Download PDF
Gesundheitswesen 2023; 85(01): 58-64
DOI: 10.1055/a-1933-2779
Zur Diskussion

Digitale Gesundheitsinterventionen entwickeln, evaluieren und implementieren (Teil I) – Diskussionspapier der Arbeitsgruppe Digital Health des Deutschen Netzwerk Versorgungsforschung (DNVF)

Development, Evaluation and Implementation of Digital Health Interventions (Part 1) – Discussion Paper of the Digital Health Working Group of the German Network for Health Services Research (DNVF)
Sven Kernebeck 
1   Lehrstuhl für Didaktik und Bildungsforschung im Gesundheitswesen – Fakultät für Gesundheit, Universität Witten Herdecke, Witten, Germany
,
Madlen Scheibe
2   Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der TU Dresden, Dresden, Germany
,
Monika Sinha
3   Mitglied AG Bioinformatik, Charité Universitätsmedizin Berlin, Berlin, Germany
4   Beratung im Gesundheitswesen – angewandte Versorgungsforschung, SINHA, Berlin, Germany
,
Florian Fischer
5   Bayerisches Forschungszentrum Pflege Digital, Hochschule Kempten, Kempten, Germany
6   Institut für Public Health, Charité Universitätsmedizin Berlin, Berlin
,
Andreas Knapp 
7   Mint Medical GmbH, Heidelberg
,
Patrick Timpel
2   Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der TU Dresden, Dresden, Germany
8   Wissenschaftliches Institut für Gesundheitsökonomie und Gesundheitssystemforschung , WIG2 GmbH, Leipzig, Germany
,
Lorenz Harst 
2   Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der TU Dresden, Dresden, Germany
,
Ulrich Reininghaus
9   Department of Public Mental Health, Central Institute of Mental Health, University of Heidelberg, Manheim, Germany
10   ESRC Centre for Society and Mental Health, King’s College London, London, United Kingdom of Great Britain and Northern Ireland
11   Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, Germany
,
Horst Christian Vollmar 
12   Abteilung für Allgemeinmedizin (AM RUB), Medizinische Fakultät, Ruhr-Universität Bochum, Bochum, Germany
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Corrected by:

Erratum: Digitale Gesundheitsinterventionen entwickeln, evaluieren und implementieren (Teil I) – Diskussionspapier der Arbeitsgruppe Digital Health des Deutschen Netzwerk Versorgungsforschung (DNVF)Gesundheitswesen 2023; 85(01): e1-e1
DOI: 10.1055/a-1996-6141

Zusammenfassung

Digitale Interventionen (DI) zu gesundheitsbezogenen Themen gewinnen zunehmend an Bedeutung. Oftmals sind sie komplexe Interventionen, die in einem komplexen Versorgungskontext evaluiert und implementiert werden. Aufgrund der Merkmale digitaler Interventionen ist die Versorgungsforschung vor methodische Herausforderungen gestellt. Daher hat die Arbeitsgruppe Digital Health des Deutschen Netzwerks Versorgungsforschung (DNVF) ein Diskussionspapier erstellt. Darin wird diskutiert, welche Herausforderungen mit der Entwicklung und Evaluation von DI einhergehen. Es werden Lösungsansätze und zukünftige Forschungsbedarfe aufgezeigt.

Abstract

The development and application of digital interventions in health-related topics are gaining momentum in health service research. Digital interventions are often complex and need to be evaluated and implemented in complex settings. Due to their characteristics, this poses methodological challenges for health services research that have to be identified and addressed. Hence, the Working Group on Digital Health of the German Network for Health Services Research (DNVF) has prepared a discussion paper. This paper discusses methodological, practical and theoretical challenges associated with the development and evaluation of digital interventions from the perspective of health services research. Possible solutions are suggested and future research needs to address these methodological challenges are identified.

Schlüsselwörter

Digital Health - digitale Interventionen - Evaluation - Implementierung - Versorgungsforschung - E-Health

Key words

digital health - digital interventions - E-Health - evaluation - implementation - health services research


Publication History

Article published online:
29 November 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • Literatur

