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.

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.

Virtual Reality-simulations offer new opportunities for alcohol prevention in adolescents. As an innovative medium, Virtual Reality can be attractive for the target group, and avatar-based pathways allow tailoring prevention in a gender-specific manner. However, tailoring may reproduce gender stereotypes and be exclusive. Therefore, this systematic review aims to summaries existing evidence regarding Virtual Reality-simulations for alcohol prevention targeting adolescents and to examine how gender is considered. A systematic search was conducted in seven databases. Two reviewers independently performed screening, data extraction, and quality assessment. Out of 224 search hits, four publications derived out of an Australian, a Danish, and a US-American project met the inclusion criteria. Research designs included qualitative (2), quantitative (1), and mixed-method approaches (1). Qualitative methods focused on development, evaluation, and participatory methods in the creation process, demonstrating adolescents’ involvement in Virtual Reality design. Adolescents appreciated the realism and the exposure to peer pressure and to negative alcohol consequences. Quantitative designs focused mainly on measuring alcohol-related outcomes (e.g., attitude and behavioral intentions towards binge drinking), and positive changes were found. In all studies, gender was assessed in the male-female dichotomy. Further gender-sensitive research is needed to develop and test the possibilities and pitfalls of tailoring Virtual Reality-simulations.

Zusammenfassung: Hintergrund: Fachkräfte für den Bereich Digital Public Health (DiPH) sind für eine erfolgreiche digitale Transformation im Sozial- und Gesundheitswesen notwendig. Unklar ist jedoch, inwiefern im Public-Health-(PH-)Studium DiPH-bezogene Inhalte vermittelt werden. Methode: Mittels systematischer Modulhandbuchanalyse wurden DiPH-bezogene Inhalte von akkreditierten PH-orientierten Studiengängen öffentlicher Hochschulen und Universitäten in Deutschland analysiert. Über die Plattform „Hochschulkompass“ und Mitgliedsstudiengänge der Deutschen Gesellschaft für Public Health (DGPH) wurden 422 Studiengänge identifiziert. Eingeschlossene Modulhandbücher wurden inhaltsanalytisch mittels MAXQDA ausgewertet. Ergebnisse: Lediglich 10 Bachelor- und 6 Masterstudiengänge weisen einen inhaltlichen DiPH-Bezug auf. Sie sind in ihren Schwerpunkten heterogen und unterschiedlichen PH-Teilbereichen zuzuordnen („Methoden, Definition, Geschichte und Sozialmedizin“ = 5; „Gesundheitsmanagement“ = 5; „Digital Health“ = 3; „Versorgungsforschung“ = 2; „Gesundheitskommunikation“ = 1). Zwischen dem wissenschaftlich gängigen Verständnis von DiPH und den darauf bezogenen Inhalten in den Modulhandbüchern zeigen sich Unterschiede. Die identifizierten Inhalte fokussieren eher technische und geringfügiger sozial- und gesundheitswissenschaftliche Bereiche. Diskussion: Die heterogenen Studiengänge mit DiPH-Bezug ermöglichen akademischen PH-Fachkräften eine spezifische Profilierung. Um umfassende Kompetenzen im Bereich DiPH zu erlangen, bedarf es eines weiteren Ausbaus entsprechender Module, die für den jeweiligen Studiengang relevant sind. Die Ergebnisse könnten zur (Weiter‑)Entwicklung geeigneter Module sowie eines DiPH-Kerncurriculums dienen.

Ziel der Studie Die Nutzer*innenakzeptanz von digitalen Gesundheitstechnologien bei leicht- bis mittelgradiger Depression ist bislang rudimentär erforscht und wird in vorliegender Studie untersucht. Methodik Es wurden problemzentrierte Einzelinterviews mit 3 Betroffenen, 3 Angehörigen und 13 Leistungserbringern (v. a. Medizin, Psychologie, Pflege) durchgeführt und qualitativ ausgewertet. Ergebnisse Entlang der Unified Theory of Acceptance and Use of Technology wurden Haltungen von Betroffenen, Angehörigen und Leistungserbringern dargestellt. Die Leistungserwartung und unterstützenden Rahmenbedingungen stellen bedeutsame Prädiktoren für die Nutzungsintention dar. Schlussfolgerung Die Ergebnisse bieten eine Basis, um im Folgeschritt die Kernbedürfnisse und Haltungen zu priorisieren. Im Sinne eines ethischen, nachhaltigen und ökonomischen Einsatzes ist weitere Forschung zur Nutzer*innenakzeptanz notwendig. 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. In terms of ethical, sustainable and economical use further research on user acceptance is required. Publication Date: 20 May 2021 (online) © 2021. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany