A Population-Based Survey

Background: Chronic conditions pose a challenge for individuals and for the health care system. The use of smartphones and mobile health apps could help managing chronic conditions and changing health behaviors that are associated with these conditions. Objective: The present study investigated (1) the proportion of smartphone use and health app use, (2) putative associations of social as well as individual factors with the smartphone use and health app use, and (3) correlates of app usage and app characteristics with reported health behaviors. Methods: A population-based survey among 4144 German residents, aged 35 years and older, was conducted. Assessments took place at home visits and sociodemographic factors as well as health status, health behaviors, quality of life, and health literacy, and the use of the Internet, smartphone, and health apps were measured. Binary logistic regression models were applied. Results: Analyses showed that almost two thirds of the sample used a smartphone. Smartphone users were, on average, younger, did more research on the Internet, were more likely to work fulltime and more likely to have a university degree, engaged more in physical activity, and less in low fat diet, and had a higher health-related quality of life and health literacy than nonusers. Health apps were used by a fifth of the smartphone users. Health app users were younger, did more research on the Internet, were less likely to be native German speakers, were more likely to be chronically ill, engaged more in physical activity, and low fat diet, and were more health literate compared to those who had a smartphone without any health app. Health apps mainly focused on smoking cessation, healthy diet, and weight loss. The most widespread app characteristics were planning, reminding, prompting motivation, and the provision of information. Analysis revealed that the app characteristic planning was associated with physical activity and so was feedback or monitoring. Further, monitoring of behavior was associated with adherence to doctor’s advice. Conclusions: The present study reveals that mobile health apps are an important tool for people suffering from chronic conditions. This offers great opportunities as health apps may support individuals in changing health detrimental behavior or maintain health promoting behavior. Our findings suggest disparities in access to health apps related to age, socioeconomic status, health literacy, and health. Accordingly, the needs of older people, of people with low health literacy, and chronic conditions should be taken into account.Hintergrund: Chronische Erkrankungen sind eine Herausforderung für die Betroffenen, sowie für das Gesundheitswesen. Smartphones und Gesundheits-Apps können eine Möglichkeit darstellen, mit chronischen Erkrankungen umzugehen und gesundheitsbezogene Verhaltensweisen zu verändern, welche mit diesen Erkrankungen assoziiert sind. Thema: Folgende Ziele wurden untersucht: 1) Die Verbreitung von Smartphones und GesundheitsApps, 2) potentielle Assoziationen soziodemographischer, medizinischer und verhaltensbezogener Parameter mit der Nutzung von Smartphones und Gesundheits-Apps, 3) mögliche Zusammenhänge der Nutzung bestimmter Gesundheits-Apps und App-Features mit gesundheitsbezogenem Verhalten. Methoden: Eine bundesweite, repräsentative Umfrage mit 4144 Teilnehmern wurde durchgeführt. Die Teilnehmer wurden bei sich zuhause zu soziodemografischen Faktoren, ihrem Gesundheitsstatus, gesundheitsbezogenem Verhalten, Lebensqualität, Gesundheitskompetenz und dem Einsatz von Smartphones, Gesundheits-Apps und App-Features befragt. Analysen erfolgten anhand binär logistischer Regressionen. Ergebnisse: Annähernd zwei Drittel der Teilnehmer besaß ein Smartphone. Smartphone-Nutzer waren im Vergleich zu Nicht-Nutzern jünger, informierten sich eher im Internet über Gesundheitsthemen, arbeiteten häufiger in Vollzeit, besaßen häufiger einen Hochschulabschluss, ernährten sich seltener fettarm, trieben häufiger Sport und zeigten eine höhere Gesundheitskompetenz und Lebensqualität. Jeder fünfte Nutzer eines Smartphones gab an, auch Gesundheits-Apps zu nutzen. Nutzer dieser Applikationen waren signifikant jünger, seltener deutsche Muttersprachler, informierten sich häufiger im Internet über Gesundheitsthemen, waren vermehrt chronisch erkrankt, häufiger körperlich aktiv, ernährten sich öfter fettarm und waren gesundheitskompetenter auf als jene Smartphone-Nutzer, die keine Gesundheits-Apps nutzten. Die Mehrzahl der genutzten Gesundheits-Apps unterstützte die Anwender dabei, mit dem Rauchen aufzuhören, sich gesund zu ernähren und Gewicht zu reduzieren. Dabei gaben die Teilnehmer an, vor allem folgende Features in den GesundheitsApps zu nutzen: Unterstützung bei Planung, Erinnerung, Motivation und Information. Hierbei zeigte sich, dass Teilnehmer, welche Apps zur Planung verwendeten, häufiger körperlich aktiv waren als jene, die kein Planungs-Feature verwendeten. Nutzer von Apps mit Verlaufskontrollen (Monitoring) waren häufiger körperlich aktiv und folgten eher dem Rat ihres Arztes als Leute, die andere Gesundheits-Apps benutzten. Schlussfolgerung: Die Nutzung von Gesundheits-Apps scheint für chronisch Erkrankte von hoher Bedeutung zu sein. Darum bieten Apps eine große Chance, Menschen dabei zu unterstützen, gesundheitsschädigende Verhaltensweisen zu verändern bzw. förderliche Gesundheitsverhaltensweisen aufzunehmen oder aufrecht zu erhalten. Ein beträchtlicher Anteil der Bevölkerung hat jedoch erschwerten Zugang zu Gesundheits-Apps. Dazu zählten vorrangig ältere Menschen und solche, die einer niedrigeren sozialen Bevölkerungsschicht angehörten oder eine geringere Gesundheitskompetenz aufwiesen. App-Entwickler und Forscher sollten daher künftig verstärkt die Bedürfnisse chronisch erkrankten Menschen, älteren Personen und Leuten mit geringer Gesundheitskompetenz in den Fokus rücken

A Population-Based Survey

Background: Chronic conditions are an increasing challenge for individuals and the health care system. Smartphones and health apps are potentially promising tools to change health-related behaviors and manage chronic conditions. Objective: The aim of this study was to explore (1) the extent of smartphone and health app use, (2) sociodemographic, medical, and behavioral correlates of smartphone and health app use, and (3) associations of the use of apps and app characteristics with actual health behaviors. Methods: A population-based survey (N=4144) among Germans, aged 35 years and older, was conducted. Sociodemographics, presence of chronic conditions, health behaviors, quality of life, and health literacy, as well as the use of the Internet, smartphone, and health apps were assessed by questionnaire at home visit. Binary logistic regression models were applied. Results: It was found that 61.25% (2538/4144) of participants used a smartphone. Compared with nonusers, smartphone users were younger, did more research on the Internet, were more likely to work full-time and more likely to have a university degree, engaged more in physical activity, and less in low fat diet, and had a higher health-related quality of life and health literacy. Among smartphone users, 20.53% (521/2538) used health apps. App users were younger, less likely to be native German speakers, did more research on the Internet, were more likely to report chronic conditions, engaged more in physical activity, and low fat diet, and were more health literate compared with nonusers who had a smartphone. Health apps focused on smoking cessation (232/521, 44.5%), healthy diet (201/521, 38.6%), and weight loss (121/521, 23.2%). The most common app characteristics were planning (264/521, 50.7%), reminding (188/521, 36.1%), prompting motivation (179/521 34.4%), and the provision of information (175/521, 33.6%). Significant associations were found between planning and the health behavior physical activity, between feedback or monitoring and physical activity, and between feedback or monitoring and adherence to doctor’s advice. Conclusions: Although there were many smartphone and health app users, a substantial proportion of the population was not engaged. Findings suggest age-related, socioeconomic-related, literacy-related, and health-related disparities in the use of mobile technologies. Health app use may reflect a user’s motivation to change or maintain health behaviors. App developers and researchers should take account of the needs of older people, people with low health literacy, and chronic conditions

Using Smartphones and Health Apps to Change and Manage Health Behaviors: A Population-Based Survey

Background: Chronic conditions are an increasing challenge for individuals and the health care system. Smartphones and health apps are potentially promising tools to change health-related behaviors and manage chronic conditions.  Objective: The aim of this study was to explore (1) the extent of smartphone and health app use, (2) sociodemographic, medical, and behavioral correlates of smartphone and health app use, and (3) associations of the use of apps and app characteristics with actual health behaviors.  Methods: A population-based survey (N=4144) among Germans, aged 35 years and older, was conducted. Sociodemographics, presence of chronic conditions, health behaviors, quality of life, and health literacy, as well as the use of the Internet, smartphone, and health apps were assessed by questionnaire at home visit. Binary logistic regression models were applied.  Results: It was found that 61.25% (2538/4144) of participants used a smartphone. Compared with nonusers, smartphone users were younger, did more research on the Internet, were more likely to work full-time and more likely to have a university degree, engaged more in physical activity, and less in low fat diet, and had a higher health-related quality of life and health literacy. Among smartphone users, 20.53% (521/2538) used health apps. App users were younger, less likely to be native German speakers, did more research on the Internet, were more likely to report chronic conditions, engaged more in physical activity, and low fat diet, and were more health literate compared with nonusers who had a smartphone. Health apps focused on smoking cessation (232/521, 44.5%), healthy diet (201/521, 38.6%), and weight loss (121/521, 23.2%). The most common app characteristics were planning (264/521, 50.7%), reminding (188/521, 36.1%), prompting motivation (179/521 34.4%), and the provision of information (175/521, 33.6%). Significant associations were found between planning and the health behavior physical activity, between feedback or monitoring and physical activity, and between feedback or monitoring and adherence to doctor’s advice.  Conclusions: Although there were many smartphone and health app users, a substantial proportion of the population was not engaged. Findings suggest age-related, socioeconomic-related, literacy-related, and health-related disparities in the use of mobile technologies. Health app use may reflect a user’s motivation to change or maintain health behaviors. App developers and researchers should take account of the needs of older people, people with low health literacy, and chronic conditions

Associations of Health App Use and Perceived Effectiveness in People With Cardiovascular Diseases and Diabetes: Population-Based Survey

