Aktivitätstracker im Alltag: Charakteristika von Motivation und User Diversity zur Erklärung individueller Nutzungstrajektorien

Die fortlaufend stärkere Durchdringung unseres Alltags mit digitalen Technologien wird besonders deutlich durch tragbare Geräte wie Smartphones, auf die jederzeit zugegriffen werden kann. Noch einen Schritt weiter gehen körpernah getragene, vernetzte Self-Tracking-Systeme wie Aktivitätstracker, welche kontinuierlich Bewegungsdaten und physiologische Parameter erfassen, algorithmisch aufbereiten und an die Nutzer*innen als quantifiziertes Feedback, oft zur Verhaltensmodifikation, zurückmelden. Diese spezifische Form der Interaktion zwischen Mensch und Technologie – körpernah, kontinuierlich, quantifiziert, vernetzt und persuasiv – ist für die Ingenieurpsychologie besonders relevant, da sie eine sehr enge Verbindung von Körper und Technik erfordert und spezifische Herausforderungen für die Stärkung der Selbstbestimmung ihrer Nutzer*innen bereithält. Einerseits dienen Aktivitätstracker der erleichterten Selbstreflexion durch Sichtbarmachung von Zusammenhängen, die zuvor verborgen blieben, wie etwa zwischen sportlicher Aktivität und Ruheherzfrequenz. Andererseits sollen Aktivitätstracker die Motivation für körperliche Verhaltensänderungen steigern. Die Nutzung von Aktivitätstrackern bewegt sich also potenziell in einem Spannungsfeld zwischen der Steigerung von Selbstbestimmung durch erweitertes Wissen sowie Aufzeigen von Handlungsoptionen und der Einschränkung der Selbstbestimmung durch persuasive Strategien zur Motivationssteigerung. Dieses Spannungsfeld bedingt neue Ansätze zur Beziehungsgestaltung zwischen Mensch und Trackingsystem. In der empirischen Forschung zur Nutzung von Aktivitätstrackern wird häufig darauf hingewiesen, dass ein Großteil der Nutzenden nach wenigen Wochen oder Monaten den kontinuierlichen Gebrauch beendet. Dieser Befund deutet daraufhin, dass Barrieren existieren, die die Langzeitnutzung unwahrscheinlicher machen. Des Weiteren wird immer wieder über negative Effekte der Trackernutzung berichtet, beispielsweise Stress. Allerdings ist auch bekannt, dass zahlreiche andere Personen ihr Trackingsystem über Jahre hinweg intensiv und erfolgreich gebrauchen. Es lässt sich also in Bezug auf die Nutzungstrajektorien eine bedeutsame Varianz feststellen, die es zu erklären gilt, um Self-Tracking-Anwendungen für diverse Nutzende gewinnbringend zu gestalten. Um diesem Vorhaben gerecht zu werden, ist es unabdingbar zu verstehen, welche individuellen Differenzen in der Gruppe der Nutzer*innen die Interaktion mit dem Aktivitätstracker, insbesondere in Bezug auf motivationale Aspekte, prägen. Dieser Herausforderung stellt sich die vorliegende Dissertation und greift dazu auf etablierte Theorien und Konzepte der Persönlichkeits- und Sozialpsychologie zurück. Da der theoriegeleitete Einbezug von Personenmerkmalen in die ingenieurpsychologische Forschung noch wenig vorangetrieben war, bestand zu Beginn des Promotionsvorhabens die Notwendigkeit, ein Konstrukt zu konzeptualisieren, welches zum einen auf einem stabilen psychologischen Theoriefundament steht und zum anderen spezifisch auf den Kontext der Mensch-Technik-Interaktion zugeschnitten ist. Im Rahmen der vorliegenden Dissertation wurde aus diesem Grund an der Herleitung der interaktionsbezogenen Technikaffinität (ATI) als kontextspezifische Variante der Denkfreude und ihrer Messbarmachung gearbei-tet. Insgesamt umfassten die Datenerhebungen zur Bestimmung der Gütekriterien der ATI-Skala fünf Datensätze mit über 1500 Teilnehmenden. Das Resultat der Skalenentwicklung ist ein unidimensionales, ökonomisches, reliables und valides Erhebungsinstrument der interaktionsbezogenen Technikaffinität (Artikel 1). Als relativ stabiles Persönlichkeitsmerkmal, das die Motivation zur Auseinandersetzung mit Technik grundlegend beeinflusst, wurde ATI in die folgenden Studien zur Interaktion zwischen Mensch und Aktivitätstracker miteinbezogen. Um die alltägliche, individuelle Mensch-Tracker-Interaktion umfassend zu verstehen und erklären zu können, wie es zu den unterschiedlichen Nutzungsverläufen kommt, müssen verschiedene Phasen der Nutzung untersucht werden. Zunächst ist zu klären, welche Motivatoren Menschen eigentlich dazu veranlassen, mit der Trackernutzung zu beginnen. Weiterhin ist die Nutzungsphase selbst zu beleuchten, um zu beschreiben, wie sich die oben beschriebene, spezifische Form der