participation in health-
care planning (Frankish et al., 2002; Goldman,
2004; Τraulsen et al., 2005; Rosén 2006; Abelson
et al., 2007; Sabik, 2008). But, there are also seri-
ous reservations, even objections, by several re-
searchers on the purposefulness and usefulness
of public participation in healthcare priority set-
ting and decision making processes (Stronks
et al., 1997; Jordan et al., 1998; Evans 1999; Tor-
genson and Gosden 2000). Lastly, there are dif-
ficulties and impediments associated with the
processes to allow public participation in deci-
sion-making, in addition to the issue of the pub-
lic’s objectivity (Kapiriri et al., 2003).
Aim of our study was to explore public opinion
concerning participation of the public in health-
care priority setting, as well as identify methods
used when conducting these types of research.
METHODOLOGY: INCLUSION
CRITERIA:
We conducted a review of the literature to iden-
tify studies relevant to the public participation in
healthcare priority setting, published between
January 1, 1994 and February 1, 2014. Search was
limited to papers published in peer-reviewed sci-
entific journals (in the English language), Inclu-
sion criteria to select papers for the literature re-
view were the following two: (a) include citizens
(the public) in the study sample, and (b) provide
clear description of the study methods used to
gather data about public opinion.
SEARCH STRATEGY
To identify relevant papers for the present lit-
erature review, the authors carried out a thor-
ough search in the following electronic data-
bases: Medical Literature Analysis and Retrieval
System Online (MEDLINE), Cumulative Index of
Nursing and Allied Health Literature (CINAHL),
Excerpta Medica Databases (EMBASE), Public
Medline (PubMed) and Google Scholar. The key-
words used are: public health participation, par-
ticipation methods, health practices, health pri-
orities, lay or and public participation. Two of the
authors examined all identified papers separate-
ly against the inclusion criteria. When differing
opinions emerged, the third member of the re-
search team examined the paper to reach final
decision.
Results: The initial search returned 212 papers
(Figure 1). Of those, 14 were duplicated articles,
thus excluded from the process. After reading
the papers’ titles, authors excluded 87 of the re-
maining articles and after reading the abstracts,
47 papers were also eliminated. The authors re-
viewed the full text of the remaining 64 papers
and excluded 45 of them. At the end of this pro-
cess, 19 studies that met the inclusion criteria,
were analyzed for the purposes of this literature
review.
In Table 1, we present the 19 papers included and
analyzed in the present literature review, which
the authors classified into the following three
categories:

17ISSUE 41
 Thematic Category A: 11 papers (listed as No.
1 to 11 in Table 1), mainly concerned with the
issue of investigating views/opinions of the
public and healthcare professionals about
their participation in the process of health-
care priority setting.
 Thematic Category B: 4 papers (listed as No.
12 to 15 in Table 1), dealing with the assess-
ment of methodological approaches to pub-
lic participation in healthcare priority setting.
 Thematic Category C: 4 papers (listed as No.
16 to 19 in Table 1), concerned with the ex-
ploration and examination of efforts and ini-
tiatives in various countries to improve public
participation in healthcare priority setting.
Search identified 212 papers
87 papers excluded after reading their titles, in
addition to 14 papers that showed up twice
125 papers remained
47 papers excluded after reading their
abstracts
64 papers remained
19 papers included in review
45 papers excluded because they did not meet
the inclusion criteria
Figure 1. Flow diagram of the systematic review