Background: Mobile health apps can help to change health-related behaviors and manage chronic conditions in patients with cardiovascular diseases (CVDs) and diabetes mellitus, but a certain level of health literacy and electronic health (eHealth) literacy may be needed. Objective: The aim of this study was to identify factors associated with mobile health app use in individuals with CVD or diabetes and detect relations with the perceived effectiveness of health apps among app users. Methods: The study used population-based Web-based survey (N=1500) among Germans, aged 35 years and older, with CVD, diabetes, or both. A total of 3 subgroups were examined: (1) Individuals with CVD (n=1325), (2) Individuals with diabetes (n=681), and (3) Individuals with CVD and diabetes (n=524). Sociodemographics, health behaviors, CVD, diabetes, health and eHealth literacy, characteristics of health app use, and characteristics of apps themselves were assessed by questionnaires. Linear and logistic regression models were applied. Results: Overall, patterns of factors associated with health app use were comparable in individuals with CVD or diabetes or both. Across subgroups, about every fourth patient reported using apps for health-related purposes, with physical activity and weight loss being the most prominent target behaviors. Health app users were younger, more likely to be female (except in those with CVD and diabetes combined), better educated, and reported more physical activity. App users had higher eHealth literacy than nonusers. Those users who perceived the app to have a greater effectiveness on their health behaviors tended to be more health and eHealth literate and rated the app to use more behavior change techniques (BCTs). Conclusions: There are health- and literacy-related disparities in the access to health app use among patients with CVD, diabetes, or both, which are relevant to specific health care professionals such as endocrinologists, dieticians, cardiologists, or general practitioners. Apps containing more BCTs had a higher perceived effect on people’s health, and app developers should take the complexity of needs into account. Furthermore, eHealth literacy appears to be a requirement to use health apps successfully, which should be considered in health education strategies to improve health in patients with CVD and diabetes

Antibiotic use, knowledge and health literacy among the general population in Berlin, Germany and its surrounding rural areas.

Knowledge concerning antibiotic use in the general population is insufficient. The way health literacy is related to antibiotic use aside from knowledge needs further investigation. Our aim was to compare the levels of knowledge of antibiotics and health literacy in individuals who had taken antibiotics in recent years compared with those who not had taken antibiotics.A population-based cross-sectional survey of 2,000 individuals aged 35 and older from Berlin, Germany and its surrounding rural and suburban areas (response rate 59%) with strata urban/rural, sex, age, and education. Computer-assisted personal interviews were conducted by external, trained interviewers during home visits. Knowledge, health literacy, and antibiotic use were assessed using standardized questionnaires.In all, 33.3% (666/2,000) of the participants indicated having had an antimicrobial therapy during the previous 12 months. Adjusting for sex, age, educational level and health literacy, individuals with four correct answers regarding antibiotics were 1.70 times and those with three correct answers 1.94 more likely to have had a history of recent antibiotic use than those who did not have any correct answers. Individuals with sufficient health literacy were 0.57 times less likely to have had a recent history of antibiotic use than individuals with insufficient health literacy.Patients who have used antibiotics might have more knowledge as a result of their recent involvement with the topic of antibiotic use; health literacy may be a preventive mechanism to use antibiotics more critically. Besides improving the health knowledge of the general population and of vulnerable groups such as patients with low levels of health literacy, intervention strategies should focus on providers as well

Patients’ health literacy in relation to the preference for a general practitioner as the source of health information

Background: For many patients, the general practitioner (GP) is the most important point of contact for obtaining information about a wide range of health topics. However, patients with different characteristics may seek health information from different sources, such as friends or the internet. The relationship between patient characteristics and preferences for information sources is understudied. We investigate which information sources are used by patients for health-related questions and how this relates to patients’ sociodemographics, health, and health literacy. Methods: A stratified and population-based survey was conducted to investigate health information sources within the German population over 35 years (n = 4144). Sociodemographics, use of technology, health-related indicators, and health literacy (including self-efficacy and action planning), as well as questions regarding the ratings of multiple health-related information sources, were investigated in personal interviews and analyzed using logistic regression. Results: In our study, GPs were the most important source of information for the patients, followed by medical specialists, pharmacists and the internet. Patient age and number of illnesses were associated with the choice of information source. Furthermore, action planning and self-efficacy for acquiring health knowledge were associated with the selected source of information. Conclusions: Information provider appears to be an important role for GPs, particularly among old and chronically ill patients. GPs should have the specific capabilities to fill this role and should be trained and referred to accordingly. Selfefficacy and action planning for acquiring health knowledge are important patient factors doctors can use for brief inventions during consultations

Multivariate associations with history of antibiotics.

<p>A cross-sectional survey of a population-based sample of 2,000 individuals from Berlin and its surrounding rural and suburban areas.</p

Main reasons for having antimicrobial therapy.

<p>Cross-sectional survey of a population-based sample of 2,000 individuals from Berlin and its surrounding rural and suburban areas. Note. UTI, urinary tract infection; SSI, surgical site infection. 12.8% noted for other reasons and 7.9% I don´t know.</p