[Participatory health research: origins and current trends]

[Designing participation-promoting digital health literacy : Experiences from developing a course programme for people with chronic diseases]

BACKGROUND

Patient organisations are increasingly calling for a participatory approach to health research. In the "KundiG - Klug und digital durch das Gesundheitswesen" project, the perspective of chronically ill people was included in the development of a training programme for digital health literacy (dGK). The aim of this work is to show the personal effort involved in the participatory development of a training programme and the prerequisites for this.

METHODS

During the project period (April 2021 to March 2023), a basic concept was developed by the researchers and continuously refined in a structured participatory process with regard to content, depth of topics, procedure, didactics and course materials. A participation model was created for this purpose. A formative evaluation took place as part of eight pilot courses.

RESULTS

A total of 20 people were involved in the working groups and the evaluation, including 6 from organised self-help, 3 from BARMER and 11 from the Hannover Medical School. The participatory collaboration was labour intensive and tightly scheduled, meaning that not all members were able to participate to the same extent. The result was an internet-based training programme that received positive feedback and suggestions for improvement from the participants in the pilot courses. The result was a 15-hour online course to promote dGK, a 300-page course manual and six digital, accessible booklets.

DISCUSSION

Participation meant the active involvement of all participants in the entire process, a high number of appointments, the consideration of different perspectives and a constant endeavour to reach a consensus. Prior training of the participants could be helpful in future projects. The roll-out of the programme and continuous evaluation in the context of self-help are in preparation.

Digital solutions for migrant and refugee health: a framework for analysis and action

Digital technologies can help support the health of migrants and refugees and facilitate research on their health issues. However, ethical concerns include security and confidentiality of information; informed consent; how to engage migrants in designing, implementing and researching digital tools; inequitable access to mobile devices and the internet; and access to health services for early intervention and follow-up. Digital technical solutions do not necessarily overcome problems that are political, social, or economic. There are major deficits with regard to (1) reliable data on the health needs of migrants and mobile populations and on how they can use digital tools to support their health; (2) evidence on effectiveness of solutions; and (3) a broad framework to guide future work. This article provides a wide socio-technical perspective, as a framework for analysis and developing coherent agendas across global-to-local spaces, with particular attention to the European region.

[Effects of citizen involvement and participation in knowledge processes of integrated municipal health promotion: a systematic scoping review]

BACKGROUND

Participation and its preliminary stages are recognized requirements in various fields of public health. By means of a scoping review, the impact of participation and its preliminary stages of residents in knowledge-generating processes in integrated municipal health promotion are systematically investigated and presented.

METHODS

The scoping review was conducted in accordance with the PRISMA framework and extended by systematic manual research. An analysis grid was developed based on the impact model of community-based participatory research and the PHINEO impact model.

RESULTS

In total, 30 publications from six subprojects of research alliances (also publications across research consortia) and six independent projects were analysed. Impact was mostly shown regarding positive changes in awareness and skills for the residents and stakeholder that were directly involved. To a smaller extent, impact was also reported for residents and stakeholders that did not participate in the projects. Changes in conditions and life circumstance for residents resulted from changes in the awareness and actions of the stakeholders involved in the projects.

DISCUSSION

The impact of participation and its preliminary stages of residents in knowledge-generating processes of integrated municipal health promotion is broad and exceeds the target group of the (sub)project. At the same time, impact going beyond the directly involved residents or stakeholders is rarely described. Adequate funding and resources are necessary to systematically facilitate, evaluate and disseminate participatory knowledge-generating processes.

[Involvement of representatives of patients and relatives in guideline processes : S3 guidelines on psychosocial therapies for severe mental illnesses breaks new ground]

BACKGROUND

The participation of representatives of patients and relatives in the development of guidelines is of central importance for the quality, feasibility and acceptance of guidelines. In Germany this has not been sufficiently implemented in the discipline of psychiatry, although in practice there are many examples for the benefits of the expertise of people with psychiatric experience.

OBJECTIVE

The article describes the development and a first process evaluation of a trialogical working group (AG Impuls) accompanying the guideline process. Possibilities for further development and implementation are discussed.

METHODS

Description of the working process of the Impuls working group as well as the results of the satisfaction survey after 18 months and summarised content analysis.