18
The main features of all 19 studies, i.e. author(s)
and year of publication, country(-ies) involved,
population, main research objectives/study
goals, survey methods used to gather data about
public opinion and finally, key research results,
are recorded in the annexed table.
The 19 studies cover extensive geographical ar-
eas, which include the United States of America,
Canada, the United Kingdom, Sweden, Greece,
Portugal, Germany, Tanzania, Iran and Uganda,
while one study surveyed eight (8) countries.
Size of samples varies with the largest one in-
cluding 3702 individuals (Arvidsson et al., 2012)
and the smallest just 16 (Lenaghan et al., 1996).
Twelve studies used a sample of less than 100
individuals, 4 studies had a sample containing
more than 100 individuals and 3 had a sample of
more than 2000 people.
In the first thematic category, we included pa-
pers that dealt with the investigation of views/
opinions of the public and healthcare profes-
sionals about their participation in the process
of healthcare priority setting. A wide range of
research methods was used. Seven studies re-
lied solely on self-report questionnaires (Dolan
Shaw 2003; Kapiriri Norheim 2004, Theodorou
et al 2008; Arvidsson et al., 2009; Diederich et al.,
2011; Arvidsson et al., 2012; Botelho et al., 2013),
3 studies used the method of Community Com-
mittees’ discussions (Abelson et al., 1995; Martin
et al., 2002 ; Kapiriri et al., 2003), while 1 study re-
lied on focus groups and discussions (Arvidsson
et al., 2010). Overall, these studies showed posi-
tive attitudes to public participation in decision-
making concerning resource allocation in health-
care, in addition to citizens indicating that they
wish to be consulted with respect to resource al-
location issues (Abelson et al., 1995; Martin et al.,
2002; Kapiriri et al., 2003; Theodorou et al., 2008;
Arvidsson et al., 2009; Botelho et al., 2013). Espe-
cially, it is evident that individuals favor public
engagement through group processes (Abelson
et al., 1995; Martin et al., 2002).
Studies In the first thematic category showed
positive attitudes to public participation in de-
cision-making concerning resource allocation in
healthcare Regarding the participation of specif-
ic groups and the role they should have in pri-
ority setting, Martin et al. (2002) pointed out to
the need to engage with different groups (med-
ical specialists, general practitioners, public sec-
tor representatives and patients’ representatives,
members of the general population, etc.) and to
clarify the precise responsibilities, functions and
role of each group.
Botelho’s et al. (2013) research documented that
members of the public are reluctant to partici-
pate in health-related decision-making process-
es, evidently due to them having limited knowl-
edge and the ‘right’ skills for full participation in
the processes. Thus, citizens tend to cede their
powers to traditional decision-making bodies
(Abelson et al., 1995) mentioning that thorough
information about healthcare needs is necessary
so that the public is able to engage in the process
(Abelson et al., 1995). On the other hand, some
research studies (Theodorou et al., 2008; Arvids-
son et al., 2009; Botelho et al., 2013) indicate that
the public is positively inclined toward the partic-
ipation of healthcare professionals and the pub-
lic in the decision-making processes and not so
much of the politicians, especially when deci-
sion-making processes deal with priority setting.
However, young patients and males are notably
more positive toward the role politicians have
(Arvidsson et al., 2009).
Young patients and males were also more posi-
tivetowardstheneedforprioritysettinginhealth
(Arvidsson et al., 2009). Concerning this, citizens
– the public – modulate prioritization taking in-
to consideration personal characteristics (Dolan
Shaw 2003). Moreover, there are variations in
the views and perceptions of the general popu-
lation, patients and healthcare professionals rela-
tive to ranking priorities, with patients emphasiz-

