Planning, implementation and revision of the longitudinal scientific curriculum at the Medical School Brandenburg.

Objectives: The aim of this paper is to present the development of a longitudinal curriculum for medical students that is rooted in the particularity of the medical sciences and that aims to build and strengthen medical students' scientific skills and use thereof in clinical practice. Methods: The curriculum development was initiated based on students' feedback on the initial curriculum. To improve and expand the curriculum appropriately, a needs assessment, a literature review to define science specific to the medical sciences and practice, and an analysis of national and international curricula were performed. The curriculum development followed the PDCA cycle (Plan-Do-Check-Act). Results: The curriculum extends across the entire medical study programme from semesters 1 to 10. It consists of the seminar series on basic conduct and the epistemological groundings of science, scientific methods in medical research and health sciences, statistics and the scientific internship. Up to the sixth semester, the focus is on the acquisition of skills and abilities to work on and carry out a concrete research project; starting in semester seven, the critical evaluation and application of research results in everyday clinical practice are introduced. The curriculum is taught by epidemiologists, anthropologists, statisticians and public health scholars. Starting in semester seven, seminars are generally taught together with clinicians as tandem teaching. The curriculum is regularly assessed and adjusted. Conclusions: The Brandenburg Scientific Curriculum can be seen as a model of a longitudinal curriculum to teach scientific thinking and acting. One that is at the same time highly integrated in the medical curriculum overall. A central coordination point seems to be necessary to coordinate the teaching content and to ensure that teachers are interconnected. Furthermore, a complex curriculum in scientific methodology requires a set of teachers from a range of disciplinary backgrounds. To ensure equally high-quality education, the variability of research projects and faculty must be taken into account by establishing generally applicable evaluation criteria and fostering faculty development, and providing all students supporting courses throughout the research project.

[On the Potential of Prevention Counselors in the Primary Care Setting: Evaluation Study of an Intervention in the State of Brandenburg (Germany)]. / Zum Potential von Präventionsberatern im hausärztlichen Setting: Evaluationsstudie einer Intervention im Land Brandenburg.

PURPOSE OF THE STUDY: The study investigates the extent to which medical assistants can support primary prevention measures in family practices as prevention advisors. METHODS: Between July 2019 and December 2020, preventive measures were implemented by trained prevention counselors in general practitioners' practices in a rural region in Brandenburg. They consisted of longer-term support for individuals in lifestyle changes in the areas of "nutrition", "exercise" and "relaxation". The accompanying process and outcome evaluation included pre-post comparisons of selected medical parameters as well as the investigation of possible changes in health literacy and health-related quality of life using standardized questionnaires (HeiQ-Core, SF-12v2). Furthermore, thematic analyses of training documents, participant surveys using a questionnaire, two focus groups with prevention counselors, and five interviews with study participants were conducted. RESULTS: Four primary care practices and two health care facilities were recruited and seven health care workers were trained as prevention counselors. Thirty-eight individuals were enrolled in the prevention program. Although overall counseling sessions were conducted according to training specifications, various individual as well as structural barriers ensured low uptake of the intervention. CONCLUSIONS: The extent to which preventive measures adapted to the individual can be successfully established in primary care practices with the help of health care workers trained as prevention counselors depends strongly on the respective practice structures as well as the patient clientele. Temporal integration and coordination of the activities of prevention advisors in the daily practice routine seems to be likely to lead to success in interventions of the kind evaluated here.

Crafting Ethnographic Relationships During the COVID-19 Pandemic in Germany Using Voice-Based Technologies.

Drawing on a two-year ethnography of care practices during the COVID-19 pandemic in Germany, we discuss the affordances of voice-based technologies (smartphones, basic mobile phones, and landline telephones) in collecting ethnographic data and crafting relationships with participants. We illustrate how such technologies allowed us to move with participants, eased data collection through the social expectations around their use, and reoriented our attention to the multiple qualities of sound. Adapting research on the performativity of technology, we argue that voice-based technologies integrated us into participants' everyday lives while also maintaining physical distance in times of infectious sociality.

Did the prevalence of depressive symptoms change during the COVID-19 pandemic? A multilevel analysis on longitudinal data from healthcare workers.

