The COVID-19 pandemic requires numerous measures to protect against infection, such as contact reduction and adherence to hygiene and social distancing rules. The former leads to mental disorders (possibly requiring treatment) due to social isolation, the latter require adaptation in the implementation of medical therapies. With overall limited therapy capacities, the use of digital (health) applications can be of particular importance in the therapy of chronic and psychological diseases in particular. The present study investigates which health apps are being used by people with mental health problems.1,060 insured persons in preparation for psychosomatic rehabilitation measures were surveyed by means of an online questionnaire. Descriptive analyses, frequency analyses, and analyses of variance with post-hoc tests and correlation analyses were used for evaluation.Participants used on average three apps; the most common topics were "nutrition" (n=313), "self-diagnosis" (n=244) and "relaxation" (n=234). Female participants were more likely to use apps than male participants, and younger participants were more likely to use apps than older participants. Symptoms of anxiety were correlated to the use of digital applications, especially concerning heart rate and blood pressure monitoring, while depressive symptoms were not associated with a more frequent use of apps.Digital apps are being frequently used by people with mental health problems. Increasing acceptance of digital (health) apps has significant potential in the treatment of chronic mental illness in particular. The focus should be on individual applications with integration into the regular care process.Increasing digitalization, also in the healthcare sector, can be used to ensure care, especially in times of contact restrictions and limited human resources.Die Corona-Pandemie erfordert zum Infektionsschutz zahlreiche Maßnahmen wie Kontaktreduktion und Einhalten von Hygiene- und Abstandsregeln. Ersteres kann durch eine soziale Isolation zu (möglicherweise behandlungsbedürftigen) psychischen Störungen führen, letztere erfordern Anpassungen in der Durchführung medizinischer Therapien. Bei insgesamt begrenzten Therapiekapazitäten kann der Nutzung digitaler (Gesundheits-) Anwendungen in der Therapie insbesondere chronischer psychischer Erkrankungen eine besondere Bedeutung zukommen. Die vorliegende Studie hat daher als Ziel, zu untersuchen, welche Gesundheits-Apps von psychisch vorerkrankten Menschen genutzt werden.Es wurden 1.060 Versicherte in Vorbereitung auf eine psychosomatische Rehabilitationsmaßnahme mittels eines Online-Fragebogens befragt. Die Auswertung erfolgte mit deskriptiven Analysen, Frequenzanalysen und Varianzanalysen mit Post-hoc Tests sowie Korrelationsanalysen.Die Teilnehmenden nutzten im Durchschnitt drei Apps; die häufigsten Themen waren „Ernährung“ (n=313), „Selbstdiagnose“ (n=244) und „Entspannung“ (n=234). Weibliche Teilnehmende nutzten Apps häufiger als männliche und jüngere Teilnehmende häufiger als ältere. Eine Angstsymptomatik hing mit der Nutzung von Apps zusammen, insbesondere zu Herzfrequenz/Blutdruck; während eine depressive Symptomatik nicht mit der Nutzung digitaler Anwendungen korrelierte.Einige Gesundheits-Apps werden häufig durch psychisch vorerkrankte Menschen genutzt. Eine zunehmende Akzeptanz von digitalen (Gesundheits-)Anwendungen bietet erhebliches Potenzial in der Behandlung insbesondere psychisch erkrankter Menschen. Der Fokus sollte auf individuellen Anwendungen mit Einbindung in den regulären Versorgungsprozess liegen.Die zunehmende Digitalisierung auch im Gesundheitswesen kann dazu genutzt werden, die Versorgung gerade in Zeiten der Kontaktbeschränkungen und begrenzter personeller Ressourcen sicherzustellen.
