Impact of the COVID-19 Pandemic on CSR Activities of Healthcare Providers.

(1) Background: Corporate social responsibility (CSR) is important for every company that cares for sustainable structures. Healthcare providers especially have made social responsibility their goal. However, crises such as the COVID-19 pandemic impacted different activities within the healthcare sector including CSR and its monitoring. However, theory-driven CSR research within the healthcare sector is scarce and monitoring requires a structured understanding of the processes. Therefore, the objective of this study was to investigate the CSR practices and activities which healthcare providers have implemented in an exemplified country namely Germany and the effect of the pandemic in this process. (2) Methods: Participants were sampled based on their field of care (general, psychiatric, or rehabilitation), the type of organization (public, private, or non-profit), and group membership. A total of 18 healthcare providers were initially recruited, out of which nine participated in the interviews. They represent companies with yearly revenue of between EUR 110 million and EUR 6 billion, and have between 900 and 73,000 employees. (3) Results: CSR-related activities were postponed due to times of crisis. There was a necessity to rapidly digitalize processes. Frequent and precise communication turned out to be important for keeping employees' well-being, motivation, and satisfaction levels high. Environmental efforts were counteracted by new hygienic requirements and a shift in priorities. Many study participants expressed the hope that after the pandemic, newly established methods, processes, and structures (e.g., digital meetings, quicker and more inclusive communication) would be maintained and developed further. (4) Conclusions: The pandemic has been challenging and at the same time, these challenges also created opportunities to strike a new path using the learnings to overcome future health-related or economic crises.

Digital Interventions for Treating Post-COVID or Long-COVID Symptoms: Scoping Review.

BACKGROUND: Patients with post-COVID/long-COVID symptoms need support, and health care professionals need to be able to provide evidence-based patient care. Digital interventions can meet these requirements, especially if personal contact is limited. OBJECTIVE: We reviewed evidence-based digital interventions that are currently available to help manage physical and mental health in patients with post-COVID/long-COVID symptoms. METHODS: A scoping review was carried out summarizing novel digital health interventions for treating post-COVID/long-COVID patients. Using the PICO (population, intervention, comparison, outcome) scheme, original studies were summarized, in which patients with post-COVID/long-COVID symptoms used digital interventions to help aid recovery. RESULTS: From all scanned articles, 8 original studies matched the inclusion criteria. Of the 8 studies, 3 were "pretest" studies, 3 described the implementation of a telerehabilitation program, 1 was a post-COVID/long-COVID program, and 1 described the results of qualitative interviews with patients who used an online peer-support group. Following the PICO scheme, we summarized previous studies. Studies varied in terms of participants (P), ranging from adults in different countries, such as former hospitalized patients with COVID-19, to individuals in disadvantaged communities in the United Kingdom, as well as health care workers. In addition, the studies included patients who had previously been infected with COVID-19 and who had ongoing symptoms. Some studies focused on individuals with specific symptoms, including those with either post-COVID-19 or long-term symptoms, while other studies included patients based on participation in online peer-support groups. The interventions (I) also varied. Most interventions used a combination of psychological and physical exercises, but they varied in duration, frequency, and social dimensions. The reviewed studies investigated the physical and mental health conditions of patients with post-COVID/long-COVID symptoms. Most studies had no control (C) group, and most studies reported outcomes (O) or improvements in physiological health perception, some physical conditions, fatigue, and some psychological aspects such as depression. However, some studies found no improvements in bowel or bladder problems, concentration, short-term memory, unpleasant dreams, physical ailments, perceived bodily pain, emotional ailments, and perceived mental health. CONCLUSIONS: More systematic research with larger sample sizes is required to overcome sampling bias and include health care professionals' perspectives, as well as help patients mobilize support from health care professionals and social network partners. The evidence so far suggests that patients should be provided with digital interventions to manage symptoms and reintegrate into everyday life, including work.

Understanding and overcoming challenges in times of personal or global crisis-Editorial on the Special Issue on Loneliness and Health.

The ever-present interest in loneliness has increased during the last decade. Although loneliness is generally not as prevalent as other topics and not among the top 5 most read papers in the journal Applied Psychology: Health and Well-Being, it is closely connected to topics therein, such as well-being and health. Conceptualizing loneliness as indicator of risk, it may function as a cue for action. Accordingly, understanding loneliness, its development, prevalence, effects, and how to support individuals to prevent or overcome loneliness is key and the main aim of this special issue. Therefore, theories and models are reviewed in this paper and synthesized together with other aspects relating to the field of loneliness research and intervention. Accordingly, we propose an agenda including key determinants (e.g., risk groups), how to proceed (various research methods), intervention components (e.g., behavior change techniques, SDGs), and how to perform dissemination (open science practices, co-creative approaches, etc.). The original studies in this special issue provide stimulating examples. Moreover, the commentaries give new insights and inspiring ideas. Overall, this special issue aims to give readers a lens with which to re-examine their own research, enable innovation, and empower addressing loneliness and its interconnection synergistically.