BACKGROUND: Healthcare workers (HCW) are at high risk to develop mental health problems during the COVID-19 pandemic because of additional work load, perceived stress, and exposure to patients with COVID-19. Currently, there are few studies on change over time in the prevalence of depressive symptoms during pandemic start among HCW. Thus, the aims of the current study were to examine whether depressive symptoms increased during the pandemic and were associated with perceived stress and own COVID-19 infection and workplace exposure to virus-infected patients. METHODS: The cohort study used longitudinal data from HCW collected monthly (July 2020 till December 2020) during the first year of the pandemic before vaccination became available. The sample of n = 166 was drawn from a German hospital and included medical (e.g. nurses, therapists, and physicians) and administrative staff. Using multilevel models, we analyzed the change in depressive symptoms [assessed with General Depression Scale (GDS), a validated German version of the Center for Epidemiological Studies Depression Scale (CES-D)] and its association with perceived stress across the study period. Laboratory-confirmed own infection was tested as a potential moderator in this context. Subscales of the GDS were used to examine change over time of depressive symptom modalities (e.g. emotional, somatic, and social interactions (ß, 95% confidence interval). RESULTS: Depression scores increased significantly during the study period (ß = .03, 95% CI [0.02, 0.05]). Perceived stress was associated with depressive symptoms (ß = .12, 95% CI [0.10, 0.14]) but did not change over time. Exposure to COVID-19 infection was associated with a higher increase of depressive symptoms (ß = .12, 95% CI [0.10, .14]). Somatic symptoms of depression increased among medical HCW with workplace exposure to COVID-19 (ß = .25, 95% CI [0.13, 0.38]), but not in administrators (ß = .03, 95% CI [-0.04, 0.11]). CONCLUSION: Research is needed to identify factors that promote the reduction of depressive symptoms in medical HCW with exposition to COVID-19 patients. Awareness of infection protection measures should be increased.

Talking numbers: how women and providers use risk scores during and after risk counseling - a qualitative investigation from the NRG Oncology/NSABP DMP-1 study.

OBJECTIVES: Little research exists on how risk scores are used in counselling. We examined (a) how Breast Cancer Risk Assessment Tool (BCRAT) scores are presented during counselling; (b) how women react and (c) discuss them afterwards. DESIGN: Consultations were video-recorded and participants were interviewed after the consultation as part of the NRG Oncology/National Surgical Adjuvant Breast and Bowel Project Decision-Making Project 1 (NSABP DMP-1). SETTING: Two NSABP DMP-1 breast cancer care centres in the USA: one large comprehensive cancer centre serving a high-risk population and an academic safety-net medical centre in an urban setting. PARTICIPANTS: Thirty women evaluated for breast cancer risk and their counselling providers were included. METHODS: Participants who were identified as at increased risk of breast cancer were recruited to participate in qualitative study with a video-recorded consultation and subsequent semi-structured interview that included giving feedback and input after viewing their own consultation. Consultation videos were summarised jointly and inductively as a team.tThe interview material was searched deductively for text segments that contained the inductively derived themes related to risk assessment. Subgroup analysis according to demographic variables such as age and Gail score were conducted, investigating reactions to risk scores and contrasting and comparing them with the pertinent video analysis data. From this, four descriptive categories of reactions to risk scores emerged. The descriptive categories were clearly defined after 19 interviews; all 30 interviews fit principally into one of the four descriptive categories. RESULTS: Risk scores were individualised and given meaning by providers through: (a) presenting thresholds, (b) making comparisons and (c) emphasising or minimising the calculated risk. The risk score information elicited little reaction from participants during consultations, though some added to, agreed with or qualified the provider's information. During interviews, participants reacted to the numbers in four primary ways: (a) engaging easily with numbers; (b) expressing greater anxiety after discussing the risk score; (c) accepting the risk score and (d) not talking about the risk score. CONCLUSIONS: Our study highlights the necessity that patients' experiences must be understood and put into relation to risk assessment information to become a meaningful treatment decision-making tool, for instance by categorising patients' information engagement into types. TRIAL REGISTRATION NUMBER: NCT01399359.

Social health: rethinking the concept through social practice theory and feminist care ethics.

