Building Habits in the Digital Age: Incorporating Psychological Needs and Knowledge from Practitioners to Inform the Design of Digital Therapeutics

Interventions for noncommunicable diseases (NCDSs) often require changing behaviors. In this regard, habitual behaviors (i.e., habits) are positively evaluated to foster behavioral changes. Forming habits is challenging but can be supported digitally until the habit is formed. This paper reviews the requirements of forming habits and uses a content analysis to investigate how these requirements are implemented in habit apps. Based on the results, design principles to digitally support habit formation are discussed for digital therapeutics. In contrast to conventional apps, digital therapeutics have a definite medical purpose and can be prescribed for the time it needs for a habit to form. The analysis results reveal that conventional apps try to bind the user and ignore the state where the habit needs to be strengthened by decreasing technology use. In this regard, digital therapeutics reveal great potential in supporting the formation of habits to prevent and treat NCDs

Digitale Gesundheitsanwendungen (DiGA) im Spannungsfeld von Fortschritt und Kritik : Diskussionsbeitrag der Fachgruppe „Digital Health“ der Gesellschaft für Informatik e. V. = Digital health applications (DiGA) in the area of tension between progress and criticism – Discussion paper from the “Digital health” specialist group of the German Informatics Society

Im Dezember 2019 wurden in Deutschland Digitale Gesundheitsanwendungen (DiGA) in die Regelversorgung aufgenommen und können somit durch die gesetzlichen Krankenkassen erstattet werden, um PatientInnen bei der Behandlung von Erkrankungen oder Beeinträchtigungen zu unterstützen. Inzwischen gibt es 48 DiGA (Stand: Oktober 2023) im Verzeichnis des Bundesinstituts für Arzneimittel und Medizinprodukte (BfArM), die vor allem in den Bereichen mentale Gesundheit, Hormone und Stoffwechsel sowie Muskeln, Knochen und Gelenke eingesetzt werden. In diesem Artikel beschreibt die Fachgruppe „Digital Health“ der Gesellschaft für Informatik e. V. (GI) die aktuellen Entwicklungen rund um die DiGA sowie das derzeitige Stimmungsbild zu Themen wie Nutzerzentrierung, Akzeptanz von PatientInnen und Behandelnden sowie Innovationspotenzial. Zusammenfassend haben DiGA in den letzten 3 Jahren eine positive Entwicklung in Form eines langsam steigenden Angebots verschiedener DiGA und Leistungsbereiche erfahren. Nichtsdestotrotz sind in einigen Bereichen noch erhebliche regulatorische Weichenstellungen notwendig, um DiGA langfristig in der Regelversorgung zu etablieren. Zentrale Herausforderungen bestehen u. a. in der Nutzerzentrierung oder in der nachhaltigen Verwendung der Anwendungen

All together now – patient engagement, patient empowerment, and associated terms in personal healthcare

Background - Patients as active partners in their personal healthcare are key drivers to reducing costs, securing an effective usage of resources, and ensuring patient-provider satisfaction. Even though these benefits are acknowledged, a theoretical framework for the plethora of concepts used in this context, such as patient engagement, patient empowerment, or patient involvement is missing. Furthermore, the heterogeneous or synonymous usage of these terms leads to miscommunication, missing standard conceptual measures, and a deficiency in theory building and testing. Our objective is to show what the relationships and distinctions between concepts focussing on patients as active partners in their personal healthcare are. - Methods - systematic literature review was conducted to consolidate terms related to patients’ having an active role in their healthcare. From 442 articles screened in PubMed, a final set of 17 papers was included. Any articles conceptualising or presenting relationships between the concepts were included. Information was synthesised, and contradictions were unravelled systematically. The concepts and their relationships are structured and represented by employing a concept map. - Results - Patient-centredness is a concept dominantly influenced by health care providers and can enhance patients’ competencies, attitudes, and behaviours towards their personal healthcare. Enabling patients to become more empowered can ultimately lead to their greater involvement and engagement. Fostering an active role of patients can also increase their adherence to the care pathway. In general, patient engagement seems to be the most conclusive and furthest developed concept in terms of turning patients into active partners in their personal healthcare. - Conclusions We plead for a stricter demarcation and therefore a terminological standardisation of the terms in the future to avoid further ambiguity and miscommunication. The concept map presents a basis for a uniform understanding and application of the concepts. Through a comprehensive understanding of the terms and their dimensions, relationships between the concepts can be utilised, measures can be derived, and theory building and testing can be enhanced, leading to better acceptance and utilisation of concepts in healthcare services. Furthermore, patient engagement is presented to be the most conclusive and furthest developed concept in the subject area

