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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.

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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.

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While several studies have explored the use of mobile health applications, few have observed determinants of mobile health information behavior. To develop a model explaining parents' mobile information behavior on child poisoning prevention, we first explored relevant theories to suggest a theoretical model. In that, we combine existing models on risk and health information seeking, such as the Planned Risk Information Seeking Model, with models on the acceptance of mobile technologies, such as the Unified Theory of Acceptance and Use of Technologies. Thereafter, we employed a sequential mixed-method design with an initial qualitative study (four online focus groups with n = 25 parents in total) and a standardized online survey of n = 1,013 parents to evaluate our research model. Results confirm that both, determinants of information seeking and determinants of technology acceptance, contribute to the explanation of mobile information behavior. App use intention was mainly related to the performance expectancy of app use, the subjective information norm, and social influence on app use. To increase the usage of prevention apps and contribute to the reduction of child injuries, communication on poisoning apps should address subdimensions of the performance expectancy, such as their utility and peoples' trust in app providers. Moreover, physicians are important multipliers for these messages.

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BACKGROUND: Handwashing is an effective and cost-efficient health behavior for preventing infectious diseases; however, its practice is shaped by multiple contextual factors and inequalities between different social groups in Sierra Leone. To address these inequalities, participatory approaches that allow a more equitable distribution of resources and the development of locally tailored interventions are increasingly used. However, social power dynamics have not been well integrated into the concept of participation, despite their known impact. OBJECTIVE: We sought to investigate the role of power dynamics in participatory approaches to handwashing in Sierra Leone. METHODS: From a socio-ecological perspective, this qualitative, formative interview study aimed to identify relevant actors and their power relationships before designing a participatory handwashing project in rural Sierra Leone. A field experiment with focus groups and a research diary compared the development of power dynamics in a participatory, community-driven approach with that in a nonparticipatory top-down approach. RESULTS: According to our formative study, in community-based projects, multiple groups and actors interact directly or indirectly with each other, located within a macro level (eg, political institutions), meso level (eg, community leaders and groups), and micro level (eg, families) of a socio-ecological model. Although distinct leadership structures were noticeable and affected intervention attendance and processes of change in nonparticipatory approaches, community-led activities and handwashing increased in the participatory approach, irrespective of the leadership structure. Despite their ambivalence, the strategic inclusion of different community leaders appeared essential to enhance the value of the project, mobilize creative action, and empower lower-ranking individuals to practice handwashing. A similar ambivalent role could be observed in relation to external researchers, especially if they come from a different cultural background than the research participants, for example, from a Western country in a non-Western project setting. Although external researchers can initiate a project or provide certain resources, distinct expectations regarding their roles and resources can impact participatory efforts and power relations. CONCLUSIONS: The results highlight the advantages of participatory approaches for health promotion. Power dynamics should be a core component of continuous reflection and analysis in participatory projects.

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Although the importance of emotions for the effects of gain-loss framed messages has been supported, the emotional effects of mixed frames have not been sufficiently investigated. To fill this gap, this experimental study exposed participants (N = 154) to single gain- or loss-framed vs. mixed frame messages about sun-protection outcomes. Integrating the idea of mixed frames with the concept of emotional flow, data were analyzed using a serial mediation model with emotional experience (as indexed by valence and arousal) and intention as factors mediating the effect of shifts on actual behavior, measured two weeks after message exposure. Results demonstrate that mixed messages and their impact on emotional experiences are not generally more effective than pure gain or pure loss messages. However, the application of mixed frame or purely loss-framed messages offers a higher potential to increase behavioral health intentions (resulting in respective behaviors) than messages simply focusing on gain frames.

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As there are many and sometimes ambivalent intersections of health and religion, strategic collaborations with religious opinion leaders in health campaigns have been increasingly explored. Despite the known influence of distinct contextual factors within emergency and non-emergency settings, existing research seldom distinguishes between those different factors and their impact on the inclusion of religious leaders as health messengers. To compare the contextual factors of religious leaders as health messengers during emergency and non-emergency situations in a setting with high religious affiliations, this study used a qualitative approach and triangulated the perspectives of three different samples, including (religious) opinion leaders, members of religious communities, and developers of health communication strategies in Sierra Leone. The results provide multifaceted insights into contextual factors applicable to emergency and non-emergency settings as well as the risks and opportunities. Recommendations for the incorporation of religious leaders in health promotion activities in consideration of different contextual factors are provided.

