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The digitization of health care led to a steady increase in the adoption and use of mobile health (mHealth) apps. Germany is the first country in the world to cover the costs of mHealth apps through statutory health insurance. Although the benefits of mHealth apps are discussed in detail, aspects of problems and barriers are rarely studied. This scoping review aimed to map and categorize the evidence on problems and barriers related to the use of mHealth apps. Systematic searches were conducted in the MEDLINE, Embase, and PsycINFO databases. Additional searches were conducted on JMIR Publications and on websites of relevant international organizations. The inclusion criteria were publications dealing with apps similar to those approved in the German health care system, publications addressing problems and barriers related to the use of mHealth apps, and articles published between January 1, 2015, and June 8, 2021. Study selection was performed by 2 reviewers. The manuscript was drafted according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. The analysis of the included publications and categorization of problems and hurdles were performed using MAXQDA (VERBI Software GmbH). The database search identified 1479 publications. Of the 1479 publications, 21 (1.42%) met the inclusion criteria. A further 8 publications were included from citation searching and searching in JMIR Publications. The identified publications were analyzed for problems and barriers. Problems and barriers were classified into 10 categories (\"validity,\" \"usability,\" \"technology,\" \"use and adherence,\" \"data privacy and security,\" \"patient-physician relationship,\" \"knowledge and skills,\" \"individuality,\" \"implementation,\" and \"costs\"). The most frequently mentioned categories were use and adherence (eg, incorporating the app into daily life or dropouts from use; n=22) and usability (eg, ease of use and design; n=19). The search identified various problems and barriers in the context of mHealth apps. Although problems at the app level (such as usability) are studied frequently, problems at the system level are addressed rather vaguely. To ensure optimal use of and care with mHealth apps, it is essential to consider all types of problems and barriers. Therefore, researchers and policy makers should have a special focus on this issue to identify the needs for quality assurance. RR2-10.2196/32702.

Since fall 2020, mobile health (mHealth) apps have become an integral part of the German health care system. The belief that mHealth apps have the potential to make the health care system more efficient, close gaps in care, and improve the economic outcomes related to health is unwavering and already partially confirmed. Nevertheless, problems and barriers in the context of mHealth apps usually remain unconsidered. The focus groups and interviews conducted in this study aim to shed light on problems and barriers in the context of mHealth apps from the perspective of patients. Guided focus groups and individual interviews were conducted with patients with a disease for which an approved mHealth app was available at the time of the interviews. Participants were recruited via self-help groups. The interviews were recorded, transcribed, and subjected to a qualitative content analysis. The content analysis was based on 10 problem categories (\"validity,\" \"usability,\" \"technology,\" \"use and adherence,\" \"data privacy and security,\" \"patient-physician relationship,\" \"knowledge and skills,\" \"individuality,\" \"implementation,\" and \"costs\") identified in a previously conducted scoping review. Participants were asked to fill out an additional questionnaire about their sociodemographic data and about their use of technology. A total of 38 patients were interviewed in 5 focus groups (3 onsite and 2 web-based) and 5 individual web-based interviews. The additional questionnaire was completed by 32 of the participants. Patients presented with a variety of different diseases, such as arthrosis, tinnitus, depression, or lung cancer. Overall, 16% (5/32) of the participants had already been prescribed an app. During the interviews, all 10 problem categories were discussed and considered important by patients. A myriad of problem manifestations could be identified for each category. This study shows that there are relevant problems and barriers in the context of mHealth apps from the perspective of patients, which warrant further attention. There are essentially 3 different areas of problems in the context of mHealth apps that could be addressed to improve care: quality of the respective mHealth app, its integration into health care, and the expandable digital literacy of patients.