RESULTS

Concept: during the further development of the S3 guidelines on psychosocial therapies, the expertise of 12 experts is bundled in the Impuls working group and supported by the members of the steering group. An open discussion takes place in regular digital working meetings and face to face meetings are held once a year as part of the German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) congress. The results are presented to the guideline committee at the consensus conferences. Text boxes from the Impuls working group constitute an important tool.

EVALUATION

the following topics were identified in connection with the participatory work: (a) exchange at eye level, broadening perspectives and contributing impulses, (b) giving a voice to experienced experts, (c) implementation requirements and possibilities and (d) limitations of the cooperation. Various preconditions and implementation requirements for long-term successful participation in guideline development were identified.

CONCLUSION

The Impuls working group can be used to specifically address insufficient participation in guideline processes. The structured approach could form a blueprint for other guideline processes.

[Developing Knowledge Together: Participatory Methods in Psychological and Neuroscientific Research with Children and Adolescents]

Developing Knowledge Together: Participatory Methods in Psychological and Neuroscientific Research with Children and Adolescents Abstract: Participatory action research understands the implementation of research as a cooperation or coproduction of researchers with nonscientific individuals. However, the general knowledge about the participatory approach as well as participatory methods and their implementation is still limited. Especially the active involvement and empowerment of children and adolescents require special measures and a creative and flexible application of various methods. In addition, the use of participatory methods in neurodevelopmental research first demands prior explanation of complex techniques to successfully implement the cooperation and coproduction between researchers and children and adolescents. In this contribution, we emphasize the relevance of the participatory approach for scientific work, present different methods that allow an introduction of complex techniques in neurodevelopmental research, and illustrate how to systematically apply this approach to research in children and adolescents.

Development of an interprofessional diagnostic toolkit to enhance outside walking gait-related participation of people after stroke in Germany: study protocol of an ongoing multi-methods study

INTRODUCTION

Persons after stroke experience limitations in activities of daily living even in the chronic phase. Many patients who had a stroke report mobility limitations with loss of social roles such as reduced gait-related participation. International best-practice recommendations for patients who had a stroke include interprofessional diagnostics as a core element for goal setting and intervention planning to improve social participation. Interprofessional diagnostics has not yet been implemented in Germany.

METHODS AND ANALYSIS

The aim is to develop an interprofessional diagnostic toolkit. This will be done in a multi-step process: first, an integrative review is conducted to synthesise the literature. Second, the experiences regarding diagnostics and walking outside is captured in focus groups with persons after stroke, relatives and health professionals. Third, a toolkit for the interprofessional diagnostic process of gait-related-participation will be developed based on the results of the previous steps in a future workshop. Fourth, the results of each work package will be integrated into the iterative development process for evaluation and implementation. All steps will be performed in accordance with the respective reporting guidelines.

ETHICS AND DISSEMINATION

This study has been approved by the ethics committee at the Ludwig Maximilians University (LMU), Germany and is overseen by LMU-Medical Institutional Review Board. Written informed consent will be obtained from all participants. Results will be disseminated through knowledge exchange with stakeholders and in peer-reviewed journal publications, scientific conferences, formal and informal reports. Stakeholders, patients and providers will be involved in most steps of the development from the beginning, which will facilitate later implementation at a larger scale.

TRIAL REGISTRATION NUMBER

German Register Clinical Trials/Deutsches Register Klinischer Studien DRKS00032389.

[Participatory Design of Health Technologies - Challenges and Requirements for Action from the Perspective of Health Services Research]

The use of participatory design (PD) provides a framework for involving users in the process of developing healthcare technologies. Within PD, theoretical and methodological decisions need to be made. However, these decisions are often not adequately described or justified. This can lead to limited interpretability of the results. This paper has three objectives: First, to provide an overview of the key theoretical and methodological decisions that must be made in PD from the perspective of health services research; second, to describe the associated challenges and third, to describe action requirements for the future development of PD in health services research.

The participation of hard-to-reach older people in the research and development process of health technologies from the perspective of multipliers-A qualitative analysis

Introduction

The participation of older people in research and development processes has long been called for but has not been sufficiently put into practice. In addition, participation is often late and not particularly intensive, so that certain older groups of people are underrepresented in the development of health technologies (HT). Heterogeneity, e.g., between urban and rural populations, in access to and motivation for participation is also rarely taken into account. The aim of this study was to investigate form and phases of participation for hard-to-reach older people in the research and development process of HT.

Methods

The qualitative study among multipliers was conducted using focus groups and telephone interviews and took place in a city and an adjacent rural area in northwestern Lower Saxony, Germany. A content analysis of the data was undertaken using deductive-inductive category formation.