19ISSUE 41
ing on the treatment of acute conditions, while
the medical and the nursing staff on the treat-
ment of chronic diseases (Arvidsson et al., 2012).
Health benefits and health deterioration caused
by the lack of treatment are two of the most im-
portant issues citizens take into consideration in
setting priorities (Dolan Shaw 2003). Elements
that yield high prioritization are also the severi-
ty of disease, expected benefits of the proposed
intervention/treatment and the cost of the treat-
ment, while factors not characterized as impor-
tant are religion, power and influence of the pa-
tient (Kapiriri Norheim 2004). Age was another
factor not treated as an acceptable criterion for
priority setting (Diederich et al., 2011).
Research studies belonging to the second the-
matic category dealt with the assessment of vari-
ous methodological approaches to public partic-
ipation in healthcare priority setting. The results
of the studies incorporated in this thematic cate-
gory are positively inclined toward methods that
include the public’s active forms of participation,
like for instance, discussions, exchange of views
and consultations. Moreover, studies showed
that qualitative research methods have the po-
tential to improve legitimacy and enhance the
transparency of political decisions concerning
healthcare (Lenaghan et al., 1996; McKie et al.,
2008) and stressed the need for further research
in solving methodological problems resulting
from their implementation.
Regarding the use of “citizens’ juries”, Lenaghan
et al. (1996) concluded that this method could be
applied to respond to problems such as lack of
knowledge and citizens’ unwillingness to partici-
pate in health policy decision-making, after con-
cluding that provided there is enough time and
proper information, the public is able to contrib-
ute substantially to debates on priority setting.
Abelson et al. (2003) were in favor of the ‘consul-
tation’ method, stressing that its implementa-
tion is still in a premature stage and its success
depends greatly on the proper understanding
of the citizens’ thought change process. Singer
et al. (2002) identified as a success factor for the
‘consultation’ method the need to involve all so-
cial groups.
Success and scale of initiatives to improve pub-
lic participation in healthcare priority setting
worldwide has been the research topic of stud-
ies included in the third thematic category. Their
results are consistent to those of the previous
category as far as the success of focus groups and
others forms and methods of community consul-
tations is concerned, highlighting the need to
provide the public with thorough information.
As the data showed, Litva et al. (2002) recorded
the strong desire of the British public to partici-
pate in healthcare priority setting and the Unit-
ed Kingdom is a country already experiencing re-
forms to integrate ways of public participation in
decision making processes, albeit that participa-
tion is still limited due to the lack of knowledge
(Sabik Lie, 2008). Sabik Lie (2008) explored in-
itiatives in eight countries and more specifically
Norway, Sweden, Israel, Holland, Denmark, New
Zealand, the United Kingdom and the state of Or-
egon in the U.S.A., indicating the lack of mean-
ingful public participation, despite the fact that
some attempts in Israel, Oregon and the Unit-
ed Kingdom had relative success. Divergence
from previously mentioned studies was record-
ed in the research surveys of Mubyazi et al. (2007)
and Khayatzadeh-Mahani et al. (2013) conduct-
ed in Tanzania and Iran respectively, countries
where the political and governing do not allow
the meaningful public involvement in health-
care decision-making, thus reinforcing the view
of theorists that public participation and consul-
tation on public policies is sign of democracy and
equality in a country.

20
Table 1. Results of systematic review (19 studies were included)
No. Study Country Study Population Aim Methodology
Results
1
Abelson et al.,
1995
Canada
280 citizens from 3
rural and 3 urban
communities. The 6
communities were
selected from the
32 areas covered
by a district health
council in Ontario.
To obtain and contrast
the informed opinions of
participants concerning
public’s participation in
healthcare priority setting.
A series of
s t r u c t u r e d
meetings, each
lasting two
hours
189 (72%) participants in total were
personally willing to take on a role
involving responsibilities for the
overall healthcare decision-making
process, but far fewer (30%) men-
tioned that their group was suited
to taking on responsibility or a con-
sulting role (55%). Elected officials
were the most willing (85% indicated
personally willing, 50% considered
that their group is suitable), while
randomly selected citizens were the
least willing (60% indicated person-
ally willing, 17% considered that their
group is suitable) to assume respon-
sibility for the overall decision-mak-
ing process.
The majority of the surveyed citi-
zens indicated low interest in partic-
ipating in specific types of decisions,
apart from planning and priority set-
ting. Only 24 participants (9%) indi-
cated that their group was suitable
to assume responsibility for raising
revenue, 91 (33%) thought that their
group is suitable for resource allo-
cation and 108 (39%) felt that their
group is suitable for management
of services. People in all groups felt
that the healthcare needs is the most
important information they must
have in order to be able to respond
to any role. It is noteworthy that par-
ticipants indicated that the most ap-
propriate decision making body is a
body composed of various communi-
ty groups, while people were also in
favor of the representation of elected
officials, provisional government and
technocrats/experts in this body.
2
Martin et al.,
2002
Canada
21 individuals
(patients and
members of
the public) that
participated in 2
priority setting
committees
Exploring the views of par-
ticipants in the process of
priority setting and deci-
sion making in health
Personal semi-
structured in-
terviews. Qual-
itative research
methodology
used.
Participants agreed on the positive
contribution the public has in set-
ting priorities concerning health-
care. Participants recorded the fol-
lowing six (6) groups as having an
important role to play on healthcare
priority setting: committee chairs,
administrators, medical specialists,
general practitioners, representatives
of the public sector and representa-
tives of patients. Moreover, partici-
pants described the main responsi-
bilities as well as the limitations of the
envisioned role of each group.
3
Dolan Shaw
2003
United King-
dom
52 individuals (23
members of the
general public and
29 undergraduate
students). All, in the
city of York.
The purpose of the research
was to investigate whether
and to what extent the
public is willing to attribute
different priorities when
asked to choose between
providing
healthcare treatment
for different individuals
and groups, taking into
consideration personal
characteristics and other
variables.
S e l f - r e p o r t
questionnaire
The benefits on (estimated gains) and
the consequences for health dete-
rioration that result from the lack of
treatment (estimated losses) are two
of the most important factors citi-
zens take into account in priority set-
ting. This particular research reinforc-
es the popular view that citizens – i.e.
the general public – shapes the rank-
ing of healthcare priorities by consid-
ering personal characteristics.

