[Opportunities and Challenges Of The Ethics Review Of Qualitative Health Services Research: A Survey Of Qualitative Researchers]. / Chancen und Herausforderungen der Ethikbegutachtung qualitativer Versorgungsforschung ­ eine Befragung qualitativ Forschender.

Ethics committees ensure compliance with ethical principles in medical research. They are oriented towards clinical studies, but also review e. g., qualitative research. Using a semi-structured online survey, we collected data on experiences of qualitative researchers with the review by ethics committees and analysed them via content analysis. In July 2019, 73 researchers took part in the survey. Five main topics were derived from their statements regarding the ethics review of qualitative research: 1. relevance of qualitative research expertise; 2. cooperation between researchers and ethics committees; 3. transparency of review criteria; 4. dealing with formal review requirements; 5. evaluation of the review's significance for qualitative research. The results show the potential of ethics review for reflection on ethical questions in qualitative research. Prerequisites for this are the fit with the characteristics and quality criteria of qualitative research, the presence of qualitative research expertise in ethics committees, the transparency of the ethics review process as well as openness to different professional cultures and a constructive communication culture.

[Health Services Research in the Public Health Department - An Explorative Interview Study on Scientific Methodological Competence in the PHS in Baden-Württemberg, Germany]. / Versorgungsforschung im Gesundheitsamt ­ eine explorative Interviewstudie zur wissenschaftlichen Methodenkompetenz im ÖGD in Baden-Württemberg.

BACKGROUND AND AIM OF THE STUDY: One aim of the pact for the Public Health Service ("Pakt für den ÖGD") is to increase scientific activity in the Public Health Service (PHS). This study deals with the question, which methods related to health services research are known and applied in the PHS and which methods are needed by PHS employees in the federal state Baden-Württemberg in Germany. METHODS: Guideline-based interviews (focus group and individual interviews) were conducted with 12 persons at different hierarchy levels from public health departments in Baden-Württemberg. The interviews were subjected to content analysis acording to Kuckartz. RESULTS: The interviewees described their heterogeneous needs as well as their methodological competences. Staff members expressed existing competences more frequently than leaders. These competencies included those used in everyday work such as literature research in routinely collected data (e. g., school entry examination), or different methods for data analysis. Needs seemed to exist primarily in the area of data analysis and collection, but were also expressed in the area of basic scientific methods. Topics relating to guidelines for good scientific practice (e. g., ethics proposals) and publications were also rather less known. A need for a support from research institutions or higher authorities was frequently mentioned. In addition, motivation and barriers for research in public health departments were mentioned. CONCLUSION: This study shows that existing methodological competencies and needs are heterogeneous and can be attributed to the heterogeneous backgrounds and fields of activity of the interviewees. Competencies are indicated, for example, in literature research and analysis of existing data. There is a need in methods, for example, of data collection/analysis as well as in basic scientific methods and deepening of existing skills. Furthermore support offers regarding scientific methodological competence for public health departments are required. There is also a lack of research infrastructure (e. g. software, access to literature) and a legal basis. The results can serve as a basis for the design of demand-oriented methodological programs for employees of the PHS in Baden-Württemberg.

Impacts of Symptom Checkers for Laypersons' Self-diagnosis on Physicians in Primary Care: Scoping Review.