The social sciences have long shown that health is not born of pure biology, empirically (re)centred the social and material causes of disease, and affirmed the subjective experiences of disease. Disputed both in popular and academic discourses, social health has variously attempted to stress the social aspects of health. Existing conceptions remain analytically limited as they are predominantly used as descriptors for populational health. This article theorises social health as an analytical lens for making sense of the relations, affects and events where health unfolds and comes into expression. Drawing on social practice theory, feminist care ethics and posthumanism this conceptual paper re-imagines how social health might be conceived as lived social practices anchored in care. Care within our framework acknowledges the unavoidable interdependency foundational to the existence of beings and stresses the 'know how' and embodied practices of care in the mundane in order to emphasise that care itself is absolutely integral to the maintenance of social health. The article argues that health needs to be understood as a verb intrinsically (re)made in and through social contexts and structures and comprised of meaningful, human-human and human-non-human interactions. Ultimately, in theorising social health through mundane care practices, we hope to open up research to making sense of how the doing of health unfolds inside often banal, patterned forms of social activity. Such taken-for-granted social practices exemplify the often overlooked lived realities that comprise our health. To understand health in its own right, we argue, these everyday practices need to be interrogated.

Using decision tree analysis to identify population groups at risk of subjective unmet need for assistance with activities of daily living.

BACKGROUND: Identifying predictors of subjective unmet need for assistance with activities of daily living (ADL) is necessary to allocate resources in social care effectively to the most vulnerable populations. In this study, we aimed at identifying population groups at risk of subjective unmet need for assistance with ADL and instrumental ADL (IADL) taking complex interaction patterns between multiple predictors into account. METHODS: We included participants aged 55 or older from the cross-sectional German Health Update Study (GEDA 2019/2020-EHIS). Subjective unmet need for assistance was defined as needing any help or more help with ADL (analysis 1) and IADL (analysis 2). Analysis 1 was restricted to participants indicating at least one limitation in ADL (N = 1,957). Similarly, analysis 2 was restricted to participants indicating at least one limitation in IADL (N = 3,801). Conditional inference trees with a Bonferroni-corrected type 1 error rate were used to build classification models of subjective unmet need for assistance with ADL and IADL, respectively. A total of 36 variables representing sociodemographics and impairments of body function were used as covariates for both analyses. In addition, the area under the receiver operating characteristics curve (AUC) was calculated for each decision tree. RESULTS: Depressive symptoms according to the PHQ-8 was the most important predictor of subjective unmet need for assistance with ADL. Further classifiers that were selected from the 36 independent variables were gender identity, employment status, severity of pain, marital status, and educational level according to ISCED-11. The AUC of this decision tree was 0.66. Similarly, depressive symptoms was the most important predictor of subjective unmet need for assistance with IADL. In this analysis, further classifiers were severity of pain, social support according to the Oslo-3 scale, self-reported prevalent asthma, and gender identity (AUC = 0.63). CONCLUSIONS: Reporting depressive symptoms was the most important predictor of subjective unmet need for assistance among participants with limitations in ADL or IADL. Our findings do not allow conclusions on causal relationships. Predictive performance of the decision trees should be further investigated before conclusions for practice can be drawn.

Evaluating Interoperability in German Critical Incident Reporting Systems.

INTRODUCTION: In industrialised countries, one in ten patients suffers harm during hospitalization. Critical Incident Reporting Systems (CIRS) aim to minimize this by learning from errors and identifying potential risks. However, a lack of interoperability among the 16 CIRS in Germany hampers their effectiveness. METHODS: This study investigates reports' syntactic and semantic interoperability across seven different reporting systems. Syntactic interoperability was examined using WHO's Minimal Information Models (MIM), while semantic interoperability was evaluated with SNOMED concepts. RESULTS: The findings reveal a low structural overlap, with only two terms correctly represented in the SNOMED CT terminology. In addition, most systems showed no syntactic interoperability. CONCLUSION: Improving interoperability is essential for increasing the effectiveness and usability of CIRS. The study suggests a unified data model such as MIM or using Health Level 7 Fast Healthcare Interoperability Resources (HL7 FHIR) resources and expanding SNOMED CT with patient safety-relevant terms for semantic interoperability. Given the current lack of both syntactic and semantic interoperability in CIRS, developing a patient safety ontology is recommended for efficient critical incident analysis too.

Feasibility of a patient-oriented navigation programme for patients with lung cancer or stroke in Germany: Protocol of the CoreNAVI study.