  • 1 Zeeb H, Pigeot I, Schüz B. Digital Public Health – ein Überblick. Bundesgesundheitsblatt – Gesundheitsforschung – Gesundheitsschutz 2020; 63: 137-144
    CrossrefPubMedGoogle Scholar
  • 2 WHO. Classification of Digital Health Interventions v1.0A shared language to describe the uses of digital technology for health [Internet]. 2018. Available from: http://apps.who.int/iris/bitstream/handle/10665/260480/WHO-RHR-18.06-eng.pdf;jsessionid=E06A96F29EE14D51614B4C25590A04D7?sequence=1
    PubMed
  • 3 SVR-Gesundheit. Digitalisierung für Gesundheit Ziele und Rahmenbedingungen eines dynamisch lernenden Gesundheitssystems [Internet]. 2021. Available from: https://www.svr-gesundheit.de/fileadmin/Gutachten/Gutachten_2021/SVR_Gutachten_2021_online_.pdf
    PubMed
  • 4 Kramer U, Borges U, Fischer F. et al. DNVF-Memorandum – Gesundheits- und Medizin-Apps (GuMAs). Das Gesundheitswesen 2019; 81: e154-e170
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Vollmar H, Kramer U, Müller H. et al. Digitale Gesundheitsanwendungen – Rahmenbedingungen zur Nutzung in Versorgung, Strukturentwicklung und Wissenschaft – Positionspapier der AG Digital Health des DNVF. Das Gesundheitswesen 2017; 79: 1080-1092
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Murray E, Hekler EB, Andersson G. et al. Evaluating Digital Health Interventions Key Questions and Approaches. Am J Prev Med 2016; 51: 843-851
    CrossrefPubMedGoogle Scholar
  • 7 Byambasuren O, Sanders S, Beller E. et al. Prescribable mHealth apps identified from an overview of systematic reviews. Npj Digital Medicine 2018; 1: 12
    CrossrefPubMedGoogle Scholar
  • 8 Kolasa K, Kozinski G. How to Value Digital Health Interventions? A Systematic Literature Review. Int J Environ Res Pu 2020; 17: 2119
    CrossrefPubMedGoogle Scholar
  • 9 Tokgöz P, Hrynyschyn R, Hafner J. et al. Digital health interventions in prevention, relapse, and therapy of mild and moderate depression: scoping review. JMIR Mental Health 2021; 8 (04) e26268 DOI: 10.2196/26268.
    CrossrefPubMedGoogle Scholar
  • 10 Mathews S, D’Arcey J, Tokgöz P. et al. Digital Health Interventions in Prevention, Relapse, and Therapy of Mild and Moderate Depression: Scoping Review. Jmir Ment Heal 2021; 8: e26268
    CrossrefPubMedGoogle Scholar
  • 11 Timpel P, Oswald S, Schwarz PEH. et al. Mapping the Evidence on the Effectiveness of Telemedicine Interventions in Diabetes, Dyslipidemia, and Hypertension: An Umbrella Review of Systematic Reviews and Meta-Analyses. J Med Internet Res 2020; 22: e16791
    CrossrefPubMedGoogle Scholar
  • 12 Shaw T, McGregor D, Brunner M. et al. What is eHealth (6)? Development of a Conceptual Model for eHealth: Qualitative Study with Key Informants. J Med Internet Res 2017; 19: e324
    CrossrefPubMedGoogle Scholar
  • 13 WHO. National eHealth Strategy ToolkitOverview [Internet]. 2012. Available from: https://www.who.int/ehealth/publications/overview.pdf
    PubMed
  • 14 Otto L, Harst L, Schlieter H. et al. Towards a Unified Understanding of eHealth and Related Terms – Proposal of a Consolidated Terminological Basis. Proc 11th Int Jt Conf Biomed Eng Syst Technologies 2018; 533-539
    CrossrefPubMedGoogle Scholar
  • 15 Fischer F, Aust V, Krämer A. eHealth in Deutschland, Anforderungen und Potenziale innovativer Versorgungsstrukturen 2016; 3-23
    PubMed
  • 16 Reininghaus U. Ambulatorische Interventionen in der Psychiatrie: das Momentum f?r Ver?nderung im allt?glichen sozialen Kontext. Psychiat Prax 2018; 45: 59-61
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Nahum-Shani I, Smith SN, Spring BJ. et al. Just-in-Time Adaptive Interventions (JITAIs) in Mobile Health: Key Components and Design Principles for Ongoing Health Behavior Support. Ann Behav Med 2016; 52: 1-17
    PubMedGoogle Scholar
  • 18 Lin J, Baumeister H. Internet- und Mobilebasierte Interventionen in der Psychotherapie. Public Heal Forum 2015; 23: 176-179