Patients' Post-/Long-COVID Symptoms, Vaccination and Functional Status-Findings from a State-Wide Online Screening Study.

(1) Background: Better understanding of post-/long-COVID and limitations in daily life due to the symptoms as well as the preventive potential of vaccinations is required. It is unclear whether the number of doses and timepoint interrelate with the trajectory of post-/long-COVID. Accordingly, we examined how many patients positively screened with post-/long-COVID were vaccinated and whether the vaccination status and the timepoint of vaccination in relation to the acute infection were related to post-/long-COVID symptom severity and patients' functional status (i.e., perceived symptom severity, social participation, workability, and life satisfaction) over time. (2) Methods: 235 patients suffering from post-/long-COVID were recruited into an online survey in Bavaria, Germany, and assessed at baseline (T1), after approximately three weeks (T2), and approximately four weeks (T3). (3) Results: 3.5% were not vaccinated, 2.3% were vaccinated once, 20% twice, and 53.3% three times. Overall, 20.9% did not indicate their vaccination status. The timepoint of vaccination was related to symptom severity at T1, and symptoms decreased significantly over time. Being vaccinated more often was associated with lower life satisfaction and workability at T2. (4) Conclusions: This study provides evidence to get vaccinated against SARS-CoV-2, as it has shown that symptom severity was lower in those patients who were vaccinated prior to the infection compared to those getting infected prior to or at the same time of the vaccination. However, the finding that being vaccinated against SARS-CoV-2 more often correlated with lower life satisfaction and workability requires more attention. There is still an urgent necessity for appropriate treatment for overcoming long-/post-COVID symptoms efficiently. Vaccination can be part of prevention measures, and there is still a need for a communication strategy providing objective information about the usefulness and risks of vaccinations.

Distress, loneliness, and mental health during the COVID-19 pandemic: Test of the extension of the Evolutionary Theory of Loneliness.

COVID-19 restrictions such as lockdowns or quarantines may increase the risk for social isolation and perceived loneliness. The mechanisms can be modeled by Cacioppo's Evolutionary Theory of Loneliness (ETL), which predicts that a lack of perceived social connectedness may lead, in the long-term, to mental and physical health consequences. However, the association between COVID-19 pandemic distress, mental health, and loneliness is not sufficiently understood. The present longitudinal study examined the relationship between distress and depression, and the mediating effects of anxiety and loneliness in a German rehabilitation sample (N = 403) at two timepoints (≤6 weeks pre-rehabilitation; ≥12 weeks post-rehabilitation; mean time between T1 and T2 was 52 days). Change scores between T1 and T2 were examined for the variables COVID-19 Peritraumatic Distress Index (CPDI), anxiety, loneliness, and depression. The results of the serial mediation analysis indicated that anxiety and loneliness were able to explain the relationship between distress and depression with 42% of variance in depression accounted for. Findings extend research on the relationship between COVID-19 and mental health by considering anxiety and loneliness as sustaining factors of depressive symptoms, thus, successfully applying the ETL. Results stress the necessity to consider anxiety and loneliness in the treatment or prevention of depression.

Mitigating Feelings of Loneliness and Depression by Means of Web-Based or Print-Based Physical Activity Interventions: Pooled Analysis of 2 Community-Based Intervention Trials.