Trackerinteraktion auf die Nutzungserfahrung und anhaltende Motivation auswirkt und wie sich negative Nutzungskonsequenzen bemerkbar machen. Schließlich sind zum Verständnis der Nutzungstrajektorien die Gründe für den Abbruch zu berücksichtigen, sodass auch die Phase nach der Nutzung relevant ist. Da sich diese Dissertation dezidiert damit beschäftigt, wie sich die Interaktion mit Aktivitätstrackern im Alltag gestaltet, ist die Untersuchung der Nutzung in Stichproben von tatsächlichen bzw. ehemaligen Aktivitätstracker-Nutzer*innen angezeigt. Aus diesem Grund wurden zwei Online-Erhebungen durchgeführt, um ebendiese Stichproben zu erreichen. Das Ziel der ersten Studie (N = 210) war die quantitative Analyse von Nutzungsmotivationen sowie unintendierten, negativen Effekten der Trackernutzung im Alltagsgebrauch. Es zeigte sich, dass das Tracken sowohl zum Selbstzweck (intrinsische Motivation) als auch zur Erreichung eines externen Ziels (extrinsische Motivation) durchgeführt wird und diese Motivationstypen oft gleichzeitig auftreten. Darüber hinaus konnte gezeigt werden, dass negative Effekte in Form von Motivationsverlusten in Bezug auf die Trackernutzung und die körperliche Aktivität eine Rolle im Alltag vieler Nutzer*innen spielen. Die Wahrscheinlichkeit des Auftretens dieser Effekte wird teilweise von Personenmerkmalen wie ATI und der Nutzungsmotivation bestimmt (Artikel 2). Die zweite Studie nahm ehemalige Nutzer*innen (N = 159) in den Blick und fokussierte auf die Erfassung der Gründe für den Nutzungsabbruch sowie die Stabilität der Abbruchentscheidung. Die Ergebnisse machten deutlich, dass zahlreiche Nutzungsbarrieren für die Entscheidung, den Tracker abzulegen, ausschlaggebend sind. Außerdem sind die Abbruchentscheidungen oft nicht permanent, was auf eine episodische Trackernutzung hindeutet (Artikel 3). Schließlich wurden wiederum Personenmerkmale und außerdem Interaktionscharakteristika in Betracht gezogen, um die große Varianz hinsichtlich Abbruchgründen und -permanenz zu erklären. Die Analysen offenbarten unter anderem, dass eine episodische Nutzung (d. h. nicht endgültige Beendigung) wahrscheinlicher ist, wenn sich die Nutzungsmotivation durch einen hohen Grad an Selbstbestimmung auszeichnet (Artikel 4). Abschließend betonen die Befunde der Dissertation die zentrale Rolle der wahrgenommenen Selbstbestimmung im Kontext der Mensch-Tracker-Interaktion und geben Anlass für Designrichtlinien, die die Beziehung zwischen Trackingsystem und Nutzer*in mit all ihren gegenseitigen Abhängigkeiten und individuellen Merkmalen berücksichtigen, um so die Selbstbestimmung zu erhalten oder sogar durch vertieftes Selbstwissen zu stärken.The ongoing permeation of our daily life with digital technologies is particularly evident in wearable devices such as smartphones, which can be accessed at any time. Wearable, connected self-tracking systems such as activity trackers go even a step further. They continuously record movement data and physiological parameters, process them algorithmically and provide quantified feedback to the user, often for behavioral modification. This specific form of interaction between humans and technology – close to the body, continuous, quantified, connected, and persuasive – is particularly relevant for engineering psychology, as it requires a very close connection between body and technology and poses specific challenges for strengthening the self-determination of its users. That is, on the one hand, activity trackers serve to facilitate self-reflection by revealing relationships which were previously hidden, such as the relationship between physical activity and resting heart rate. On the other hand, activity trackers are intended to enhance motivation for physical behavioral changes. The use of activity trackers thus potentially moves in a field of tension between the increase of self-determination through expanded knowledge as well as the identification of behavioral options and the restriction of self-determination through persuasive strategies to increase motivation. This tension requires new approaches to the design of relationships between people and tracking systems. Empirical research on activity tracker usage often highlights that a large proportion of users stop continuous use after a few weeks or months. This finding suggests the existence of barriers that make long-term use less likely. Furthermore, negative effects of tracker use, such