Digital Public Health

Inhaltsverzeichnis

1. Frontmatter

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2. Why Is It Essential to Address Digital Public Health in an Interdisciplinary Way?

   • Open Access

   Laura Maaß, Hans-Henrik Dassow, Daniel Diethei, Merle Freye, Jasmin Niess, Stefanie Do

   Abstract

   Public health requires collaborations across several disciplines to meet population health needs. Increasing technological advancements have accelerated the transformation of public health to digital public health (DiPH), including new domains to develop, maintain, and improve evidence-based digital technologies. However, having various disciplines collaborating can create unique challenges if there is no mutual understanding of DiPH. This chapter aims to illustrate and discuss interdisciplinary approaches and collaborations in DiPH research and practice. First, we will give an overview of the concept of interdisciplinarity and draw on the practical challenges of interdisciplinary research and best practice examples for promoting such competencies. Second, we will describe traditional public health core functions and their relationship with other disciplines in the social, natural, and environmental sciences and humanities. Third, we will highlight how the extension to DiPH influenced the so-called system of sub-disciplines that form public health. Fourth, we will use a case study on mental health and medical apps to highlight essential strengths and limitations of selected sub-disciplines in DiPH (epidemiology, psychology, philosophy, law, computer science, and implementation science). Finally, we provide seven key recommendations that should promote and foster effective interdisciplinary collaborations in DiPH.

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3. Overarching Issues

   1. Frontmatter

   2. Public Health in the Digital Era: Digital Entry Points for Population Health

      • Open Access

      Tina Jahnel, Benjamin Schüz, Hajo Zeeb

      Abstract

      In this chapter, we investigate the development and implementation of digital health technologies in public health using the perspective of digital entry points into the overall systems of health determinants. We use current case studies to illustrate how digital technologies can enter and shape the sphere of health and social interventions or—through their post-entry diffusion—lead to positive or adverse consequences. We present digital extensions of widely used socio-ecological models of health that illustrate entry points and interactions and outline strategies for how identified entry points on various levels can be used to develop strategies for wider dissemination of digital approaches for public health, e.g., through participatory research. Further applied examples focusing on co-created tools and interventions to address social media misinformation illustrate some of the analytic and developmental potentials of the perspectives outlined in this chapter.

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   3. A Framework to Develop and Evaluate Digital Public Health Interventions

      • Open Access

      Chen-Chia Pan, Núria Pedrós Barnils, Saskia Muellmann, Tina Jahnel, Dorothee Jürgens, Merle Freye, Hans-Henrik Dassow, Wolf Rogowski, Ansgar Gerhardus

      Abstract

      A rapidly increasing number of digital technologies have emerged with the aim of improving public health. To assess these technologies, a framework is needed that incorporates a public health perspective and takes the complexity of the technology, the context in which it operates, and its implementation into account.

      Existing frameworks focus on health technologies, public health, or digital technologies. A framework for digital public health that supports developers, evaluators, policymakers, and researchers in systematically developing and evaluating digital public health interventions is missing.

      We combined a scoping review of existing public health and digital health frameworks together with a consensus meeting with multidisciplinary experts. The outcome was a framework (DigiPHrame) that consists of 182 questions, structured by 12 domains: (1) Health Condition and Current Public Health Interventions, (2) Technical Aspects, (3) Usability, (4) Infrastructure and Organization, (5) Implementation, (6) Intended & Unintended Health-related Effects, (7) Social, Cultural, and Intersectional Aspects, (8) Ethics, (9) Legal and Regulatory, (10) Data Security and Data Protection, (11) Cost and Economics, and (12) Sustainability.

      Potential users can apply these questions to any digital public health intervention they want to develop and assess. The framework is a living framework that will be constantly revised.