21ISSUE 41
Results
4
Kapiriri et al.,
2003
Uganda
12 decision making
bodies at the
national, regional
and community
level and 51
individuals (women,
men, young people
and teenagers)
The purpose of this
research is to investigate
the experiences of the
public and individuals who
participate in health policy
with respect to priority
setting in healthcare in a
decentralized region of
Uganda.
Personal inter-
views. Qualita-
tive research
methodology
used.
Participants at the regional level stat-
ed that they have assumed decision-
making responsibilities but at the
same time expressed their concerns
about the extent to which they have
financial independence. Participants
at the national level expressed con-
cerns about the ability of the regions
to absorb their newly appointed
roles. Amongst the general common
concerns expressed by participants
are the actual public participation in
healthcare priority setting and the
poor communication between the
various levels of the decentralization
system.
5
K a p i r i -
ri Norhe-
im,2004
Uganda
408 individuals of
average age 30.4
years old (health
care professionals,
people responsible
for healthcare plan-
ning, people work-
ing in all levels of the
country’s healthcare
system and mem-
bers of the general
public.
To explore the acceptance
of criteria in healthcare
priority setting by various
stakeholders in Uganda.
questionnaire
Based on the responses, the follow-
ing criteria are the most acceptance
ones (‘high-weight criteria’): severity
of the disease, the expected benefits
of the planned treatment, the cost of
the treatment, comparing cost-effec-
tiveness of the treatment, the quali-
ty of data concerning effectiveness,
patients’ age, place of residence, life-
style, importance of providing equal
access to healthcare and the views of
the community. The criteria partial-
ly accepted by participants (‘average-
weight criteria’) are the following: so-
cial status of the patient, the patient’s
mental health, his/hers physical abil-
ities, political views, whether or not
the patient has dependents and gen-
der. Lastly, the criteria least accepted
by participants (‘low-weight criteria’)
are patient’s religion, power and in-
fluence.
6
Theodorou et
al., 2008
Greece
400 individuals
(300 citizens and
100 doctors), all
residents and
working in the
Attica Basin.
Investigate the public’s and
doctors’ views/opinions
on critical issues that
concern priority setting
and resource allocation in
healthcare.
S t r u c t u r e d
s e l f - r e p o r t
questionnaire
consisting of
27 questions
Consensus amongst surveyed indi-
viduals for the need to participate in
priority setting, while consensus was
also evident on resource allocation to
various healthcare programmes.
7
Arvidsson et
al., 2009
Sweden
2517 patients in 4
healthcare centers
in Sweden
Investigate and analyze
patients’ views and
perceptions concerning
priority setting in primary
healthcare in Sweden
questionnaire
75% of the patients agreed with
statements such as “public health
services need to always provide the
best possible treatment and care
irrespective of cost”. Almost 3/4 of pa-
tients wanted the healthcare person-
nel and not the politicians to make
decisions concerning healthcare pri-
ority setting. Younger patients and
men were most in favor of setting up
priorities and had a more favorable
approach to the role of politicians.
8
Arvidsson et
al., 2010
Sweden
31 individuals, 16
doctors (10 men
and 6 female) and
15 nursing staff (all
female)
Quantitative evaluation of
the perceptions of the gen-
eral practitioners and the
nursing staff concerning
the adoption of three key
criteria for priority setting.
focus groups
(8)
The results of this research indicate
that there is a need to include three
additional parameters/dimension
in the process of priority setting: 1)
opinions/viewpoint (medical or the
patient’s), 2) timeframe, and 3) level
of evidence.

