The skills, knowledge and resources to search for, find, understand, evaluate and apply health information is defined as health literacy (HL). If individuals want to use health information from the Internet, they need Digital Health Literacy (eHL), which in addition to HL also includes, for example, media literacy. If information cannot be found or understood by patients due to low (e)HL, patients will not have the opportunity to make informed decisions. In addition, many health apps for self-management or prevention also require (e)HL. Thus, it follows that active participation in healthcare, in terms of Person-Centered Care (PCC) is only possible through (e)HL. Currently, there is a great need to strengthen these competencies in society to achieve increased empowerment of patients and their health. However, at the same time, there is a need to train and improve competencies in the field of healthcare professionals so that they can counsel and guide patients. This article provides an overview with a focus on HL and eHL in healthcare, shows the opportunities to adapt services and describes the possible handling of patients with low (e)HL. In addition, the opportunities for patients and healthcare professionals to improve (e)HL are highlighted.

Zusammenfassung: Viele digitale Interventionen sind auf die Mitwirkung ihrer Nutzer*innen angewiesen, damit sie eine positive Wirkung erzielen können. In verschiedenen Bereichen ist zu beobachten, dass die Anwendung digitaler Interventionen durch Nutzer*innen oftmals nach einer kurzen Zeit reduziert oder in Gänze eingestellt wird. Dies wird als einer der wesentlichen Faktoren angesehen, der die Wirksamkeit digitaler Interventionen einschränken kann. In diesem Zusammenhang gewinnt das Konzept der Adhärenz (Einhalten therapeutischer Vorgaben) bei digitalen Interventionen zunehmend an Bedeutung. Definiert wird Adhärenz bei digitalen Interventionen etwa als „the degree to which the user followed the program as it was designed“ („Ausmaß, in dem die Nutzer*innen die Software so verwenden, wie sie konzipiert wurde“). Dies wird auch oftmals mit „intended use“ oder „use as it is designed“ umschrieben („bestimmungsgemäße Verwendung“ bzw. „Verwendung, wie es konzipiert wurde“). Jedoch finden sowohl die theoretisch-konzeptionelle als auch die praktische Auseinandersetzung hinsichtlich der Adhärenz bei digitalen Interventionen noch eine zu geringe Berücksichtigung in der Forschung.Ziel dieses narrativen Übersichtsartikels ist es, das Konzept der Adhärenz bei digitalen Interventionen näher zu beleuchten und von verwandten Konzepten abzugrenzen. Zudem wird diskutiert, mit welchen Methoden und Messgrößen die Adhärenz operationalisiert werden kann und welche Prädiktoren die Adhärenz positiv beeinflussen. Weiterhin wird auf die Dosis-Wirkungs-Beziehung bei der Anwendung digitaler Interventionen eingegangen und auf Faktoren, die die Adhärenz positiv beeinflussen können. Abgeschlossen wird mit einer ethischen Betrachtung der Thematik.

Background: Electronic health records (EHRs) are a promising approach to document and map (complex) health information gathered in health care worldwide. However, possible unintended consequences during use, which can occur owing to low usability or the lack of adaption to existing workflows (eg, high cognitive load), may pose a challenge. To prevent this, the involvement of users in the development of EHRs is crucial and growing. Overall, involvement is designed to be very multifaceted, for example, in terms of the timing, frequency, or even methods used to capture user preferences.Objective: Setting, users and their needs, and the context and practice of health care must be considered in the design and subsequent implementation of EHRs. Many different approaches to user involvement exist, each requiring a variety of methodological choices. The aim of the study was to provide an overview of the existing forms of user involvement and the circumstances they need and to provide support for the planning of new involvement processes.Methods: We conducted a scoping review to provide a database for future projects on which design of inclusion is worthwhile and to show the diversity of reporting. Using a very broad search string, we searched the PubMed, CINAHL, and Scopus databases. In addition, we searched Google Scholar. Hits were screened according to scoping review methodology and then examined, focusing on methods and materials, participants, frequency and design of the development, and competencies of the researchers involved.Results: In total, 70 articles were included in the final analysis. There was a wide range of methods of involvement. Physicians and nurses were the most frequently included groups and, in most cases, were involved only once in the process. The approach of involvement (eg, co-design) was not specified in most of the studies (44/70, 63%). Further qualitative deficiencies in the reporting were evident in the presentation of the competences of members of the research and development teams. Think-aloud sessions, interviews, and prototypes were frequently used.Conclusions: This review provides insights into the diversity of health care professionals’ involvement in the development of EHRs. It provides an overview of the different approaches in various fields of health care. However, it also shows the necessity of considering quality standards in the development of EHRs together with future users and the need for reporting this in future studies.