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   4. Participatory Approaches for Digital Public Health: Giving Voice to Values

      • Open Access

      Rehana Shrestha, Anke V. Reinschluessel, Jasmin Niess

      Abstract

      This chapter discusses the need for community involvement and stakeholder engagement in the development and implementation of digital public health tools. The advent of digitalization in public health has necessitated an exploration of how to design tools that meet the needs of the community they serve. This can be achieved through a participatory approach that incorporates the voices and perspectives of all stakeholders in a democratic manner. Specifically, this chapter discusses two participatory approaches: participatory design and participatory research. These approaches originate from different intellectual traditions but share a vision of incorporating everyone from the community affected by the intervention or technology. Additionally, this chapter presents application examples from the literature on how the development of health-related applications benefited from participatory research and participatory design to illustrate the added value of integrating these approaches.

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   5. Open Data for DiPH Research Versus Data Protection

      • Open Access

      Merle Freye, Benedikt Buchner

      Abstract

      Research in public health is particularly dependent on the unrestricted use of data. The processing of personal health data can serve health-related public interests and bring significant benefits to individuals and society (https://www.oecd.org/health/ministerial-statement-2017.pdf). In contrast, data protection law aims to protect personal data and is consequently based on the prohibition principle and the principle of purpose limitation. Although the General Data Protection Regulation (GDPR) also contains research-friendly approaches and provides the possibility of privileging research data processing at various points, in practice, data protection still poses challenges to research for public health purposes. The concept of consent is questionable, and—especially in Germany—many uncertainties arise from the complex patchwork of state-specific regulations. New concepts such as “broad consent,” “dynamic consent,” “no consent,” and “synthetic data” are intended to facilitate the processing of data for research purposes in line with data protection law. Fueled by these debates, national and international data protection laws will inevitably have to face changes in the near future.

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   6. Evidence-Based Approaches in Digital Public Health

      • Open Access

      Joanna Albrecht, Pinar Tokgöz, Christoph Dockweiler

      Abstract

      Rapid innovation in technology as well as an increase in its availability for health promotion and care, have revolutionized health service delivery today. Further, this has a maximum impact on developing and improving public health interventions and evidence-based approaches in digital public health. The collection and analysis of user-generated data (real-world evidence) created opportunities for both individual health promotion and the potential to improve and optimize healthcare delivery. However, the development and evaluation of digital health interventions also offer complex challenges. These include, among others: Uncertain dynamics in technology development, intricacies of data analysis methods under data security concerns, and the complexity of personalized health promotion or medicine. To address these challenges, an application-oriented systematization of evidence-based approaches is needed for specific areas of digital public health.

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   7. Digital Interventions for Public Health: A Systematic Planning Approach

      • Open Access

      J. Bruinsma, R. Crutzen

      Abstract

      This chapter outlines the Intervention Mapping (IM) approach, a planning framework for the systematic development, implementation, and evaluation of health promotion interventions. IM is a comprehensive approach to intervention development in general. This chapter describes the six steps of IM and emphasizes using it for digitally supported interventions within the context of public health specifically. The chapter starts by describing Core Processes, a systematic way of answering planning questions to safeguard the use of available evidence and insights from theory. Subsequently, this chapter zooms in on understanding behavior as this is key during the development of health-promoting interventions that aim to establish behavior change. Successively, the steps of IM are discussed separately and illustrated by examples of interventions that use digital technology in the context of public health. This chapter guides readers through the six IM steps and hopes to inspire them to learn more about IM and behavior change principles and their use for digital interventions.

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   8. Evaluation of Digital Public Health Interventions

      • Open Access

      Oliver Lange, Paula Boskamp, Werner Brannath, Karina Karolina De Santis, Saskia Muellmann, Wolf Rogowski, Heinz Rothgang

      Abstract

      The evaluation of digital public health (DiPH) interventions is as necessary as the evaluation of any other medical or public health intervention. This chapter addresses the two important dimensions of evaluation: effectiveness and cost-effectiveness. In doing so, we ask (1) what is already known about the (cost-)effectiveness of DiPH interventions and (2) what factors should be considered when evaluating such interventions.