22
Results
9
Diederich et
al., 2011
Germany
2031 individuals
from households
Exploring the age factor as
a criterion for priority set-
ting in healthcare based on
the opinions of the public.
questionnaire
There are very few indications that
the public in Germany accepts age
as a criterion for setting priorities in
healthcare services.
10
Arvidsson et
al., 2012
Sweden
3702 individuals,
out of which 1851
were patients and
1951 were members
of the medical and
nursing staff.
Description and analysis of
the way by which general
practitioners, nursing staff
and patients set priorities
in primary healthcare, as
well as investigation of
the relationship between
three (3) criteria for
priority setting and overall
priorities set by general
practitioners and nursing
staff in personalized
patients’ treatments.
questionnaire
Diversification of priorities set by
patients (treatment of acute situa-
tions) and by medical and nursing
staff (treatment of chronic diseases).
The severity of the condition of the
patient’s health is the criterion for
priority setting that had the strongest
correlation with the overall priority
for the medical and nursing staff,
with the exception of the general
practitioners (cost-effectiveness
analysis).
11
Botelho et al.,
2013
Portugal 442 students
Explore participants’ views
on various stakeholders
and the degree to which
each should have a role
in decision-making
and priority setting in
healthcare.
questionnaire
Despite the fact that citizens wish to
be consulted in healthcare priority
setting, the majority believe that do
not possess the right knowledge and
proper skills to be able to fully partici-
pation in decision-making. Findnings
susggests that healthcare profession-
als (doctors) should play the most im-
portant role in healthcare decision-
making because of their experience
and involvement in the health sector.
12
Lenaghan et
al., 1996
U n i t e d
Kingdom
16 individuals
Assessment of the work
carried out by the first Brit-
ish Citizens’ Jury Board es-
tablished to form more ef-
ficient methods for public
participation in healthcare
priority setting.
4 citizens’
juries
With adequate time and proper in-
formation, the public is capable of
participating effectively and mean-
ingfully in discussions concerning
healthcare priority setting.
The research indicated two (2) models
of citizens’ committees: one is a par-
ticipative model, based on which the
public has a consulting/advisory role,
forms guidelines that decision-mak-
ing bodies can use and offers fruitful
feedback concerning the opinions/
perceptions of the local community.
The other, is a model based on which
the Citizens’ Jury Board has a more
active role and according to the re-
searchers has the ability to enhance
the legitimacy and transparency of
the processes involved in healthcare
priority setting.
13
Singer et al.,
2000
Canada
26 individuals
from 2 committees
responsible for
providing advisory/
consulting services
with respect to
prioritization for
new technologies
in the treatment
of cancer patients
(n=15) and heart
patients (n=11)
Description of priority
setting decision-making
processes for new
technologies in medicine
Document re-
view, personal
interviews and
meetings’ ob-
servation
With respect to the importance of
consultation, one of the key findings
was that it is extremely important
to involve individuals from various
societal groups in consultations.