as stress, are repeatedly reported. However, it is also known that many other users have enjoyed intensive and successful use of their tracking system for many years. Thus, a significant variance in usage trajectories can be observed, which needs to be explained in order to make self-tracking applications beneficial for diverse users. To meet this goal, it is essential to understand which individual differences in the group of users shape the interaction with their activity tracker, especially with respect to motivational aspects. This dissertation addresses this challenge by drawing on established theories and concepts of personality and social psychology. At the beginning of the dissertation project, the theory-based inclusion of personal characteristics in engineering psychology had not yet been sufficiently advanced. Thus, there was a need to conceptualize a construct which, on the one hand, stands on a stable psychological theoretical foundation and, on the other hand, is specifically tailored to the context of human-technology interaction. For this reason, the conceptualization of affinity for technology interaction (ATI) as a context-specific variant of need for cognition and its measurability took place within the context of the dissertation. In total, the data collection to determine the quality criteria of the ATI scale comprised five data sets with over 1500 participants. The result of the scale development is a unidimensional, economical, reliable, and valid survey instrument of ATI (Article 1). As a relatively stable personality trait that fundamentally influences motivation to engage with technology, ATI was included in subsequent studies of human-activity tracker interaction. In order to comprehensively understand the everyday, individual human-tracker interaction and to be able to explain how the various usage patterns occur, different phases of usage must be examined. First, it must be clarified which motivators actually cause a person to start using a tracker. Furthermore, the usage phase itself must be examined to describe how the specific form of tracker interaction described above affects the usage experience and ongoing motivation, and how negative usage consequences become apparent. Finally, to understand usage trajectories, the reasons for discontinuation need to be considered, hence the post-usage phase is also relevant. Since this dissertation decidedly focuses on the interaction with activity trackers in everyday life, the investigation of actual or former activity tracker users is indicated. For this reason, two online surveys were conducted to assess these actual (former) users. The aim of the first study (N = 210) was to quantitatively analyze motivations for usage as well as unintended, negative effects of tracker usage in daily use. It was shown that tracking is performed both for an end in itself (intrinsic motivation) and to achieve an external goal (extrinsic motivation), and that these motivation types often occur simultaneously. Furthermore, it was shown that negative effects in terms of motivation losses with respect to tracker use as well as physical activity play a role in many users' daily lives. The likelihood of these effects occurring is partly determined by personal characteristics such as ATI and motivation for usage (Article 2). The second study examined former users (N = 159) and focused on the reasons for discontinuing use and the stability of abandonment. The results indicated that numerous barriers to use are decisive for the decision to discontinue tracking. In addition, abandonment decisions are often not permanent, suggesting episodic tracker use (Article 3). Finally, person and interaction characteristics were considered to explain the large variance in abandonment reasons and permanence. The analyses revealed, among other things, that episodic use (i.e., not definitive termination) is more likely when the motivation for usage is characterized by a high degree of self-determination (Article 4). In conclusion, the findings of the dissertation emphasize the central role of perceived self-determination in the context of human-tracker interaction and give rise to design guidelines that take into account the relationship between the tracking system and the user with all its interdependencies and individual characteristics in order to preserve or even strengthen self-determination through deeper self-knowledge