Results

Seventeen participants (13 female) took part in the study (median age 61, 33-73). Participants from both areas identified particular forms and phases of participation in the research and development process. Longer forms of participation for hard-to-reach groups and the development process of technologies for older people from the rural area were viewed as challenges. Passive and active access strategies are needed to achieve sufficient heterogeneity in the research and development process. Trusted multipliers can play an important role in gaining access to hard-to-reach older people, but also during the research process. Apart from facilitating factors (e.g., age-specific study materials), inhibiting factors such as contact anxieties are also indicated. Only urban participants mention financial/material incentives and community as possible motivations.

Conclusions

The results provide important insights from the perspective of multipliers. They show specificities in access and participation for rural areas and for hard-to-reach older people. Many older people may have uncertainties about research projects and HT. Multipliers can assume a key role to help reduce these uncertainties in the future.

Enriching a randomized controlled treatment trial for anorexia nervosa by lived experience-Chances and effects of a lived experience council in the SUSTAIN study

BACKGROUND

The development and advancement of treatment and care options is one priority in the field of eating disorders. The inclusion of persons with lived experience with eating disorders into clinical research could enrich and accelerate this endeavor, as they can add different perspectives on the disease and its treatment. Although lived experience perspectives are increasingly part of eating disorder research, they have not been widely or structurally implemented into clinical trials and there is limited information on the practice of participatory research, its framework and consequences.

AIMS

The present work outlines the participatory collaboration with a lived experience council in the randomized controlled treatment trial SUSTAIN.

MATERIALS & METHODS

The manuscript is a participatory publication co-written by individuals with lived experience with anorexia nervosa and eating disorder researchers.

RESULTS

We report on motivations for this approach, our collaboration principles, structures and shared experience of working together in the trial, the potential burdens and benefits related to participation for people with lived experience.

DISCUSSION

We outline future directions and perspectives to integrate a participatory framework into clinical eating disorder research.

CONCLUSION

The involvement of people with experiential knowledge is complex, but possible in clinical research on ED and bears huge potential for the development of more effective care.

PUBLIC SIGNIFICANCE

Incorporating perspectives of people with lived experience into a participatory framework of mental health research bears huge potential on a societal level. This includes more relevant research topics and designs, more tailored and effective interventions, and facilitated implementation, as well as dissemination, higher credibility, destigmatization of mental illness, and patient empowerment. Participatory clinical research, however, needs structural anchorage within science and society.

[Research partners in health services research: need, acceptance and feasibility of preparatory trainings]

AIM

The aim of this online survey was to assess the need, acceptance and practical feasibility of a training program for research partners in health services research by patients and the public.

METHOD

In January 2023, we sent the survey to patient associations and groups nationwide via Patient Advisory Board members of the German Network for Health Services Research (DNVF). The survey included both closed and open questions. The research team analysed the information provided by the participants (n=125) descriptively and used content analysis according to Kuckartz and Rädiker (2022).

RESULTS

The majority (90.4%) of respondents considered patient and the public involvement in the planning and implementation of scientific studies to be very or extremely important. 41.5% (17.9%) of respondents indicated that more than 10% (more than 25%) of patients would be willing to participate in free training and be available as research partners. More than three-quarters (76.8%) of respondents agreed that training was very or extremely important. Participants preferred written information (57.3%), short online training (56.5%) and short digital information sessions (53.2%). Frequently cited barriers to delivering training include travel costs (60%), time (53.3%) and the need for extensive prior information (48.3%). Participants' suggestions for successful training implementation included comprehensibility of the training program and its organisation (location, duration and format).

CONCLUSION

In addition to the high training needs of research partners, the results also reveal some obstacles. A compact, comprehensible and digital information event with written information material increases acceptance. Researchers should take these results into account when designing and implementing training programs.

[Patient and public involvement at the German Center for Mental Health: achievements and challenges]

BACKGROUND

Patient and public involvement (PPI) describes the participation of patients and relatives, i.e., experts by experience (EE), in the research process. The PPI has not been widely adopted in the fields of medicine and clinical psychology in Germany and there is a notable absence of institutional support. The German Center for Mental Health (DZPG), which has been under construction since May 2023, aims to achieve nationwide and cross-center implementation of PPI, constituting one of its primary objectives. Participation of EE is to be implemented in the DZPG at all levels of decision-making.