BACKGROUND: Symptom checkers (SCs) for laypersons' self-assessment and preliminary self-diagnosis are widely used by the public. Little is known about the impact of these tools on health care professionals (HCPs) in primary care and their work. This is relevant to understanding how technological changes might affect the working world and how this is linked to work-related psychosocial demands and resources for HCPs. OBJECTIVE: This scoping review aimed to systematically explore the existing publications on the impacts of SCs on HCPs in primary care and to identify knowledge gaps. METHODS: We used the Arksey and O'Malley framework. We based our search string on the participant, concept, and context scheme and searched PubMed (MEDLINE) and CINAHL in January and June 2021. We performed a reference search in August 2021 and a manual search in November 2021. We included publications of peer-reviewed journals that focused on artificial intelligence- or algorithm-based self-diagnosing apps and tools for laypersons and had primary care or nonclinical settings as a relevant context. The characteristics of these studies were described numerically. We used thematic analysis to identify core themes. We followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist to report the study. RESULTS: Of the 2729 publications identified through initial and follow-up database searches, 43 full texts were screened for eligibility, of which 9 were included. Further 8 publications were included through manual search. Two publications were excluded after receiving feedback in the peer-review process. Fifteen publications were included in the final sample, which comprised 5 (33%) commentaries or nonresearch publications, 3 (20%) literature reviews, and 7 (47%) research publications. The earliest publications stemmed from 2015. We identified 5 themes. The theme finding prediagnosis comprised the comparison between SCs and physicians. We identified the performance of the diagnosis and the relevance of human factors as topics. In the theme layperson-technology relationship, we identified potentials for laypersons' empowerment and harm through SCs. Our analysis showed potential disruptions of the physician-patient relationship and uncontested roles of HCPs in the theme (impacts on) physician-patient relationship. In the theme impacts on HCPs' tasks, we described the reduction or increase in HCPs' workload. We identified potential transformations of HCPs' work and impacts on the health care system in the theme future role of SCs in health care. CONCLUSIONS: The scoping review approach was suitable for this new field of research. The heterogeneity of technologies and wordings was challenging. We identified research gaps in the literature regarding the impact of artificial intelligence- or algorithm-based self-diagnosing apps or tools on the work of HCPs in primary care. Further empirical studies on HCPs' lived experiences are needed, as the current literature depicts expectations rather than empirical findings.

["This is Not at All Foreseeable from the Outset" - Research Ethics in Qualitative Health Services Research: A Survey of Researchers]. / "Das ist vorher gar nicht absehbar"? ­ Forschungsethische Fragen in der qualitativen Versorgungsforschung. Eine Befragungsstudie mit Forschenden.

BACKGROUND: Health services research is multidisciplinary and involves the use of a plurality of research methods. Medicine as a discipline serves as an important reference, also in terms of addressing ethics issues in research. At the same time, however, the highly formalized ethical reviews common in medicine, are controversial within the social sciences, especially among qualitative researchers. So far, little is known about which research ethics issues arise in qualitative health services research. METHODS: In summer 2019, an online survey was conducted among health services researchers on two main topics: a) research ethics issues in qualitative health services research and b) experiences with the ethics review procedures. The questionnaire contained ten open questions; the responses were analyzed for content. The first topic (ethical issues) is addressed within this article. RESULTS: A total of 73 researchers with heterogeneous professional background and an average of more than seven years of work experience in health services research participated in the survey. The following were reported as central research ethics issues: a) legitimacy and anticipation of ethical challenges in the planning of research, b) field access, consent and burdens during data collection, c) anonymization and data protection in data processing, d) data analysis, e) publication of results and data and f) general topics such as central principles and goals of research as well as the role of researchers. The main formats for dealing with these issues were exchange and consultation as well as referring to texts and regulations. CONCLUSIONS: On the one hand, the data documents typical central research ethics questions that researchers are confronted with in the context of qualitative health services research; on the other hand, they also point to gaps and less considered topics. A systematizing ethical reflection could take up these findings in order to develop health services research-specific principles and strategies for handling research ethics issues.

Work-related psychosocial demands related to work organization in small sized companies (SMEs) providing health-oriented services in Germany - a qualitative analysis.