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BACKGROUND: With the easing of governmental COVID-19 restrictions, promoting voluntary public compliance with protective measures becomes essential for the pandemic evolution. A highly relevant target group for such health promotion are adolescents and young adults since they showed a strong decline in compliance throughout the pandemic. Building on an extended version of the Theory of Planned Behavior, this article investigates drivers of young people's intentions to engage in voluntary COVID-19 measures in phases of re-opening. METHODS: We conducted a sequential multi-method study among 14- to 29-year-olds in Germany: (1) a semi-standardized online survey (N = 88) to examine underlying beliefs and (2) a standardized online survey (N = 979) to identify influencing factors of compliance. The pre-study addressed the respondents' perceptions about wearing a mask, social distancing, and avoiding crowded locations (open-ended questions). Responses for all protective measures were aggregated to identify general behavioral, normative, and control beliefs about COVID-19 protective measures. In order to gain generalizable insights into the factors determining voluntary compliance intentions in younger adults, we conceptualized the model constructs in the subsequent standardized online survey as formative measures based on their underlying beliefs. PLS-SEM was used to examine the effects of attitudes, subjective norms, perceived behavioral control, risk perceptions, and knowledge on young people's intentions to comply (main study). Furthermore, a multi-group analysis was conducted to investigate differences between compliers and non-compliers. RESULTS: The pre-study revealed that young people's instrumental attitudes not only cover reasons of protection but also aspects of self-presentation (e.g., being a role model). The main study showed that besides knowledge and perceived severity of illness, instrumental attitude is the strongest predictor of intention to comply. The influence is even stronger in the group of non-compliers. CONCLUSION: This article highlights the importance of theory-based campaign planning and provides practical guidance to health communicators on how to increase voluntary compliance with COVID-19 protective measures in adolescents and young adults. The findings demonstrate the great potential of combining the Theory of Planned Behavior with risk perception and knowledge to gain deeper insights into the feelings and thoughts of younger target groups during a health crisis.

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This article investigates the effects of message framing and distraction on older adults' responses to a radio public service announcement (PSA) to promote influenza and pneumococci vaccinations. In detail, it addresses the message impact on recognition, attitudes toward the ad, and information-seeking intentions. The 2 × 2 online experiment was conducted in August 2019 in Germany. 378 participants aged 60 years and above received a radio PSA with either gain- or loss-framed messages (factor 1). Additionally, half of the participants completed a distraction task while listening (factor 2). Gain frames (η2p =.02) and a non-distracted reception situation (η2p =.04) positively influenced older adults' recognition accuracy. Recognition, in turn, was found to mediate the effect of framing and distraction on the intention to seek further information on the campaign (framing: b = -0.03, distraction: b = 0.05). We conclude that gain-framed radio PSAs are an appropriate tool to raise awareness for a vaccination campaign and its contents, especially when recipients are concentrated while listening to it. We suggest to implement them at the early stages of a health intervention to sensitize people about vaccination, followed by more in-depth information material (e.g., brochures) to create behavior change.

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OBJECTIVE: This review systematically examines the theory base and effectiveness of communication strategies (i.e., message content, message attributes, communication channels, and communicators) of interventions for caregivers to prevent unintentional child injuries. METHODS: Relevant articles were searched in the databases Communication and Mass Media Complete, PsycInfo, Pubmed, and Google Scholar, the journal Injury Prevention, and the literature of included studies. A total of 71 articles reporting 67 different studies were included and fully coded. Quality was assessed using the Mixed Methods Appraisal Tool. Coded categories and their frequencies are described, and the effectiveness of different communication strategies is explored with crosstabs. RESULTS: Only 17 studies stated the use of a specific theory base; Precaution Adoption Process-Model, Theory of Planned Behavior, and Health Belief Model were most often used. The message content of most studies aimed at knowledge dissemination; however, addressing behavioral determinants, such as risk perception and self-efficacy, was more effective. About half of the studies did not elaborate on message attributes; calls to action, exemplars, and tailoring were most often used, the latter being most effective. Communication channels ranged from printed products to face-to-face communication and digital media. In addition, studies specifying interpersonal communicators were highly effective. CONCLUSION: The results of the review suggest that the following aspects can contribute to effective communication in child injury prevention: theory-based communication, addressing broad knowledge and further behavioral determinants, digital tailoring, and health professionals as communicators. However, a conclusive statement on the effectiveness of different communication strategies is hampered by the fact that they are not specified and/or confounded in many studies. PRACTICE IMPLICATIONS: Communication strategies should be theory based and address, in addition to knowledge, behavioral determinants such as risk perception and self-efficacy. Moreover, digital tailoring is an advanced way of enhancing effectiveness and health professionals, such as pediatricians and clinic staff, are important multipliers.