BACKGROUND: Patient navigation programmes were introduced in the United States and recently gained interest in Germany, where the health care system is fragmented. Navigation programmes aim to decrease barriers to care for patients with age-associated diseases and complex care paths. Here we describe a feasibility study to evaluate a patient-oriented navigation model that was developed in a first project phase by integrating data about barriers to care, vulnerable patient populations and existing support services. METHODS: We designed a mixed-methods feasibility study that consists of two two-arm randomized controlled trials aligned with observational cohorts. The intervention group of the RCTs gets support by personal navigators for 12 months. The control group receives a brochure with regional support offers for patients and caregivers. The feasibility of the patient-oriented navigation model for two prototypic age-associated diseases, lung cancer and stroke, is evaluated with regard to its acceptance, demand, practicality and efficacy. This investigation includes process evaluation measures with detailed documentation of the screening and recruitment process, questionnaires about satisfaction with navigation, observant participation and qualitative interviews. Estimates of efficacy for patient-reported outcomes are obtained at three follow-up time points including satisfaction with care and health-related quality of life. Furthermore, we analyze health insurance data from patients of the RCT insured at a large German health insurance (AOK Nordost) to investigate heath care utilization, costs and cost effectiveness. TRIAL REGISTRATION: The study is registered at the German Clinical Trial Register (DRKS-ID: DRKS00025476).

[Access to cardiological care infrastructure in the federal state of Brandenburg considering the local care needs]. / Erreichbarkeit der kardiologischen Versorgungsinfrastruktur im Bundesland Brandenburg in Abhängigkeit des lokalen Versorgungsbedarfs.

AIM OF THE STUDY: In a nationwide comparison, the state of Brandenburg has one of the highest morbidity and mortality rates of ischemic heart disease. Access to medical care infrastructure is considered to be one possible explanation for regional health inequalities. Accordingly, the study aims to calculate the distances to different types of cardiology care at the community level and to consider these in the context of local care needs. METHODOLOGY: Preventive sports facilities, general practitioners, outpatient specialist care, hospitals with cardiac catheterization laboratory and outpatient rehabilitation were chosen and mapped as essential facilities for cardiological care. Thereafter, the distances across the road network from the center of each Brandenburg community to the nearest location of each care facility was calculated and divided into quintiles. Medians and interquartile ranges of the German Index of Socioeconomic Deprivation and the proportion of the population over 65 were used as measures of the need for care. They were then related to the distance quintiles per type of care facility. RESULTS: For 60% of Brandenburg's municipalities, general practitioners were found to be within 2.5 km, preventive sports facilities within 19.6 km, cardiology practices within 18.3 km, hospitals with cardiac catheterization laboratories within 22.7 km, and outpatient rehabilitation facilities within 14.7 km. The median of the German Index of Socioeconomic Deprivation rose with increasing distance for all types of care facilities. The median of the proportion of over 65-year-olds showed no significant variation between distance quintiles. CONCLUSIONS: The results show that a high proportion of the population lives far away from cardiology care services, while a high proportion seems to be able to reach a general practitioner. In Brandenburg, a regional and locally oriented cross-sectoral care seems to be necessary.

Navigating responsible bio-political citizenship: Cross-country comparison of stigma in Covid-19 illness narratives in Germany, Japan, the UK and the USA.

This paper aims to further understanding of discourses of responsible bio-political citizenship during the first year of the Covid-19 pandemic. This was an interview-based qualitative study comparing experiences of 103 people who were ill with Covid for the first time across 2020 in Japan, Germany, the USA and the UK. Comparative thematic analysis explored discussion of responsibility in relation to Covid illness, experiences of social fracture and stigma, and the strategies employed to resist or mitigate stigma. This comparative analysis highlighted significant similarities across countries. We identified three mysteries of Covid illness experiences that impacted the work of navigating biopolitical citizenship. First, the mystery of how people caught Covid. There was an inherent paradox of following guidance yet nonetheless falling ill. Disclosure of Covid to minimise onward transmission was held in tension with accusations of irresponsibility. Second, the mystery of onward transmission. Uncertainty about transmission placed participants in a liminal space of potentially having caused harm to others. Third, the mystery of how long illness should last. Uncertainty about ongoing infectiousness made social re-entry difficult, particularly in instances of persistent symptoms. We demonstrate the instability of certainty in the context of new and emerging forms of biopolitical citizenship. Guidance and emerging scientific evidence sought to demystify Covid through providing certainty that could guide responsible actions, but where citizens experienced paradoxes this had the potential to exacerbate stigma.