      Although the body of literature is growing rapidly, the existing evidence is limited and often poor. So far, the effectiveness of DiPH interventions in terms of user outcomes was mainly assessed short-term (i.e., pre- vs. post-intervention) and compared to no intervention conditions. When assessing cost-effectiveness, it is important to distinguish between the perspectives of different types of decision makers (individuals, companies, healthcare payer, other public payers). In general, the estimated return on investment from a company perspective is positive in studies with a low quality of evidence, but negative in randomized controlled trials (RCTs) with a high quality of evidence.

      We argue that the evaluation of DiPH interventions requires alternative evaluation methods that, unlike the traditional methods (e.g., RCTs) could generate evidence faster and detect evidence gaps to be addressed in future studies.

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4. Challenges for Digital Public Health

   1. Frontmatter

   2. Cyberspaces: Modifying the Digital Environment for Health Promotion and Prevention

      • Open Access

      A. L. Stark-Blomeier, J. Albrecht, C. Dockweiler

      Abstract

      Digital transformation is creating new digital spheres of experience and venues for everyday interaction. New cyberspaces are emerging that have the potential to fundamentally change the way we live and communicate. The conceptual understanding of spaces, places, and environments is changing. This has implications for understanding health-promoting settings. The questions arise whether the common understanding of settings and the setting approach of the World Health Organization is still appropriate today and what challenges and opportunities for health promotion and prevention arise with the expansion of settings to digital spaces, places, and environments.

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   3. Digital Public Health in Europe: Was the COVID-19 Pandemic an Enabler for Healthcare Digitalization?

      • Open Access

      Laura Maaß, Brian Li Han Wong, Rok Hrzic, Ave Põld, Juan José Rachadell, Marine Delgrange, Robin van Kessel, Stefan Buttigieg

      Abstract

      Digital public health has influenced how healthcare is delivered and how health data is used for research and the monitoring of infectious diseases. The COVID-19 pandemic prompted a broader adoption of digital health interventions for public health purposes in several European countries. The European Union passed regulations to ensure data security and developed data hubs for international health data exchange to improve healthcare and public health research in the region. This chapter will present the essential European digital health and digital public health regulations (e.g., the General Data Protection Regulation). It will discuss the European Health Data Space and the importance of equitable access to digital public health interventions. This chapter will then analyze selected national perspectives through seven country case studies. These applied digital public health in various settings: through educational websites, patient portals, telemedicine, medical apps on prescription, infectious disease surveillance systems, and many more. By ensuring equitable access to these interventions and balancing investment in digital public health between populations with high levels of access and those with limited access, Europe can create a future where everyone can access quality health services, regardless of location or socioeconomic status.

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   4. Global Perspectives on Digital Public Health: A Framework

      • Open Access

      Luís Velez Lapão

      Abstract

      This chapter addresses the evolution from global health to public health and back to global public health, as well as delving into the establishment of digital public health, where globalization has played a critical role.

      We examine a set of examples of global application of digital public health from both Europe and Africa (Angola, Cape Verde, and São Tomé and Principe) contexts. This includes case studies of collaborations comprising several institutions leveraging their different skills and expertise, fully encompassing the concept of global public health.

      Design science is presented as a relevant scientific approach to support the implementation of digital public health, and a specific framework is provided to relate concrete public health functions with digital public health development opportunities. This can also be used as an agenda for research in global digital public health.

      In conclusion, a set of global digital public health challenges are summarised. It is argued that capacity building will play a role as public health professionals need to understand how to leverage digital health to bridge the gap with other areas of health. Digital public health could establish a new global and environmental health paradigm within the next ten years, paving the way to digital planetary health.

