BACKGROUND: Professionals, especially in the field of digital public health (DiPH), are crucial for a successful digital transformation in social and health care. However, it is still unclear to what extent academic professionals are taught DiPH-related content in their public health (PH) studies. METHODS: This study used a systematic module handbook analysis to analyze accredited full-time PH-oriented degree programs at public colleges and universities in Germany for DiPH-related module content. Through the "Hochschulkompass" platform and the member programs of the German Public Health Association (DGPH), 422 programs were identified. Included module handbooks were evaluated by content analysis using MAXQDA. RESULTS: Only 10 bachelor and 6 master programs contain DiPH. They are heterogeneous in their focus and belong to different subfields of public health ("methods, definition, history, and social medicine"â¯= 5; "health management"â¯= 5; "digital health"â¯= 3; "health services research"â¯= 2; "health communication"â¯= 1). Differences were found between the common understanding of DiPH in academia and the content in the module handbooks. The content identified in the analysis focuses mainly on technical areas. Social and health science content is only marginally present. DISCUSSION: The heterogeneous study programs with a connection to DiPH allow academic PH specialists to develop specific profiles. To achieve comprehensive competencies in DiPH, there is a need for further development of modules with relevance to the respective degree program. The results could be used for the (further) development of relevant modules and a core curriculum in DiPH.
Curriculum , Public Health , Humans , Universities , Time and Motion Studies , Germany
VR FestLab is a virtual reality party simulation application. The tool allows users to make decisions while experiencing a virtual party where they are offered alcohol. This study examines the user experience, game satisfaction, and engagement of 181 adolescent users (aged 15-18) with VR FestLab involving seven schools in Denmark. All user experience factors of the short user experience questionnaire were rated positively or neutral, and 66% of the students liked the VR experience. Neither the user experience score nor a score for game satisfaction and engagement were associated with sex, age, perceived family affluence, school performance, alcohol consumption and attitudes or mental health of students. Overall, positive user experiences and game satisfaction of VR FestLab were found not to differ according to student characteristics. We conclude that virtual simulations offer new ways for developing drinking refusal skills that are attractive and acceptable for adolescent users.
Virtual Reality , Humans , Adolescent , Computer Simulation , Ethanol , Personal Satisfaction , Denmark
Background: Excessive alcohol consumption is a major public health problem, with substance use early in life contributing to higher levels of use later in life. Virtual reality (VR) is an innovative technology for alcohol prevention among adolescents that could solve the problem of insufficient outreach to the target group of young people. The co-created German Virtual LimitLab simulation is one of the few examples of VR-based alcohol prevention tools and consists of a virtual house party simulation. The aims of Virtual LimitLab are to increase the users' awareness of how social pressure can influence their own decision-making as well as to enable various actions and communication strategies in order to train competencies when dealing with alcohol. The present study thus aims to explore adolescents' content- and technique-specific perceptions of Virtual LimitLab in order to gain insights into user experiences and to test the prototype with the German target group. Methods: Four semi-structured focus groups with adolescents aged 15-18 years (n = 13) were conducted and analyzed using thematic analyses. A user experience questionnaire (UEQ-S) was applied in order to quantitatively assess adolescents' satisfaction with Virtual LimitLab. Results: Three main themes were identified (VR experience, content, and technical aspects). Participants positively assessed both the content and the technical aspects of Virtual LimitLab. This trend was also seen by the UEQ-S data, which yielded positive ratings for both pragmatic and hedonic quality. The broad variety of options in the simulation that allow the user to try new behaviors was perceived particularly positively. In general, Virtual LimitLab was regarded as an innovative tool that encourages adolescents to think critically about their personal alcohol consumption. Technical errors in the simulation and users' difficulties in identifying with the simulation were the main points of criticism. Conclusions: Feedback from adolescent users revealed positive and therefore promising results when using Virtual LimitLab as a gaming alcohol-prevention tool. Some technical aspects still need to be improved in order to further refine the prototype, and suggestions for expanding the content of the application have already been made.
Alcoholism , Virtual Reality , Humans , Adolescent , Focus Groups , Alcoholism/prevention & control , Computer Simulation , Germany
Despite the potential of digital health interventions (DHIs), evaluations of their effectiveness face challenges. DHIs are complex interventions and currently established evaluation methods, e.g., the randomised controlled trial (RCT), are limited in their application. This study aimed at identifying alternatives to RCTs as potentially more appropriate evaluation approaches. A scoping review was conducted to provide an overview of existing evaluation methods of DHIs beyond the RCT. Cochrane Central Register of Controlled Trials, MEDLINE, Web of Science, and EMBASE were screened in May 2021 to identify relevant publications, while using defined inclusion and exclusion criteria. Eight studies were extracted for a synthesis comprising four alternative evaluation designs. Factorial designs were mostly used to evaluate DHIs followed by stepped-wedge designs, sequential multiple assignment randomised trials (SMARTs), and micro randomised trials (MRTs). Some of these methods allow for the adaptation of interventions (e.g., SMART or MRT) and the evaluation of specific components of interventions (e.g., factorial designs). Thus, they are appropriate for addressing some specific needs in the evaluation of DHIs. However, it remains unsolved how to establish these alternative evaluation designs in research practice and how to deal with the limitations of the designs.