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The COVID-19 pandemic is challenging healthcare systems worldwide and is causing numerous deaths. Vaccination is an important tool to help us get back to normal; however, the majority of the public must be willing to get vaccinated to reach herd immunity. By considering postulates of message framing and socioemotional selectivity theory, this study investigated the effects of gain-loss framing on younger and older adults' reactance arousal, attitudes toward the coronavirus vaccination, vaccination intention, and recognition performance. In a 2 × 2 online experiment in October 2020, 281 participants received textual health information about future vaccination against COVID-19 with either gain- or loss-framed messages (Factor 1). Half of the participants were aged 18-30 years, and the other half were 60 years and above (quasi-experimental Factor 2). Among younger adults, we found an antagonistic pattern of effects: While loss framing positively influenced vaccination attitudes and led to stronger vaccination intentions, it simultaneously decreased recognition accuracy. In contrast, there was no framing effect on attitudes and intentions in older adults, which might be a consequence of the positivity effect. These findings can be interpreted as a first step to uncover the interaction of age and framing in the coronavirus pandemic. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

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Based on the theory of planned behavior (TPB), augmented by the concept of self-concordance (derived from self-determination theory, SDT), we conducted a study to identify the key determinants of physical activity in older adults. We applied structural equation modeling of telephone survey data from a random sample of adults aged 65 years and older living in Germany (N = 865). Relations of attitude, subjective norms, and perceived behavioral control (PBC) with intention strength and self-concordance of intention to be physically active were tested. Habit strength was analyzed as a moderator. Data analysis showed this model to be well-suited for explaining the intention to be physically active-especially for people with a weak habit. The influence of TPB components on intention would have been underestimated if we had investigated intention strength only, without considering the self-concordance of intention. While attitude and PBC had positive relations with a strong and self-determined intention, the subjective norm showed no relation with intention strength but, rather, with non-self-determined regulation forms. We conclude that the combined model provides a better theoretical foundation from which to explain physical activity intentions than does just one of the theories.

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Purpose: As the proportion of older adults in Germany continues to grow, so does the need for physical activity as a strategy for health promotion. The purpose of this study is to gain insights into the belief system underlying older adults' physical activity and its interplay with motivation by integrating Theory of Planned Behaviour and Self-Determination Theory.Methods: We conducted 20 semi-structured interviews with residents of Germany who were 65 years of age or older. Transcripts of interviews were analysed with a coding frame of deductive main categories and inductive subcategories.Results: Part of our results is a typology that divides our sample into four groups based on the intensity and perceived sufficiency of their physical activity. These groups mainly differ in their intrinsic vs. extrinsic motivation and how they deal with barriers to physical activity, i.e., control beliefs.Conclusion: Messages to promote physical activity should be tailored regarding older adults' varying beliefs and motivation. To overcome barriers, intrinsic motivation plays a crucial role. Intrinsic motivation is closely linked to activities that are joyful and satisfy basic psychological needs. Moreover, it is important for older adults to be able to adjust their activities to age-related physical limitations and chronic diseases.