23ISSUE 41
Results
14
Abelson et al.,
2003
Canada
46 individuals, the
average age is 47.5
years old
Explore the method of ‘de-
liberation’ in forming and
changing the opinions of
the general public con-
cerning its participation in
healthcare priority setting
3 teams
involving the
public: (a)
research with
questionnaire
mailed to
par ticipants
(b) telephone
interviews, and
9c0 personal
interviews with
team mem-
bers.
The major opinion shifts were evident
in individuals that participated in the
community consultation group. The
results of the research indicate that
dialogue may have beneficial results
with respect to forming and shifting
opinions of participants, who are
then more receptive to changes.
15
McKie et al.,
2008
USA
54 individuals,
members of
the public and
h e a l t h c a r e
professionals
Explore the public’s opin-
ions concerning the val-
ues that should guide and
inform healthcare deci-
sion making, as well as how
the opinions expressed
by various groups that
participate in the decision
making process should be
ranked.
8 focus groups
Participants attributed a role to an ex-
tensive range of bodies/stakehold-
ers about decisions concerning pri-
ority setting. The research stressed
the importance of the process by
which decisions are reached , with
preference given to the ‘focus groups’
methodology.
16
Litva et al.,
2002
U n i t e d
Kingdom
57 individuals (8 fo-
cus groups). For half
of the focus groups,
participants were
randomly select-
ed from the general
population and for
the other half par-
ticipants were mem-
bers of various orga-
nizations
Explore public preferences
concerning the prospect,
level and means of
participating in various
forms of decision making
processes.
Mixed Meth-
odology: Focus
groups, Ques-
tionnaires with
personal inter-
views.
There was a strong desire in all groups
for the public to be involved. Partic-
ipants were generally in favor of the
‘consultation’ method with the use of
focus groups.
17
Mubyazi et al.,
2007
Tanzania
4 focus groups,
each consisting of
6 to 12 individuals
(members of the
public and patients
from 2 districts in
Tanzania)
Investigate and describe
participants’ opinions
and views on healthcare
priorities and the
participation of the public
in priority setting.
Focus groups
Consensus of public opinion
concerning the ineffectiveness
of healthcare priority setting
committees in their districts, in
comparison to the work done by
Community Committees containing
members of the general public.
18
Sabik Lie,
2008
8
geographical
s e g m e n t s :
N o r w a y ,
S w e d e n ,
Israel, the
Netherlands,
D e n m a r k ,
New Zealand,
U n i t e d
K i n g d o m ,
State of
Oregon in the
USA.
Health care systems
in 7 countries and 1
US state
Review and evaluation of
healthcare priority setting
systems in 8 geographical
segments.
Public records
With the exception of the United
Kingdom, establishing a set of values
on which to base priority setting has
none or limited impact on healthcare
policymaking. Researchers conclud-
ed that key to the success of meaning-
ful policy making in healthcare prior-
ity setting is to establish institutions/
bodies with some decision-making
power for truly applicable changes to
the healthcare system.
19
Khayatzadeh-
Mahani et al.,
2013
Iran
55 individuals in 3
groups
Explore the opinions and
experiences of bodies/
stakeholders involved in
healthcare decision-mak-
ing processes, implementa-
tion of policies and priority
setting.
P e r s o n a l
interviews
Public participation is limited. Re-
searchers suggest public involve-
ment in discussions to reveal the true
needs of the population on health-re-
lated issues, so that the moral princi-
ples based on which healthcare prior-
ity setting is implemented have both
meaningful and practical use.

24
DISCUSSION
In the present literature review, we screened and
selected for full review and analysis 19 original
articles that deal with the issue of public partic-
ipation in healthcare priority setting, based on
the procedure and criteria already mentioned.
In the first thematic category, authors included
papers that dealt with the investigation of views/
opinions of the public and healthcare profes-
sionals about their participation in the process
of healthcare priority setting. Overall, studies
showed positive attitudes to public participation
in decision-making concerning resource alloca-