Needs and Attitudes of Older Chronic Back Pain Patients towards a Wearable for Ultrasound Biofeedback during Stabilization Exercises: A Qualitative Analysis

Chronic back pain has a high prevalence, especially in older adults, and seriously affects sufferers' quality of life. Segmental stabilization exercise (SSE) is often used during physiotherapy to enhance core stability. The execution of SSE requires the selective contraction of deep abdominal and back muscles. Motor learning can be supported using ultrasound imaging as visual biofeedback. ULTRAWEAR is a mobile ultrasound system that provides deep learning-based biofeedback on SSE execution, which is currently under development. We interviewed 15 older chronic back pain patients (CBPPs) to investigate their pain management behavior, experience with SSE, as well as their needs and requirements for ULTRAWEAR. We also gathered information about future-usage scenarios. CBPPs reported a high willingness to use the system as a feedback tool both in physiotherapeutic practices and at home. The automated detection and evaluation of muscle contraction states was highlighted as a major benefit of the system compared to the more subjective feedback provided by traditional methods such as palpation. The system to be developed was perceived as a helpful solution to support learning about SSE

Interactive Versus Static Decision Support Tools for COVID-19: Randomized Controlled Trial

Background: During the COVID-19 pandemic, medical laypersons with symptoms indicative of a COVID-19 infection commonly sought guidance on whether and where to find medical care. Numerous web-based decision support tools (DSTs) have been developed, both by public and commercial stakeholders, to assist their decision making. Though most of the DSTs’ underlying algorithms are similar and simple decision trees, their mode of presentation differs: some DSTs present a static flowchart, while others are designed as a conversational agent, guiding the user through the decision tree’s nodes step-by-step in an interactive manner. Objective: This study aims to investigate whether interactive DSTs provide greater decision support than noninteractive (ie, static) flowcharts. Methods: We developed mock interfaces for 2 DSTs (1 static, 1 interactive), mimicking patient-facing, freely available DSTs for COVID-19-related self-assessment. Their underlying algorithm was identical and based on the Centers for Disease Control and Prevention’s guidelines. We recruited adult US residents online in November 2020. Participants appraised the appropriate social and care-seeking behavior for 7 fictitious descriptions of patients (case vignettes). Participants in the experimental groups received either the static or the interactive mock DST as support, while the control group appraised the case vignettes unsupported. We determined participants’ accuracy, decision certainty (after deciding), and mental effort to measure the quality of decision support. Participants’ ratings of the DSTs’ usefulness, ease of use, trust, and future intention to use the tools served as measures to analyze differences in participants’ perception of the tools. We used ANOVAs and t tests to assess statistical significance. Results: Our survey yielded 196 responses. The mean number of correct assessments was higher in the intervention groups (interactive DST group: mean 11.71, SD 2.37; static DST group: mean 11.45, SD 2.48) than in the control group (mean 10.17, SD 2.00). Decisional certainty was significantly higher in the experimental groups (interactive DST group: mean 80.7%, SD 14.1%; static DST group: mean 80.5%, SD 15.8%) compared to the control group (mean 65.8%, SD 20.8%). The differences in these measures proved statistically significant in t tests comparing each intervention group with the control group (P<.001 for all 4 t tests). ANOVA detected no significant differences regarding mental effort between the 3 study groups. Differences between the 2 intervention groups were of small effect sizes and nonsignificant for all 3 measures of the quality of decision support and most measures of participants’ perception of the DSTs. Conclusions: When the decision space is limited, as is the case in common COVID-19 self-assessment DSTs, static flowcharts might prove as beneficial in enhancing decision quality as interactive tools. Given that static flowcharts reveal the underlying decision algorithm more transparently and require less effort to develop, they might prove more efficient in providing guidance to the public. Further research should validate our findings on different use cases, elaborate on the trade-off between transparency and convenience in DSTs, and investigate whether subgroups of users benefit more with 1 type of user interface than the other. Trial Registration: Deutsches Register Klinischer Studien DRKS00028136; https://tinyurl.com/4bcfausx (retrospectively registered