Zusammenfassung Hintergrund Soziale Isolation ist ein Risikofaktor für Einsamkeit und damit für gesundheitliche Beeinträchtigungen. Veränderungen im Zusammenhang mit der Coronapandemie in Deutschland gilt es besser zu verstehen. Fragestellung Ziel der Studie war es, Einsamkeit und assoziierte Faktoren vor und während der Coronapandemie in Deutschland systematisch zu untersuchen. Die Fragestellungen waren: 1. Wie einsam fühlen sich Menschen vor und während der Coronapandemie? 2. Wie viele Menschen fühlen sich seit Beginn der Coronapandemie einsamer ? 3. Wie viele Menschen berichten über gesundheitliche Belastungen während der Coronapandemie? Material und Methoden Im Jahr 2019 (vor der Coronapandemie) wurden 1003 und im Jahr 2020 (während der Coronapandemie) 1050 Erwachsene online befragt (51 % Frauen; 18–90 Jahre). Ergebnisse Es fühlten sich 10,8 % vs. 26,6 % der Befragten vor bzw. seit der Coronapandemie mehrfach pro Woche oder täglich einsam. Alleinlebende, Frauen und Jüngere fühlten sich häufiger einsam. Seit der Coronapandemie fühlten sich 30,8 % einsamer, v. a. Jüngere. Von starken gesundheitlichen Belastungen berichteten 18,9 %, dies hing mit jüngerem Alter, verschiedenen Sorgen/Ängsten und Einsamkeit zusammen. Diskussion Die höhere Ausprägung der Einsamkeit und Sorgen während der Coronapandemie sollte bei verhaltensbezogenen Maßnahmen zur Prävention der psychischen und körperlichen Beeinträchtigungen sowie behördlichen Maßnahmen berücksichtigt werden. Jüngere Menschen und Alleinlebende könnten profitieren, indem sie zu gezielten Bewältigungsstrategien (z. B. angemessener Nutzung digitaler Medien) ermutigt werden.
To improve patient safety in obstetrics, patients should perform safe communication. However, there is a lack of attempts in targeting expectant mothers. Behaviour change theories can potentially be applied to safe communication behaviour to understand and target contributing factors. The objective of this study was to apply the Health Action Process Approach (HAPA) to obstetric patients' safe communication behaviour to understand underlying mechanisms of social-cognitive HAPA variables. N = 424 expectant mothers from two university hospitals participated in a cross-sectional survey which was the baseline of a larger randomized controlled trial. The proposed HAPA model with iterative theory-driven extensions were fitted to the data via path modelling. Fit indices were compared. Post-hoc analyses asserted sufficient statistical power. An adapted HAPA model fitted the data best. The adaptation concerned two sequential mediation pathways: The association of intention and safe communication behaviour was mediated by coping self-efficacy and via social support and action planning. Congruent with theory, intention and action planning, mediated by social support and coping self-efficacy, emerged as core factors contributing to safe communication behaviour. The HAPA model can be applied to safe communication behaviour in obstetric patients. Hence, future interventions to enhance expectant mothers' safe communication should be based on behaviour change theories like the hereby tested HAPA model.
BACKGROUND Medical internet interventions such as asynchronous apps and synchronous digital live seminars can be effective behavior change interventions. The research question of this study was whether digital interventions based on the Health Action Process Approach can improve pregnant women’s safe communication and patient safety in obstetric care. OBJECTIVE This study aims to compare a digital live seminar with a web-based application intervention and a passive control group and to identify which social cognitive variables determine safe communication behavior and patient safety. METHODS In total, 657 pregnant women were recruited, and hereof, 367 expectant mothers from 2 German university hospitals participated in the pre-post study (live seminar: n=142; web-based app: n=81; passive control group: n=144). All interventions targeted intention, planning, self-efficacy, and communication of personal preferences. The 2.5-hour midwife-assisted live seminar included exercises on empathy and clear communication. The fully automated web-based application consisted of 9 consecutive training lessons with the same content as that of the live seminar. RESULTS Controlled for sociodemographic characteristics, repeated measures analyses of covariance revealed that pregnant women significantly improved their self-reported communication behavior in all groups. The improvement was more pronounced after the digital live seminar than after the web-based application (<i>P</i><.001; η<sub>p</sub><sup>2</sup>=0.043). Perceived patient safety improved more for