OBJECTIVES

The article describes the origins, development and challenges associated with the implementation of participation structures and projects in the DZPG. The central political PPI committee in the DZPG, the Trilogue Center Council (TZR), developed a comprehensive PPI strategy for the DZPG in almost 3 years of work, before the beginning of the financial support of the DZPG. Among various measures, the strategy entails establishing a far-reaching representation for EE in all decision-making bodies of the DZPG, to involve EE as reviewers in evaluating research proposals, to integrate participatory elements into all studies of the DZGG and to foster user-initiated research endeavors. The implementation of the strategy is ensured by a cross-center PPI infrastructure, the Center for PPI, and scientific PPI consultants. The Center for PPI's tasks include supporting the voice of the EE and developing instruments and guidelines for participatory research, bringing together EE and researchers for joint DZPG projects as well as the documentation and quality assurance for participatory research. One of the particular challenges for the successful implementation of the PPI strategy is the limited experience with PPI in Germany in the field of mental health research and the widespread lack of structural implementation. Currently developed solution strategies include training for researchers and EE to communicate the benefits and pathways in the realization of PPI and thus enable shared decision-making and research. In addition, extensive access to knowledge and resources for EE will be created and uniform remuneration regulations for EE will be developed.

CONCLUSION

A PPI strategy at the DZPG has been successfully developed and is currently being implemented by the cross-center infrastructure Center for PPI.

Self-help friendliness and cooperation with self-help groups among rehabilitation clinics in Germany (KoReS): a mixed-methods study protocol

INTRODUCTION

Self-help is an important complement to medical rehabilitation for people with chronic diseases and disabilities. It contributes to stabilising rehabilitation success and further coping with disease and disability. Rehabilitation facilities are central in informing and referring patients to self-help groups. However, sustainable cooperation between rehabilitation and self-help, as can be achieved using the concept of self-help friendliness in healthcare, is rare, as is data on the cooperation situation.

METHODS AND ANALYSIS

The KoReS study will examine self-help friendliness and cooperation between rehabilitation clinics and self-help associations in Germany, applying a sequential exploratory mixed-methods design. In the first qualitative phase, problem-centred interviews and focus groups are conducted with representatives of self-help-friendly rehabilitation clinics, members of their cooperating self-help groups and staff of self-help clearinghouses involved based on a purposeful sampling. Qualitative data collected will be analysed through content analysis using MAXQDA. The findings will serve to develop a questionnaire for a quantitative second phase. Cross-sectional online studies will survey staff responsible for self-help in rehabilitation clinics nationwide, representatives of self-help groups and staff of self-help clearinghouses. Quantitative data analysis with SPSS will include descriptive statistics, correlation, subgroup and multiple regression analyses. Additionally, a content analysis of rehabilitation clinics' websites will evaluate the visibility of self-help in their public relations.

ETHICS AND DISSEMINATION

The University Medical Center Hamburg-Eppendorf Local Psychological Ethics Committee at the Center for Psychosocial Medicine granted ethical approval (reference number LPEK-0648; 10.07.2023). Informed consent will be obtained from all participants. Results dissemination will comprise various formats such as workshops, presentations, homepages and publications for the international scientific community, rehabilitation centres, self-help organisations and the general public in Germany. For relevant stakeholders, practical guides and recommendations to implement self-help friendliness will derive from the results to strengthen patient orientation and cooperation between rehabilitation and self-help to promote the sustainability of rehabilitation processes.

[Planning, Reflecting and Evaluating Participatory Health Research: Adaptation and Piloting of the "Community Based Participatory Research (CBPR) Model" for German-Speaking Countries]

Participatory research approaches are becoming increasingly established in both academic and practice settings. The participation of people with varied lived experiences and professional backgrounds can help academia and practitioners to learn from and empower each other. In the exchange of different perspectives, needs and ideas, it is possible to plan, reflect on, implement and evaluate projects in the health sector jointly and with attention to the needs of all stakeholders. The Community Based Participatory Research (CBPR) Model is often used internationally to guide participatory processes. However, an accessible translation has been lacking for application in German-speaking countries. To address this problem, a multidisciplinary working group composed of academic researchers and practitioners came together within the German-speaking Participatory Health Research Network (PartNet) to adapt the CBPR model for German-speaking countries and to test the adapted version with potential users. The adaptation was more than a translation, as the four model components "Contexts", "Partnership Processes", "Intervention & Research" and "Outcomes" as well as their associated contents are not directly applicable to the socio-structural and political contexts of the German-speaking countries. This article describes the process of adapting the model. This includes how translation drafts for German-speaking countries were first discussed in detail and then agreed upon as an initial template for testing in practice. Subsequently, various users reflected on the German-language model based on their experience of testing it in different projects, focusing on accuracy, comprehensibility and applicability. At the same time, the model was presented and discussed at conferences. The diverse feedback was incorporated into further revisions of the model. The result is a German-language version called "Modell für partizipative Gesundheitsforschung (PGF-Modell)".