BACKGROUND: Micro, small and medium-sized enterprises (SMEs) represent the majority of businesses in the EU. Little is known about psychosocial demands faced by company owners, managers, and employees in SMEs, especially in the health and service sector. The current study aimed to identify which psychosocial demands related to work organization are reported by managers and employees in the health and service sector, and if managers and employees differ in their perspective on these psychosocial demands. METHODS: We conducted nine single interviews and two focus group discussions with seven company owners and managers as well as eleven employees from six different German companies between January and February 2020. The psychosocial factors of the psychosocial risk assessment of the Joint German Occupational Safety and Health Strategy (GDA) served as a framework for data collection and analysis. The interview material was analysed using Mayring's method of qualitative content analysis. RESULTS: We identified four prevailing work-related psychosocial demands related to work organization among managers and employees: (1) possibilities and time for recovery after work, (2) communication and cooperation, (3) work intensity, and (4) interruptions, and prioritization. According to the managers, they were confronted with a lack of possibilities and time for recovery after work. They report issues related to inadequate communication and cooperation affecting the entire company team, and also face high work intensity and frequent interruptions and prioritization. Employees reported a clearer division between work and private life. However, they also face periods of high work intensity, frequent interruptions and the need for prioritization. CONCLUSION: Managers and employees in SMEs in the health and service sector would benefit from evidence-based and evaluated tailored interventions and approaches for improved work organization. Further studies are needed to support managers and employees in SMEs in the health and service sector in facing and handling work-related psychosocial demands like lack of possibilities and time for recovery after work, high work intensity or frequent interruptions.

Researching Alcohol Consumption During Pregnancy. Opportunities and Challenges With Two Methods of Data Acquisition.

Qualitative research methods, primarily interviews, have become more common in the field of addiction research. Other data sources were often neglected, although sources such as social media can offer insights into the realities of people, since social media also plays a relevant role in today's living environments. This article examines the use of online forums as an underutilized data source in contrast to telephone interviews, to identify methodological opportunities and challenges. We analyzed nine discussion threads and seven interviews about 'alcohol consumption during pregnancy'. Discursive comparison of the results was performed with a focus on sampling issues, comparability and risks for participants and researchers. Key issues were present in both data sources. People with different opinions were openly hostile in forums, while tolerance was more often expressed in interviews. The interviews showed a rather mild communication style, which could be attributed to social desirability. In the forum discussions, the participants often expressed themselves very directly. To comprehensively grasp the subject matter of the research, it is important to recognize the types of communication promoted by different data sources. These results have implications for research about female substance use. Knowledge of the issues will bestow a valuable contribution to researchers working in the field of substance use to help develop appropriate research approaches, as they engage in research into this highly stigmatized and controversial area.

Ethical, legal, and social aspects of symptom checker applications: a scoping review.

Symptom Checker Applications (SCA) are mobile applications often designed for the end-user to assist with symptom assessment and self-triage. SCA are meant to provide the user with easily accessible information about their own health conditions. However, SCA raise questions regarding ethical, legal, and social aspects (ELSA), for example, regarding fair access to this new technology. The aim of this scoping review is to identify the ELSA of SCA in the scientific literature. A scoping review was conducted to identify the ELSA of SCA. Ten databases (e.g., Web of Science and PubMed) were used. Studies on SCA that address ELSA, written in English or German, were included in the review. The ELSA of SCA were extracted and synthesized using qualitative content analysis. A total of 25,061 references were identified, of which 39 were included in the analysis. The identified aspects were allotted to three main categories: (1) Technology; (2) Individual Level; and (3) Healthcare system. The results show that there are controversial debates in the literature on the ethical and social challenges of SCA usage. Furthermore, the debates are characterised by a lack of a specific legal perspective and empirical data. The review provides an overview on the spectrum of ELSA regarding SCA. It offers guidance to stakeholders in the healthcare system, for example, patients, healthcare professionals, and insurance providers and could be used in future empirical research to investigate the perspectives of those affected, such as users.

Desire to Die: How Does the Patients' Chorus Sound?