Since their introduction with the Digital Care Act in 2019, selected digital health apps (DiGA) have been a part of the German statutory health care system. In order to become a DiGA, digital health apps have to complete a certification process covering both technical and evidence-related aspects. After completion, DiGA are added to the DiGA directory, containing a list of all reimbursable DiGA within German statutory health insurance. The first apps were added at the end of 2020, with the number steadily increasing. The novelty of this digital health care service and the fast implementation led to problems and barriers to optimal use along the way, which are studied from different stakeholder perspectives in this paper. The aim of this survey was to identify problems and barriers in the context of the admission, financing, and service provision of DiGA in the statutory health care system in Germany. We used semistructured expert interviews to evaluate the perspective of stakeholders of the German health care system on DiGA. The interview guide was developed according to Helfferich. The interviews were transcribed and analyzed using the qualitative content approach by Mayring, with the adjustments by Kuckartz. We conducted web-based interviews with stakeholders between February and June 2022. The stakeholder collective consisted of DiGA, statutory health insurance, physician, patient, technological, and quality assurance representatives. To identify problems from stakeholder perspectives regarding the admission, financing, and service distribution of DiGA, 21 interviews were conducted. The interviewed stakeholders reported problems with the authorization of DiGA and the corresponding process, for example, the duration of the DiGA Fast Track process. DiGA prices and the different negotiation positions were criticized, and financial challenges for smaller DiGA manufacturers were noted. Another problem was seen in the reimbursement of DiGA, independent of actual use by the patients. Within service provision, the participants reported superordinate aspects, for example, the negative public perception of DiGA and negative statements from stakeholders. In relation to the direct care process, technical problems (eg, with activation codes or software surrounding DiGA prescription) and insufficient knowledge and skills on the side of the patients, as well as the medical providers, were mentioned. Digital health apps have the potential to improve health care by addressing health problems in new, innovative ways. Since the evidence-based and regulated use of this technology is relatively new, problems and barriers limiting the optimized, patient-centered use arose throughout the first years. This study provides an overview of problems and barriers in the context of DiGA in Germany from different stakeholder perspectives. Nevertheless, with these problems being continuously addressed, digital health apps are trending toward becoming a contributing factor to health care in Germany. Since other countries showed interest in implementing a federally regulated approach similar to Germany, valuable implications can be drawn from this survey.

Mental and behavioral disorders affect approximately 28% of the adult population in Germany per year, with treatment being provided through a diverse health care system. Yet there are access and capacity problems in outpatient mental health care. One innovation that could help reduce these barriers and improve the current state of care is the use of mobile health (mHealth) apps, known in Germany as Digitale Gesundheitsanwendungen (DiGA). DiGA are certified apps reimbursed by statutory health insurance funds. They are evaluated before use, for example, by proving their medical benefit in clinical studies, or approved for use according to the concept of \"coverage with evidence development.\" Most DiGA currently included in the DiGA directory are approved for use by people with mental disorders. However, the low and stagnant use numbers point to barriers to their uptake and integration in the German health care system. The analysis of concepts for implementation and integration is important to find effective ways to realize the potential of these apps in mental health care. This scoping review aimed to identify concepts and frameworks for the successful integration of mHealth apps into international health care systems and how they can be adapted and transferred to DiGA used in the German health care system. The scoping review followed the methodological framework for scoping reviews proposed by Arksey and O'Malley. The scientific databases PubMed, Embase, and PsycINFO were searched. A 2-stage (title and abstract, followed by full text) screening process was conducted by 2 different reviewers independently. A total of 3710 publications were identified. Of these, 20 were included in the review, with 3 additional studies identified through a targeted search. Results are presented in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist. The literature identified through this scoping review provides an overview of a variety of aspects of mHealth apps for mental disorders and their integration into health care systems. There are different general, organizational, legal, and technical requirements to create a suitable environment, therefore specific concepts for integration and implementation of mHealth apps are necessary. We identified regulatory concepts, for example, directories for mHealth apps, and care-related concepts, for example, training and support of medical professionals. The generated evidence contributes to improved and user-oriented structures and processes, potentially leading to better patient support through mHealth apps. Evidence already shows that mHealth apps can effectively support patients with mental health disorders. To realize this potential, mHealth apps need to work within the structures and processes of health care systems. Therefore, this scoping review provides insights on the integration of mHealth apps into (outpatient) mental health care.