Facilitating stress prevention in micro and small-sized enterprises:Protocol for a mixed method study to evaluate the effectiveness and implementation process of targeted web-based interventions

BACKGROUND: Workplace-related stress is a major risk factor for mental and physical health problems and related sickness absence and productivity loss. Despite evidence regarding the effectiveness of different workplace-based interventions, the implementation of stress prevention interventions is rare, especially in micro and small-sized enterprises (MSE) with fewer than 50 employees. The joint research project “PragmatiKK”(+) aims to identify and address the specific barriers to the implementation of stress prevention interventions in MSE. This study protocol describes a mixed method study design to evaluate the effectiveness of adapted stress prevention interventions and the implementation process via an integrated web-based platform (“System P”) specifically targeted at MSE. METHODS: First, we develop a web-based intervention, which accounts for the specific working conditions in MSE and addresses stress prevention at a structural and behavioral level. Second, we use common methods of implementation research to perform an effect and process evaluation. We analyze the effectiveness of the web-based stress prevention interventions by comparing depressive symptoms at baseline and follow-up (after 6 months and 12 months). Indicators for a successful implementation process include acceptability, adoption, feasibility, reach, dose, and fidelity, which we will measure with quantitative web-based questionnaires and qualitative interviews. We will also analyze the accumulated usage data from the web-based platform. DISCUSSION: Collecting data on the implementation process and the effectiveness of a web-based intervention will help to identify and overcome common barriers to stress prevention in MSE. This can improve the mental health of employees in MSE, which constitute more than 90% of all enterprises in Germany. (+) Full Project Name: „PragmatiKK - Pragmatische Lösungen für die Implementation von Maßnahmen zur Stressprävention in Kleinst- und Kleinbetrieben “(= Pragmatic solutions for the implementation of stress prevention interventions in micro and small-sized enterprises). TRIAL REGISTRATION: German Register of Clinical Studies (DRKS): DRKS00026154, date of registration: 2021-09-16. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-022-12921-7

What do end-users really want? Investigation of human-centered XAI for mobile health apps

In healthcare, AI systems support clinicians and patients in diagnosis, treatment, and monitoring, but many systems' poor explainability remains challenging for practical application. Overcoming this barrier is the goal of explainable AI (XAI). However, an explanation can be perceived differently and, thus, not solve the black-box problem for everyone. The domain of Human-Centered AI deals with this problem by adapting AI to users. We present a user-centered persona concept to evaluate XAI and use it to investigate end-users preferences for various explanation styles and contents in a mobile health stress monitoring application. The results of our online survey show that users' demographics and personality, as well as the type of explanation, impact explanation preferences, indicating that these are essential features for XAI design. We subsumed the results in three prototypical user personas: power-, casual-, and privacy-oriented users. Our insights bring an interactive, human-centered XAI closer to practical application

What Do End-Users Really Want? Investigation of Human-Centered XAI for Mobile Health Apps