[Specific Workloads among Employees with a Migration Background in Nursing and Geriatric Care: A Systematic Review]

BACKGROUND

Multimorbidity, increasing numbers of chronically ill patients and demographic change are leading to increased care costs in Germany with an increasing shortage of staff in skilled nursing and geriatric care. In this context, more and more caregivers with a migration background of the 1st generation (PmMH) are being recruited and integrated into existing (corporate) cultures. This represents an important starting point for a permanent and needs-based supply landscape.

THE AIM OF THE STUDY

The aim of the study was to identify and analyze the specific stresses of PmMH at the workplace in nursing and geriatric care MATERIAL AND METHODS: A systematic literature search was carried out in relevant specialist databases (Pubmed, PsychInfo, Web of Science, Cochrane), supplemented by an extended snowball and hand search. This was followed by a descriptive presentation of the results of the study content, which in a subsequent step was iteratively brought together and consolidated into thematic categories by several people.

RESULTS

A total of 15 publications were identified as relevant and included in the analysis. Specific, migration-associated stress factors could be identified. In particular, the categories: "Discrimination and racism", "Language and communication problems" and "Cultural adjustment" characterized the (collaborative) work in nursing and care for the elderly and led to additional stress for employees and patients.

DISCUSSION

The present review article identified and summarized specific burdens of PmMH. At this point it can be assumed that these affect both PmMH and patients. So far, operational concepts do not seem to be able to adequately solve the challenges, so that effective, sustainable approaches have to be found. The extent to which the specificed stress factors only affect PmMH is not considered in this context, so that further research is needed.

[Motivational Reasons and Perceptions about Future Participation of Older People in the Research and Development Process of Health Technologies: a Mixed Methods Study]

BACKGROUND

Although digital approaches for disease prevention in older people have a high potential and are being used more often, there are still inequalities in access and use. One reason could be that in technology development future users are insufficiently taken into consideration, or involved very late in the process using inappropriate methods. The aim of this work was to analyze the motivation of older people participating, and their perceptions of future participation in the research and development process of health technologies aimed at health care for older people.

METHODOLOGY

Quantitative and qualitative data from one needs assessment and two evaluation studies were analyzed. The quantitative data were analyzed descriptively and the qualitative data were analyzed content-analytically with inductive-deductive category formation.

RESULTS

The median age of the 103 participants (50 female) was 75 years (64-90), most of whom were interested in using technology and had prior experience of study participation. Nine categories for participation motivation were derived. A common motivation for participation was to promote and support their own health. Respondents were able to envision participation both at the beginning of the research process and at its end. In terms of technique development, different ideas were expressed, but there was a general interest in technological development. Methods that would enable exchange with others were favored most.

CONCLUSIONS

Differences in motivation to participate and ideas about participation were identified. The results provide important information from the perspective of older people and complement the existing state of research.

[Public Health and Participation of Experts from Experience in Austria: a First Exploratory Survey]

Participation is a basic principle of health promotion and public health. Citizen and patient participation in health care is considered to be poor in Austria and the existing practice is not very visible. An explorative online survey was conducted among members of the Austrian Public Health Association. The aim was to identify the current state of participation of experts from experience ("affected persons") in research, strategy development and practice. 29 organisations working on participation were identified. The survey revealed participation practice was methodologically diverse. Orientation towards participatory models, as the lowest common denominator, can provide a basis for further exchange and shared learning of participation.