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BACKGROUND: The proportion of older adults among the population is constantly growing. At the same time, the risk of health problems increases with age. From a health promotion perspective, it is therefore important to reach this target group. The selection of media and communication channels should be based on media use and health information behavior of the target group. In this context, it may be necessary to segment the heterogeneous group of older adults into subgroups. OBJECTIVES: The article provides current empirical data on the health information behavior of older adults in general and in particular subgroups. On this basis, adequate communication channels can be selected to address these groups. METHODS: First, 20 people participated in guided qualitative interviews. Second, a subsequent standardized telephone survey of 1001 randomly selected people aged 65 years and above was conducted. RESULTS: Older adults can best be reached via interpersonal and traditional mass media sources. Health-related media such as pharmacy magazines also play an important role, especially for people with chronic diseases. Furthermore, health professionals are also an important source of information for older adults with chronic diseases and a negative attitude towards aging. On the internet, men and people with a higher income are more likely to be reached. CONCLUSIONS: Older adults in Germany are a heterogeneous target group. To reach them effectively, differences in the health information behavior of subtarget groups must be considered. Furthermore, the content and design of communication measures should also be evidence based.

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BACKGROUND: Current systematic reviews of randomized controlled trials suggest positive influences of mobile app-based health promotion programs on dietary and physical activity behaviors. However, the actual adoption of and rates of nutrition app use remain low among the overall population. Therefore, we took a step back and investigated actual use patterns. In doing so, we took an appropriation perspective in order to reveal different styles of everyday life integration of these apps. METHODS: We conducted an online survey with 761 German-speaking users of the MyFitnessPal app. Respondents were asked about their detailed use of nutrition apps according to an adapted version of the mobile phone appropriation model. Based on a cluster analysis, different user types were identified. These user types were compared and further described based on analyses of variance. In addition, we conducted a multinomial logistic regression to determine significant predictors of the varying usage patterns. RESULTS: Four different user types were identified: (1) Supported, (2) Indifferent, (3) Health-conscious, and (4) Socializer. These user types mainly differed regarding three aspects: (1) their willingness to adjust default settings to one's own needs and abilities, (2) the role of social support and social norms, and (3) app use for socializing and competition. CONCLUSIONS: Our study sheds light on the multi-faceted appropriation patterns of nutrition apps in Germany, thus paving the way for future studies on mHealth appropriation patterns and the design of more refined mHealth-interventions.

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BACKGROUND: Uncertainty is integral to evidence-informed decision making and is of particular importance for preference-sensitive decisions. Communicating uncertainty to patients and the public has long been identified as a goal in the informed and shared decision-making movement. Despite this, there is little quantitative research on how uncertainty in health information is perceived by readers. OBJECTIVE: The aim of this study was to examine the impact of different uncertainty descriptions regarding the evidence for a treatment effect in a written research summary for the public. METHODS: We developed 8 versions of a research summary on a fictitious drug for tinnitus with varying degrees (Q1), sources (Q2), and magnitudes of uncertainty (Q3). We recruited 2099 members of the German public from a web-based research panel. Of these, 1727 fulfilled the inclusion criteria and were randomly presented with one of these research summaries. Randomization was conducted by using a centralized computer with a random number generator. Web-based recruitment and data collection were fully automated. Participants were not aware of the purpose of the study and alternative presentations. We measured the following outcomes: perception of the treatment effectiveness (primary), certainty in the judgement of treatment effectiveness, perception of the body of evidence, text quality, and intended decision. The outcomes were self-assessed. RESULTS: For the primary outcome, we did not find a global effect for Q1 and Q2 (P=.25 and P=.73), but we found a global effect for Q3 (P=.048). Pairwise comparisons showed a weaker perception of treatment effectiveness for the research summary with 3 sources of uncertainty compared to the version with 2 sources of uncertainty (P=.04). Specifically, the proportion of the participants in the group with 3 sources of uncertainty that perceived the drug as possibly beneficial was 9% lower than that of the participants in the group with 2 sources of uncertainty (92/195, 47.2% vs 111/197, 56.3%, respectively). The proportion of the participants in the group with 3 sources of uncertainty that considered the drug to be of unclear benefit was 8% higher than that of the participants in the group with 2 sources of uncertainty (72/195, 36.9% vs 57/197, 28.9%, respectively). However, there was no significant difference compared to the version with 1 source of uncertainty (P=.31). We did not find any meaningful differences between the research summaries for the secondary outcomes. CONCLUSIONS: Communicating even a large magnitude of uncertainty for a treatment effect had little impact on the perceived effectiveness. Efforts to improve public understanding of research are needed to improve the understanding of evidence-based health information. TRIAL REGISTRATION: German Clinical Trials Register DRKS00015911, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00015911. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/13425.