In healthcare, AI systems support clinicians and patients in diagnosis, treatment, and monitoring, but many systems' poor explainability remains challenging for practical application. Overcoming this barrier is the goal of explainable AI (XAI). However, an explanation can be perceived differently and, thus, not solve the black-box problem for everyone. The domain of Human-Centered AI deals with this problem by adapting AI to users. We present a user-centered persona concept to evaluate XAI and use it to investigate end-users preferences for various explanation styles and contents in a mobile health stress monitoring application. The results of our online survey show that users' demographics and personality, as well as the type of explanation, impact explanation preferences, indicating that these are essential features for XAI design. We subsumed the results in three prototypical user personas: power-, casual-, and privacy-oriented users. Our insights bring an interactive, human-centered XAI closer to practical application

Improvements in Patient Monitoring in the Intensive Care Unit: Survey Study

Background: Due to demographic change and, more recently, coronavirus disease (COVID-19), the importance of modern intensive care units (ICU) is becoming apparent. One of the key components of an ICU is the continuous monitoring of patients' vital parameters. However, existing advances in informatics, signal processing, or engineering that could alleviate the burden on ICUs have not yet been applied. This could be due to the lack of user involvement in research and development. Objective: This study focused on the satisfaction of ICU staff with current patient monitoring and their suggestions for future improvements. We aimed to identify aspects of monitoring that interrupt patient care, display devices for remote monitoring, use cases for artificial intelligence (AI), and whether ICU staff members are willing to improve their digital literacy or contribute to the improvement of patient monitoring. We further aimed to identify differences in the responses of different professional groups. Methods: This survey study was performed with ICU staff from 4 ICUs of a German university hospital between November 2019 and January 2020. We developed a web-based 36-item survey questionnaire, by analyzing a preceding qualitative interview study with ICU staff, about the clinical requirements of future patient monitoring. Statistical analyses of questionnaire results included median values with their bootstrapped 95% confidence intervals, and chi-square tests to compare the distributions of item responses of the professional groups. Results: In total, 86 of the 270 ICU physicians and nurses completed the survey questionnaire. The majority stated they felt confident using the patient monitoring equipment, but that high rates of false-positive alarms and the many sensor cables interrupted patient care. Regarding future improvements, respondents asked for wireless sensors, a reduction in the number of false-positive alarms, and hospital standard operating procedures for alarm management. Responses to the display devices proposed for remote patient monitoring were divided. Most respondents indicated it would be useful for earlier alerting or when they were responsible for multiple wards. AI for ICUs would be useful for early detection of complications and an increased risk of mortality; in addition, the AI could propose guidelines for therapy and diagnostics. Transparency, interoperability, usability, and staff training were essential to promote the use of AI. The majority wanted to learn more about new technologies for the ICU and required more time for learning. Physicians had fewer reservations than nurses about AI-based intelligent alarm management and using mobile phones for remote monitoring. Conclusions: This survey study of ICU staff revealed key improvements for patient monitoring in intensive care medicine. Hospital providers and medical device manufacturers should focus on reducing false alarms, implementing hospital alarm standard operating procedures, introducing wireless sensors, preparing for the use of AI, and enhancing the digital literacy of ICU staff. Our results may contribute to the user-centered transfer of digital technologies into practice to alleviate challenges in intensive care medicine. Trial registration: ClinicalTrials.gov NCT03514173; https://clinicaltrials.gov/ct2/show/NCT03514173

Examining the impact of a symptom assessment application on patient-physician interaction among self-referred walk-in patients in the emergency department (AKUSYM): study protocol for a multi-center, randomized controlled, parallel-group superiority trial

Background: Due to the increasing use of online health information, symptom checkers have been developed to provide an individualized assessment of health complaints and provide potential diagnoses and an urgency estimation. It is assumed that they support patient empowerment and have a positive impact on patient-physician interaction and satisfaction with care. Particularly in the emergency department (ED), symptom checkers could be integrated to bridge waiting times in the ED, and patients as well as physicians could take advantage of potential positive effects. Our study therefore aims to assess the impact of symptom assessment application (SAA) usage compared to no SAA usage on the patient-physician interaction in self-referred walk-in patients in the ED population. Methods: In this multi-center, 1:1 randomized, controlled, parallel-group superiority trial, 440 self-referred adult walk-in patients with a non-urgent triage category will be recruited in three EDs in Berlin. Eligible participants in the intervention group will use a SAA directly after initial triage. The control group receives standard care without using a SAA. The primary endpoint is patients’ satisfaction with the patient-physician interaction assessed by the Patient Satisfaction Questionnaire. Discussion: The results of this trial could influence the implementation of SAA into acute care to improve the satisfaction with the patient-physician interaction. Trial registration: German Clinical Trials Registry DRKS00028598. Registered on 25.03.2022