Kommunale bewegungsbezogene Gesundheitsförderung in Deutschland

Ansätze der kommunalen bewegungsbezogenen Gesundheitsförderung (kbG) werden empfohlen, um körperlicher Inaktivität in der Bevölkerung entgegenzuwirken. Der vorliegende Artikel hat zum einen das Ziel, eine systematische Übersicht zur kbG in Deutschland darzustellen. Zum anderen sollen in diesem Bereich Good-Practice-Projekte identifiziert werden, die als Orientierungsrahmen für die Umsetzung und Verbreitung von kbG genutzt werden können. Im ersten Schritt wurden Projekte über eine Suche in 4 wissenschaftlichen Datenbanken sowie 21 Projektdatenbanken identifiziert und Daten zu „Bundesland“, „Berücksichtigung gesundheitlicher Chancengleichheit“ und „Umsetzung im städtischen oder ländlichen Raum“ extrahiert. Zudem wurden eingeschlossene Projekte in verschiedene Ansätze im Setting Kommune unterteilt. Im nächsten Schritt wurden Projekte mit einer dokumentierten Prozess- und/oder Ergebnisevaluation anhand von Qualitätskriterien in den Bereichen Konzipierung, Implementierung und Evaluation bewertet. Projekte, die mindestens 50 % der Qualitätskriterien erfüllten, wurden als Good-Pratice-Projekte ausgewählt. Insgesamt wurden 240 Projekte der kbG erfasst. Im ländlichen Raum wurden primär umweltbezogene Ansätze und im städtischen Raum vermehrt Mehrkomponentenansätze sowie Angebote und Veranstaltungen umgesetzt. 45 Projekte wiesen eine ausreichende Dokumentation der Prozess- und/oder Ergebnisevaluation auf, wovon 17 Projekte als Good-Practice identifiziert wurden. Optimierungspotenzial besteht bei der Adressierung von gesundheitlicher Chancengleichheit, einer aktiven Beteiligung von Menschen in schwierigen Lebenslagen über den gesamten Projektzyklus sowie der Implementierung von Mehrkomponentenansätzen. Dies erfordert Förderprogramme, die strukturbildende Good-Practice-Projekte ermöglichen und insbesondere deprivierte Kommunen erreichen. Ein von Akteur:innen aus Wissenschaft, Praxis und Politik gemeinsam verabschiedeter Standard zur Anwendung der Qualitätskriterien und einer damit einhergehenden Legitimation für die Bezeichnung als Good-Practice könnte einen Mehrwert für die strategische Weiterentwicklung der kbG in Deutschland bieten.

Partizipativ mit unseren PatientInnen für bessere Therapie und Versorgung forschen – Patient & Public Involvement (PPI) in der Psychosomatischen Medizin

Unter dem Schlagwort Patient & Public Involvement (PPI) gewinnt der Einbezug von Menschen, die direkt oder indirekt von einem spezifischen Themenfeld oder einer Erkrankung betroffen sind, zunehmend an Bedeutung. Bezogen auf Gesundheitsforschung und Medizin umfasst PPI die aktive und partnerschaftliche Zusammenarbeit von WissenschaftlerInnen oder BehandlerInnen mit PatientInnen, Angehörigen oder anderen Gesellschaftsmitgliedern in allen Phasen eines partizipativen Forschungs- und Implementierungsprozesses. In einem prägnanten Satz zusammengefasst: „Wir forschen nicht über Menschen, sondern wir forschen gemeinsam mit ihnen.“

Participatory development and implementation of inclusive digital health communication on COVID-19 with homeless people

Introduction

People experiencing homelessness (PEH) are disproportionally affected by the COVID-19 pandemic. The realities of their daily lives have been given little consideration in the pandemic response. They are not represented in existing health information campaigns, and many are structurally excluded from digital information. The project aimed to develop inclusive COVID-19-information material to strengthen infection prevention and control of PEH.

Material and methods

In a participatory process, PEH were involved in the planning, production, and evaluation of poster and video information material on COVID-19. Various stakeholders were consulted for external supervision. Service providers all over Germany were informed about the material that could be ordered free of charge. For the evaluation, semi-structured interviews with homeless service providers and PEH were conducted, and the online views of the videos were measured.

Results

Sixteen PEH participated actively in the project. Two COVID-19-information videos were launched in 5 languages in February 2021. Posters promoting vaccination against COVID-19 were produced in 9 languages. As of May 2022, the videos have been viewed more than 2,000 times. A total of 163 service providers for PEH and public institutions received the posters, thereof 72 upon request. Twelve service providers and 8 PEH participated in the evaluation. They pointed out the lack of targeted information material for PEH. The consideration of the concerns and the diverse representation of PEH was perceived as particularly important. Most of the service providers were unable to show the videos due to technical and spatial limitations. Digital challenges for PEH, like the lack of and maintenance of a smart phone, became apparent.

