Christoph Dockweiler

Infodemiology and infodemic management rest on a premise so foundational that it is rarely stated: health information behaviour leaves traces that researchers and public institutions can observe. This paper argues that the premise is dissolving. Health information seeking is migrating from publicly observable websites and platforms into conversational artificial intelligence, where exchanges unfold in private dyads between user and system and are visible in full only to the providers operating them. The paper develops a typology of three observability regimes, termed open, brokered and enclosed observability, which differ in trace custody, conditions of third‐party observation, attainable granularity, stability of access and the epistemic position of public health. It traces the arc from the open web through the platform era, whose brokered observability collapsed in the post‐API age, to the enclosed regime of conversational agents, in which knowledge about population health information behaviour is produced and selectively disclosed by commercial providers. The analysis derives implications for infodemic management, for the evaluation of health information environments and for regulation, and argues that privacy‐preserving research access to conversational health data should be established as public health infrastructure.

Background: Digital game–based learning (DGBL) is gaining traction in medical and nursing education, but its integration into public health and health sciences curricula remains limited. This study addresses this research gap by exploring student perspectives, use patterns, and expectations regarding DGBL within German public health study programs. Objective: The study investigated how public health and health sciences students perceive DGBL and identified conditions that promote or hinder its integration into academic training for public health professionals. Methods: A cross-sectional online survey was conducted from January 2021 to March 2024. A total of 444 students participated, with 326 completing the questionnaire. The instrument combined closed- and open-ended questions on sociodemographic characteristics, digital media use, attitudes toward DGBL, and structural and pedagogical requirements. Quantitative data were analyzed descriptively using SPSS; qualitative data were evaluated using MAXQDA and Kuckartz structured content analysis. Results: The sample consisted predominantly of full-time students enrolled in bachelor’s or master’s programs in public health and health communication. Digital media are widely used for communication (n=320, 98.2%), information search (n=291, 89.3%), and entertainment (n=268, 82.2%) in daily student routines. In contrast, video gaming and online shopping play a minor role. Students expressed a generally positive attitude toward DGBL, particularly in practical learning contexts such as exam preparation, visualizing complex content, and knowledge checks. High agreement was found for using DGBL in modules such as Prevention and Health Promotion (n=277, 84.9%), Epidemiology and Statistics (n=271, 83.2%), and Population Medicine (n=251, 76.7%). Preferred devices include desktop PCs, tablets, and smartphones, while immersive technologies such as virtual reality or augmented reality glasses or consoles are less favored. Students highlighted specific prerequisites for DGBL integration: a functioning technical infrastructure (n=321, 98.5%), media-literate teaching staff (n=311, 95.4%), and compliance with data protection standards (n=303, 93%). Furthermore, students valued user-friendly design (n=255, 78.2%), technical reliability (n=299, 91.7%), clear feedback (n=236, 72.4%), and flexibility regarding the time and place of use (n=307, 94.2%). Game elements such as animations, multimedia, and reward systems were appreciated, whereas features such as 3D graphics, avatars, and multiplayer modes were considered less important. Conclusions: The findings show a high willingness among students to engage with DGBL, especially when its design emphasizes clarity, usability, and relevance to course content. Emotional safety, flexible access, and pedagogical integration are more decisive than immersive game features. To effectively implement DGBL in public health education, developers and educators should cocreate low-threshold, didactically sound applications that align with students’ preferences and study realities. Future research should assess learning outcomes and emotional effects longitudinally and explore scalable implementation strategies.

Zusammenfassung: Hintergrund: Die zunehmende Belastung des Gesundheitssystems erfordert innovative Versorgungslösungen, insbesondere für chronisch Erkrankte wie Diabetiker*innen. Hybride Interaktionssysteme kombinieren digitale Technologien und persönliche Betreuung, um Versorgungslücken zu schließen. Ziel: Die Studie analysiert Anforderungen, Potenziale und Hürden bei der Nutzung hybrider Systeme aus Sicht von Patient*innen und medizinischen Fachkräften. Methode: Im Rahmen der HIS4DiaPedes-Studie wurden Online-Befragungen ( n = 69) und qualitative Interviews ( n = 45) mit Patient*innen und Fachkräften durchgeführt. Die quantitative Analyse erfolgte deskriptiv mit SPSS, die qualitative inhaltsanalytisch nach Mayring mit MAXQDA. Ergebnisse: Sowohl von medizinischen Fachkräften, als auch von Patient*innen werden sich Echtzeitdaten, individualisierbare Warnfunktionen, eine zentrale Plattform zur Datenerfassung, einfache Kommunikationswege und transparente Datenschutzlösungen gewünscht. Herausforderungen bestehen insbesondere bei älteren Patient*innen sowie in der technischen Infrastruktur. Schlussfolgerung: Hybride Interaktionssysteme erscheinen als potenziell geeignete Ergänzung der Diabetesversorgung, wenn diese benutzerfreundlich, anpassbar und datenschutzkonform gestaltet sind. Die Ergebnisse liefern Hinweise darauf, dass die Kombination digitaler und persönlicher Elemente sowie partizipative Entwicklungsprozesse für die Akzeptanz solcher Systeme relevant sein könnten; diese Annahmen sollten jedoch in konfirmatorischen Folgeuntersuchungen überprüft werden.