[Development of an Index of Social Structures to Determine the Sociostructural Need for Physicians in Outpatient Care in Brandenburg]. / Entwicklung eines Sozialstrukturindex zur Ermittlung des soziostrukturellen Versorgungsbedarfs in der ambulanten medizinischen Versorgung in Brandenburg.

INTRODUCTION: Despite the growing numbers of physicians in outpatient care, continuing discussion about the planning of physician requirements suggests remaining problems in this field, which could be due to focussing on the ratio of physician to population rather than on morbidity-based evaluations. Against this background, this paper tries to depict the latent need in outpatient care, illustrates supply and demand and further tests the hypothesis that there is a relative inequality in distribution due to physicians preferring to locate in socially privileged areas in the German state of Brandenburg. METHODS: We aggregated all data available on a small scale with potential impact on demand and examined it via principal component analysis. The generated factor was mapped together with the locations of general practitioners and specialists in general care. Using linear regressions, the number of practitioners was compared to the local index value to determine regional inequalities. RESULTS: The PCA suggested a one factor solution; that factor was designated Social Structure Index due to its values. The mapping showed a tendency of higher index values towards the central areas of Brandenburg surrounding Berlin. Regressions of the number of practitioners against the index values revealed no significant differences between communities with high and low index values. CONCLUSION: The extension of factors concluding the evaluation of physician demand in outpatient care confirms the problems of physician supply in rural areas, where sparse populations meet social disadvantages and poor accessibility. An underlying inequality in distribution in terms of physicians preferring socially privileged areas could not be detected.

[Concern about Covid-19 Infection and the Risk of Burnout Symptoms: a Study of Caregiver Stress in Brandenburg Nursing Homes During the Covid-19 Pandemic]. / Sorge vor Covid-19-Infektion und das Risiko für Burnout-Symptome: eine Studie zur Belastung von Pflegekräften in Brandenburger Pflegeheimen während der Covid-19-Pandemie.

OBJECTIVE: Investigation of the association of concern about own infection or infection of friends, family and care recipients with Covid-19 and burnout symptoms of caregivers in Brandenburg full inpatient geriatric care facilities. METHODS: Cross-sectional survey of nursing staff (n=195) in Brandenburg nursing homes between August and December 2020 regarding their psychosocial stress at work. RESULTS: Concern about having infected oneself, family and/or friends, or care recipients with Covid-19 is associated with increased expression of burnout symptoms (b=0,200, t(155)=2,777, p=0,006). CONCLUSION: Increased experience of burnout symptoms due to concerns of risk of infection with Covid-19 in the workplace indicates a need for comprehensive support measures as well as sustainable approaches to managing psychosocial stress for geriatric caregivers.

Investigating people's attitudes towards participating in longitudinal health research: an intersectionality-informed perspective.

BACKGROUND: Increasing evidence suggests that participation proportions in longitudinal health research vary according to sex/gender, age, social class, or migration status. Intersectionality scholarship purports that such social categories cannot be understood in isolation and makes visible the co-dependent nature of the social determinants of health and illness. This paper uses an intersectionality-informed approach in order to expand the understanding of why people participate in health research, and the impact of intersecting social structures and experiences on these attitudes. METHODS: A sample of 80 respondents who had previously either accepted or declined an invitation to participate in the German National Cohort (NAKO) participated in our interview study. Interviews were semi-structured and contained both narrative elements and more structured probes. Data analysis proceeded in two steps: first, the entire data set was analysed thematically (separately for participants and non-participants); second, key themes were compared across self-reported sex/gender, age group and migration status to identify differences and commonalities. RESULTS: Respondents' attitudes towards study participation can be categorised into four themes: wanting to make a contribution, seeking personalised health information, excitement and feeling chosen, and seeking social recognition. Besides citing logistical challenges, non-participants narrated adverse experiences with or attitudes towards science and the healthcare system that deterred them from participating. A range of social experiences and cultural value systems shaped such attitudes; in particular, this includes the cultural authority of science as an arbiter of social questions, transgressing social categories and experiences of marginalisation. Care responsibilities, predominantly borne by female respondents, also impacted upon the decision to take part in NAKO. DISCUSSION: Our findings suggest that for participants, health research constitutes a site of distinction in the sense of making a difference and being distinct or distinguishable, whereas non-participants inhabited an orientation towards science that reflected their subjective marginalisation through science. No clear relationship can thereby be presumed between social location and a particular attitude towards study participation; rather, such attitudes transgress and challenge categorical boundaries. This challenges the understanding of particular populations as more or less disadvantaged, or as more or less inclined to participate in health research.