pregnant women participating in the live seminar than for those participating in the web-based application group (<i>P</i>=.03 η<sub>p</sub><sup>2</sup>=0.015). A regression analysis revealed that social cognitive variables predicted safe communication behavior. CONCLUSIONS Overall, the web-based application intervention appeared to be less effective than the digital live training in terms of communication behavior. Application interventions addressing communication behaviors might require more face-to-face elements. Improving intention, coping planning, and coping self-efficacy appeared to be key drivers in developing safe communication behavior in pregnant women. Future research should include social learning aspects and focus on the practical application of medical internet interventions when aiming to improve pregnant women’s communication and patient safety in obstetrics. CLINICALTRIAL ClinicalTrials.gov NCT03855735; https://clinicaltrials.gov/ct2/show/NCT03855735
Human failure and a lack of effective communication are the main reasons for preventable adverse events, compromising patient safety in obstetrics. In order to improve safety, team and communication interventions have been implemented but lack feasibility in obstetric care. Psychological models such as the health action process approach might help to improve interventions.In a cross-sectional online survey with N = 129 healthcare workers (Study 1) and a paper-pencil survey with N = 137 obstetric healthcare workers at two obstetric university hospitals (Study 2), associations of social-cognitive variables were tested in a path analysis and a multiple regression. Preliminary results informed a communication training for all obstetric healthcare workers. A repeated-measures MANOVA was used to compare pre- and post-intervention data.Social-cognitive variables were associated according to model suggestions (β = -0.26 to 0.45, p < 0.05) except for planning in the first study. Triggers of adverse events were associated (β = -0.41 to 0.24, p < 0.05) with communication behavior (Study 2), action self-efficacy and planning (Study 1), as well as barriers to effective communication (both studies). The intervention was rated positively (M = 3.3/4). Afterward, fewer triggers were reported and coping self-efficacy increased. There were group differences regarding hospital, experience, and time.The health action process approach was examined in the context of safe communication in obstetrics and can be used to inform interventions. A theory-based, short training was feasible and acceptable. Perceived patient safety improved but communication behavior did not. Future research should aim to test a more comprehensive psychological communication intervention in a thorough RCT design.
BACKGROUND The COVID-19 pandemic has largely affected people’s mental health and psychological well-being. Specifically, individuals with a pre-existing mental health disorder seem more impaired by lockdown measures posing as major stress factors. Medical rehabilitation treatment can help people cope with these stressors. The internet and digital apps provide a platform to contribute to regular treatment and to conduct research on this topic. OBJECTIVE Making use of internet-based assessments, this study investigated individuals from the general population and patients from medical, psychosomatic rehabilitation clinics. Levels of depression, anxiety, loneliness, and perceived stress during the COVID-19 pandemic, common COVID-19–related worries, and the intention to use digital apps were compared. Furthermore, we investigated whether participating in internet-delivered digital trainings prior to and during patients’ rehabilitation stay, as well as the perceived usefulness of digital trainings, were associated with improved mental health after rehabilitation. METHODS A large-scale, online, cross-sectional study was conducted among a study sample taken from the general population (N=1812) in Germany from May 2020 to April 2021. Further, a longitudinal study was conducted making use of the internet among a second study sample of psychosomatic rehabilitation patients at two measurement time points—before (N=1719) and after (n=738) rehabilitation—between July 2020 and April 2021. Validated questionnaires and adapted items were used to assess mental health and COVID-19–related worries. Digital trainings were evaluated. Propensity score matching, multivariate analyses of covariance, an exploratory factor analysis, and hierarchical regression analyses were performed. RESULTS Patients from the psychosomatic rehabilitation clinics reported increased symptoms with regard to depression, anxiety, loneliness, and stress (<i>F</i><sub>4,2028</sub>=183.74, <i>P</i><.001, <i>η<sup>2</sup><sub>p</sub></i>=0.27) compared to the general population. Patients perceived greater satisfaction in communication with health care professionals (<i>F</i><sub>1,837</sub>=31.67, <i>P</i><.001, <i>η<sup>2</sup><sub>p</sub></i>=0.04), had lower financial worries (<i>F</i><sub>1,837</sub>=38.96, <i>P</i><.001, <i>η<sup>2</sup><sub>p</sub></i>=0.04), but had higher household-related worries (<i>F</i><sub>1,837</sub>=5.34, <i>P</i>=.02, <i>η<sup>2</sup><sub>p</sub></i>=0.01) compared to the general population. Symptoms of depression, anxiety, loneliness, and perceived stress were lower postrehabilitation (<i>F</i><sub>1,712</sub>=23.21, <i>P</i><.001, <i>η<sup>2</sup><sub>p</sub></i>=0.04) than prior to rehabilitation. Psychosomatic patients reported a higher intention to use common apps and digital trainings (<i>F</i><sub>3,2021</sub>=51.41, <i>P</i><.001, <i>η<sup>2</sup><sub>p</sub></i>=0.07) than the general population. With regard to digital trainings offered prior to and during the rehabilitation stay, the perceived usefulness of digital trainings on rehabilitation goals was associated with decreased symptoms of depression (<i>β</i>=–.14, <i>P</i><.001), anxiety (<i>β</i>=–.12, <i>P</i><.001), loneliness (<i>β</i>=–.18, <i>P</i><.001), and stress postrehabilitation (<i>β</i>=–.19, <i>P</i><.001). Participation in digital group therapy for depression was associated with an overall change in depression (<i>F</i><sub>1,725</sub>=4.82, <i>P</i>=.03, <i>η<sup>2</sup><sub>p</sub></i>=0.01) and anxiety (<i>F</i><sub>1,725</sub>=6.22, <i>P</i>=.01, <i>η<sup>2</sup><sub>p</sub></i>=0.01) from pre- to postrehabilitation. CONCLUSIONS This study validated the increased mental health constraints of psychosomatic rehabilitation patients in comparison to the general population and the effects of rehabilitation treatment. Digital rehabilitation components are promising tools that could prepare patients for their rehabilitation stay, could integrate well with face-to-face therapy during rehabilitation treatment, and could support aftercare. CLINICALTRIAL ClinicalTrials.gov NCT04453475; https://clinicaltrials.gov/ct2/show/NCT04453475 and ClinicalTrials.gov NCT03855735; https://clinicaltrials.gov/ct2/show/NCT03855735
Medical internet interventions such as asynchronous apps and synchronous digital live seminars can be effective behavior change interventions. The research question of this study was whether digital interventions based on the Health Action Process Approach can improve pregnant women's safe communication and patient safety in obstetric care.This study aims to compare a digital live seminar with a web-based application intervention and a passive control group and to identify which social cognitive variables determine safe communication behavior and patient safety.In total, 657 pregnant women were recruited, and hereof, 367 expectant mothers from 2 German university hospitals participated in the pre-post study (live seminar: n=142; web-based app: n=81; passive control group: n=144). All interventions targeted intention, planning, self-efficacy, and communication of personal preferences. The 2.5-hour midwife-assisted live seminar included exercises on empathy and clear communication. The fully automated web-based application consisted of 9 consecutive training lessons with the same content as that of the live seminar.Controlled for sociodemographic characteristics, repeated measures analyses of covariance revealed that pregnant women significantly improved their self-reported communication behavior in all groups. The improvement was more pronounced after the digital live seminar than after the web-based application (P<.001; ηp2=0.043). Perceived patient safety improved more for pregnant women participating in the live seminar than for those participating in the web-based application group (P=.03 ηp2=0.015). A regression analysis revealed that social cognitive variables predicted safe communication behavior.Overall, the web-based application intervention appeared to be less effective than the digital live training in terms of communication behavior. Application interventions addressing communication behaviors might require more face-to-face elements. Improving intention, coping planning, and coping self-efficacy appeared to be key drivers in developing safe communication behavior in pregnant women. Future research should include social learning aspects and focus on the practical application of medical internet interventions when aiming to improve pregnant women's communication and patient safety in obstetrics.ClinicalTrials.gov NCT03855735; https://clinicaltrials.gov/ct2/show/NCT03855735.
