Digitization and Health in Germany: Cross-sectional Nationwide Survey

Abstract

Background Digital technologies are shaping medicine and public health. Objective The aim of this study was to investigate the attitudes toward and the use of digital technologies for health-related purposes using a nationwide survey. Methods We performed a cross-sectional study using a panel sample of internet users selected from the general population living in Germany. Responses to a survey with 28 items were collected using computer-assisted telephone interviews conducted in October 2020. The items were divided into four topics: (1) general attitudes toward digitization, (2) COVID-19 pandemic, (3) physical activity, and (4) perceived digital health (eHealth) literacy measured with the eHealth Literacy Scale (eHEALS; sum score of 8=lowest to 40=highest perceived eHealth literacy). The data were analyzed in IBM-SPSS24 using relative frequencies. Three univariate multiple regression analyses (linear or binary logistic) were performed to investigate the associations among the sociodemographic factors (age, gender, education, and household income) and digital technology use. Results The participants included 1014 internet users (n=528, 52.07% women) aged 14 to 93 years (mean 54, SD 17). Among all participants, 66.47% (674/1014) completed up to tertiary (primary and secondary) education and 45.07% (457/1017) reported a household income of up to 3500 Euro/month (1 Euro=US $1.18). Over half (579/1014, 57.10%) reported having used digital technologies for health-related purposes. The majority (898/1014, 88.56%) noted that digitization will be important for therapy and health care, in the future. Only 25.64% (260/1014) reported interest in smartphone apps for health promotion/prevention and 42.70% (433/1014) downloaded the COVID-19 contact-tracing app. Although 52.47% (532/1014) reported that they come across inaccurate digital information on the COVID-19 pandemic, 78.01% (791/1014) were confident in their ability to recognize such inaccurate information. Among those who use digital technologies for moderate physical activity (n=220), 187 (85.0%) found such technologies easy to use and 140 (63.6%) reported using them regularly (at least once a week). Although the perceived eHealth literacy was high (eHEALS mean score 31 points, SD 6), less than half (43.10%, 400/928) were confident in using digital information for health decisions. The use of digital technologies for health was associated with higher household income (odds ratio [OR] 1.28, 95% CI 1.11-1.47). The use of digital technologies for physical activity was associated with younger age (OR 0.95, 95% CI 0.94-0.96) and more education (OR 1.22, 95% CI 1.01-1.46). A higher perceived eHealth literacy score was associated with younger age (β=–.22, P<.001), higher household income (β=.21, P<.001), and more education (β=.14, P<.001). Conclusions Internet users in Germany expect that digitization will affect preventive and therapeutic health care in the future. The facilitators and barriers associated with the use of digital technologies for health warrant further research. A gap exists between high confidence in the perceived ability to evaluate digital information and low trust in internet-based information on the COVID-19 pandemic and health decisions.

Evaluation of Digital Interventions for Physical Activity Promotion: Scoping Review

“…The contribution of these elements to the success or failure of digital interventions for physical activity promotion is unclear, primarily because this information was either not coded in reviews or not reported in the primary studies. Furthermore, sociodemographic factors, including age, gender, education, income, and digital health literacy, affect the use of and interest in digital health technologies [ 1 ] and could also facilitate or hinder the efficacy of digital interventions. Further research is needed to identify health needs or barriers associated with digital health technology use in low socioeconomic settings [ 65 ] to improve the efficacy of digital interventions for physical activity promotion in such populations [ 66 ].…”

“…Fifth, the reviews included in this scoping review predominantly focused on mixed healthy or clinical samples and predominantly adult populations. Since digital interventions can support health promotion and disease prevention [ 1 ], future research should focus on the evaluation of digital interventions or digital tools in healthy populations to promote healthy lifestyle, including physical activity. Furthermore, children and adolescents are important target populations for digital interventions that focus on physical activity promotion because the use of digital technologies contributes to sedentary behavior, especially in early childhood [ 75 ].…”

“…The field of digital public health aims to promote and improve the health of people and communities through the application of digital technologies [ 1 , 2 ]. Digital technologies specifically designed to promote and improve health have emerged on a large scale and already permeate seemingly all aspects of daily life.…”

Use and Perception of Digital Health Technologies by Surgical Patients in Germany in the Pre–COVID-19 Era: Survey Study

“…We did not use validated instruments or methods for user technology acceptance in this work, such as the unified theory of acceptance and use of technology model, as our focus was not on a thorough technology acceptance investigation but rather on obtaining a general status quo of use, attitudes, and behavior of surgical patients in terms of new digital health technologies. However, recently, much work has been done regarding digitization and digital health technology in Germany, which we will use to design future trials [ 49 - 51 ]. For further studies, it would be recommended to use additional validated instruments.…”

Evaluation of Digital Interventions for Physical Activity Promotion: Protocol for a Scoping Review

“…The field of digital public health is rapidly developing [1]. Digitization is likely to have a major impact on therapy in the future, and it already increasingly contributes to prevention and health promotion [2]. Interventions supported by modern technologies (ie, digital interventions [DIs]) are enormously popular in the context of healthy lifestyle and behavior change, including physical activity (PA) promotion [3,4].…”