BACKGROUND: Physical activity (PA) is associated with benefits, such as fewer depressive symptoms and loneliness. Web- and print-based PA interventions can help older individuals accordingly. OBJECTIVE: We aimed to test the following research questions: Do PA interventions delivered in a web- or print-based mode improve self-reported PA stage of change, social-cognitive determinants of PA, loneliness, and symptoms of depression? Is subjective age a mediator and stage of change a moderator of this effect? METHODS: Overall, 831 adults aged ≥60 years were recruited and either allocated to a print-based or web-based intervention group or assigned to a wait-list control group (WLCG) in 2 community-based PA intervention trials over 10 weeks. Missing value imputation using an expectation-maximization algorithm was applied. Frequency analyses, multivariate analyses of variance, and moderated mediation analyses were conducted. RESULTS: The web-based intervention outperformed (47/59, 80% of initially inactive individuals being adopters, and 396/411, 96.4% of initially active individuals being maintainers of the recommended PA behavior) the print-based intervention (20/25, 80% of adopters, and 63/69, 91% of maintainers) and the WLCG (5/7, 71% of adopters; 141/150, 94% of maintainers). The pattern regarding adopters was statistically significant (web vs print Z=-1.94; P=.02; WLCG vs web Z=3.8367; P=.01). The pattern was replicated with stages (χ24=79.1; P<.001; contingency coefficient 0.314; P<.001); in the WLCG, 40.1% (63/157) of the study participants moved to or remained in action stage. This number was higher in the groups receiving web-based (357/470, 76%) or print-based interventions (64/94, 68.1%). A significant difference was observed favoring the 2 intervention groups over and above the WLCG (F19, 701=4.778; P<.001; η2=0.098) and a significant interaction of time and group (F19, 701=2.778; P<.001; η2=0.070) for predictors of behavior. The effects of the interventions on subjective age, loneliness, and depression revealed that both between-group effects (F3, 717=8.668; P<.001; η2=0.018) and the interaction between group and time were significant (F3, 717=6.101; P<.001; η2=0.025). In a moderated mediation model, both interventions had a significant direct effect on depression in comparison with the WLCG (web-based: c' path -0.86, 95% CI -1.58 to -0.13, SE 0.38; print-based: c' path -1.96, 95% CI -2.99 to -0.92, SE 0.53). Furthermore, subjective age was positively related to depression (b path 0.14, 95% CI 0.05-0.23; SE 0.05). An indirect effect of the intervention on depression via subjective age was only present for participants who were in actor stage and received the web-based intervention (ab path -0.14, 95% CI -0.34 to -0.01; SE 0.09). CONCLUSIONS: Web-based interventions appear to be as effective as print-based interventions. Both modes might help older individuals remain or become active and experience fewer depression symptoms, especially if they feel younger. TRIAL REGISTRATION: German Registry of Clinical Trials DRKS00010052 (PROMOTE 1); https://tinyurl.com/nnzarpsu and DRKS00016073 (PROMOTE 2); https://tinyurl.com/4fhcvkwy. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/15168.

Screening and assessment for post-acute COVID-19 syndrome (PACS), guidance by personal pilots and support with individual digital trainings within intersectoral care: a study protocol of a randomized controlled trial.

BACKGROUND: Because the clinical patterns and symptoms that persist after a COVID-19 infection are diverse, a diagnosis of post-acute COVID-19 syndrome (PACS) is difficult to implement. The current research project therefore aims to evaluate the feasibility and the practicability of a comprehensive, interdisciplinary, and cross-sectoral treatment program consisting of a low-threshold online screening and holistic assessment for PACS. Furthermore, it aims to evaluate digital interventions and the use of so-called personal guides that may help to facilitate the recovery of PACS. METHODS: This German study consists of a low-threshold online screening for PACS where positively screened participants will be supported throughout by personal pilots. The personal pilots are aimed at empowering patients and helping them to navigate through the study and different treatment options. Patients will then be randomly assigned either to an intervention group (IG) or an active control group (ACG). The IG will receive a comprehensive assessment of physiological and psychological functioning to inform future treatment. The ACG does not receive the assessment but both groups will receive a treatment consisting of an individual digital treatment program (digital intervention platform and an intervention via a chatbot). This digital intervention is based on the needs identified during the assessment for participants in the IG. Compared to that, the ACG will receive a more common digital treatment program aiming to reduce PACS symptoms. Importantly, a third comparison group (CompG) will be recruited that does not receive any treatment. A propensity score matching will take place, ensuring comparability between the participants. Primary endpoints of the study are symptom reduction and return to work. Secondary outcomes comprise, for example, social participation and activities in daily life. Furthermore, the feasibility and applicability of the online screening tool, the holistic assessment, digital trainings, and personal pilots will be evaluated. DISCUSSION: This is one of the first large-scale studies to improve the diagnosis and the care of patients with PACS by means of empowerment. It is to be evaluated whether the methods utilized can be used for the German and international population. Trial registration ClinicalTrials.gov Identifier: NCT05238415; date of registration: February 14, 2022.

Association of Social-Cognitive Factors with Individual Preventive Behaviors of COVID-19 among a Mixed-Sample of Older Adults from China and Germany.