Mental disorders are complex diseases that affect 28% (about 17.8 million people) of the adult population in Germany annually. Since 2020, certain mobile health (mHealth) apps, so-called digital health applications (DiGA), are reimbursable in the German statutory health insurance system. A total of 27 of the 56 currently available DiGA are approved for the treatment of mental and behavioral diseases. An indicator of existing problems hindering the use of DiGA is the rather hesitant prescribing behavior. This project aims to develop health policy recommendations for the optimal integration of DiGA into outpatient psychotherapeutic care. The project is funded by the Innovation Fund of the Joint Federal Committee (grant 01VSF22029). The current status quo of the use of DiGA will be analyzed. Furthermore, concepts for the integration of mHealth apps, as well as their transfer into the care process will be investigated. In addition, barriers will be identified, and existing expectations of different perspectives captured. The project will be based on a mixed methods approach. A scoping review and a qualitative analysis of focus groups and expert interviews will be carried out. Additionally, an analysis of claims data of the statutory health insurance will be conducted. This will be followed by a written survey of insured persons and health care providers. Finally, health policy recommendations will be derived in cooperation with stakeholders. The scoping reviews and qualitative analyses have been completed, and the quantitative surveys are currently being carried out. The target number of responses in the survey of insured persons has already been achieved. Furthermore, the analysis claims data of the statutory health insurance is currently being conducted. There is a need for research on how DiGA can be optimally integrated into the care process of patients with mental disorders as evidence regarding the topic is limited and prescribing behavior low. Although the potential of DiGA in mental health care has not yet fully unfolded, Germany serves as a model for other countries regarding reimbursable mHealth apps. This project aims to explore the potentials of DiGA and to describe the organizational, institutional, and procedural steps necessary for them to best support mental health care. DERR1-10.2196/56205.

Mental disorders affect nearly one-third of adults in Germany, with a 12-month prevalence of approximately 28%. Following Germany's 2019 Digital Care Act, digital health applications (Digitale Gesundheitsanwendungen [DiGA]) became reimbursable interventions by the statutory health insurance for mental health conditions. However, adoption remains uneven. General practitioners (GPs) issue most mental health DiGA prescriptions, while psychotherapists or psychiatrists prescribe far fewer, even though most DiGA target mental health. Existing studies imply profession-specific barriers but lack quantitative evidence on preference drivers or remain descriptive. Whether and how these preferences differ across professional groups has not been systematically quantified. This study aimed to quantify and compare GPs' and psychotherapists' or psychiatrists' preferences for factors associated with DiGA prescription decisions using best-worst scaling (BWS). A cross-sectional BWS study was conducted among outpatient GPs and psychotherapists or psychiatrists. Eleven DiGA objects were evaluated using a balanced incomplete block design. Preferences were analyzed using conditional logit regression. Likelihood ratio tests assessed differences between professional groups, with stratified models estimating group-specific odds ratios (OR) and 95% CIs. Of 484 respondents (244 GPs and 240 psychotherapists or psychiatrists), 408 completed the BWS experiment. Group-specific ORs ranged from 0.47 to 1.72 (likelihood ratio test: χ =328.76; P<.001), suggesting that GPs and psychotherapists or psychiatrists operate within a broadly shared evaluative space but assign different relative emphasis to specific factors influencing DiGA prescription decisions. Relative to the reference object (intuitive usability for patients), GPs most strongly preferred scientific recommendations (OR 1.72, 95% CI 1.42-2.09) and patients' interest in DiGA (OR 1.70, 95% CI 1.40-2.06) while significantly showing lower preferences for cross-device availability (OR 0.57, 95% CI 0.47-0.69) and access to patient-entered data (OR 0.47, 95% CI 0.39-0.57). Psychotherapists or psychiatrists showed different preference patterns, most strongly preferring device availability (OR 1.47, 95% CI 1.22-1.76) and contact points for technical support (OR 1.36, 95% CI 1.13-1.64) while showing significantly lower preference for alignment with scientific recommendations (OR 0.75, 95% CI 0.62-0.90). Professional role is a source of preference heterogeneity for factors associated with DiGA prescription decisions. GPs assigned comparatively greater weight to evidence-based recommendations and patient interest, while psychotherapists or psychiatrists emphasized technical integration feasibility and peer experience. These structured differences in priority gradients indicate that uniform implementation approaches may not adequately reflect the evaluative frameworks of both professional groups.