Patients receiving palliative care often express a desire to die. Forms and backgrounds of these expressions can be diverse. To contribute to a better understanding of this phenomenon, we analyzed patients' desire to die expressions reported by palliative care providers participating in 11 communication trainings on desire to die. The 102 participants were asked to reproduce related patients' statements from their everyday practice. The 165 reported statements could be assigned to the four topics: "Putting an end to life by …," "Social death," "Death images," as well as "Specific and unspecific references to life, death and dying." Across these topics, phrasing differs particularly regarding sentence type (interrogative, declarative, propositional, exclamatory), explicitness and (the way of) referencing others (e.g. attribution of power). The compilation of statements reflects a chorus of expressions, which the palliative care providers might hear throughout their professional career as well as during a patient's process(ing) of disease.

[Evaluation of the Model project "Prescription for Exercise" in Baden-Württemberg: An Explorative Qualitative Survey]. / Evaluation des Modellprojektes "Rezept für Bewegung" in Baden-Württemberg mittels explorativer qualitativer Befragung.

OBJECTIVE: Exercise has a positive effect on health, which has already been proven in many studies. Doctors have an important role in helping patients to get more exercise. Against this background, the preventive model project "Exercise on Prescription" (RfB) was launched in Germany in 2009. This allows doctors to give their patients a prescription for exercise. In Baden-Württemberg, this offer was tested in 4 regions from 2015 to 2016. The aim of the present study was to evaluate the use of the RfB by doctors in Baden-Württemberg at the end of the trial phase by means of qualitative interviews of physicians participating in the program in 2017. METHODS: The telephone interviews were conducted using a structured interview guide. RESULTS: The qualitative survey showed a positive attitude of the physicians towards the RfB. The lack of local offers and the lack of direct cost reimbursement by the statutory health in-surances were cited as inhibiting factors for the issuance of the RfB. Further influencing factors were the self-motivation of the patients and the anticipated probability of implementation. CONCLUSION: The present qualitative survey not only documented the obstacles to RfB being issued by doctors and the patients' implementation of the physical activity recommendations, but also beneficial factors with regard to the future use of the RfB outside the model project.

[Opinions on Alcohol Consumption During Pregnancy and The Role of The Medical Staff as an Expert in This Regard - A Grounded Theory Analysis of Online Forum Discussions]. / Meinungen zum Alkoholkonsum in der Schwangerschaft und zur diesbezüglichen ExpertInnenrolle von medizinischem Fachpersonal.

BACKGROUND: Alcohol consumption during pregnancy carries many risks for the unborn child. Despite preventive measures, some pregnant women consume alcohol. The aim of this study is to identify possible reasons for consumption during pregnancy and also to shed light on the attribution of an expert role to medical professionals by those affected. METHODS: In this study, 9 discussion threads from online forums on the topic of alcohol consumption during pregnancy with a total of 115 discussion participants were analyzed using grounded theory. The discursive validation of the results took place in the research team. RESULTS: It turned out that the individual definition of the mother role has an influence on consumer behavior. Women who are very concerned about the child's well-being occasionally used alcohol in stressful situations or on social occasions, but often reported a guilty conscience after the consumption. Women who gave more weight to their own needs were more likely to consume for pleasure or because they felt they were being patronized by prohibitions. An equitable doctor-patient relationship and detailed, non-directive information were identified as beneficial factors for ascribing the expert role to the gynecologist. On the other hand, a paternalistic attitude and the issuing of bans proved to be a hindrance. DISCUSSION: All women showed a high need for information about alcohol consumption during pregnancy. The doctor-patient relationship seems to play an important role in conveying information. In addition, it became clear that the desire for support in women striving for abstinence is not being sufficiently fulfilled. CONCLUSION: Alcohol consumption during pregnancy should be addressed regularly in the care of all pregnant women. In addition to information on consumption risks, information on support offers is relevant.

The views of physicians and nurses on the potentials of an electronic assessment system for recognizing the needs of patients in palliative care.