Identifying modifiable correlates of older adults' preventive behaviors is contributable to the prevention of the COVID-19 and future pandemics. This study aimed to examine the associations of social-cognitive factors (motivational and volitional factors) with three preventive behaviors (hand washing, facemask wearing, and physical distancing) in a mixed sample of older adults from China and Germany and to evaluate the moderating effects of countries. A total of 578 older adults (356 Chinese and 222 German) completed the online cross-sectional study. The questionnaire included demographics, three preventive behaviors before and during the pandemic, motivational factors (health knowledge, attitude, subjective norm, risk perception, motivational self-efficacy (MSE), intention), and volitional factors (volitional self-efficacy (VSE), planning, and self-monitoring) of preventive behaviors. Results showed that most social-cognitive factors were associated with three behaviors with small-to-moderate effect sizes (f2 = 0.02 to 0.17), controlled for demographics and past behaviors. Country moderated five associations, including VSE and hand washing, self-monitoring and facemask wearing, MSE and physical distancing, VSE and physical distancing, and planning and physical distancing. Findings underline the generic importance of modifiable factors and give new insights to future intervention and policymaking. Country-related mechanisms should be considered when aiming to learn from other countries about the promotion of preventive behaviors.

Association of Social-Cognitive Factors with Individual Preventive Behaviors of COVID-19 among a Mixed-Sample of Older Adults from China and Germany

Identifying modifiable correlates of older adults' preventive behaviors is contributable to the prevention of the COVID-19 and future pandemics. This study aimed to examine the associations of social-cognitive factors (motivational and volitional factors) with three preventive behaviors (hand washing, facemask wearing, and physical distancing) in a mixed sample of older adults from China and Germany and to evaluate the moderating effects of countries. A total of 578 older adults (356 Chinese and 222 German) completed the online cross-sectional study. The questionnaire included demographics, three preventive behaviors before and during the pandemic, motivational factors (health knowledge, attitude, subjective norm, risk perception, motivational self-efficacy (MSE), intention), and volitional factors (volitional self-efficacy (VSE), planning, and self-monitoring) of preventive behaviors. Results showed that most social-cognitive factors were associated with three behaviors with small-to-moderate effect sizes (f2 = 0.02 to 0.17), controlled for demographics and past behaviors. Country moderated five associations, including VSE and hand washing, self-monitoring and facemask wearing, MSE and physical distancing, VSE and physical distancing, and planning and physical distancing. Findings underline the generic importance of modifiable factors and give new insights to future intervention and policymaking. Country-related mechanisms should be considered when aiming to learn from other countries about the promotion of preventive behaviors.

Birthing under the Condition of the COVID-19 Pandemic in Germany: Interviews with Mothers, Partners, and Obstetric Health Care Workers.

BACKGROUND: The COVID-19 pandemic and the necessary containment measures challenge obstetric care. Support persons were excluded while protection measures burdened and disrupted the professionals' ability to care and communicate. The objective of this study was to explore the first-hand experience of the impact of the COVID-19 pandemic on mothers, their partners, and obstetric professionals regarding birth and obstetric care in a university hospital. METHODS: To answer the descriptive research questions, we conducted a qualitative content analysis using a data triangulation approach. We carried out 35 semi-structured interviews with two stratified purposive samples. Sample one consisted of 25 mothers who had given birth during the pandemic and five partners. Sample two included 10 obstetric professionals whose insights complemented the research findings and contributed to data validation. Participants were recruited from the study sample of a larger project on patient safety from two German university hospitals from February to August 2021. The study was approved by two ethics committees and informed consent was obtained. RESULTS: Mothers complied with the rules, but felt socially isolated and insecure, especially before transfer to the delivery room. The staff equally reported burdens from their professional perspective: They tried to make up for the lack of partner and social contacts but could not live up to their usual professional standards. The exclusion of partners was seen critically, but necessary to contain the pandemic. The undisturbed time for bonding in the maternity ward was considered positive by both mothers and professionals. CONCLUSION: The negative effects of risk mitigation measures on childbirth are to be considered carefully when containment measures are applied.

Hygiene Behaviors and SARS-CoV-2-Preventive Behaviors in the Face of the COVID-19 Pandemic: Self-Reported Compliance and Associations with Fear, SARS-CoV-2 Risk, and Mental Health in a General Population vs. a Psychosomatic Patients Sample in Germany

Background: During the COVID-19 pandemic, hygiene behaviors such as keeping distance, avoiding masses, wearing face masks, and complying with hand hygiene recommendations became imperative. The current study aims to determine factors interrelating with hygiene behaviors. Methods: A total of 4049 individuals (1305 male, 2709 female, aged 18–80 years) were recruited from rehabilitation clinics or freely on the internet. They were surveyed via online questionnaires between May 2020 and August 2021. Sociodemographics, hygiene behaviors, and fear of COVID-19 infection were assessed. Results: Overall prevalence for hygiene behaviors was: keeping a distance—88.1%;avoiding mass gatherings—88.0%;wearing face masks—96.9%;and hand hygiene—81.6%, with 70% of the study participants complying with all four researched behaviors. Hygiene behaviors were significantly related to fear in a linear and quadratic fashion. Conclusion: Patients are more compliant according to their self-reported responses than the general population. To improve hygiene behavior, hand hygiene in particular provides options for improvements. A medium level of fear seems to be more functional than too-elevated fear. Behavioral interventions and targeted communication aiming at improving different behaviors in orchestration can help individuals to protect their health and to remain healthy. Accordingly, communication is required to ensure high hygiene standards and patient safety, and to prevent adverse effects.

