The number of students studying abroad has increased considerably in recent years. International students often face barriers to accessing health information, affecting their mental and physical well-being. Using a repertoire-based approach, this study extends previous research that mainly focused on individual sources, online information, or specific contexts. By expanding the media repertoire approach to include an interpersonal dimension and analysing the combination of search modes, intermediaries, channels, and sources, the study provides a comprehensive examination of international students’ health information-seeking patterns in Germany, covering a wider range of topics. A two-week online diary study with 15 participants generated 102 search situations. Using a multilevel latent class analysis, the study is the first to examine health information repertoire types among international students, identifying Online Information Seekers and Online and Interpersonal Information Seekers. The findings reveal that online information is frequently used across a wide range of search purposes. Even for more serious health topics, participants relied more on lay information from the internet or trusted individuals than on health professionals. Among Online Information Seekers, the exclusive reliance on online sources warrants critical consideration, as it may reflect barriers to accessing health information and services. The study offers practical implications for target group–oriented health communication, considering varying sources and language preferences, including the introduction of dedicated health officers at universities.

Background Chronic diseases, such as type 1 and type 2 diabetes, asthma, and chronic obstructive pulmonary disease , demand long-term treatment and permanent adaptation. One important pillar in coping with these diseases is individuals’ self-management, including support from digital media. Research on their effects confirms their potential. However, it is flawed by theoretical underdevelopment and methodological weaknesses, such as a focus on short-term effects, single digital features, and microlevel studies. Objective The research unit (RU) DISELMA (“Digital Media in Chronic Disease Self-Management”) aims to examine the continued use patterns and effects of the digital self-management of chronic diseases, as well as the role of the interpersonal, organizational, and societal levels to gain a comprehensive picture of the individual processes, their contextual embeddedness, and cross-level interactions. Methods To fully capture the manifold multilevel influences, the RU comprises 6 individual projects (IPs), each of which conducts several studies. Two projects at the individual level analyze determinants of use, usage patterns, and effects of digital media, combining systematic reviews, experience sampling method studies, focus groups, panel surveys, and content analysis of apps used. Two projects examine the interpersonal context by analyzing the role of health care providers and the diffusion of digital media in informal networks, conducting a scoping review, online surveys with physicians, semistructured interviews, and participant observations of physician-patient dyads, patient focus groups, and interviews with peers. One project aims to analyze the role of organizations within the mobile health market by conducting a content analysis of organizational messages and a survey. Finally, one project analyzes journalistic and social media to gain insight into the discourses about digital chronic disease self-management on the societal level. Results The RU received funding approval from the Deutsche Forschungsgemeinschaft (German Research Foundation; grant 456132969) in July 2023, and the 4-year funding period ranges from December 2023 to November 2027. IP1 is currently conducting its systematic reviews and experience sampling method studies, both to be finalized in 2026. IP2 is conducting its systematic review and meta-analysis alongside panel surveys until June 2026. IP3 has completed its online survey with physicians and is currently conducting observations until August 2026. IP4 is conducting its scoping review and peer interviews through 2026, while IP5 is working on its content analysis and survey, and IP6 on its manual content analysis. First publications of the results are expected in 2026. Conclusions The results will contribute to the existing research through a theoretically and methodologically comprehensive approach that improves our understanding of the processes within and between all levels. These insights will inform providers of digital health solutions and health care practitioners about users’ needs, advance evidence-based disease self-management programs, and contribute to better coping with chronic diseases, improved well-being of affected individuals, and reduced health care costs. International Registered Report Identifier (IRRID) DERR1-10.2196/77811

Introduction: Relying on theory and evidence is a tenet of health intervention planning. Beyond these principles, it is important to understand how theory and the available evidence are combined and inform subsequent steps in the process. This article presents an integrated process model for designing health interventions using behavioral insights and Human-centered Design (HCD). To illustrate the model, we describe its application in developing an educational intervention addressing older adults’ influenza and pneumococcal vaccination behavior. Methods: A representative survey assessed psychological, health information, demographic, and lifestyle determinants. HCD methods, e.g., personas, were used to combine the findings. The perception and memory effects of three different intervention ideas were tested with an experiment and qualitative interviews, followed by the implementation and evaluation of a final intervention idea. Open science principles were used to facilitate transparency. Results: Following the process model, the final intervention idea “For the Plus in life” was chosen, that met the criteria of good recall, recognition, and positive evaluations. The intervention portrayed the protection of oneself and others and emphasized an improved quality of life by avoiding illness. Preliminary evaluation results after implementation in two consecutive years show that the intervention fulfilled important outcomes. Discussion: The process model demonstrates how to combine behavior-oriented theory and evidence to develop a data-driven, human-centered educational health intervention. The model provides a practical guide for public health practitioners to combine and implement data at different steps in health intervention planning. Trial Registration: German Clinical Trials Register (Deutsches Register Klinische Studien) DRKS00012653.

