Digital technologies have long been part of modern healthcare. However, not everyone benefits equally from apps and online services - especially when psychosocial stressors make access difficult. A new study by the Chair of Social Determinants of Health led by Prof. Dr. Matthias Richter now shows that it is not stress or depression that make the decisive difference, but above all positive psychological resources such as optimism and self-efficacy. The results were published in the journal “JMIR Mental Health,” which has an impact factor of 5.8.
The research team led by Johannes Stephan, Research Associate at the Chair of Social Determinants of Health, examined 173 participants in the hybrid prevention program “RV Fit Mental Health” of the German Pension Insurance. The program combines a two-week inpatient phase with a twelve-week digital training phase, which is accompanied by an app. It strengthens the mental health and work ability of people with work-related stress. Using cluster analysis, the researchers identified four different psychosocial profiles – groups of people with different patterns of stress, quality of life, self-efficacy, and optimism – and analyzed how these relate to digital health literacy (“eHealth literacy”).
“We initially assumed that mental stress and digital health literacy were simply linearly related – in other words, the more stressed, the less digitally competent,” explains Stephan, lead author of the study. "However, the data paint a more nuanced picture. Some people with high levels of stress have surprisingly good digital skills, while others with better psychosocial values tend to have more difficulty using digital applications. Resources such as self-efficacy or optimism can apparently have a strong influence on these correlations."
In addition to psychological characteristics, sociodemographic influences such as age and subjective social status, i.e., the individual's assessment of their own social position or social class, were also taken into account. The study found that younger participants and people with higher status were more likely to have better eHealth literacy. Gender, on the other hand, did not play a significant role. The influence of self-efficacy was particularly clear: people who were confident in their ability to deal with difficulties achieved higher scores in all dimensions of digital health literacy. Optimism and quality of life also correlated positively with digital skills.
“Digital prevention programs should be more tailored to the individual needs of participants,” emphasizes Stephan. “We need to provide targeted support to those who feel insecure in the digital space – for example, through low-threshold instructions or personal guidance. Digital health literacy is a key factor here – not only for prevention, but also for rehabilitation and therapy.”
The study was conducted as part of the PE³PP project, which is coordinated by the German Pension Insurance Central Germany and funded by the Federal Ministry of Labor and Social Affairs. The aim is to develop hybrid prevention programs that combine digital and analog elements, thus enabling more people to access health promotion in a low-threshold manner. The results provide valuable insights into how such programs can be designed in the future. Different psychosocial profiles also require different forms of support – for example, through digital health guides, customized app interfaces, or supplementary coaching elements.
“We should promote digital health literacy in a targeted manner – as early and continuously as possible,” says Stephan. “Ideally, this promotion should begin before rehabilitation measures start. Then participants can confidently use digital offerings and independently help shape their own health.”
Prof. Dr. Matthias Richter, Professor of Social Determinants of Health, also emphasizes the social relevance of the findings: "Digital health is not only a technical challenge, but also a social one. People differ in their circumstances, experiences, and resources. If we digitize prevention, we must ensure that no one is excluded – especially those who are more mentally or socially disadvantaged. Our results show that mental and social factors are closely related and together shape people's lives. They cannot be understood separately."
The research team therefore calls for future health programs to be more person-centered and for digital literacy promotion to be systematically integrated into prevention strategies. In this way, digital participation can become an integral part of modern health promotion.
“We have already planned the next study, in which we want to examine more closely how usage behavior and adherence – i.e., the actual use of digital content – develop in everyday life,” says Stephan. “From these findings, we want to derive a competency model that will help make digital health programs even more targeted and user-friendly in the future.”
To the publication „Association Between Psychosocial Characteristics andeHealth Literacy: Cross-Sectional Study of Hybrid Secondary Prevention in Mental Health” in the journal „JMIR Mental Health”
To the homepage of the Chair of Social Determinants of Health
Contact:
Prof. Dr. Matthias Richter
Chair of Social Determinants of Health
Am Olympiacampus 11
80809 München
phone: 089 289 24190
e-mail: richter.matthias(at)tum.de
Johannes Stephan
Chair of Social Determinants of Health
Am Olympiacampus 11
80809 München
phone: 089 289 24191
e-mail: johannes.stephan2(at)tum.de
Text: Romy Schwaiger
Photos: Freepik, Copyright: yanalya/Andreas Heddergott, TUM/private