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BACKGROUND: Recent studies increasingly examine social support for diabetes self-management delivered via mHealth. In contrast to previous studies examining social support as an outcome of technology use, or technology as a means for delivering social support, this paper argues that social support has an impact on the use of diabetes mHealth apps. Specifically, we postulate differences between the impact of healthcare professional versus non-professional (family/friends) support on mobile app use for diabetes self-management. METHODS: This research employed a triangulation of methods including exploratory semi-structured face-to-face interviews (N = 21, Study 1) and an online survey (N = 65, Study 2) with adult type 1 and type 2 diabetes patients. Thematic analysis (Study 1) was used to explore the relevance of social support (by professionals versus non-professionals) for diabetes app use. Binary logistic regression (Study 2) was applied to compare healthcare decision-making, healthcare-patient communication, and the support by the personal patient network as predictors of diabetes app use, complemented by other predictors from self-management and technology adoption theory. RESULTS: The interviews (Study 1) demonstrated that (technology-supported) shared decision-making and supportive communication by healthcare professionals depended on their medical specialty. The personal patient network was perceived as either facilitating or hindering the use of mHealth for self-management. Binary logistic regression (Study 2) showed that the physician specialty significantly predicted the use of diabetes apps, with supervision by diabetes specialists increasing the likelihood of app use (as opposed to general practitioners). Additionally, specialist care positively related to a higher chance of shared decision-making and better physician-patient communication. The support by the personal patient network predicted diabetes app use in the opposite direction, with less family/friend support increasing the likelihood of app use. CONCLUSION: The results emphasize the relevance of support by healthcare professionals and by the patient network for diabetes app use and disclose differences from the existing literature. In particular, the use of diabetes apps may increase in the absence of social support by family or friends (e.g., compensation for lack of support), and may decrease when such support is high (e.g., no perceived need to use technology).

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BACKGROUND: As a result of demographic changes, the number of people aged 60 years and older has been increasing steadily. Therefore, older adults have become more important as a target group for health communication efforts. Various studies show that online health information sources have gained importance among younger adults, but we know little about the health-related internet use of senior citizens in general and in particular about the variables explaining their online health-related information-seeking behavior. Media use studies indicate that in addition to sociodemographic variables, lifestyle factors might play a role in this context. OBJECTIVE: The aim of this study was to examine older people's health-related internet use. Our study focused on the explanatory potential of lifestyle types over and above sociodemographic variables to predict older adults' internet use for health information. METHODS: A telephone survey was conducted with a random sample of German adults aged 60 years and older (n=701) that was quota-allocated by gender, age, educational status, and degree of urbanity of their place of residence. RESULTS: The results revealed that participants used the internet infrequently (mean 1.82 [SD 1.07]), and medical personnel (mean 2.89 [SD 1.11]), family and friends (mean 2.86 [SD 1.21]), and health brochures (mean 2.85 [SD 1.21]) were their main sources of health information. A hierarchical cluster analysis based on values, interests, and leisure time activities revealed three different lifestyle types for adults aged over 60 years: the Sociable Adventurer, the Average Family Person, and the Uninterested Inactive. After adding these types as second-step predictors in a hierarchical regression model with sociodemographic variables (step 1), the explained variance increased significantly (R2=.02, P=.001), indicating that the Average Family Person and the Sociable Adventurer use the internet more often for health information than the Uninterested Inactive, over and above their sociodemographic attributes. CONCLUSIONS: Our findings indicate that the internet still plays only a minor role in the health information-seeking behavior of older German adults. Nevertheless, there are subgroups including younger, more active, down-to-earth and family-oriented males that may be reached with online health information. Our findings suggest that lifestyle types should be taken into account when predicting health-related internet use behavior.