tion in healthcare, in addition to citizens indicat-
ing that they wish to be consulted with respect
to resource allocation issues.
Studies belonging to the second thematic cate-
gory dealt with the assessment of various meth-
odological approaches to public participation
in healthcare priority setting. Overall, studies
showed that if there is enough time and prop-
er information, the public is able to contribute
substantially to debates on priority setting. Im-
plementation is still in a premature stage and its
success depends greatly on the proper under-
standing of the citizens’ thought change process.
Identified as a success factor for the ‘consultation’
method the need to involve all social groups.
Success and scale of initiatives to improve pub-
lic participation in healthcare priority setting
worldwide has been the research topic of stud-
ies included in the third thematic category. The
success of focus groups and others forms and
methods of community consultations is con-
cerned, highlighting the need to provide the
public with thorough information.
To conclude, it should be noted that the public
participation in shaping healthcare policies is a
subject of significant scientific interest, with var-
ious aspects, implications, various and differing
opinions and a great many difficulties to tack-
le. On the other hand, is the strong desire of the
public to participate in the processes as long as
proper information is provided. The means to ac-
complish this and the processes by which citi-
zens’ participation will be meaningful and yield
positive results and value-added on healthcare
policies are matters that need further investiga-
tion.
Public’s participation in decision-making and pri-
ority setting in health care is slim to nonexistent
in both Greece and Cyprus. This non-assertive at-
titude seems to be related to many different fac-
tors, such as the overall lack of citizen engage-
ment in the social agenda and the culture of both
Greeks and Cypriots that hardly question the
‘medical authority and power’ and thus scarce-
ly claim involvement and participation in health
care priority setting. Because of the above, now-
adays, in both countries, efforts to adopt partici-
patory processes in health care planning is limit-
ed, as is their overall effectiveness.
Focusing on Cyprus, pending the implemen-
tation of the new General Health Care Scheme
(ΓεΣΥ) and considering the economic crisis, the
above review could form the basis of a process
that will lead to public participation in health
care decision-making. In such a case, and if an
institutional role and substantial participation
of the public in the design of measures and pri-
ority setting, would be foreseen, any reactions
would be milder. Moreover, it is almost undenia-
ble that where people are privy to the actual cir-
cumstances that inevitably lead to solutions and
practices that restrict access and coverage, the
solutions adopted are more balanced and have
greater social acceptance.
What can and should be pursued concerning
public’s participation in health care resource al-
location, is securing conditions for appropriate
communication channels and interaction with
the general public, so as to hear what the citizens
have to say. Citizens could participate successful-
ly in these health care related processes if only
they had sufficient time and proper information.
Another crucial facilitating factor is choosing the
right means and methods that provide oppor-
tunities for discussion, consultation and synthe-
sis of new perceptions and ideas. Such methods
could be focused interviews, in addition to oth-
er means that facilitate and engage public’s par-
ticipation. Only with the above, it will be possible
to create the right conditions for consensus deci-
sion-making and solutions, particularly in today’s
fragmented and multicultural social structures. It
is important to remember that future challenges
will require enhanced legitimation in the context
of democracy.
REFERENCES
Abelson, J., Eyles, J., McLeod, C. B., Collins, P. McMul-
lan, C., Forest, PG. (2003) Does deliberation make a
difference? Results from a citizens panel study of
health goals priority setting. Health Policy, 66: 95-
106.
Abelson, J., Giacomini, M., Lehoux, P. and Gauvin, FP.
(2007) Bringing “the public” into health technology
assessment and coverage policy decisions: From
principles to practice. Health Policy, 82: 37-50.