Validating the Concept of Patient Pathways: A European Survey on Their Characteristics, Definition and State of Practice

Patient pathways (PPs) are considered a valuable instrument for managing integrated, patient-centred healthcare services. Still, a uniform understanding and definition of PPs is lacking, leading to misunderstandings and inconsistent use in both science and practice. Accordingly, the objective of this paper is to assess the practical view of PP stakeholders on characteristics, a definition and current implementation practice. Building on the findings of a previous systematic scoping review, a questionnaire was developed, tested and applied in the domain of cancer care. The findings show broad acceptance of the PP characteristics surveyed. The initial PP definition was revised using respondents’ suggestions for modification. Existing diversity in practical PP usage is identified, but high expectations regarding positive impacts on care delivery are confirmed. Further work will continue the validation in other healthcare domains of complex, chronic diseases. This work contributes to drive PP implementation by shedding light on the perspective of practice

Die Generation Alpha der Digital Health Innovationen – Eine Fallstudie aus der Multiple Sklerose Versorgung

Die digitale Transformation im Gesundheitswesen ermöglicht durch die Entwicklung zahlreicher neuer Technologien und Standards eine zunehmend individualisierte, bedarfsgerechte und berufsgruppenübergreifende Versorgung von Patienten. Diese neue Generation von Digital Health Innovationen – die Digital Health Generation Alpha (in Anlehnung an die korrespondierende Alterskohorte) – erfüllt Informations‑, Kommunikations- und Interoperabilitätsanforderungen entlang des gesamten Versorgungsprozesses, die aufgrund von abgegrenzten Leistungs- und Zuständigkeitsbereichen sowie Vergütungsregelungen oft eine unüberwindbare Hürde dargestellt haben. Im Beitrag werden mit der i) Pfadorientierung, ii) Patientenorientierung und -einbeziehung, iii) Qualitätsorientierung und iv) Integrationsfähigkeit vier zentrale Gestaltungsdimensionen von Digital Health Innovationen der Generation Alpha vorgestellt. Diese werden literaturgestützt aufgearbeitet und deren praktische Umsetzung anhand einer Fallstudie im Bereich der Versorgung von Patienten mit Multipler Sklerose aufgezeigt. Zentrale Leitfragen, konkrete Umsetzungsmaßnahmen und literaturgestützte Gestaltungsziele werden anhand eines prototypischen Vorgehensmodells beschrieben. Anhand der Fallstudie werden anschließend Implikationen für die zukünftige Digital Health Agenda abgeleitet, welche insbesondere für die Realisierung innovativer Werteversprechen und deren Integration in komplexe Zielumgebungen des Gesundheitswesens notwendig sind.Through the development of numerous new technologies and standards the digital health care transformation progressively enables an individualized, need-based, and interprofessional treatment provision. The new generation of digital health innovations—in analogy to the age cohorts, the digital health generation alpha—can therefore fulfill information, communication, and interoperability tasks along the entire care process, that previously often represented an insurmountable challenge. The four design dimensions of digital health generation alpha are introduced: i) pathway orientation, ii) patient orientation and involvement, iii) quality orientation, and iv) integration capability. These are first discussed on basis of current literature and their practical utilization is then demonstrated in a case study on patients with multiple sclerosis. A process model for pathway development is presented that incorporates the four design dimensions and transforms a treatment process into a digital, participative, and integrated care model. Central guiding questions, concrete implementation measures and literature-based design goals are described based on the process model. Finally, implications for the future digital health agenda are derived, which are particularly necessary for the realization of innovative value propositions and their integration into complex healthcare target environments

Digitale Gesundheitsanwendungen (DiGA) im Spannungsfeld von Fortschritt und Kritik

Since December 2019, digital health applications (DiGA) have been included in standard care in Germany and are therefore reimbursed by the statutory health insurance funds to support patients in the treatment of diseases or impairments. There are 48 registered DiGA listed in the directory of the Federal Institute of Drugs and Medical Devices (BfArM), mainly in the areas of mental health; hormones and metabolism; and muscles, bones, and joints. In this article, the “Digital Health” specialist group of the German Informatics Society describes the current developments around DiGA as well as the current sentiment on topics such as user-centricity, patient and practitioner acceptance, and innovation potential. In summary, over the past three years, DiGA have experienced a positive development, characterized by a gradually increasing availability of various DiGA and coverage areas as well as prescription numbers. Nevertheless, significant regulatory adjustments are still required in some areas to establish DiGA as a well-established instrument in long-term routine healthcare. Key challenges include user-centeredness and the sustainable use of the applications