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   5. Digital Health Inequality

      • Open Access

      T. Brand, P. S. Herrera-Espejel, H. Busse

      Abstract

      Unequal health outcomes across population groups as defined by, for example, socio-economic status, gender, minority status, or sexual orientation are a major public health concern. Health interventions may unintentionally add to these health inequalities through differences in access, usage, and effectiveness (intervention-generated inequalities). Since access and usage of digital tools are known to be socially patterned, digital public health interventions are at a high risk of generating inequality effects (“the digital divide”). In this chapter, we collate evidence on digital divides and their implications for health inequalities and discuss potential solutions for minimizing the risk of intervention-generated inequalities. We argue that the involvement of diverse population groups in the development process of digital public health interventions is a central element for achieving equitable outcomes.

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   6. Digital Health Literacy

      • Open Access

      Hajo Zeeb, Julia Dratva

      Abstract

      Digital health literacy (DiHL) is a new and evolving concept. Given the ongoing digitalization of health, social and other systems, and the shift of health-related information and communication exchange into the digital space, it is becoming an increasingly important qualification for citizens, but also for health workers. The DiHL concept has recently begun to move away from being solely an issue for individuals or patients to an issue for populations and health providers. Privacy and ethical issues associated with digital technology use and data sharing are also closely related to digital health literacy.

      The chapter provides an overview of the field, moving from definitions and the evolution of the underlying concept to an overview of core instruments for the assessment of digital health literacy, with selected results on empirical findings from various populations. After discussing critical aspects of current concepts and available knowledge on digital health literacy levels, we provide an outlook that goes beyond enhancing not only individual capacities but also organizational digital health literacy.

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   7. Public Health Goes Digital—Or Not? Ethical Considerations Concerning Limits and Necessary Alternatives

      • Open Access

      Dagmar Borchers, Regina Müller

      Abstract

      Digitalization is making significant advancements in public health, but does it lead to good healthcare for everyone? Our analysis presents the accomplishments of digitalization in the field of public health and explores their ethical implications, for example, regarding access to healthcare. The analysis focuses on the ethical obligation of society to provide alternatives to digital public health services for those who cannot or do not wish to participate in digital healthcare. In the present transitional period, we suggest that such an obligation (still) exists. We draw our analysis on the principles of public health ethics, including the well-being and health of the population as a value, societal responsibility, justice and equality, and health as a fundamental element of a good life. Different challenges are identified for various groups due to age-related physical and mental limitations, illness, disabilities, and marginalized social categories. We highlight the distinct needs and claims of these groups based on ethical values in public health ethics. Society bears the responsibility of providing alternative solutions for those who are physically incapable of participating in digital processes. Similarly, for individuals and groups who desire inclusion but face inadequate representation, societal efforts must be made to integrate them into digital public health initiatives. However, we face a more complex ethical question regarding the societal obligation to support individuals who willingly abstain from digitalization. Overall, the analysis emphasizes the importance of considering ethical obligations in the context of digital public health, encompassing both the provision of alternatives for those unable to engage and the inclusion of those currently excluded from digital processes.

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   8. Social Media in Digital Public Health

      • Open Access

      Elida Sina, Merle Freye, Thomas Eßmeyer, Lara Reich, Daniel Diethei

      Abstract

      In over two decades of social media (SM) and constantly increasing user accounts, it is unquestionable that SM has taken an ever more important stand in society, combining various functions for communication and entertainment. SM represents a powerful tool to promote healthy behaviors to a larger public audience and hence, has the potential to be integrated into digital public health (DiPH). Using this potential requires a profound understanding of the potential impact of SM on health, well-being, and related behaviors. This chapter, therefore, discusses the impact of SM on DiPH, with a particular focus on the vulnerable group of children and adolescents.

      This chapter considers three perspectives: First, epidemiological studies show that SM exposure has a negative impact on children’s and adolescents’ diets and can further contribute to addiction, psychosocial distress, and depressive symptoms. Second, from the perspective of Human-Computer Interaction (HCI), SM provides interface strategies such as dark patterns that trick users into unwanted interactions, which may lead to increased screen time, and could thus worsen the adverse health outcomes. Third, from a legislative perspective, we explore how European and mainly German laws protect vulnerable groups in the SM environment.

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