OBJECTIVES: Patients in oncological and palliative care (PC) often have complex needs, which require a comprehensive treatment approach. The assessment of patient-reported outcomes (PROs) has been shown to improve identification of patient needs and foster adjustment of treatment. This study explores occupational routines, attitudes and expectations of physicians and nurses with regards to a planned electronic assessment system of PROs. METHODS: Ten physicians and nine nurses from various PC settings in Southern Germany were interviewed. The interviews were analysed with qualitative content analysis. RESULTS: The interviewees were sceptical about the quality of data generated through a patient self-assessment system. They criticised the rigidity of the electronic assessment questionnaire, which the interviewees noted may not fit the profile of all palliative patients. They feared the loss of personal contact between medical staff and patients and favoured in-person conversation and on-site observations on site over the potential system. Interviewees saw potential in being able to discover unseen needs from some patients. Interviewees evaluated the system positively in the case that the system served to broadly orient care plans without affecting or reducing the patient-caregiver relationship. CONCLUSIONS: A significant portion of the results touch upon the symbolic acceptance of the suggested system, which stands for an increasing standardisation and technisation of medicine where interpersonal contact and the professional expertise are marginalized. The study results can provide insight for processes and communication in the run-up to and during the implementation of electronic assessment systems.

Psychosomatic consultation in the workplace: opportunities and limitations of the services offered--results of a qualitative study.

PURPOSE: In Germany, innovative concepts of anchoring psychotherapeutic consultations within an occupational setting emerge in models like the "psychosomatic consultation in the workplace" (PCIW). Characteristic quality is the close cooperation between company-based occupational health physicians (OPs) and external psychotherapeutic consultants. Little is currently known about the attitudes of OPs and other stakeholders in companies in terms of possible contributions of these offers to their tasks within the field of mental health and work. METHODS: Data were collected via individual interviews with different stakeholders (n = 8) and two OP focus groups (each n = 5) with and without experience with PCIW. Data were analysed with content analysis. RESULTS: Common mental disorders (CMD) were perceived as occurring increasingly but still being stigmatized. PCIW allows employees quick access to a neutral psychotherapist and thus might help to avoid chronification of CMD. For companies, this may mean that longer periods of absenteeism (and presenteeism) can be avoided. The interviewees also feel that the ongoing collaboration with a psychotherapeutic specialist may sensitize OPs to recognize mental disorders earlier and provide basic treatment. PCIW was stated as an early, easy and fast first access to psychotherapy. The effort of PCIW is limited if structural changes in the workplace are necessary to reduce mental stressors. Also, if financed by the company, PCIW should have clear time limits and cannot aim to replace health insurance benefits. CONCLUSIONS: Taking above-mentioned limitations into account, PCIW appears to be a promising tool to bridge the gap between OP-conducted company-based health promotion and early secondary care.

SARS-CoV-2 and Adolescent Psychiatric Emergencies at the Tübingen University Hospital: Analyzing Trends, Diagnoses, and Contributing Factors.

Psychiatric emergencies have increased in recent decades, particularly with the onset of the SARS-CoV-2 pandemic, and far too little is known about the backgrounds of these emergencies. In this study, we investigated the extent to which the number of psychiatric emergencies changed during and in the aftermath of the SARS-CoV-2 pandemic at the Child and Adolescent Psychiatry (CAP) Tübingen. We considered age and psychiatric diagnoses. Additionally, we evaluated the backgrounds of the emergencies. We applied a mixed- (quantitative and qualitative) methods approach to data on emergency presentations at the CAP Tübingen from the pre-SARS-CoV-2 pandemic period (October 2019-January 2020) to Restriction Phase 1 (October 2020-January 2021), Restriction Phase 2 (October 2021-January 2022), and endemic phase (October 2022-January 2023). The total number of emergencies and those with eating disorders and affective disorders increased, while obsessive-compulsive disorders, expansive disorders and anxiety disorders decreased. The patients presenting in the pre-SARS-CoV-2 pandemic period were younger than those in the subsequent periods. We content-coded the reasons behind the emergency presentations. We also identified four areas of stressors and personality characteristics associated with the emergency presentations. In light of the increasing number of psychiatric emergencies, the long-term aim should be to meet the growing demands and create options for prevention.