[Which Digital Services do Psychosomatic Rehabilitation Patients Use During the Corona Pandemic and do Interrelations with Anxiety and Depressive Symptoms Exist?] / Welche digitalen Angebote nutzen psychisch vorerkrankte Menschen während der Corona-Pandemie und gibt es Zusammenhänge mit Angst und depressiven Symptomen?

OBJECTIVE: The COVID-19 pandemic requires numerous measures to protect against infection, such as contact reduction and adherence to hygiene and social distancing rules. The former leads to mental disorders (possibly requiring treatment) due to social isolation, the latter require adaptation in the implementation of medical therapies. With overall limited therapy capacities, the use of digital (health) applications can be of particular importance in the therapy of chronic and psychological diseases in particular. The present study investigates which health apps are being used by people with mental health problems. METHODS: 1,060 insured persons in preparation for psychosomatic rehabilitation measures were surveyed by means of an online questionnaire. Descriptive analyses, frequency analyses, and analyses of variance with post-hoc tests and correlation analyses were used for evaluation. RESULTS: Participants used on average three apps; the most common topics were "nutrition" (n=313), "self-diagnosis" (n=244) and "relaxation" (n=234). Female participants were more likely to use apps than male participants, and younger participants were more likely to use apps than older participants. Symptoms of anxiety were correlated to the use of digital applications, especially concerning heart rate and blood pressure monitoring, while depressive symptoms were not associated with a more frequent use of apps. DISCUSSION: Digital apps are being frequently used by people with mental health problems. Increasing acceptance of digital (health) apps has significant potential in the treatment of chronic mental illness in particular. The focus should be on individual applications with integration into the regular care process. CONCLUSION: Increasing digitalization, also in the healthcare sector, can be used to ensure care, especially in times of contact restrictions and limited human resources.

Implementing Digital Trainings within Medical Rehabilitations: Improvement of Mental Health and Synergetic Outcomes with Healthcare Service.

The need for new technologies in healthcare services has been stressed. However, little is known about the effectiveness of digital interventions integrated in psychosomatic rehabilitation processes. Data from 724 patients from psychosomatic rehabilitation clinics were analyzed with regard to the effectiveness of digital trainings indicated by a change in symptoms related to depression, anxiety, stress, and loneliness from pre- to post-rehabilitation. Rehabilitation satisfaction was examined in association with reaching rehabilitation goals and satisfaction with communication. A mixed repeated measures analyses of covariance, analyses of covariance, and hierarchical stepwise regression analyses were performed. Results indicated a superior effectiveness for the intervention group receiving all offered digital treatments in addition to the regular face-to-face rehabilitation program with regard to symptoms of depression (F (2674) = 3.93, p < 0.05, ηp2 = 0.01), anxiety (F (2678) = 3.68, p < 0.05, ηp2 = 0.01) post-rehabilitation, with large effect sizes for both depression (d = 1.28) and anxiety (d = 1.08). In addition, rehabilitation satisfaction was positively associated with reaching rehabilitation goals and perceived communication with healthcare workers. Digital interventions appeared effective in supporting mental health of psychosomatic rehabilitation patients' post-rehabilitation. These findings support the inclusion of multidisciplinary and interdisciplinary digital and face-to-face treatment programs and call for more implementations of new technologies in a context of complexity to improve health and healthcare service.

Psychosomatic Rehabilitation Patients and the General Population During COVID-19: Online Cross-sectional and Longitudinal Study of Digital Trainings and Rehabilitation Effects.