Background Unintentional childhood injuries such as poisonings are prevalent among young children and can have severe or even fatal consequences. As most of these injuries happen in and around the home, parents and other caregivers need to be prepared to prevent and deal with them. mHealth apps are promising for this, since regular smartphone use is widespread. This study evaluated the German app “Vergiftungsunfälle bei Kindern” ( Poisoning Accidents in Children ). Methods Parents ( n = 21) and temporary caregivers ( n = 21) of children under the age of seven were recruited for a mixed-methods study, comprising a remote usability test (thinking aloud, observation data and click protocols), focused interviews and the System Usability Scale (SUS). Results The mean usability score was 77.6 ± 15.7 out of 100. Most participants reported they trust the app and would use it in specific situations. The general app structure was perceived as clear. Perceived usefulness was facilitated by education on childhood injuries and contact to the poison control center, whereas it was impaired by the perception that the app impedes learning and rapid action in critical situations. Major obstacles included a reduced comprehensibility in terms of text design, visualizations, and complex language, all causing high time expenditure. Moreover, while some participants wished for condensed information, others expressed the need for more detailed explanations. Conclusion The results indicate that the intention to use the app was high, but its perceived ease of use and usefulness could be further enhanced by a better tailoring to different needs of caregivers.

IntroductionIn recent years, Germany has experienced a steady rise in international student enrollment at its higher education institutions. While universities publicly commit to diversity, equity, and inclusion (DEI) principles, many fall short in translating these commitments into concrete practices. The lack of initiatives fostering meaningful cross-cultural engagement frequently contributes to integration challenges and experiences of othering. These experiences cause international students to face greater adjustment challenges than their local peers, often resulting in increased feelings of loneliness, depression, and isolation. Limited social interaction and othering can further create barriers in accessing health information and services. In this challenging time, however, it is particularly important to have access to health information and services that support and advise international students in coping with emotional and social difficulties. Drawing on social capital theory, this study examines the interrelationship between international students’ experiences of othering, their ties within their country of origin and Germany—reflected in their acculturation trajectories—and access to health information.MethodsTo examine these interrelations and the role of othering in these processes, we conducted interviews with 15 international students in Germany.ResultsThe findings indicate that acculturation trajectories are reflected in participants’ health information repertoires, particularly regarding access to trusted individuals as health information sources. Participants undergoing integration typically reported utilizing a broader set of sources from multiple cultural contexts, whereas those experiencing separation or assimilation tended to rely on sources from only one context. Experiences of social othering—particularly within university settings—shaped the international students’ acculturation trajectories, especially among those experiencing separation. Linguistic exclusion and discriminatory behaviors by health professionals prompted many participants to avoid medical consultations and instead rely more on online sources.DiscussionThese findings underscore the need for cultural sensitivity training among health professionals and institutional efforts to counteract othering on campus through comprehensive integration strategies and cross-cultural engagement initiatives.

Child poisoning accidents are a serious public health problem that could significantly be reduced by adopting preventive measures. This raises the question of how communication campaigns can address caregivers to increase the likelihood of performing preventive behaviours that may reduce childhood accidents. To develop evidence-based interventions, we first developed a theory-based model for explaining the intention to prevent child poisoning accidents based on determinants of pre-existing models. The model was tested among a quota sampled survey of parents of children under seven years in Germany (Study 1, N = 1,013). The attitude towards preventing poisoning accidents and the perceived behavioural control (PBC) showed the strongest relationship with the intention. Furthermore, behavioural and control beliefs based on the Theory of Planned Behaviour (TPB) were identified and experimentally addressed in Study 2 (N = 550) to examine effects on attitude, PBC, and intention. Addressing these beliefs did not affect the dependent variables. However, there was a relationship between the respective beliefs, attitudes, and the PBC. Furthermore, attitude and PBC were strongly related to the intention. The results suggest that in the communication of child accident prevention, addressing the attitude towards preventive behaviour, the PBC, and risk perception may be useful.