'Better see a doctor?' Status quo of symptom checker apps in Germany: A cross-sectional survey with a mixed-methods design (CHECK.APP).

Background: Symptom checker apps (SCAs) offer symptom classification and low-threshold self-triage for laypeople. They are already in use despite their poor accuracy and concerns that they may negatively affect primary care. This study assesses the extent to which SCAs are used by medical laypeople in Germany and which software is most popular. We examined associations between satisfaction with the general practitioner (GP) and SCA use as well as the number of GP visits and SCA use. Furthermore, we assessed the reasons for intentional non-use. Methods: We conducted a survey comprising standardised and open-ended questions. Quantitative data were weighted, and open-ended responses were examined using thematic analysis. Results: This study included 850 participants. The SCA usage rate was 8%, and approximately 50% of SCA non-users were uninterested in trying SCAs. The most commonly used SCAs were NetDoktor and Ada. Surprisingly, SCAs were most frequently used in the age group of 51-55 years. No significant associations were found between SCA usage and satisfaction with the GP or the number of GP visits and SCA usage. Thematic analysis revealed skepticism regarding the results and recommendations of SCAs and discrepancies between users' requirements and the features of apps. Conclusion: SCAs are still widely unknown in the German population and have been sparsely used so far. Many participants were not interested in trying SCAs, and we found no positive or negative associations of SCAs and primary care.

Assessing Attitudes and Participation Regarding a Pilot COVID-19 Workplace Vaccination Program in Southern Germany Considering the Occupational Health Perspective-A Mixed Methods Study.

This mixed methods study retrospectively assessed attitudes and participation of employees, occupational health personnel, and key personnel regarding the rollout of a pilot COVID-19 workplace vaccination program in five German companies in May/June 2021 in Baden-Württemberg (Southern Germany) by combining survey data and qualitative interviews. A total of 652 employees completed a standardized questionnaire and we conducted ten interviews with occupational health personnel and key personnel with other professional backgrounds organizing the pilot workplace vaccination program. Survey data were analyzed descriptively and interviews were audio recorded, transcribed verbatim, and analyzed using qualitative content analysis. Employees participated widely in COVID-19 vaccinations at their workplaces, and most employees (n = 608; 93.8%) had a full COVID-19 immunization at the time of the survey. The main advantages of the pilot COVID-19 workplace vaccination program were seen in the flexible and time-saving vaccination offer as well as the trust in and long-standing relationship with occupational health physicians. The main disadvantage of the pilot vaccination offer was increased workload for occupational health personnel, especially during the roll-out phase of the program. The pilot COVID-19 workplace vaccination program was predominantly positively assessed, and the important role of occupational health services in managing the COVID-19 pandemic was highlighted. The main criticisms of the COVID-19 workplace vaccination program related to the high organizational and administrative burden. Findings from our study can support the development of future programs for the administration of generally recommended vaccination in the workplace setting in Germany.

Uptake of Voluntary Occupational Health Care-Assessments of German Occupational Health Physicians and Employees.