BACKGROUND: The COVID-19 pandemic has largely affected people's mental health and psychological well-being. Specifically, individuals with a pre-existing mental health disorder seem more impaired by lockdown measures posing as major stress factors. Medical rehabilitation treatment can help people cope with these stressors. The internet and digital apps provide a platform to contribute to regular treatment and to conduct research on this topic. OBJECTIVE: Making use of internet-based assessments, this study investigated individuals from the general population and patients from medical, psychosomatic rehabilitation clinics. Levels of depression, anxiety, loneliness, and perceived stress during the COVID-19 pandemic, common COVID-19-related worries, and the intention to use digital apps were compared. Furthermore, we investigated whether participating in internet-delivered digital trainings prior to and during patients' rehabilitation stay, as well as the perceived usefulness of digital trainings, were associated with improved mental health after rehabilitation. METHODS: A large-scale, online, cross-sectional study was conducted among a study sample taken from the general population (N=1812) in Germany from May 2020 to April 2021. Further, a longitudinal study was conducted making use of the internet among a second study sample of psychosomatic rehabilitation patients at two measurement time points-before (N=1719) and after (n=738) rehabilitation-between July 2020 and April 2021. Validated questionnaires and adapted items were used to assess mental health and COVID-19-related worries. Digital trainings were evaluated. Propensity score matching, multivariate analyses of covariance, an exploratory factor analysis, and hierarchical regression analyses were performed. RESULTS: Patients from the psychosomatic rehabilitation clinics reported increased symptoms with regard to depression, anxiety, loneliness, and stress (F4,2028=183.74, P<.001, η2p=0.27) compared to the general population. Patients perceived greater satisfaction in communication with health care professionals (F1,837=31.67, P<.001, η2p=0.04), had lower financial worries (F1,837=38.96, P<.001, η2p=0.04), but had higher household-related worries (F1,837=5.34, P=.02, η2p=0.01) compared to the general population. Symptoms of depression, anxiety, loneliness, and perceived stress were lower postrehabilitation (F1,712=23.21, P<.001, η2p=0.04) than prior to rehabilitation. Psychosomatic patients reported a higher intention to use common apps and digital trainings (F3,2021=51.41, P<.001, η2p=0.07) than the general population. With regard to digital trainings offered prior to and during the rehabilitation stay, the perceived usefulness of digital trainings on rehabilitation goals was associated with decreased symptoms of depression (ß=-.14, P<.001), anxiety (ß=-.12, P<.001), loneliness (ß=-.18, P<.001), and stress postrehabilitation (ß=-.19, P<.001). Participation in digital group therapy for depression was associated with an overall change in depression (F1,725=4.82, P=.03, η2p=0.01) and anxiety (F1,725=6.22, P=.01, η2p=0.01) from pre- to postrehabilitation. CONCLUSIONS: This study validated the increased mental health constraints of psychosomatic rehabilitation patients in comparison to the general population and the effects of rehabilitation treatment. Digital rehabilitation components are promising tools that could prepare patients for their rehabilitation stay, could integrate well with face-to-face therapy during rehabilitation treatment, and could support aftercare. TRIAL REGISTRATION: ClinicalTrials.gov NCT04453475; https://clinicaltrials.gov/ct2/show/NCT04453475 and ClinicalTrials.gov NCT03855735; https://clinicaltrials.gov/ct2/show/NCT03855735.

Improving professional health literacy in hospitals: study protocol of a participatory codesign and implementation study.

INTRODUCTION: In connection with a hospital stay, patients have to make important health-related decisions. They need to find, understand, assess and apply health-related information, and therefore, require health literacy. Adequately responding to the needs of patients requires promoting the communication skills of healthcare professionals within healthcare organisations. Health-literate healthcare organisations can provide an environment strengthening professionals' and patients' health literacy. When developing health-literate healthcare organisations, it has to be considered that implementing organisational change is typically challenging. In this study, a communication concept based on previously evaluated communication training is codesigned, implemented and evaluated in four clinical departments of a university hospital. METHOD AND ANALYSIS: In a codesign phase, focus group interviews among employees and patients as well as a workshop series with employees and hospital management are used to tailor the communication concept to the clinical departments and to patients' needs. Also, representatives responsible for the topic of health literacy are established among employees. The communication concept is implemented over a 12-month period; outcomes studied are health literacy on the organisational and patient levels. Longitudinal survey data acquired from a control cohort prior to the implementation phase are compared with data of an intervention cohort after the implementation phase. Moreover, survey data from healthcare professionals before and after the implementation are compared. For formative evaluation, healthcare professionals are interviewed in focus groups. ETHICS AND DISSEMINATION: The study protocol was approved by the Ethics Committee of the Medical Faculty of the University of Oldenburg and is in accordance with the Declaration of Helsinki. Study participants are asked to provide written informed consent. The results are disseminated via direct communication within the hospital, publications and conference presentations. If the intervention turns out to be successful, the intervention and implementation strategies will be made available to other hospitals. TRIAL REGISTRATION NUMBER: DRKS00019830.