Background: Interest in digital technologies in the health care sector is growing and can be a way to reduce the burden on professional caregivers while helping people to become more independent. Social robots are regarded as a special form of technology that can be usefully applied in professional caregiving with the potential to focus on interpersonal contact. While implementation is progressing slowly, a debate on the concepts and applications of social robots in future care is necessary. Objective: In addition to existing studies with a focus on societal attitudes toward social robots, there is a need to understand the views of professional caregivers and patients. This study used desired future scenarios to collate the perspectives of experts and analyze the significance for developing the place of social robots in care. Methods: In February 2020, an expert workshop was held with 88 participants (health professionals and educators; [PhD] students of medicine, health care, professional care, and technology; patient advocates; software developers; government representatives; and research fellows) from Austria, Germany, and Switzerland. Using the scenario methodology, the possibilities of analog professional care (Analog Care), fully robotic professional care (Robotic Care), teams of robots and professional caregivers (Deep Care), and professional caregivers supported by robots (Smart Care) were discussed. The scenarios were used as a stimulus for the development of ideas about future professional caregiving. The discussion was evaluated using qualitative content analysis. Results: The majority of the experts were in favor of care in which people are supported by technology (Deep Care) and developed similar scenarios with a focus on dignity-centeredness. The discussions then focused on the steps necessary for its implementation, highlighting a strong need for the development of eHealth competence in society, a change in the training of professional caregivers, and cross-sectoral concepts. The experts also saw user acceptance as crucial to the use of robotics. This involves the acceptance of both professional caregivers and care recipients. Conclusions: The literature review and subsequent workshop revealed how decision-making about the value of social robots depends on personal characteristics related to experience and values. There is therefore a strong need to recognize individual perspectives of care before social robots become an integrated part of care in the future.

Background: Paediatric palliative care (PPC) is a noncurative approach to the care of children and adolescents with life-limiting and life-threatening illnesses. Electronic medical records (EMRs) play an important role in documenting such complex processes. Despite their benefits, they can introduce unintended consequences if future users are not involved in their development. Aim: The aim of this study was to evaluate the acceptance of a novel module for nursing documentation by nurses working in the context of PPC. Methods: An observational study employing concurrent think-aloud and semi-structured qualitative interviews were conducted with 11 nurses working in PPC. Based on the main determinants of the unified theory of acceptance and use of technology (UTAUT), data were analysed using qualitative content analysis. Results: The main determinants of UTAUT were found to potentially influence acceptance of the novel module. Participants perceived the module to be self-explanatory and intuitive. Some adaptations, such as the reduction of fragmentation in the display, the optimization of confusing mouseover fields, and the use of familiar nursing terminology, are reasonable ways of increasing software adoption. Conclusions: After adaptation of the modules based on the results, further evaluation with the participation of future users is required.

Zusammenfassung: Digitale Interventionen (DI) zu gesundheitsbezogenen Themen gewinnen zunehmend an Bedeutung. Oftmals sind sie komplexe Interventionen, die in einem komplexen Versorgungskontext evaluiert und implementiert werden. Aufgrund der Merkmale digitaler Interventionen ist die Versorgungsforschung vor methodische Herausforderungen gestellt. Daher hat die Arbeitsgruppe Digital Health des Deutschen Netzwerks Versorgungsforschung (DNVF) ein Diskussionspapier erstellt. Darin wird diskutiert, welche Herausforderungen mit der Entwicklung und Evaluation von DI einhergehen. Es werden Lösungsansätze und zukünftige Forschungsbedarfe aufgezeigt.