The German version of the mHealth App Usability Questionnaire (GER-MAUQ): Translation and validation study in patients with cardiovascular disease.

Objective: In Germany, only a few standardized evaluation tools for assessing the usability of mobile Health apps exist so far. This study aimed to translate and validate the English patient version for standalone apps of the mHealth App Usability Questionnaire (MAUQ) into a German version. Methods: Following scientific guidelines for translation and cross-cultural adaptation, the patient version for standalone apps was forward and back-translated from English into German by an expert panel. In total, 53 participants who were recruited as part of the beta testing process of the recently developed mHealth app HerzFit, answered the questions of the German version of the MAUQ (GER-MAUQ) and the System Usability Scale. Subsequently, a descriptive as well as a psychometric analysis was performed to test validity and reliability. Results: After conducting three cognitive interviews, five items were modified. The values for Cronbach alpha for the entire questionnaire and the three subscales (0.966, 0.814, 0.910, and 0.909) indicate strong internal consistency. The correlation analysis revealed that the scores of the GER-MAUQ, the subscales and the SUS were strongly correlated with each other. The correlation coefficient of the SUS and the GER-MAUQ overall score was r = 0.854, P < 0.001 and the coefficients of the subscales and the SUS were r = 0.642, P < 0.001; r = 0.866, P < 0.001 and r = 0.643, P < 0.001. Conclusions: We have developed a novel German version of the MAUQ and demonstrated it as a reliable and valid measurement tool for assessing the usability of standalone mHealth apps from the patients' perspective. The GER-MAUQ allows a new form of standardized assessment of usability of mHealth apps for patients with cardiovascular disease in Germany. Further research with a larger sample and other samples is recommended.

[Geriatrics and geriatric aspects in the German coalition agreement of 2021]. / Geriatrie und geriatrische Aspekte im Koalitionsvertrag 2021.

BACKGROUND: The proportion of older people in Germany is increasing. By the next federal election in 2025 the Federal Statistical Office of Germany expects that one third of the population will have reached retirement age. Older people are thus one of the largest voter groups and are particularly politically relevant. OBJECTIVE: How does the federal government support the living conditions of this voter group? What are the plans of the federal government regarding medical care of older people? METHODS: A content analysis of the coalition agreement was carried out with respect to aspects of demographic change, geriatric care and living conditions of older people. The coded text passages were categorized using a mixed inductive-deductive approach. Finally, the implementation progress of concrete projects after 1.5 years in office was evaluated. RESULTS: This study identified and categorized 23 passages with just under 620 words (about 1% of the total text) in the coalition agreement. Of the passages nine were assigned to the topic older population, six passages to medical care and eight to nursing care. Of the 23 passages 14 contained concrete plans for action or target dates. In the first 1.5 years of the federal government, partial progress could be identified in 4 of these, while no projects were realized. CONCLUSION: Overall, the coalition agreement shows an awareness for an ageing population. In view of the demographic development, however, few solutions are proposed for genuine geriatric aspects. The first year in office was strongly influenced by other topics, which resulted in unplanned laws and regulations and projects from the coalition agreement faded into the background.

[Primary Care Aspects in the German Coalition Agreement 2021]. / Allgemeinmedizinische und hausärztliche Aspekte im Koalitionsvertrag 2021.

INTRODUCTION: Despite statewide rising numbers of family physicians during the last legislative period, their overall health care providing capacity has declined, mainly due to their working part-time. In the legislative period starting in 2021, this trend appears likely to continue. The German Health System Advisory Council foresees the number of general practitioners (GPs) who will have to be replaced by the next federal election in 2025 as exceeding 26,000. This results in a need for political action to sustain the primary care workforce. METHODS: We conducted a content analysis of the coalition agreement 2021 between SPD, Greens and FDP with regard to explicit and related topics of GP care. A mixed inductive-deductive classification of the included text passages was used to thematically structure the results. RESULTS: A total of 34 relevant text passages were identified between pages 8 to 139 of the coalition agreement. Family physician care was explicitly addressed only once, when the planned abolition of budgeting was discussed. Other proposals which affect family physicians work included reduction of bureaucracy, prevention, or easier access to medical care for disadvantaged groups. Other passages of the coalition agreement regarding security of medical supply, included demand planning, innovative healthcare models, and cross-sectoral care. One focus of the coalition agreement was on digitalization. It mentions e. g., a digitization strategy for the healthcare sector, telemedicine services, and the electronic medical record, including opt-out possibility. Other assessed passages included projects to facilitate research or climate change and health. CONCLUSION: Despite the lack of mention of family physicians in the coalition agreement, many projects relate to the work of family physicians. Some of the ideas mentioned have also already been written down by the German Society for General Practice and Family Medicine (DEGAM) in its positions on the future of general practice, digitization or climate change and health. The planned projects in the coalition agreement have the potential to strengthen health care by family doctors and also make it more attractive for young doctors. However, further measures may be necessary to maintain GP care in the short and long term.