25ISSUE 41
Abelson, J., Lomas, J., Eyles, J., Birch, S., Veenstra, G.
(1995) Does the community want devolved author-
ity? Results of deliberative polling in Ontario. Cana-
dian Medical Association Journal, 153: 403-412.
Arvidsson, E., André, M., Borgquist, L., Andersson,
D., Carlsson, P. (2012) Setting priorities in prima-
ry health care – on whose conditions? A question-
naire study. BMC Family Practice, 13: 114-121.
Arvidsson, E., André, M., Borgquist, L., Linstrom, K.
Carlsson, P. (2009) Primary care patients’ attitudes
to priority setting in Sweden. Scandinavian Journal
of Primary Health Care, 27: 123-128.
Botelho, A., Pinho, MM., Veiga, P. (2013) Who should
participate in health care priority setting and how
should priorities be set? Evidence from a Portu-
guese survey. Revista Portuguese Saude Publica, 31:
214-222.
Council of Europe (2000) The Development of struc-
tures for citizen and patient participation in the
decition- making process affecting health care. In:
Recommendation Rec (2000). Committee of Minis-
ters of the Council of Europe on 24 February 2000.
Strasbourg.
Clark S., Weale A., (2012) Social Values in health pri-
ority setting: a Conceptual framework, Journal of
Health organization and Management, 26:293-316.
Diederich, A. Swait, J. Wirsik, N. (2012) Citizen Partic-
ipation in Patient Prioritization Policy Decisions:
An Empirical and Experimental Study on Patients’
Characteristics. PLoS ONE, 7:1
Diederich, A., Winkelhage, J. Wirsik, N. (2011) Age as a
Criterion for Setting Priorities in Health Care? A Sur-
vey of the German Public View. PLoS ONE, 6: 1-10.
Dolan, P. Shaw, R. (2003) A note on the relative impor-
tance that people attach to different factors when
setting priorities in health care. Health Expecta-
tions, 6: 53-59.
Evans DB., Lim SS., Adam T., Edejer TT., (2005) Achiev-
ing the millennium development goals for health:
evaluation of current strategies and future priori-
ties for improving health in developing countries.
British Medical Journal. 331: 1457-1461.
Frankish J., Kwan B., Ratner P., Higgins, J., Larsen C.
(2002) Challenges of citizen participation in re-
gional health authorities. Social Science and Medi-
cine, 54:1471-1480.
Goldman J., (2004) Millions of voices: a blueprint for
engaging the American public in national policy-
making. Washington (DC): America Speaks.
Honingsbaum, F., Calltrorp, C., Ham, C., Holmstrom, S.,
(1999) Priority Setting Processes for Health Care. Ox-
ford: Radcliffe Medical Press.
Jordan J., Dowswell T., Harrison S., Lilford R., Mort M.,
(1998). Health needs-assessment: Whose priorities?
Listening to users and the public. British Medical
Journal, 316:1668-1670.
Kapiriri, L., Norheim, OF. (2004) Criteria for priority-
setting in health care in Uganda: exploration of
stakeholders’ values. Bulletin of the World Health Or-
ganization, 82: 172-179.
Kapiriri, L., Norheim, OF., Heggenhougen, K. (2003)
Public Participation in health planning and priority
setting at the district level in Uganda. Health Policy
and Planning, 18: 205-213.
Khayatzadeh-Mahani, A., Fotaki, M., Harvey, G. (2013)
Priority setting and implementation in a central-
ized health system: a case study of Kerman prov-
ince in Iran. Public Health Ethics, 6: 60-72.
Lenaghan, J., Coote, A. (1996) Citizens’ Juries: Theory in-
to practice. Institute for Public Policy Research: Lon-
don.
Litva, A., Coast, J., Donovan. J., Eyles, J., Shepherd, M.,
Tacchi, J. et al (2002) The public is too subjective:
public involvement at different levels of health-
care decision making. Social Science and Medicine,
54: 1825-1837.
Martin, D., Abelson, J., Singer, P. (2002) Participation
in health care priority-setting through the eyes of
the participants. Journal of Health Services Research
Policy, 7: 222-229.
McKie, J., Shrimpton, B., Hurworth, R., Bell, C., Rich-
ardson, J. (2008) Who should be involved in health
care decision making? A qualitative study. Health
Care Analysis, 16:114–126.
Mossialos, E. and King, D. (1999) Citizens and ration-
ing: analysis of a European survey. Health Policy, 49:
75-135.
Mubyazi, G. M., Mushi, A., Kamugish, M., Massaga,
J., Mdira, K. Y., Segeja, M. et al. (2007) Community
views on health sector reform and their participa-
tion in health priority setting: case of Lushoto and
Muheza districts, Tanzania. Journal of Public Health,
29: 147-156.
Rosen, P. (2006) Public dialogue on healthcare prioriti-
zation, Health Policy, 79: 107-116.
Sabik, L. M. Lie, R. K. (2008) Priority setting in health
care: lessons from the experiences of eight coun-
tries. International Journal for Equity in Health, 7:
4-16.
Singer, P. A., Martin, D. K. Giacomini, M. Purdy, L. (2000)
Priority setting for new technologies in medicine:
qualitative case study. BMJ, 321: 1316-1319.
Stronks, K. (1997) Who should decide? Qualitative
analysis of panel data from public, patients, health-
care professionals and insurers on priorities in
health care. BMJ, 315: 92–96
Theodorou, M., Samara, K., Pavlakis, A., Middleton, N.,
Polyzos, N., Maniadakis,N., (2010) The Public’s and
Doctors’ Perceived Role in Participation in Setting
Health Care Priorities in Greece. Hellenic Journal of
Cardiology, 51: 200-208
Torgenson D., Gosden T., (2000) Priority setting in
health care: Should we ask the tax payer? British
Medical Journal, 320:1699.
Traulsen,JM., Almarsdóttir, AB. (2005) Pharmaceutical
policy and the lay public. PharmWorld Sci,27:273-
277.
World Health Organisation (1996) The Ljubljana Char-
ter on Reforming Health Care in Europe. Availa-
ble at: http://WWW.euro,who.int/data/assets/pdf
file/0010/113302/E55363.pdf

26
Vatatzi 55, 114 73 Athens, Greece
ΤEL. : 210 6431108
E-MAIL: ekdoseis.ocelotos@gmail.com
www. ocelotos. gr

Issue 41

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Similar to Issue 41

Similar to Issue 41 (20)

More from Εταιρεία Νοσηλευτικών Σπουδών

More from Εταιρεία Νοσηλευτικών Σπουδών (18)

Recently uploaded

Recently uploaded (20)

Issue 41