Currently we observe a gap between theory and practices of patient engagement. If both scholars and health practitioners do agree on the urgency to realize patient engagement, no shared guidelines exist so far to orient clinical practice. Despite a supportive policy context, progress to achieve greater patient engagement is patchy and slow and often concentrated at the level of policy regulation without dialoguing with practitioners from the clinical field as well as patients and families. Though individual clinicians, care teams and health organizations may be interested and deeply committed to engage patients and family members in the medical course, they may lack clarity about how to achieve this goal. This contributes to a wide “system” inertia—really difficult to be overcome—and put at risk any form of innovation in this filed. As a result, patient engagement risk today to be a buzz words, rather than a real guidance for practice. To make the field clearer, we promoted an Italian Consensus Conference on Patient Engagement (ICCPE) in order to set the ground for drafting recommendations for the provision of effective patient engagement interventions. The ICCPE will conclude in June 2017. This document reports on the preliminary phases of this process. In the paper, we advise the importance of “fertilizing a patient engagement ecosystem”: an oversimplifying approach to patient engagement promotion appears the result of a common illusion. Patient “disengagement” is a symptom that needs a more holistic and complex approach to solve its underlined causes. Preliminary principles to promote a patient engagement ecosystem are provided in the paper.

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mHealth is an expanding field of research and experimentation, concerned with the potentialities of mobile applications as tools to enhance patients' abilities in the management of chronic conditions. We present a systematic review of mHealth applications available on the Italian market and for the Italian speakers in order to assess their reported usability and functions. The review shows that there are rather few products on offer and the ones that are available display weak educational components, do not seem to be based on solid theoretical models of behavior change or decision making, and do not seem to be intended as devices to be integrated in the ecology of the doctor-patient relationship.

Doubt is a double-edge sword. On the one hand, uncertainty is essential for epistemic progress, and yet, doubt can also make us vulnerable to deception, confused to the point of no longer knowing what is true. What distinguishes a doubt that is epistemologically beneficial from one which is deceptive, or even manufactured in the context of a conspiracy theory? In this chapter, we explore doubt, its role, and the way it is being handled in the context of the public controversy about the COVID-19 vaccine. We approach conspiracy theories as argumentative discourses and reconstruct the generic structure of a conspiracy theory macro argument. Through the structure, we look into the discourse of the twelve prominent anti-vaxxers known as the “Disinformation Dozen”, focusing on the argumentative potential that doubt can have in the public controversy about the COVID-19 vaccine. We suggest to distinguish ambivalence from scepticism and denialism as three argumentative potentials that a motivated doubt can have. We argue that ambivalent doubt ought to be acknowledged, addressed and incorporated into the public health narrative, in order to avoid that an unnecessarily broad interpretation of conspiracy theory dominates the public debate and leaves an uncertain public a prey to it.