Conclusion

The cooperation of research, practice and the community were key factors for the realization of this project. Strong links to the community and the involvement of relevant stakeholders are indispensable when working with PEH. Exclusion from digital information is an increasingly important component of the structural marginalization of PEH. Digital inclusion for PEH and service providers can help to counteract social and health inequalities. The lessons learned through this project can contribute to strengthen participation of PEH and to consider their perspectives in future health communication strategies.

Co-Creative Vermittlungsplattformen für die Psychische Gesundheitsversorgung

Im deutschen Gesundheitswesen nimmt die Versorgung psychischer Störungen eine immer wichtigere Rolle ein. Nicht erst seit dem Beginn der Corona-Pandemie steigt die Zahl der Menschen mit psychischen Erkrankungen deutlich an. Damit gehen sowohl wirtschaftliche als auch persönliche Herausforderungen einher.

Dieser Artikel leistet einen Beitrag zur digitalen Transformation im Gesundheitswesen, indem eine konzeptionelle Analyse der Vermittlungsproblematik in der psychischen Gesundheitsversorgung vorgenommen wird. Die Studie zeigt, dass digitale Plattformen die Möglichkeit bieten, den bisherigen undurchsichtigen Angebotsmarkt zu strukturieren, Betroffenen sowie deren Angehörigen passende online und offline Versorgungs- und Unterstützungsangebote niederschwellig zugänglich zu machen und die Patient*innenreise sinnvoll zu erweitern. Die Ergebnisse verdeutlichen die Notwendigkeit der Berücksichtigung der Eigenschaften Regionalität, Inklusion und Kollaboration der Plattform sowie die der Umsetzung mit Hilfe co-creativer Methodiken. Zusammenfassend stellt die Studie eine umfassende und kontextualisierte Konzeption einer Vermittlungsplattform dar, und liefert damit sowohl für den wissenschaftlichen Diskurs im Bereich Gesundheits-IT als auch für Stakeholder aus der Praxis relevante Anhaltspunkte für die Gestaltung und Konzeption zukünftiger Plattformen.

"Back into Life-With a Power Wheelchair": Learning from People with Severe Stroke through a Participatory Photovoice Study in a Metropolitan Area in Germany

Severe stroke leads to permanent changes in everyday life. Many stroke survivors depend on support in community mobility (CM). This leads to restrictions and limited social participation. A power wheelchair (PWC) can enable independent CM and reduce such restrictions. This participatory study focused on how people with severe stroke experience their CM in a PWC in Berlin/Germany and what changes they want to initiate. A research team of five severe stroke survivors and two occupational therapists examined the question using photovoice. Stroke survivors took photos of their environment, presented, discussed, and analyzed them at group meetings to identify themes, and disseminated their findings at exhibitions and congresses. The photos emphasize the significance of and unique relationship to the PWC for the self-determined expression of personal freedom. As a complex, individualized construct, CM requires an accessible environment and diverse planning strategies by PWC users to arrive at their destination and overcome suddenly occurring obstacles. Desired changes stress CM independent of external help, increased social esteem, and active involvement in the provision of assistive devices. Voices of severe stroke survivors need to be heard more in healthcare and research to ensure the possibility of equal social participation.

What are Digital Public Health Interventions? First Steps Toward a Definition and an Intervention Classification Framework

Digital public health is an emerging field in population-based research and practice. The fast development of digital technologies provides a fundamentally new understanding of improving public health by using digitalization, especially in prevention and health promotion. The first step toward a better understanding of digital public health is to conceptualize the subject of the assessment by defining what digital public health interventions are. This is important, as one cannot evaluate tools if one does not know what precisely an intervention in this field can be. Therefore, this study aims to provide the first definition of digital public health interventions. We will merge leading models for public health functions by the World Health Organization, a framework for digital health technologies by the National Institute for Health and Care Excellence, and a user-centered approach to intervention development. Together, they provide an overview of the functions and areas of use for digital public health interventions. Nevertheless, one must keep in mind that public health functions can differ among different health care systems, limiting our new framework’s universal validity. We conclude that a digital public health intervention should address essential public health functions through digital means. Furthermore, it should include members of the target group in the development process to improve social acceptance and achieve a population health impact.