Delivery of Health Care , Research Design , Randomized Controlled Trials as Topic
Virtual reality (VR) is an innovative tool for alcohol prevention among adolescents. However, many aspects of virtual simulations for alcohol prevention remained unstudied, and research on opportunities for tailoring such tools to users' gender using avatar-based pathways is lacking. The present study, therefore, explores adolescents' perceptions of gender portrayal and gender tailoring using Virtual LimitLab-a VR simulation for building refusal skills for dealing with peer pressure to consume alcohol. Focus groups were conducted after individual simulation testing with 13 adolescents in four groups, whose statements and discussion underwent thematic analysis. Three main themes were identified: the relevance of gender, opinions on different tailoring options for gender, and opinions on flirt orientation. Divergent arguments for different tailoring options and representations of gender in the simulation were proposed. Some participants changed opinions during discussions. Sexual harassment was consensually deemed an important issue that is linked to both partying and alcohol and was concluded to require being addressed along with alcohol prevention. A consensus also formed around open flirting possibilities (regardless of gender), and awareness of non-binary peers was raised. Based on the observed sensitivity of the adolescents to gender diversity, it is necessary to include LGBTQIA+ adolescents when developing gender-sensitive simulations.
Alcoholism , Virtual Reality , Adolescent , Alcoholism/prevention & control , Computer Simulation , Focus Groups , Humans , Peer Influence
Risky alcohol consumption among adolescents continues to be of high public health relevance in Germany. Therefore, preventive measures should promote the skills of adolescents to deal with alcohol and peer pressure. Interactive and gender-sensitive primary prevention programs in schools have a great potential to reach the target group and to increase the effectiveness of interventions. Digital tools such as virtual simulations may help with this process.Virtual reality (VR) enables the experience of risk situations in a safe environment. Internationally, there are currently two VR alcohol prevention programs for adolescents. Their co-creation with the target group was a core element, and comprehensive research on the usability and subjective effectiveness has already been published. Conventional effectiveness evaluations such as randomized controlled trials, however, have limitations with interactive formats. Alternative and complementary evaluation approaches are needed in the future. Furthermore, the potential of tailoring VR to recipients has to be examined. In this context, a gender-sensitive design is both an opportunity and a challenge.Further research is needed to study possibilities to use VR in alcohol prevention in adolescents in Germany.
Alcoholism , Virtual Reality , Adolescent , Alcohol Drinking/epidemiology , Alcohol Drinking/prevention & control , Alcoholism/prevention & control , Germany , Humans
OBJECTIVE: User acceptance of digital health interventions in light to moderate depressive disorders has been rudimentarily researched and is examined in this study. METHODS: Problem-centered individual interviews were conducted with 3 affected persons, 3 relatives and 13 health care professionals. The data evaluation was based on the structured qualitative content analysis. RESULTS: Along the Unified Theory of Acceptance and Use of Technology attitudes of affected persons, relatives and health care professionals were presented. Expectations of performance and the supportive framework conditions were the most significant influencing predictors for the positive intention to use. CONCLUSION: The results provide a basis for prioritizing needs and attitudes in next step.âIn terms of ethical, sustainable and economical use further research on user acceptance is required.
Depressive Disorder , Health Personnel , Attitude , Depressive Disorder/therapy , Germany , Humans , Qualitative Research
BACKGROUND: Depression is a major cause for disability worldwide, and digital health interventions are expected to be an augmentative and effective treatment. According to the fast-growing field of information and communication technologies and its dissemination, there is a need for mapping the technological landscape and its benefits for users. OBJECTIVE: The purpose of this scoping review was to give an overview of the digital health interventions used for depression. The main goal of this review was to provide a comprehensive review of the system landscape and its technological state and functions, as well as its evidence and benefits for users. METHODS: A scoping review was conducted to provide a comprehensive overview of the field of digital health interventions for the treatment of depression. PubMed, PSYNDEX, and the Cochrane Library were searched by two independent researchers in October 2020 to identify relevant publications of the last 10 years, which were examined using the inclusion and exclusion criteria. To conduct the review, we used Rayyan, a freely available web tool. RESULTS: In total, 65 studies were included in the qualitative synthesis. After categorizing the studies into the areas of prevention, early detection, therapy, and relapse prevention, we found dominant numbers of studies in the area of therapy (n=52). There was only one study for prevention, 5 studies for early detection, and 7 studies for relapse prevention. The most dominant therapy approaches were cognitive behavioral therapy, acceptance and commitment therapy, and problem-solving therapy. Most of the studies revealed significant effects of digital health interventions when cognitive behavioral therapy was applied. Cognitive behavioral therapy as the most dominant form was often provided through web-based systems. Combined interventions consisting of web-based and smartphone-based approaches are increasingly found. CONCLUSIONS: Digital health interventions for treating depression are quite comprehensive. There are different interventions focusing on different fields of care. While most interventions can be beneficial to achieve a better depression treatment, it can be difficult to determine which approaches are suitable. Cognitive behavioral therapy through digital health interventions has shown good effects in the treatment of depression, but treatment for depression still stays very individualistic.