    CrossrefPubMedGoogle Scholar
  • 19 Fischer F. Digitale Interventionen in Prävention und Gesundheitsförderung: Welche Form der Evidenz haben wir und welche wird benötigt?. Bundesgesundheitsblatt – Gesundheitsforschung – Gesundheitsschutz 2020; 1-7
    PubMedGoogle Scholar
  • 20 Mühlhauser I, Lenz M, Meyer G. Bewertung von komplexen Interventionen: Eine methodische Herausforderung. 2012; 109 (1–2): A-22. Available from: https://www.aerzteblatt.de/int/article.asp?id=118129
    PubMed
  • 21 Robert-Koch-Institut, Lebensmittelsicherheit BL für G und. Evaluation komplexer Interventionsprogramme in der Prävention: Lernende Systeme, lehrreiche Systeme? [Internet]. 2012. Available from: https://www.rki.de/DE/Content/Gesundheitsmonitoring/Gesundheitsberichterstattung/GBEDownloadsB/evaluation_praevention.pdf?__blob=publicationFile
    PubMed
  • 22 Koppe G, Guloksuz S, Reininghaus U. et al. Recurrent Neural Networks in Mobile Sampling and Intervention. Schizophrenia Bull 2018; 45: 272-276
    CrossrefPubMedGoogle Scholar
  • 23 Dockweiler C, Razum O. Digitalisierte Gesundheit: neue Herausforderungen f?r Public Health. Das Gesundheitswesen 2015; 78: 5-7
    Article in Thieme ConnectPubMedGoogle Scholar
  • 24 ISO. ISO 9241-210:2019(en) Ergonomics of human-system interaction — Part 210: Human-centred design for interactive systems [Internet]. 2019. Available from: https://www.iso.org/obp/ui/#iso:std:iso:9241:-210:ed-2:v1:en
    PubMed
  • 25 Diekmann A. Empirische Sozialforschung: Grundlagen, Methoden, Anwendungen. 2020
    PubMed
  • 26 Goodman E, Kuniavsky M, Moed A. Observing the User Experience. 2012
    PubMed
  • 27 Sherwin K. Card Sorting: Uncover Users’ Mental Models for Better Information Architecture. 2018; Available from: https://www.nngroup.com/articles/card-sorting-definition/
    PubMed
  • 28 Baxter K, Courage C, Caine K. Understanding your Users. A Practical Guide to User Research Methods. 2015
    PubMedGoogle Scholar
  • 29 Arnold K, Scheibe M, Müller O. et al. Principles for the evaluation of telemedicine applications: Results of a systematic review and consensus process. Zeitschrift Für Evidenz Fortbildung Und Qual Im Gesundheitswesen. 2016; 117: 9-19
    PubMedGoogle Scholar
  • 30 Kowatsch T, Otto L, Harperink S. et al. A design and evaluation framework for digital health interventions. Information Technology 2020; 61: 253-263
    CrossrefPubMedGoogle Scholar
  • 31 NICE. Evidence standards framework for digital health technologies. 2019. https://www.nice.org.uk/corporate/ecd7
    PubMed
  • 32 Venkatesh V, Morris M, Davis G. et al. User acceptance of information technology: Toward a unified view. MIS Quarterly 2003; 27: 425-478
    CrossrefPubMedGoogle Scholar
  • 33 Maramba I, Chatterjee A, Newman C. Methods of usability testing in the development of eHealth applications: A scoping review. Int J Med Inform 2019; 126: 95-104
    CrossrefPubMedGoogle Scholar
  • 34 Peiris D, Miranda JJ, Mohr DC. Going beyond killer apps: building a better mHealth evidence base. Bmj Global Heal 2018; 3: e000676
    CrossrefPubMedGoogle Scholar
  • 35 Guo C, Ashrafian H, Ghafur S. et al. Challenges for the evaluation of digital health solutions – A call for innovative evidence generation approaches. Npj Digital Medicine 2020; 3: 110
    CrossrefPubMedGoogle Scholar
  • 36 Henderson M, Donnachie C. Improving eHealth intervention development and quality of evaluations. The Lancet Digital Health 2019; 1: e194-e195
    CrossrefPubMedGoogle Scholar
  • 37 Pawloski PA, Brooks GA, Nielsen ME. et al. A Systematic Review of Clinical Decision Support Systems for Clinical Oncology Practice. J Natl Compr Canc Ne 2019; 17: 331-338
    CrossrefPubMedGoogle Scholar
  • 38 Champion KE, Parmenter B, McGowan C. et al. Effectiveness of school-based eHealth interventions to prevent multiple lifestyle risk behaviours among adolescents: a systematic review and meta-analysis. Lancet Digital Heal 2019; 1: e206-e221