Association of Social-cognitive Factors With Individual Preventive Behaviors of Covid-19 Among a Mixed-sample of Older Adults From China and Germany (preprint)

Background: Older adults are vulnerable to infection and infections developing into severe diseases during the COVID-19 pandemic. Performing individual preventive behaviors including hand washing frequently, facemask wearing and physical distancing play an important role to reduce the transmission of COVID-19 in the community. Identifying key correlates of the preventive behaviors that are modifiable through intervention is a recognized priority. This study aimed to examine the association of social-cognitive factors (motivational and volitional factors) with preventive behaviors in a mixed-sample of older adults from China and Germany and to evaluate the moderating effects of countries on the associations of these factors with preventive behaviors.Methods: Cross-sectional questionnaire surveys were conducted in China (June 2020 to July 2020) and Germany (June 2020 to February 2021). 578 older adults completed the online survey (N Chinese = 356, mean age = 67.75, SD = 6.24, 39.6% females; N German = 222, mean age = 69.09, SD = 6.9, 63.5% females). The questionnaire consisted of demographics, three preventive behaviors (hand washing, facemask wearing and physical distancing) before and during the pandemic, motivational factors (health knowledge, attitude, subjective norm, risk perception, motivational self-efficacy, intention) and volitional factors (volitional self-efficacy, planning and self-monitoring) of preventive behaviors. Univariate linear regressions and multiple hierarchical linear regressions with simple slope analyses were used. Results: The majority of motivational and volitional factors were associated with three preventive behaviors with small-to-moderate effect sizes (f2 = .02 to .17), when controlling for demographics and past preventive behaviors. When country was included in the regression models, it predicted all three preventive behaviors. Country also moderated five associations, including 1) volitional self-efficacy and hand washing, 2) self-monitoring and facemask wearing, 3) motivational self-efficacy and physical distancing, 4) volitional self-efficacy and physical distancing, and 5) planning and physical distancing. Conclusions: Findings underline the generic importance of modifiable factors and addressing them through preventive behavior interventions especially increasing health knowledge, developing intentions and plans, and strengthening self-efficacy among older adults. Country-related mechanisms should be considered when aiming to learn from other countries on the promotion of preventive behaviors. 

[Fear of Coronavirus, Intention to Follow the AHA Rules and Risk Perception Regarding Visits to the Doctor: Cross-sectional Study with Patients suffering from Pre-existing Mental Illness]. / Angst vor dem Coronavirus, Absicht zum Befolgen der AHA-Regeln und Risikowahrnehmung bezüglich Arztbesuchen: Querschnittsstudie mit psychisch vorerkrankten Menschen.

BACKGROUND: The COVID-19 pandemic requires containment measures such as contact restrictions and hygiene requirements. It is accompanied by psychological problems and the fear of infection or of a severe course of the disease. This paper examines the relationship between fear of infection and adherence to rules of hygiene as well as the utilization of medical services. METHODS: 1005 patients (20-79 years, 626=62.4% female) were interviewed by online questionnaire before starting a psychosomatic rehabilitation program. Data are presented descriptively and analysed by variance analyses. RESULTS: 68.6% were rarely/sometimes afraid and 17.9% were always afraid of contracting coronavirus or of a severe course of the disease. Those who were afraid intended to wash their hands more frequently (97.2%) than those who were not afraid. Regardless of any change in their physical and mental health status, participants felt it to be risky to seek medical care. CONCLUSION: The intention to follow hygiene rules in people with pre-existing mental illness depends on a fear of infecting oneself or others with the coronavirus or of contracting a severe form of the disease. Especially mentally or psychosomatically affected individuals need to be informed adequately about the coronavirus and the necessary individual protective measures in order to reduce resistance and to increase willingness to seek medical help.

To What Extent is Internet Activity Predictive of Psychological Well-Being?