[Implementing a secure instant messaging app in the COVID-19 pandemic: Usage experiences of primary care physicians and local health authorities]. / Implementierung einer Secure Instant Messaging-App in der COVID-19 Pandemie: Nutzungserfahrungen von Hausärzt*innen und Mitarbeiter*innen von Gesundheitsämtern.

BACKGROUND: At the onset of the COVID-19 pandemic general practitioners complained about feeling uninformed and lacking a sufficient flow of information from the local health authorities. Secure instant messaging describes a digital, chat-based form of communication enabling ambulatory care providers to connect in real-time and share information across medial sectors. KomPan, a proof-of-concept study, established a secure instant messaging structure in two model regions in Germany to improve communication between general practitioners and local health authorities via an additional communication pathway. This paper presents results of a qualitative user survey. METHODS: We recruited general practitioners (n = 43) and staff of local health authorities (n=10) in two Hessian model regions for using the secure instant messaging (SIM) app of the Famedly GmbH, starting in December 2020 (2nd COVID-19 wave). We asked participants to share their usage experiences after a usage time of multiple months. In guided telephone interviews, we primarily asked how communication between the two user groups had changed while using secure instant messaging. The interviews were transcribed verbatim and analysed using thematic analysis. RESULTS: We conducted ten interviews with general practitioners and two with staff of the participating local health authorities. Using our SIM-based platform promoted professional exchange between general practitioners. In contrast, the app had little impact on communication between local health authorities and general practitioners. Opposing expectations and usage patterns of the two user groups, among other reasons, probably led to a reduced direct trans-sectoral communication via secure instant messaging. CONCLUSION: Establishing local chat groups for general practitioners was welcomed, especially during the pandemic situation, to improve professional exchange while experiencing challenging working conditions. To use secure instant messaging effectively for trans-sectoral communication a more comprehensive approach seems to be needed, such as digitalisation of institutional communication structures and improved networks of local healthcare providers.

[Disease Prevention and Health Promotion in Germany: A Qualitative Analysis of the Federal Goverment's Coalition Agreement]. / Prävention und Gesundheitsförderung im Koalitionsvertrag: Eine qualitative Analyse.

BACKGROUND: The creation of healthful living conditions has contributed to improving health and prolonging life in Germany and worldwide. Despite this progress, avoidable behavioural, occupational and environmental risk factors still contribute considerably to the burden of disease in Germany. Many of these risk factors are strongly influenced by political determinants. The coalition agreement outlining the agenda of Germany's federal government for 2018-2022 provides insights regarding relevant political priorities and plans. METHODS: We performed qualitative content analysis of the coalition agreement signed on March 12, 2018 by Germany's governing parties with regard to content related to disease prevention and health promotion. We present results in tables and narratively and discuss them against the background of evidence-based scientific recommendations and in the national and international political context. RESULTS: The coalition agreement discusses various measures to strengthen disease prevention in and health promotion in general, to support the prevention of specific disease groups, and to reduce the burden of a number of behavioural, occupational and environmental risk factors. This includes an evaluation and reform of Germany's Law for Health Promotion and Prevention, a strengthening of relevant research capacities, the development of a national obesity strategy, and measures to increase vaccination rates. DISCUSSION: The extensive discussion of health promotion and disease prevention in the coalition agreement is laudable. However, the agreements fail to mention a number of important approaches, such as the regulation of tobacco and alcohol marketing and food and beverage taxation. Moreover, many statements remain vague. Adoption and implementation of effective measures will therefore require the attention and political pressure from the scientific community, civil society, the media, and members of the parliament from both government and opposition parties. The mid-term evaluation of the coalition agreement will be an opportunity to critically examine the government's achievement to date.

[Barriers to Digitalisation of Healthcare in Germany: A Survey of Experts]. / Hürden bei der Digitalisierung der Medizin in Deutschland ­ eine Expertenbefragung.

BACKGROUND: Digital health is a growing area in healthcare with a huge potential. Nevertheless, the degree of digitalization in German healthcare is low when compared internationally and with other German industries. Despite political efforts, certain barriers seem to strongly impede the process of digitalization process in healthcare. METHOD: We surveyed 18 representative healthcare experts from various sectors with semi-structured interviews on barriers and solutions for digital health. Thematic analysis by Braun and Clarke was used for interpretation. RESULTS: The interviewees identified barriers that were stakeholder-specific and across stakeholders. Self-regulatory bodies and the medical profession were found to lack willingness and organizational structure for digitalization. Lack of evidence and missing interoperability represented primary obstacles, while current legislation and financial regulations were rarely mentioned. In particular, infrastructure expansion and interoperability would require a coordinated, state intervention. Positive communication on possibilities and benefits of digital solutions was also considered important. CONCLUSION: A strong political will, an overarching strategy accompanied by a communication concept seems to be necessary in order for digital health to succeed. Regarding legislation, binding specifications, deadlines and sanctions may be needed for self-regulatory bodies, while also involving users in the development process at an early stage and creating positive incentives for using digital solutions.