Background/Objectives: Depressive disorders are among the most prevalent mental illnesses worldwide. Digital health interventions offer potential to improve access, efficiency, and outcomes in depression care. However, their sustainable integration into routine clinical practice remains limited. This study explored individual, organizational, external and contextual factors influencing digital health interventions implementation from the perspective of health professionals. Methods: Semi-structured interviews with health professionals (n = 9) were analyzed using a hybrid qualitative approach. First, structuring content analysis following Kuckartz was applied to systematically code and categorize the transcripts. Second, the resulting codes were mapped onto four domains of the Consolidated Framework for Implementation Research (Outer Setting, Inner Setting, Process, and Characteristics of Individuals) to identify implementation-relevant barriers and facilitators. This combined approach ensured a transparent, theory-informed, and reproducible analysis of factors influencing digital health intervention implementation in depression care. Results: Key individual-level enablers included openness to innovation, motivation, and prior experience with digital tools. Organizational factors such as leadership support, designated facilitators, time, training, and IT infrastructure were critical. External factors included data protection, clear regulatory frameworks, reimbursement mechanisms, and scientific validation. Barriers involved limited digital skills, ambiguous responsibilities, and concerns about misuse or risks. Conclusions: The successful implementation of digital health interventions in depression care requires alignment with organizational structures, provider capabilities, and patient needs. Supportive leadership, tailored training, and clear external frameworks can enhance acceptance and sustainability. As complementary tools, digital health interventions can help optimize mental health services and improve patient outcomes.

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.

Background: Telerehabilitation has become increasingly important worldwide, as the COVID-19 pandemic forced many rehabilitation centers to change their daily care routine and find new ways to provide medical rehabilitation and aftercare. Objective: This study aims to investigate the acceptance and implementation conditions of telerehabilitation in Germany, particularly following the COVID-19 pandemic. Methods: We conducted qualitative semistructured interviews with patients (n=9) and health care professionals (n=8) between September 2023 and January 2024. To explore individual and structural barriers to and facilitators of telerehabilitation adoption, we used the extended unified theory of acceptance and use of technology and the Consolidated Framework for Implementation Research. Results: Patients and health care professionals perceived telerehabilitation as positive, mainly due to its flexibility and accessibility. Patients expressed high acceptance levels, anticipating health benefits, although they found it challenging to familiarize themselves with the technology and establish routines. Health care professionals highlighted the need for adequate resources (financial, time, and personnel) and management support to implement telerehabilitation successfully. Both groups saw higher acceptance and cost coverage of telerehabilitation services as essential for successful implementation and use in Germany. Conclusions: This study identified institutional barriers, such as concerns about resource availability, team communication, and initial resistance among health care staff to the introduction of new technologies. At an individual level, we found that patients struggled with routine establishment and that digital and in-person support from institutions and peers could mitigate this challenge. Implementing a hybrid approach and improving funding and approval processes would enhance telerehabilitation integration in the German health care sector.

Zusammenfassung: Durch die COVID-19-Pandemie wurden die Rehabilitationseinrichtungen gezwungen, von ihrer Versorgungsroutine abzuweichen und ihre organisatorischen Abläufe den Erfordernissen des Infektionsschutzes anzupassen. In diesem Zuge sind digital unterstützte Rehabilitationsangebote weiterentwickelt und ausgeweitet worden. Ziel der Studie war eine systematische Bestandsaufnahme digital unterstützter Rehabilitationsangebote, inklusive der Erhebung hemmender und förderlicher Faktoren für deren Implementierung.Die bundesweite quantitative Onlineerhebung folgte einem explorativen Ansatz. Anhand eines neu entwickelten Fragebogens, der sich an den Konstrukten des Consolidated Framework for Implementation Research orientiert, wurden in den Fachabteilungen der medizinischen Rehabilitation digital unterstützte Rehabilitationsangebote erfasst sowie hemmende und förderliche Faktoren für deren Implementierung erhoben.452 Fachabteilungen beteiligten sich an der Befragung, von denen zum Zeitpunkt der Studie etwa die Hälfte digital unterstützte Angebote einsetzte. Am häufigsten wurden digitale Schulungen und Tele-Reha-Nachsorge genannt. Hemmende Faktoren für die Implementierung sehen die Antwortenden insbesondere in Arbeitsunterbrechungen durch technische Herausforderungen sowie in einer nicht angemessenen Vergütung durch die Kostenträger. Als besonders förderlich wurden die Unterstützung durch die Führungsebene, die Zweckmäßigkeit des digital unterstützten Angebotes sowie die Einbeziehung der Mitarbeitenden in den Implementationsprozess wahrgenommen.Die Studie gibt erstmals einen Überblick über die in der medizinischen Rehabilitation eingesetzten digital unterstützten Angebote und ermöglicht ein besseres Verständnis der hemmenden und förderlichen Faktoren für deren Implementierung.