BACKGROUND: Healthy internet activity (eg, making use of eHealth and online therapy) is positively associated with well-being. However, unhealthy internet activity (too much online time, problematic internet use/PIU, internet dependency/ID, etc.) is associated with reduced well-being, loneliness, and other related negative aspects. While most of the evidence is correlational, some research also shows that internet activity can be predictive for well-being. OBJECTIVE: The aim of this article is to elaborate on the question as to what extent internet activity is predictive of psychological well-being by means of (a) a scoping review and (b) theoretical understanding which model the interrelation of internet activity and psychological well-being. METHODOLOGY: We searched different electronic databases such as Web of Science by using the search terms "Internet" OR "App" OR "digital" OR "online" OR "mobile application" AND "Use" OR "Activity" OR "Behavior" OR "Engagement" AND "Well-being" OR "Loneliness" for (a, the scoping review) or CCAM for (b, the theoretical understanding). RESULTS: The scoping review (a) summarizes recent findings: the extent to which internet activity is predictive for well-being depends on the internet activity itself: internet activity facilitating self-management is beneficial for well-being but too much internet activity, PIU and ID are detrimental to well-being. To understand (b) why, when and how internet activity is predictive for well-being, theoretical understanding and a model are required. While theories on either well-being or internet activity exist, not many theories take both aspects into account while also considering other behaviors. One such theory is the Compensatory Carry-Over Action Model (CCAM) which describes mechanisms on how internet use is related to other lifestyle behaviors and well-being, and that individuals are driven by the goal to adopt and maintain well-being - also called higher-level goals - in the CCAM. There are few studies testing the CCAM or selected aspects of it which include internet activity and well-being. Results demonstrate the potentials of such a multifactorial, sophisticated approach: it can help to improve health promotion in times of demographic change and in situations of lacking personnel resources in health care systems. CONCLUSION AND RECOMMENDATION: Suggestions for future research are to employ theoretical approaches like the CCAM and testing intervention effects, as well as supporting individuals in different settings. The main aim should be to perform healthy internet activities to support well-being, and to prevent unhealthy internet activity. Behavior management and learning should accordingly aim at preventing problematic internet use and internet dependency.

Physical Activity, Loneliness, and Meaning of Friendship in Young Individuals - A Mixed-Methods Investigation Prior to and During the COVID-19 Pandemic With Three Cross-Sectional Studies.

Meaningful social interactions and regular physical activity are inversely associated with loneliness. Using a mixed-methods research design employing quantitative and qualitative research approaches, this research aimed to explore loneliness, physical activity, friendship, and experiences relating to the COVID-19 pandemic both prior to and during the pandemic. Quantitative data of (1) n = 363 first-year university students assessed in 2018/2019 and of (2) n = 175 individuals aged 18-29 years assessed in 2020 were gathered using independent self-administered online surveys. In addition, (3) n = 4 students were recruited for semi-structured, qualitative interviews in 2020 during the onset phase of the COVID-19 pandemic. Correlation and regression analyses as well as analyses of variance were conducted. Thematic analysis as a qualitative method was used to explore the role physical activity, friendship, and social interactions played in loneliness, particularly in times of social isolation and social distancing. Results revealed associations of varying strength between physical activity and loneliness in 2018/2019 (r = -0.09, p ≤ 0.05) and 2020 (r = -0.20, p < 0.01). In 2020, n = 73 (41.7%) participants felt that their loneliness had increased since the COVID-19 social and physical distancing guidelines were introduced, but this was not associated with a perceived change in physical activity (r = -0.05, p > 0.05). Analyses of qualitative data revealed three main themes: (1) the lack of deep friendships at university, (2) the positive perceived impact of team sports on feelings of loneliness, and (3) the need for real connection in times of crisis. Thus, with regard to feelings of loneliness during the pandemic, being physically active seems to be a small but potentially relevant factor among young individuals. The qualitative study suggests that first-year university students might buffer the lack of deep friendships and meaningful interactions by building social bonds in team sports. In times of physical distancing, young individuals vulnerable to loneliness may therefore require special support such as doing sports with physical distance and perceiving connected with their team for instance by digital devices and emotional coping.

Obstetric Healthcare Workers' Adherence to Hand Hygiene Recommendations during the COVID-19 Pandemic: Observations and Social-Cognitive Determinants.

BACKGROUND: Hand hygiene is crucial to avoid healthcare-associated infections and the transmission of COVID-19. Although the WHO has issued global hand hygiene recommendations for healthcare, adherence remains challenging. Considering social-cognitive theories such as the health action process approach (HAPA) can help to improve healthcare workers' adherence. This study aimed to observe adherence and to assess determinants in obstetric hospitals during and after the onset of the COVID-19 pandemic. METHODS: In all, 267 observations of behaviour were conducted in two German obstetric university hospitals over three time periods (pre-COVID-19 pandemic, heightened awareness, and strict precautions). In addition, 115 healthcare workers answered questionnaires regarding social-cognitive determinants of hand hygiene behaviour. Multiple regression and multiple mediation analyses were used to analyse associations. RESULTS: Adherence to hand hygiene recommendations increased from 47 per cent pre-COVID-19 pandemic to 95 per cent just before lockdown while simple measures against the pandemic were taken. Self-efficacy was associated with the intention to sanitise hands (ß = .397, p < .001). Coping self-efficacy mediated the association of intention with hand hygiene adherence. CONCLUSIONS: Obstetric healthcare workers seem to adapt their hand hygiene behaviour to prevent infections facing the global COVID-19 pandemic. To further improve interventions, social-cognitive determinants should be considered, especially intention and (coping) self-efficacy.