Workers' health surveillance is considered essential for employees' health and protection against hazardous working conditions. It is one part of occupational health care and thus one of four pillars of holistic workplace health management. In Germany, employers are obliged to provide mandatory and voluntary occupational health care (OHC) to employees, dependent on the defined occupational hazards. However, employees are not obliged to make use of voluntary OHC. No empirical information is available about the uptake of voluntary OHC by employees and the influencing factors in Germany. Thus, we carried out an explorative multi-perspective study with qualitative and quantitative elements to get insights from the view of occupational health physicians (OHPs) and employees. We conducted a survey among OHPs based on prior statements from two focus group discussions. A multivariate logistic regression analysis was performed to detect enablers and barriers regarding employee uptake of the offered voluntary OHC. We used extended qualitative methods among employees instead of an analogous survey. In total, 460 OHPs participated in the survey (response rate 29.1%), and 25 employees took part in interviews. Most of the employees had not heard the term voluntary OHC before, and only a few remembered respective occupational health care after explanatory request. In total, 78% of the OHPs assessed that employees always/mostly take up voluntary OHC. The most important attributed reason for non-uptake was that employees see no need for occupational health care when they feel healthy. The most important enabler for the perceived high uptake of voluntary OHC in the regression analysis was a positive attitude of the OHP toward voluntary OHC. While OHPs perceived that voluntary OHC was accepted by a majority of employees, this was not confirmed by the interviews with selected employees. This could indicate that the OHP respondents overestimated the amount of uptake. Since it became clear that employees are often unfamiliar with the terminology itself, we see a need for more and better information regarding the objectives and content of occupational health care to improve this important pillar of workplace health management.

Ethical, Legal, and Social Implications of Symptom Checker Apps in Primary Health Care (CHECK.APP): Protocol for an Interdisciplinary Mixed Methods Study.

BACKGROUND: Symptom checker apps (SCAs) are accessible tools that provide early symptom assessment for users. The ethical, legal, and social implications of SCAs and their impact on the patient-physician relationship, the health care providers, and the health care system have sparsely been examined. This study protocol describes an approach to investigate the possible impacts and implications of SCAs on different levels of health care provision. It considers the perspectives of the users, nonusers, general practitioners (GPs), and health care experts. OBJECTIVE: We aim to assess a comprehensive overview of the use of SCAs and address problematic issues, if any. The primary outcomes of this study are empirically informed multi-perspective recommendations for different stakeholders on the ethical, legal, and social implications of SCAs. METHODS: Quantitative and qualitative methods will be used in several overlapping and interconnected study phases. In study phase 1, a comprehensive literature review will be conducted to assess the ethical, legal, social, and systemic impacts of SCAs. Study phase 2 comprises a survey that will be analyzed with a logistic regression. It aims to assess the user degree of SCAs in Germany as well as the predictors for SCA usage. Study phase 3 will investigate self-observational diaries and user interviews, which will be analyzed as integrated cases to assess user perspectives, usage pattern, and arising problems. Study phase 4 will comprise GP interviews to assess their experiences, perspectives, self-image, and concepts and will be analyzed with the basic procedure by Kruse. Moreover, interviews with health care experts will be conducted in study phase 3 and will be analyzed by using the reflexive thematical analysis approach of Braun and Clark. RESULTS: Study phase 1 will be completed in November 2021. We expect the results of study phase 2 in December 2021 and February 2022. In study phase 3, interviews are currently being conducted. The final study endpoint will be in February 2023. CONCLUSIONS: The possible ethical, legal, social, and systemic impacts of a widespread use of SCAs that affect stakeholders and stakeholder groups on different levels of health care will be identified. The proposed methodological approach provides a multifaceted and diverse empirical basis for a broad discussion on these implications. TRIAL REGISTRATION: German Clinical Trials Register (DRKS) DRKS00022465; https://tinyurl.com/yx53er67. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/34026.

Assessing Differences in Attitudes toward Occupational Safety and Health Measures for Infection Control between Office and Assembly Line Employees during the COVID-19 Pandemic in Germany: A Cross-Sectional Analysis of Baseline Data from a Repeated Employee Survey.