Background The COVID-19 pandemic has largely affected people’s mental health and psychological well-being. Specifically, individuals with a pre-existing mental health disorder seem more impaired by lockdown measures posing as major stress factors. Medical rehabilitation treatment can help people cope with these stressors. The internet and digital apps provide a platform to contribute to regular treatment and to conduct research on this topic. Objective Making use of internet-based assessments, this study investigated individuals from the general population and patients from medical, psychosomatic rehabilitation clinics. Levels of depression, anxiety, loneliness, and perceived stress during the COVID-19 pandemic, common COVID-19–related worries, and the intention to use digital apps were compared. Furthermore, we investigated whether participating in internet-delivered digital trainings prior to and during patients’ rehabilitation stay, as well as the perceived usefulness of digital trainings, were associated with improved mental health after rehabilitation. Methods A large-scale, online, cross-sectional study was conducted among a study sample taken from the general population (N=1812) in Germany from May 2020 to April 2021. Further, a longitudinal study was conducted making use of the internet among a second study sample of psychosomatic rehabilitation patients at two measurement time points—before (N=1719) and after (n=738) rehabilitation—between July 2020 and April 2021. Validated questionnaires and adapted items were used to assess mental health and COVID-19–related worries. Digital trainings were evaluated. Propensity score matching, multivariate analyses of covariance, an exploratory factor analysis, and hierarchical regression analyses were performed. Results Patients from the psychosomatic rehabilitation clinics reported increased symptoms with regard to depression, anxiety, loneliness, and stress (F4,2028=183.74, P<.001, η2p=0.27) compared to the general population. Patients perceived greater satisfaction in communication with health care professionals (F1,837=31.67, P<.001, η2p=0.04), had lower financial worries (F1,837=38.96, P<.001, η2p=0.04), but had higher household-related worries (F1,837=5.34, P=.02, η2p=0.01) compared to the general population. Symptoms of depression, anxiety, loneliness, and perceived stress were lower postrehabilitation (F1,712=23.21, P<.001, η2p=0.04) than prior to rehabilitation. Psychosomatic patients reported a higher intention to use common apps and digital trainings (F3,2021=51.41, P<.001, η2p=0.07) than the general population. With regard to digital trainings offered prior to and during the rehabilitation stay, the perceived usefulness of digital trainings on rehabilitation goals was associated with decreased symptoms of depression (β=–.14, P<.001), anxiety (β=–.12, P<.001), loneliness (β=–.18, P<.001), and stress postrehabilitation (β=–.19, P<.001). Participation in digital group therapy for depression was associated with an overall change in depression (F1,725=4.82, P=.03, η2p=0.01) and anxiety (F1,725=6.22, P=.01, η2p=0.01) from pre- to postrehabilitation. Conclusions This study validated the increased mental health constraints of psychosomatic rehabilitation patients in comparison to the general population and the effects of rehabilitation treatment. Digital rehabilitation components are promising tools that could prepare patients for their rehabilitation stay, could integrate well with face-to-face therapy during rehabilitation treatment, and could support aftercare. Trial Registration ClinicalTrials.gov NCT04453475; https://clinicaltrials.gov/ct2/show/NCT04453475 and ClinicalTrials.gov NCT03855735; https://clinicaltrials.gov/ct2/show/NCT03855735
Background: Patients’ effective hand hygiene helps to reduce healthcare-associated infections, prevents the spread of nosocomial infections and communicable diseases, such as COVID-19. This study aimed to describe effective hand hygiene decisions based on the Health Action Process Ap-proach (HAPA) and whether this pattern is invariant for mental health.
Methods: Data were collected cross-sectionally from patients who had previously been admitted to a hospital (N=279; study 1) and longitudinally from psychosomatic rehabilitation patients (N=1,073; study 2). The fit of the HAPA framework and changes in hand hygiene decisions regarding com-pliance, as well as social-cognitive variables of the HAPA, and mental health status were examined.
Results: The trimmed HAPA framework fitted the data well (χ2=27.1, df=12, p<.01, CMIN/df=2.26, CFI=.97, RMSEA=.08). According to multi-group structural equation modeling, the HAPA model with hand hygiene behavior were found to be invariant with regard to mental health.
Conclusion: The trimmed HAPA framework revealed to be a generic framework in explaining so-cial-cognitive processes relating to hand hygiene decisions. Helping individuals to perform hand hygiene recommendation requires intention formation and bridging the intention-behavior gap. This can be done by promoting planning and self-efficacy. All processes appear generic to partic-ipants with and without mental health challenges.
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