Objective: Older adults may fail to demand vaccinations because they lack knowledge about the benefits of vaccination or underestimate disease risks. This study evaluated an extended knowledge intervention that provided information on lesser-known risks of influenza—including pneumococcal disease and sepsis—and the benefits of vaccination. Methods: The intervention was implemented in a model region in Germany during two influenza seasons. Two quota-sampled telephone surveys targeting adults 60+ were conducted to assess the impact of the intervention (N = 700 each). Quasi-experimental groups (intervention-exposed vs. non-exposed) were defined based on self-reported intervention exposure. Primary outcomes included knowledge (influenza, pneumococci, sepsis), the 5C antecedents of vaccination, and vaccination intention and behavior. Results: Intervention exposure had small positive effects on knowledge about influenza (η² = .009), pneumococci (η² = .012), and sepsis (η² = .004). It was also associated with higher risk–benefit calculation regarding influenza vaccination (η² = .003) and increased confidence in the safety of pneumococcal vaccination (η² = .020). Vaccination intentions for both diseases did not differ between groups. Although the intervention did not directly influence behavior, vaccination uptake increased over time due to external factors (influenza: OR = 1.880; pneumococci: OR = 2.080). Conclusions: Information alone can enable informed decisions and can help to change underestimated risks, but does not shift behavior. Embedding knowledge gains within multi-component strategies (e.g., provider endorsement, reminders, easy access) is the most plausible path to increased coverage. Targeting other factors is also important.

Whether individuals engage with or avoid health information and which sources are used is crucial for informed decision-making about mammography. Therefore, we aim to develop a typology of mammography-related information behaviors and explore their determinants, which were derived from the Theory of Motivated Information Management (TMIM). Based on a two-wave online survey of a sample of German women aged 40 to 69 years (N = 1,138), a cluster analysis resulted in five person-centric types of information behavior that cover respondents' variety of engagement with mammography-related information: The seekers, the scanners, the avoiders, the involved, and the inactive. The types indicated that most individuals possess a high preference for one strategy of information behavior. Looking at the determinants of belonging to a particular type of information behavior, it becomes apparent that the factors of the TMIM have only limited explanatory power. The most relevant factors in distinguishing the types of information behaviors are benefit perceptions, worry, interest, avoidance efficacy, seeking, and avoidance-related outcome expectancies. Scanners and seekers had higher benefit perceptions. Seekers were further motivated by greater worries, while involved ones felt more interested and held stronger expectancies. Avoiders were more anxious and had a higher avoidance efficacy. The study suggests that inactive individuals and avoiders are highly prevalent and relevant target groups for health interventions that support informed decision-making. To facilitate informed decision-making, women should be encouraged to weigh benefits and harms of their options and to address negative emotions, such as anxiety, that may exist or arise during decision-making.

Introduction. Information sharing is an important but under researched type of health information behaviour. In this study, we explore the characteristics of sharing behaviours, their reasons and determinants in the context of mammography screening. Method. We conducted a two-wave online survey with N = 1,136 women. In the first wave, women saw an invitation letter to mammography screening and behavioural determinants were captured with established scales. In the second wave, women reported on their information behaviour between the two waves, combining standardized and open-ended questions. Analysis. We performed qualitative content analysis and a stepwise logistic regression analysis. Results. About one-fifth of the sample shared information on mammography between the two survey waves. Qualitative results revealed different causes and purposes of information sharing. Quantitative results showed that issue importance, opinion leadership and different types of information retrieval were related to information sharing. Conclusions. The results shed light on two facets for the conceptual clarification of health information sharing: sharing in the sense of selecting and passing on information (cf. diffusion of information by opinion leaders) and sharing as the mutual exchange of opinions and experiences. Both facets should be considered to comprehensively examine health information sharing behaviours and their relation with informed decision-making.

Over the last years, infectious diseases have been traveling across international borders faster than ever before, resulting in major public health crises such as the Covid-19 pandemic. Given the rapid changes and unknown risks that mark such events, risk communication faces the challenge to raise awareness and concern among the public without creating panic. Drawing on the social amplification of risk framework-a concept that theorizes how and why risks are amplified or attenuated during the (1) transfer of risk information (by, for instance, news media) and (2) audiences' interpretation and perception of these information-we were interested in the portrayal of risk information and its impact on audiences' risk perception over the first wave of the Covid-19 pandemic in Germany. We therefore conducted a quantitative content analysis of a major public and private television (TV) newscast (N = 321) and combined it with survey data (two-wave panel survey, t1: N = 1378 and t2: N = 1061). Our results indicate that TV news (as a major information source at that time) were characterized by both risk-attenuating and risk-amplifying characteristics, although risk-amplifying attributes were particularly pronounced by the private TV newscast. Notably, those who only used private TV news between both waves showed the highest perceived severity at time 2. However, the interaction effect of time and use of public and/or private TV news was only significant for perceived susceptibility. Overall, more research is needed to examine the effects of different types of media and changes in risk perceptions over time.