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BACKGROUND: Uncertainty is integral to evidence-informed decision making and is of particular importance for preference-sensitive decisions. Communicating uncertainty to patients and the public has long been identified as a goal in the informed and shared decision-making movement. Despite this, there is little quantitative research on how uncertainty in health information is perceived by readers. OBJECTIVE: The objective of this study is to design an experiment to examine how different degrees of uncertainty (Q1) and different types of uncertainty (Q2) impact patients' perception of treatment effectiveness, the body of evidence, text quality, and hypothetical treatment intention. The experiment also examines whether there is an additive effect when multiple sources of uncertainty are communicated (Q3). METHODS: We developed 8 variations of a research summary set in a hypothetical scenario for a treatment decision in the context of tinnitus. These were modified only in the degree of uncertainty relating to the evidence of the presented treatment. We recruited members of the German public from a Web-based research panel and randomized them to one of 8 variations of the research summary to examine the 3 research questions. The trial was only open to the members of the research panel. The outcomes are perception of the effectiveness of the treatment (primary), certainty in the judgement of treatment effectiveness, perception of the body of evidence relating to the treatment, text quality, and decisional intention (secondary). Outcomes were self-assessed. We aimed to recruit 1500 participants to the trial. The recruitment and data collection was fully automated. Ethical approval was waivered by an ethics committee because of the negligible risk to participants. RESULTS: This protocol is retrospectively published in its original format. In the meantime, the trial was set up and the data collection was completed. Data collection was conducted in May 2018. A total of 1727 eligible panel members were enrolled. CONCLUSIONS: We aim to publish the results in a peer-reviewed journal by the end of 2019. In addition, results will be presented at conferences and disseminated among developers of guidance for the development of evidence-based health information and decision aids. TRIAL REGISTRATION: German Clinical Trials Register DRKS00015911; https://www.drks.de/drks_web/navigate.do? navigationId=trial.HTML&TRIAL_ID=DRKS00015911 (Archived by WebCite at http://www.webcitation.org/77zyZTGzk). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/13425.

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BACKGROUND: To achieve clarity on mobile health's (mHealth's) potential in the diabetes context, it is necessary to understand potential users' needs and expectations, as well as the factors determining their mHealth use. Recently, a few studies have examined the user perspective in the mHealth context, but their explanatory value is constrained because of their limitation to adoption factors. OBJECTIVE: This paper uses the mobile phone appropriation model to examine how individuals with type 1 or type 2 diabetes integrate mobile technology into their everyday self-management. The study advances the field beyond mere usage metrics or the simple dichotomy of adoption versus rejection. METHODS: Data were gathered in 2 qualitative studies in Singapore and Germany, with 21 and 16 respondents, respectively. Conducting semistructured interviews, we asked respondents about their explicit use of diabetes-related apps, their general use of varied mobile technologies to manage their disease, and their daily practices of self-management. RESULTS: The analysis revealed that although some individuals with diabetes used dedicated diabetes apps, most used tools across the entire mobile-media spectrum, including lifestyle and messaging apps, traditional health information websites and forums. The material indicated general barriers to usage, including financial, technical, and temporal restrictions. CONCLUSIONS: In sum, we find that use patterns differ regarding users' evaluations, expectancies, and appropriation styles, which might explain the inconclusive picture of effects studies in the diabetes mHealth context.

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PURPOSE: Occupational asthma and allergies are potentially preventable diseases affecting 5-15% of the working population. However, the use of preventive measures is often insufficient. The aim of this study was to estimate the average treatment effect of an educational intervention designed to improve the knowledge of preventive measures against asthma and allergies in farm apprentices from Bavaria (Southern Germany). METHODS: Farm apprentices at Bavarian farm schools were asked to complete a questionnaire evaluating their knowledge about preventive measures against occupational asthma and allergies (use of personal protective equipment, personal and workplace hygiene measures). Eligible apprentices were randomized by school site to either a control or an intervention group. The intervention consisted of a short educational video about use of preventive measures. Six months after the intervention, subjects were asked to complete a post-intervention questionnaire. Of the 116 apprentices (70 intervention group, 46 control group) who answered the baseline questionnaire, only 47 subjects (41%; 17 intervention group, 30 control group) also completed the follow-up questionnaire. We, therefore, estimated the causal effect of the intervention using targeted maximum likelihood estimation. Models were controlled for potential confounders. RESULTS: Based on the targeted maximum likelihood estimation, the intervention would have increased the proportion of correct answers on all six preventive measures by 18.4% (95% confidence interval 7.3-29.6%) had all participants received the intervention vs. had they all been in the control group. CONCLUSIONS: These findings indicate the improvement of knowledge by the educational intervention.

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