    CrossrefPubMedGoogle Scholar
  • 39 Vilardaga R, Casellas-Pujol E, McClernon JF. et al. Mobile Applications for the Treatment of Tobacco Use and Dependence. Curr Addict Reports 2019; 6: 86-97
    CrossrefPubMedGoogle Scholar
  • 40 Linardon J, Fuller-Tyszkiewicz M. Attrition and Adherence in Smartphone-Delivered Interventions for Mental Health Problems: A Systematic and Meta-Analytic Review. J Consult Clin Psych 2019; 88: 1-13
    CrossrefPubMedGoogle Scholar
  • 41 Reinhardt G, Schwarz PE, Harst L. Non-use of telemedicine: A scoping review. Health Inform J. 2021; 27 14604582211043148
    PubMedGoogle Scholar
  • 42 Neugebauer EAM, Rath A, Antoine S-L. et al. Specific barriers to the conduct of randomised clinical trials on medical devices. Trials. 2017; 18: 427
    CrossrefPubMedGoogle Scholar
  • 43 Timpel P, Cesena FHY, da Silva Costa C. et al. Efficacy of gamification-based smartphone application for weight loss in overweight and obese adolescents: study protocol for a phase II randomized controlled trial. Ther Adv Endocrinol Metabolism 2018; 9: 167-176
    CrossrefPubMedGoogle Scholar
  • 44 Stalujanis E, Neufeld J, Stalder MG. et al. Induction of Efficacy Expectancies in an Ambulatory Smartphone-Based Digital Placebo Mental Health Intervention: Randomized Controlled Trial. Jmir Mhealth Uhealth 2021; 9: e20329
    CrossrefPubMedGoogle Scholar
  • 45 Gensorowsky D, Lampe D, Hasemann L. et al. „Alternative Studiendesigns“ zur Bewertung digitaler Gesundheitsanwendungen – eine echte Alternative?. Zeitschrift Für Evidenz Fortbildung Und Qual Im Gesundheitswesen 2021; 161: 33-41
    CrossrefPubMedGoogle Scholar
  • 46 Pallmann P, Bedding AW, Choodari-Oskooei B. et al. Adaptive designs in clinical trials: why use them, and how to run and report them. Bmc Med 2018; 16: 29
    CrossrefPubMedGoogle Scholar
  • 47 Chen YHJ, DeMets DL, Lan KKG. Some drop-the-loser designs for monitoring multiple doses. Stat Med 2010; 29: 1793-1807
    CrossrefPubMedGoogle Scholar
  • 48 Puffer S, Torgerson DJ, Watson J. Cluster randomized controlled trials. J Eval Clin Pract 2005; 11: 479-483
    CrossrefPubMedGoogle Scholar
  • 49 Hussey MA, Hughes JP. Design and analysis of stepped wedge cluster randomized trials. Contemp Clin Trials 2007; 28: 182-191
    CrossrefPubMedGoogle Scholar
  • 50 Beard E, Lewis JJ, Copas A. et al. Stepped wedge randomised controlled trials: systematic review of studies published between 2010 and 2014. Trials 2015; 16: 353
    CrossrefPubMedGoogle Scholar
  • 51 (BfArM) B für A und M. DiGA-Verzeichnis [Internet]. 2021. Available from: https://diga.bfarm.de/de
    PubMed
  • 52 Ekeland AG, Bowes A, Flottorp S. Methodologies for assessing telemedicine: A systematic review of reviews. Int J Med Inform 2012; 81: 1-11
    CrossrefPubMedGoogle Scholar
  • 53 Wilson K, Bell C, Wilson L. et al. Agile research to complement agile development: a proposal for an mHealth research lifecycle. Npj Digital Medicine 2018; 1: 46
    CrossrefPubMedGoogle Scholar
  • 54 Angelescu K, Sauerland S. Mobile Gesundheitsanwendungen: Welche Evidenz ist n-tig?. Dtsch Arztebl International [Internet] 2019; 116 A-1057 Available from: https://www.aerzteblatt.de/int/article.asp?id=207821
    PubMedGoogle Scholar
  • 55 Dick S, O’Connor Y, Heavin C. Approaches to Mobile Health Evaluation: A Comparative Study A mHealth Evaluation Comparison Study. Inform Syst Manage 2019; 37: 1-18
    PubMedGoogle Scholar
  • 56 Philipp S-P. Digitalisierung der Versorgungsforschung – Versorgungsforschung zur Digitalisierung. In Berlin, Heidelberg. Springer; Berlin Heidelberg: 2019. p 175-184
    Google Scholar
  • 57 Moore GF, Evans RE, Hawkins J. et al. From complex social interventions to interventions in complex social systems: Future directions and unresolved questions for intervention development and evaluation. Evaluation-us 2019; 25: 23-45
    CrossrefPubMedGoogle Scholar