During times of uncertainty, such as the Covid-19 pandemic, people tend to cope through active information seeking. However, information overexposure can also lead to issue fatigue, a state in which recipients are increasingly annoyed and may actively avoid further information on this specific issue. Against this backdrop, we were interested in (1) whether people in Germany have experienced Covid-19 related issue fatigue over the course of the pandemic, (2) and if so, how Covid-19 information behaviour may have contributed to it, and (3) to what extent TV news coverage exhibits characteristics that are considered to contribute to recipients’ issue fatigue. To address these questions, we combined a two-wave panel survey (2020) and a cross-sectional survey (2021) of the German population with a quantitative content analysis of Covid-19 related TV news (2020 and 2021). The results show an increase in issue fatigue over time. However, there was no evidence indicating that people’s Covid-19 information behaviour has contributed to this. Rather, both information seeking and the reception of public TV news were negatively related to issue fatigue. Notably, TV news coverage showed characteristics that are considered determinants of issue fatigue, including its extent and an overall ambivalent-to-negative tone.

Background Despite various global health crises, the prevention and handling of unintentional childhood injuries remains an important public health objective. Although several systematic reviews have examined the effectiveness of different child injury prevention measures, these reviews did not address the evaluation of mobile communication intervention tools. Whether and how mobile apps were evaluated provides information on the extent to which communication theories, models, and evidence-based knowledge were considered. Previous studies have shown that the effectiveness of mobile apps increases when theories and evidence are considered during their development. Objective This systematic review aimed to identify research on mobile apps dealing with the prevention and handling of unintentional injuries in children and examine the theoretical and methodological approaches thereof. In addition, this review analyzed the different needs of various target groups of the mobile apps described in the articles. Methods In total, 8 electronic databases, ranging from interdisciplinary to medical and technical as well as social sciences databases, were searched for original research articles or brief reports in peer-reviewed journals or conference proceedings. Moreover, this review encompassed a systematic scan of articles published in the BMJ journal Injury Prevention. These steps were followed by a snowball search based on the literature references in the articles identified through the initial screening. The articles had to be written in English or German, published between 2008 and 2021, and evaluate mobile apps dealing with the prevention and handling of unintentional child injuries. The identified 5 studies were analyzed by 5 independent researchers using an inductive approach. Furthermore, the quality of the studies was assessed using the Mixed Methods Appraisal Tool. Results A total of 5 articles were included and assessed with regard to overall quality of theoretical and methodological foundations, assessed variables, the focal app’s architecture, and the needs of the study participants. The overall study quality was moderate, although part of this classification was due to a lack of details reported in the studies. Each study examined 1 mobile app aimed at parents and other caregivers. Each study assessed at least 1 usability- or user experience-related variable, whereas the needs of the included study participants were detailed in only 20% (1/5) of the cases. However, none of the studies referred to theories such as the Technology Acceptance Model during the development of the apps. Conclusions The future development and evaluation of apps dealing with the prevention and handling of child injuries should combine insights into existing models on user experience and usability with established theories on mobile information behavior. This theory-based approach will increase the validity of such evaluation studies.

Background Caregivers who supervise children under 7 years of age, such as (grand)parents or medical and pedagogical staff, are important target groups for communication measures in child accident prevention. To identify and reach them, multipliers from their ranks (peers and professionals) as well as multipliers from institutions (intermediaries or second order multipliers) can be important, each with their own preferences for information channels and communication occasions; however, existing information dissemination approaches do not sufficiently consider these multiple perspectives and the reciprocal perspectives of communication partners. Objective Based on a project on child accident prevention we therefore analyzed which interpersonal information sources and information occasions the respective subgroups consider significant in order to identify and reach appropriate multipliers. Material and methods For this purpose, a total of eight focus groups and four individual interviews were conducted with parents (n = 25), medical and pedagogical care personnel (n = 17), and intermediaries from institutions (n = 15). Results The results show that the perspectives of the different dialogue and multiplier groups on information sources used and occasions for seeking and sharing information differ significantly. Discussion These results underline the importance of examining the different perspectives as part of a multiplier concept and taking them into account in the development of communication measures. Future research should examine to what extent the results can be transferred to other prevention fields.

To explore the information behavior in the context of child injury prevention, we conducted online focus groups with parents, professional caregivers, and intermediaries as part of a larger project. In this paper, we discuss our qualitative interview design: audiovisual, synchronous online focus groups. To do so, we analyze a crucial methodological issue of focus group interviews: the flow of communication. In our study, three main topics emerged that influenced the flow of communication in online focus groups: (a) communication mode(s), (b) (co-)moderation, and (c) distractions and interjections of other people. We conclude that depending on the research topic and target group, audio-only communication may be advantageous compared to audiovisual communication because lay people may disclose more on sensitive topics. Moreover, the considerate composition of the focus group is essential for participants' interaction, so that all participants feel they have an important part to contribute to the discussion. Skilled co-moderation is crucial to successfully integrating all participants and evolving communication threads, and dealing with disruptions.