Männlich, mittelalt, gebildet - oder? Eine Charakterisierung deutschsprachiger Podcaster:innen

Podcasts erfahren nicht nur auf Seite der Hörenden eine immer stärkere Verbreitung. Auch die Zahl podcastproduzierender Personen steigt und macht Podcasts zu einem der aktuell wichtigsten partizipativen Medien. Zur Charakterisierung der Gruppe der Podcaster:innen liegen allerdings bisher nur wenige, überwiegend demographische Daten vor. Die vorliegende Arbeit soll daher dazu beitragen, die deutschsprachigen Podcastproduzierenden in drei Analysebereichen zu beschreiben: im Hinblick auf demographische, podcastspezifische und Persönlichkeitsvariablen. Mittels eines Online-Fragebogens wurden Daten von 653 Podcaster:innen gesammelt. Die Arbeit bietet erste Einblicke in die Diversität der deutschsprachigen Podcastproduzierenden und legt ein besonderes Augenmerk auf die Untersuchung von Geschlechterunterschieden

Web-based occupational stress prevention in German micro- and small-sized enterprises – process evaluation results of an implementation study

Background: Structural and behavioral interventions to manage work-related stress are effective in employees. Nonetheless, they have been implemented insufficiently, particularly in micro- and small-sized enterprises (MSE). Main barriers include a lack of knowledge and limited resources, which could potentially be overcome with simplified web-based alternatives for occupational stress prevention. However, there is a lack of implementation research about web-based prevention in realistic settings of MSE.Objective: The aim of this study is to evaluate the implementation process and success of an integrated web-based platform for occupational stress prevention (“System P”) and to identify potential barriers for its uptake and use in MSE in Germany. Methods: This study with a mixed-methods approach investigates eight process-related outcomes in a quantitative part I (adoption, reach, penetration, fidelity/dose, costs, acceptability) and a qualitative part II (acceptability, appropriateness and feasibility). Part I has a pre-post design with two measurements (6 months apart) with 98 individual participants and part II consists of 12 semi-structured interviews with managers and intercorporate stakeholders.Results: Part I revealed shortcomings in the implementation process. Adoption/Reach: Despite extensive marketing efforts, less than 1% of the contacted MSE responded to the offer of System P. A total of 40 MSE registered, 24 of which, characterized by good psychosocial safety climate, adopted System P. Penetration: Within these 24 MSE, 15% of the employees used the system. Fidelity/Dose: 11 MSE started a psychosocial risk-assessment (PRA), and no MSE finished it. The stress-management training (SMT) was started by 25 users and completed by 8. Costs: The use of System P was free of charge, but the time required to engage with was an indirect cost. Part II added insights on the perception of the web-based intervention: Acceptance of System P by users and stakeholders was good and it was assessed as appropriate for MSE. Results for feasibility were mixed. Conclusions: Although System P was generally perceived as useful and appropriate, only a small number of contacted MSE implemented it as intended. Prior experience and sensitivity for occupational (stress) prevention were mentioned as key facilitators, while (perceived) indirect costs were a key barrier. Enabling MSE to independently manage stress prevention online did not result in successful implementation. Increasing external support could be a solution. ⁺ Full project name: “PragmatiKK – Pragmatische Lösungen für die Implementation von Maßnahmen zur Stressprävention in Kleinst- und Kleinbetrieben” (= Pragmatic solutions for the implementation of stress prevention interventions in micro and small-sized enterprises). Trial registration: German Register of Clinical Studies (DRKS) DRKS00026154, date of registration 2021-09-16.</p