[Awareness and Use of Digital Health Services in Germany: A Cross-sectional Study Representative of the Population]. / Bekanntheit und Nutzung von digitalen Gesundheitsangeboten in Deutschland: eine bevölkerungsrepräsentative Querschnittsuntersuchung.

OBJECTIVES: In light of the current efforts of health policy to implement eHealth, the question arises which sections of the population already use online self-help in order to tailor them to users' needs. The present study aims to determine the differences in the use of health information and psychological online counseling based on socio-demographic variables, health status and previous illnesses. METHODS: The basis for the cross-sectional data analyses using logistic regression analysis was the innovation sample of the German socio-economic panel. Data were collected from September 2016 to February 2017, with 4802 participants aged between 17-95 years. RESULTS: Fifty-five percent of the sample searched for health information on the Internet, while 1.1% had experience with online counseling. Logistic regression analyses showed that online search for information was significantly determined by age (Odds Ratio (OR)=0.96; 95-%-CI=0.96-0.97), gender (OR=1.20; 95-%-CI=1.05-1.36), awareness of Internet therapy (OR=2.57; 95-%-CI=2.20-3.00), experience with psychotherapy (OR=1.40; 95-%-CI=1.16-1.69) and the diagnosis of asthma (OR=1.14; 95-%-CI=1.01-1.29) or stroke (OR=0.66; 95-%-CI=0.52-0.84). Regarding the use of online counseling, awareness of Internet therapy and experience with face-to-face psychotherapy proved to be significant determinants. CONCLUSION: For the first time, a reliable picture has become available of the determinants of the awareness of internet therapy and online self-help utilization among the German public that should enable target-group-specific strategies to improve the care situation.

Piloting an Innovative Concept of e-Mental Health and mHealth Workshops With Medical Students Using a Participatory Co-design Approach and App Prototyping: Case Study.

BACKGROUND: Medical students show low levels of e-mental health literacy. Moreover, there is a high prevalence of common mental illnesses among medical students. Mobile health (mHealth) apps can be used to maintain and promote medical students' well-being. To date, the potential of mHealth apps for promoting mental health among medical students is largely untapped because they seem to lack familiarity with mHealth. In addition, little is known about medical students' preferences regarding mHealth apps for mental health promotion. There is a need for guidance on how to promote competence-based learning on mHealth apps in medical education. OBJECTIVE: The aim of this case study is to pilot an innovative concept for an educative workshop following a participatory co-design approach and to explore medical students' preferences and ideas for mHealth apps through the design of a hypothetical prototype. METHODS: We conducted a face-to-face co-design workshop within an elective subject with 26 participants enrolled at a medical school in Germany on 5 consecutive days in early March 2020. The aim of the workshop was to apply the knowledge acquired from the lessons on e-mental health and mHealth app development. Activities during the workshop included group work, plenary discussions, storyboarding, developing personas (prototypical users), and designing prototypes of mHealth apps. The workshop was documented in written and digitalized form with the students' permission. RESULTS: The participants' feedback suggests that the co-design workshop was well-received. The medical students presented a variety of ideas for the design of mHealth apps. Among the common themes that all groups highlighted in their prototypes were personalization, data security, and the importance of scientific evaluation. CONCLUSIONS: Overall, this case study indicates the feasibility and acceptance of a participatory design workshop for medical students. The students made suggestions for improvements at future workshops (eg, use of free prototype software, shift to e-learning, and more time for group work). Our results can be (and have already been) used as a starting point for future co-design workshops to promote competence-based collaborative learning on digital health topics in medical education.

Exploring medical students' views on digital mental health interventions: A qualitative study.

BACKGROUND: Medical students show a relatively high prevalence for common mental disorders. Only few of those in need for treatment seek professional help. Therefore, easily accessible interventions are required. While several evidence-based internet- and mobile-based interventions (IMIs) have been proposed, little is known about medical students' attitudes towards using them. OBJECTIVE: We aimed to explore the views of medical students on IMIs as well as facilitators and barriers to use them and gain first insights into their preferences for tailored IMIs. METHODS: We conducted four focus groups with 26 medical students enrolled at a German medical school in March 2020. Focus groups were audio-recorded, transcribed and analyzed following established approaches for qualitative content analysis. RESULTS: Medical students valued IMIs for their low-threshold and flexible access, their potential to bridge waiting times and as a first step towards face-to-face-therapy. However, medical students preferred face-to-face interventions in case of severe mental health problems. The main disadvantages named by students included difficulties to find or decide on suitable IMIs based on clear quality criteria, fear of a misdiagnosis and lack of personalisation and human interaction. Some students also questioned the effectiveness of IMIs. Easy handling, flexible use, data safety and easily understandable terms of use were believed to facilitate the uptake of IMIs, whereas technical problems, frequent notifications, required internet access, need to register, lack of anonymity, high time expenditure and costs were reported to hinder their use. Most students did not prefer IMIs tailored to medical students but rather wanted to use IMIs suitable for students of all disciplines. CONCLUSION: Our results suggest overall positive views regarding IMIs for mental health promotion but concerns regarding their use for severe mental disorders and acute crises. Our findings indicate that IMIs may represent promising tools for stress prevention and early interventions for medical students. Students explicitly stated to prefer quality-approved IMIs recommended and provided by their university.

Exploring the influence of testimonial source on attitudes towards e-mental health interventions among university students: Four-group randomized controlled trial.

Electronic mental health services (eMHSs) offer additional options for the dissemination of psychological interventions for university students. Still, many university students are reluctant to use eMHSs. Narrative messages may help increase the awareness and acceptance of quality-approved programs. However, little is known about the usefulness of narrative messages to improve attitudes towards eMHSs. In this experiment, we thus aimed to explore in how far different ways of targeting information to students affect their attitudes towards eMHSs for stress prevention and therapy, and to identify potential determinants of attitude change. N = 451 students (Mean = 32.6 years, SD = 10.2, 75% female, 7% with eMHS experience) were randomly assigned to one of four study arms involving information designed to induce different levels of perceived similarity. While the active control condition only received general information (arm 1, "information only", n = 116), the other experimental arms were additionally exposed to testimonials on specific eMHSs either addressing an unspecified audience (arm 2, n = 112), employees (arm 3, n = 115) or working university students (arm 4, n = 108). Two-way ANOVA revealed no impact of information on the alteration of attitudes towards eMHSs for stress coping (d = 0.20). Only a small effect of target-group specific testimonials on attitudes towards online therapies was identified at post-intervention (d = 0.29). Regression analyses demonstrated significant influences of source credibility and perceived similarity on attitudes for preventative eMHSs (ps<0.01), as well as a partial mediation effect of perceived similarity in favor of testimonials targeted to students (95% CI [0.22, 0.50]). Overall, this study indicated no meaningful impact of information on attitudes and limited evidence for benefits of tailored narrative messages. Since attitudes were already positive at baseline, further research with a representative student sample mimicking real-world decision scenarios is needed to gain an in-depth understanding of acceptance-facilitating message features that may contribute to promote the adoption of evidence-based eMHSs.

Students' perspectives on interventions to reduce stress in medical school: A qualitative study.

The mental health of medical students remains to be a matter of concern. Numerous setting-based and individual-based interventions for student mental health have been proposed in the literature. However, the student perspective on those interventions has been largely neglected. This study aims to explore how medical students perceive different interventions and if they desire any additional changes with regard to their studies. Eight focus groups with 71 participants were conducted at a large German medical school. Focus groups were recorded, transcribed and content-analyzed using MAXQDA 18. We found that medical students prefer setting-based interventions. Most proposed interventions were on a setting-based level. For instance, students asked for more information on the university's psychosocial counseling services and for better information management regarding contact persons. Interventions proposed in the literature received mixed reactions: Several participants did not favour a pass/fail grading system. Students considered a peer-to-peer mentoring program for freshmen very helpful. Students had diverse attitudes towards Balint groups. They approved of several self-management courses, most of them being related to time or stress management. Interestingly, the most urgently wanted interventions appear to be rather easy to implement (e.g. a mentoring program). This study explored the medical student perspective on student mental health interventions. Additionally, our study illustrates the benefit and feasibility of involving students early on in the conception of interventions. Further research with a representative sample is needed to obtain broader information on the acceptance of the suggested interventions.

Implementation of online peer feedback for student self-reflection - first steps on the development of a feedback culture at a medical faculty.

Objective: Acquisition and application of professional and personal competences is accompanied by the formation and consolidation of attitudes and values and is influenced by the norms and moods (trust and feedback culture) experienced in the learning environment in question [1]. In particular, feedback and peer feedback can have a positive influence on the learning progress and personal development of students [2], [3], [4]. The promotion of a culture of teaching and ultimately of trust or feedback, plays a special role in this [5]. The aim was therefore to structurally integrate feedback into the curriculum of a model study course in order to develop a feedback culture in which students can develop personally and professionally with the help of regular and constructive feedback. Methodology: Following an initial pilot phase in 2009, (peer) feedback was gradually integrated into the curriculum at the medical faculty, in the first instance through checklists and subsequently through an online questionnaire and direct interviews. The activities were regularly analyzed on the basis of student evaluations using the EvaSys evaluation software and semi-standardized questionnaire-based interviews with six students in 2009 and 13 students each in 2012 and 2013. Results: Initially, students felt that the trust and feedback culture at their location as being in need of improvement. There were uncertainties regarding the use of constructive feedback and making criticism but also trust issues regarding the expression of personal perceptions to faculty members. It was possible to document the increase in the acceptance of the offers in the course of their establishment by an improvement in student evaluation and an increase in the number of participants in the voluntary offers amongst others. Qualitative data showed that students had a more positive perception or assessment of the location's feedback concept as well as indications of improvements in the culture of trust at the location. The proportion of constructive free-text comments increased significantly by 11% to 99.4% compared to the previous year (t(3)=-3.79, p=0.04). Thus, in terms of the objective, an increase in feedback activities and their quality at the faculty was achieved. Conclusion: Feedback, its acceptance as well as the quality, can be positively influenced at a faculty. Change measures should be tested repeatedly in discussion with users regarding practicability in order to directly pick up implementation issues and obstacles so they can be remedied in the interests of the users. This can influence the development of a culture of trust and feedback and should promote the personal and professional development of students in the long term.