Predictors and prevalence of hazardous alcohol use in middle-late to late adulthood in Europe.

Objectives: Even low to moderate levels of alcohol consumption can have detrimental health consequences, especially in older adults (OA). Although many studies report an increase in the proportion of drinkers among OA, there are regional variations. Therefore, we examined alcohol consumption and the prevalence of hazardous alcohol use (HAU) among men and women aged 50+ years in four European regions and investigated predictors of HAU.Methods: We analyzed data of N = 35,042 participants of the European SHARE study. We investigated differences in alcohol consumption (units last week) according to gender, age and EU-region using ANOVAs. Furthermore, logistic regression models were used to examine the effect of income, education, marital status, history of a low-quality parent-child relationship and smoking on HAU, also stratified for gender and EU-region. HAU was operationalized as binge drinking or risky drinking (<12.5 units of 10 ml alcohol/week).Results: Overall, past week alcohol consumption was 5.0 units (±7.8), prevalence of HAU was 25.4% within our sample of European adults aged 50+ years. Male gender, younger age and living in Western Europe were linked to both higher alcohol consumption and higher risks of HAU. Income, education, smoking, a low-quality parent-child relationship, living in Northern and especially Eastern Europe were positively associated with HAU. Stratified analyses revealed differences by region and gender.Conclusions: HAU was highly prevalent within this European sample of OA. Alcohol consumption and determinants of HAU differed between EU-regions, hinting to a necessity of risk-stratified population-level strategies to prevent HAU and subsequent alcohol use disorders.

[Recommendations for a Core Curriculum for Master's Degree Programs in Health Services Research]. / Empfehlungen für ein Kerncurriculum für Masterstudiengänge der Versorgungsforschung.

The aim of the present study was to develop recommendations for a core curriculum for master's degree programs in health services research. For this purpose, a standardized online survey of university lecturers was conducted in the first step. In the second step, the curricula of the existing study programs were analyzed. In the third step, a literature search was conducted. In the last step, the resulting recommendations were discussed in a panel of experts. The final recommendations comprise 13 topics on five guiding questions with 26 subtopics. The main topics come from the areas of basic sciences in the context of health services research, the health care system and health policy, the (empirical) health services research process, and knowledge transfer. The present recommendations will serve as a basis for discussion and as a starting point. The development of recommendations should be seen as an ongoing process, as the core competencies of health services researchers will have to be continuously adapted to new research topics, new research methods and regulations.

[Pandemic Management in the Context of Everyday Care and the need for Good Care: Results and Recommendations for Action from the Coronacare Workshops]. / Pandemie-Management unter Berücksichtigung des Pflegealltags und dem Bedürfnis nach guter Pflege. Ergebnisse und Handlungsempfehlungen aus den CoronaCare-Workshops.

The Covid-19 pandemic, officially declared in March 2020 by the WHO, poses major challenges to public, private, and occupational life. CoronaCare is an ethnographic research project that investigates the everyday life of people during the Covid-19 pandemic in Germany with a particular focus on social health. The aim of the project was to develop recommendations for pandemic preparedness planning focusing on expanding social health care. Through a series of workshops conducted between June and November 2021 with stakeholders from the fields of science, health and social administration drawn from both local and state levels, care institutions and social associations, the research team developed specific recommendations for pandemic preparedness and response on the basis of empirically substantiated vignettes demonstrating key tensions in caring practices. These tensions illustrate that pandemic management must be understood as a so-called wicked problem in which there are only relational rather than clear-cut, ultimate solutions. As such, the recommendations developed in the workshops point to the imperative to 1. recognize the irresolvable tension between measures to contain the pandemic in planning pandemic management and the human desire to care and be cared for; 2. understand and manage pandemics at the community level; 3. aim for close collaboration between actors at the local health, social, and family level; and 4. create spaces for ethical reflection on good care during a pandemic and develop context-specific strategies for action. For pandemic preparedness and management as a 'wicked problem', this means that measures should be disseminated as recommendations rather than regulations in order to have some leeway that enables care to be tailored to individual needs. They should be accompanied by stable guidance for action as well as regular training for staff. The workshop formats can be understood as an example of multidimensional knowledge transfer in a socially challenging situation.