Partizipative Forschung mit Menschen mit Behinderungen

Hintergrund

Partizipative Gesundheitsforschung (PGF) gewinnt zunehmend an Bedeutung. Durch die Beteiligung der zu beforschenden Zielgruppe können lebensweltnahe, praxisorientierte Ergebnisse generiert und gesundheitsbezogene Veränderungen angestoßen werden. Dies bietet auch Potenziale zur Verbesserung der Teilhabe und Gesundheit von Menschen mit Behinderungen. Viele Forschungsprojekte setzen jedoch nur niedrige Stufen der Partizipation um.

Ziel des Beitrags

Es werden Herausforderungen und entsprechende Lösungsansätze von PGF mit der Zielgruppe Menschen mit Behinderungen diskutiert. Der Beitrag soll Forschenden eine Orientierung zur Erreichung hoher Stufen von Partizipation bieten.

Material und Methode

Es wurde ein Modellvorhaben zur Entwicklung und Umsetzung gesundheitsfördernder Maßnahmen in Werkstätten für behinderte Menschen (WfbM) durchgeführt, das die Erreichung hoher Partizipationsstufen durch PGF mit Menschen mit Behinderungen zum Ziel hatte. Der Prozess wurde durch Interviews und Fragebögen evaluiert.

Ergebnisse

Herausforderungen waren die Diversität der in der Lebenswelt WfbM arbeitenden Menschen, komplexe Strukturen von WfbM, die Verfügbarkeit personeller, zeitlicher und finanzieller Ressourcen sowie lange Kommunikationswege. Der Einbezug der gesamten Lebenswelt, die Nutzung bekannter Kommunikationsmittel und ein häufiger Austausch mit den Beteiligten waren besonders zielführend. Für die Motivation sowie die Verstetigung der entwickelten Maßnahmen war die Wertschätzung gegenüber der Zielgruppe essenziell.

Schlussfolgerungen

Wenn die Herausforderungen von PGF überwunden werden, ermöglicht dies vielfältige Einblicke in die Lebenswelt von Menschen mit Behinderungen, bedarfs- und bedürfnisorientierte Gesundheitsförderung sowie hohe Motivation aller Beteiligten, diese umzusetzen.

Photovoice-Studie CORONA

Hintergrund

Personen, die der Hockrisikogruppe angehören, sind einem deutlich erhöhten Risiko ausgesetzt bei einer Infektion mit COVID-19 („coronavirus disease 2019“) einen erschwerten Krankheitsverlauf zu entwickeln und daran zu sterben. Um die Verbreitung von COVID-19 in der Bevölkerung einzudämmen, werden situationsangepasste Maßnahmen durchgesetzt, die Änderungen der Alltagsgestaltung bewirken.

Ziel der Arbeit

Die Auseinandersetzung der Hochrisikogruppe mit den Auswirkungen der Coronapandemie, die partizipative Erforschung ihrer Alltagsgestaltung, Sorgen und Gesundheitsressourcen stehen im Zentrum dieser Studie.

Material und Methoden

Zur Analyse der Lebenswelt der Hochrisikogruppe wurde die Photovoice-Methode im Online-Format mit drei Workshops eingesetzt. Sieben Hochrisikopatient:innen mit unterschiedlichen Grunderkrankungen schildern, was Corona für sie im Alltag bedeutet und wofür sie dennoch dankbar sind. Die Rekrutierung erfolgte über persönliche Kontakte des Forschungsteams.

Ergebnisse

Die Co-Forschenden haben neun Geschichten formuliert, anhand derer ihre Dankbarkeit gegenüber des Gesundheitssystems und sozialen Umfelds zum Ausdruck kommt. Die Frage einer gesellschaftlichen Stigmatisierung von Personen mit Grunderkrankungen wird kritisch reflektiert. Die Geschichten zeigen, dass sie gesundheitskompetent handeln und persönliche Gesundheitsressourcen bewusst einsetzen, um negative Folgen auf ihre Gesundheit zu vermeiden und ihr Wohlbefinden zu steigern.

Diskussion

Die Co-Forschenden erweisen sich als gesundheitskompetent und in der Lage, ihr Wohlbefinden positiv zu beeinflussen. Es deutet sich jedoch an, dass der gesellschaftliche Umgang mit vulnerablen Gemeinschaften weiter zu erforschen ist, insbesondere mit Blick auf Diskriminierungsprozesse und einer bedarfsgerechten Gesundheitsversorgung.

Virtual Reality-Based Alcohol Prevention in Adolescents: A Systematic Review

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.