In our study, we investigated possible differences across occupational groups regarding employees' perceived work-related risk of infection with SARS-CoV-2, attitudes toward technical, organisational, and personal occupational safety and health (OSH) measures for infection control, and factors associated with this attitude. We analysed baseline data (10 August to 25 October 2020) from a repeated standardised online survey distributed at a worldwide leading global supplier of technology and services in Germany. 2144 employees (32.4% women; age (mean ± SD): 44 ± 11 years) who worked predominantly remotely (n = 358), at an on-site office (n = 1451), and assembly line/manufacturing (n = 335) were included. The work-related SARS-CoV-2 risk of infection differed between office employees working remotely and on-site (mean ± SD = 2.9 ± 1.5 vs. 3.2 ± 1.5; Mann-Whitney-U-Test: W = 283,346; p < 0.002; ε2 = 0.01) and between on-site office and assembly line/manufacturing employees (3.8 ± 1.7; W = 289,174; p < 0.001; ε2 = 0.02). Attitude scores toward technical OSH-measures differed between remote and on-site office (4.3 ± 0.5 vs. 4.1 ± 0.6; W = 216,787; p < 0.001; ε2 = 0.01), and between on-site office and assembly line/manufacturing employees (3.6 ± 0.9; W = 149,881; p < 0.001; ε2 = 0.07). Findings were similar for organisational and personal measures. Affective risk perception, COVID-19-specific resilience, and information about COVID-19-related risks were associated with the employees' attitudes. To promote positive attitudes, it seems to be important to consider occupational-group-specific context factors when implementing OSH-measures for infection control.

Psychosocial demands and resources for working time organization in GP practices. Results from a team-based ethnographic study in Germany.

BACKGROUND: General practitioners (GPs) are challenged, e.g. by long working hours, and as employers they are responsible for the creation of working conditions that prevent work-related psychosocial risks. Leadership behaviour plays an important role within the working conditions of employees, thus we focused on two research questions: To what extent and how do GPs fulfil their role as entrepreneurs and leaders responsible for occupational safety and health of the team members in the organization of working time of the employees? What psychosocial factors result from the way of organization of working time for the practice team? METHODS: Data was collected by participant observations, individual interviews with six GPs, and five focus group discussions with 19 members of the practice staff in total. We gained access to five general practices through a teaching network associated with the Institute for General Medicine, University Hospital Essen (Germany). The analysis was carried out according to the Grounded Theory approach. RESULTS: GPs have several roles and related tasks to fulfil in the organization of working time. This can lead to perceived psychological stress. With regard to the organization of predictable working hours, vacations and sickness absence, the GPs determined the scope of action of the practice assistants. The delegation of these tasks took place to varying degrees and resulted in different work-related resources and stressors. CONCLUSION: We described transactional and transformational leadership behaviours which are all related to specific psychosocial demands and resources and may overlap on site. Leadership training seems recommendable as part of the training of GPs and other future leaders of micro-enterprises to promote self-reflection by the entrepreneurs and leaders and strengthen occupational health of leaders and staff.

Exploring Drivers of Work-Related Stress in General Practice Teams as an Example for Small and Medium-Sized Enterprises: Protocol for an Integrated Ethnographic Approach of Social Research Methods.

BACKGROUND: An increasing shortage of skilled personnel, including medical personnel, has been reported in many postindustrial economies. Persisting and growing trends in absenteeism and incapacity to work due to mental disorders are concerning and have increased political, economic, and scientific interest in better understanding and management of determinants related to the work environment and health. OBJECTIVE: This study protocol describes an integrated approach of social research methods to explore determinants of work-related stress in general practice teams as an example for micro, small, and medium-sized enterprises (SMEs). METHODS: The methods applied will allow an in-depth exploration of work practices and experiences relating to psychological well-being in general practice teams. An ethnographic approach will be used to develop an in-depth understanding of the drivers of work-related stress in general practice teams. We will combine participating observation and individual interviews with five to seven general practitioners (GPs), and five to seven focus group discussions with the nonphysician staff (3-4 participants per group) in approximately four GP group practices and one single practice in Germany. Data collection and analysis will follow a grounded theory approach. RESULTS: The Ethics Committee of the Medical Faculty, University Hospital of Tuebingen, Germany, has approved this study (reference number: 640/2017BO2). Recruitment has commenced with study completion anticipated in mid-2020. CONCLUSIONS: The data from this project will be used in follow-up projects to develop and test an intervention to reduce and prevent work-related stress in GP practices and other SMEs. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/15809.