A theory of change of an innovation for therapeutic care and meaningful living in a German nursing home.

BACKGROUND: Demographic changes are leading to growing care needs of older people and creating a challenge for healthcare systems worldwide. Nursing homes (NHs) need to provide care for growing numbers of residents while ensuring a high-quality care. We aimed to examine an innovative NH in Germany and apply a theory of change (ToC) approach to develop a best practice model (BPM) for therapeutic care in NHs. METHODS: A multimethod qualitative study conducted from February to July 2021 in Germany involved interviews with 14 staff members of an innovative NH and 10 directors and care managers of other NHs. The interview guidelines included questions on nursing practices, infrastructure, resources, interprofessional collaboration, and working culture. Additional material on the participating NH (website, promotion videos, newsletters, care documentation) were collected. Contextual literature on NH culture and therapeutic care in Germany, ToC methodology, and NH culture change were reviewed. Following a question-focused analysis of all material, we generated a ToC model towards a BPM of therapeutic care and meaningful living in NHs. Results were verified in interdisciplinary team meetings, with study participants and other stakeholders to establish consensus. RESULTS: The participating NH's care concept aims to improve residents' functional abilities and wellbeing as well as staff members' job satisfaction. Central components of their approach include therapeutic elements such as music and movement in all nursing activities, multidisciplinary collaboration, a broad therapy and social activity offer, the continuation of therapy in everyday activities, a focus on individual life history, values, needs, and skills, social integration into the regional community, and the creation of a meaningful living environment for residents and staff. CONCLUSION: The BPM we developed shows how a meaningful living environment can be created through therapeutic care and integrative activities. The ToC sheds light onto the contextual factors and cultural values which should be considered in the development of NH interventions. Research on not only biomedical aspects, but also psychosocial dynamics and narrative co-constructions in nursing practice should inform NH innovations. The ToC also highlights the importance of developing adequate political frameworks and infrastructures for implementing such innovative practices on a larger scale.

Validation of the German eHealth impact questionnaire for online health information users affected by multiple sclerosis.

BACKGROUND: Persons with multiple sclerosis (MS) are confronted by an overwhelming amount of online health information, which can be valuable but also vary in quality and aim. Therefore, it is of great importance for developers and providers of eHealth information to understand its impact on the users. The eHealth Impact Questionnaire (eHIQ) has been developed in the United Kingdom to measure the potential effects of health and experimental information websites. This contains user's general attitudes towards using the internet to gain health information and attitudes towards a specific health related website. The self-complete questionnaire is divided into two independently administered and scored parts: the 11-item eHIQ part 1 and the 26-item eHIQ part 2. This study aimed to validate the psychometric properties of the German version of the eHealth Impact Questionnaire (eHIQ-G). METHODS: 162 people with multiple sclerosis browsed one of two possible websites containing information on MS and completed an online survey. Internal consistency was assessed by Cronbach's alpha and structural validity by Confirmatory Factor Analysis. Construct validity was examined by assessing correlations with the reference instruments eHealth Literacy Questionnaire and the General Self-Efficacy Scale measuring related, but dissimilar constructs. Moreover, we investigated the mean difference of the eHIQ-G score between the two websites. Data were analyzed using SPSS and AMOS software. RESULTS: The eHIQ-G subscales showed high internal consistency with Cronbach's alpha from 0.833 to 0.885. The 2-factor model of eHIQ part 1 achieved acceptable levels of goodness-of-fit indices, whereas the fit for the 3-factor model of eHIQ part 2 was poor and likewise for the alternative modified models. The correlations with the reference instruments were 0.08-0.62 and as expected. Older age was related with lower eHIQ part 1 score, whereas no significant effect was found for education on eHIQ part 1. Although not significant, the website 'AMSEL' reached higher mean scores on eHIQ part 2. CONCLUSIONS: The eHIQ-G has good internal consistency, and sufficient structural and construct validity. This instrument will facilitate the measurement of the potential impact of eHealth tools.