BACKGROUND: Depression is often associated with rapid changes in mood and quality of life that persist for a period of 2 weeks. Despite medical innovations, there are problems in the provision of care. Long waiting times for treatment and high recurrence rates of depression cause enormous costs for health care systems. At the same time, comprehensive limitations in physical, psychological, and social dimensions are observed for patients with depression, which significantly reduce their quality of life. In addition to patient-specific limitations, undersupply and inappropriate health care have been determined. For this reason, new forms of care are discussed. Smartphone-based therapy is considered to have great potential due to its reach and easy accessibility. Low socioeconomic groups, which are always difficult to reach for public health interventions, can now be accessed due to the high dispersion of smartphones. There is still little information about the impact and mechanisms of smartphone-based therapy on depression. In a systematic literature review, the health implications of smartphone-based therapy were presented in comparison with standard care. OBJECTIVE: The objective of this review was to identify and summarize the existing evidence regarding smartphone-based cognitive behavioral therapy for patients with depression and to present the health implications of smartphone-based cognitive behavioral therapy of considered endpoints. METHODS: A systematic literature review was conducted to identify relevant studies by means of inclusion and exclusion criteria. For this purpose, the PubMed and Psyndex databases were systematically searched using a search syntax. The endpoints of depressive symptoms, depression-related anxiety, self-efficacy or self-esteem, and quality of life were analyzed. Identified studies were evaluated for study quality and risk of bias. After applying the inclusion and exclusion criteria, 8 studies were identified. RESULTS: The studies examined in this review reported contradictory results regarding the investigated endpoints. In addition, due to clinical and methodological heterogeneity, it was difficult to derive evident results. All included studies reported effects on depressive symptoms. The other investigated endpoints were only reported by isolated studies. Only 50% (4/8) of the studies reported effects on depression-related anxiety, self-efficacy or self-esteem, and quality of life. CONCLUSIONS: No clear implications of smartphone-based cognitive behavioral therapy could be established. Evidence for the treatment of depression using smartphone-based cognitive behavioral therapy is limited. Additional research projects are needed to demonstrate the effects of smartphone-based cognitive behavioral therapy in the context of evidence-based medicine and to enable its translation into standard care. Participatory technology development might help to address current problems in mobile health intervention studies.
Cognitive Behavioral Therapy , Depressive Disorder, Major , Depression/therapy , Depressive Disorder, Major/therapy , Humans , Quality of Life , Smartphone
BACKGROUND: In addition to lowering the quality of life of those affected, long periods of treatment and high recurrence rates of chronic wounds cause major economic costs for health care systems. Furthermore, inadequate health care and undersupply of care can be observed in Germany. Thus, new forms of care such as teleconsultation are being discussed increasingly. Recent changes in the remuneration system and macerations in the ban of remote treatment support those trends. METHODS: A systematic review was conducted in July 2018 using PubMed and CENTRAL databases for randomized controlled trials between 2008 and 2018. Only randomized clinical trials in which patients with chronic wound who received treatment and follow-up by teleconsultation using information and communication technology to share data were included. In total, 6 international clinical trials were identified. RESULTS: Regarding the current state of research, there is no definite evidence that teleconsultation can improve the care of chronic wound patients. Most likely, wound healing time was positively influenced. No correlation was found between mortality and hospitalizations when teleconsultation was used. CONCLUSION: On the basis of the included studies, the evidence for the care of chronic wounds by teleconsultation is unclear. Further research is needed to examine the health-related and economic benefits of teleconsultation to support integration into health care systems.
Diabetes Mellitus , Diabetic Angiopathies , Remote Consultation , Chronic Disease , Delivery of Health Care , Diabetic Angiopathies/therapy , Germany , Humans , Quality of Life , Randomized Controlled Trials as Topic
