Promoting Digital Health Literacy in the German Healthcare System: A delphi Study on Framework Conditions, Responsibilities, and Promotion Measures

Abstract

The German healthcare system is facing considerable challenges such as a shortage of skilled workers, demographic change, and rising treatment costs. Digitalization is seen as the key to increasing efficiency and quality. However, the population's ability to deal adequately with digital health information and applications, summarized as the concept of digital health literacy (dHL), is poorly developed. This might lead to errors in diagnoses, careless use of digital applications and risky medication changes. The current approaches to the promotion of dHL by health insurance companies are regulated in § 20k SGB V. However, this often follows a one size fits all approach, which does not do justice to the complexity of dHL and the needs of the population. In the German healthcare system, the conceptual understanding, responsibilities, and specific support measures for dHL come too short. Despite the high relevance of a high dHL for insured people, but also for the sustainability of the healthcare system, there is a clear implementation problem. The dissertation therefore aimed to generate expert opinions and recommendations for action for the future proactive and structured design of framework conditions, responsibilities, and measures to promote dHL among people with statutory health insurance in Germany. To answer the research question, a Delphi study was conducted using a mixed-methods design. This initially comprised a pre-study with a literature review and guided expert interviews. The results were then translated into theses. These theses were evaluated by 32 experts in two rounds of the Delphi survey with regard to their relevance and feasibility.

There was a high degree of agreement among the experts regarding the need for activities to promote dHL, but there were also some uncertainties, heterogeneous views, and obstacles to implementation. The results led to 18 specific recommendations for action. Among other things, a need for a uniform and more holistic conceptual understanding of dHL became evident. This should not only take into account individual abilities, but also systemic framework conditions and influencing factors. Support should not only take place in the SHI system, but also include other policy areas such as schools. In addition, content and skills facets must be continuously reviewed and further developed. This becomes even more important because of the fast technological developments, for example dealing with AI-generated information. In addition, proposals for the expansion of responsibilities beyond the health insurance funds were developed. Stakeholders such as doctors, self-help groups, patient organizations and adult education centers can contribute to dHL promotion in direct contact with the patients. Promotional measures are considered most feasible if they are integrated into existing structures of the SHI system, for example by using existing contact points. Measures should be established that both promote individual competence and raise general awareness of dHL.

Overall, the study contributes to closing the existing research gap in the area of dHL promotion in Germany. It makes it clear that dHL is a dynamic concept whose promotion requires continuous adaptation to changing skills requirements and technological developments. Integrative cooperation between different levels and stakeholders, taking into account individual and systemic requirements, is seen as crucial for successful dHL promotion in the German SHI system.