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The World Wide Web has become an essential source of health information. Nevertheless, the amount and quality of information provided may lead to information overload. Therefore, people need certain skills to search for, identify, and evaluate information from the internet. In the context of health information, these competencies are summarized as the construct of eHealth literacy. Previous research has highlighted the relevance of eHealth literacy in terms of health-related outcomes. However, the existing instrument assessing eHealth literacy in the German language reveals methodological limitations regarding test development and validation. The development and validation of a revised scale for this important construct is highly relevant. The objective of this study was the development and validation of a revised German eHealth literacy scale. In particular, this study aimed to focus on high methodological and psychometric standards to provide a valid and reliable instrument for measuring eHealth literacy in the German language. Two internationally validated instruments were merged to cover a wide scope of the construct of eHealth literacy and create a revised eHealth literacy scale. Translation into the German language followed scientific guidelines and recommendations to ensure content validity. Data from German-speaking people (n=470) were collected in a convenience sample from October to November 2020. Validation was performed by factor analyses. Further, correlations were performed to examine convergent, discriminant, and criterion validity. Additionally, analyses of measurement invariance of gender, age, and educational level were conducted. Analyses revealed a 2-factorial model of eHealth literacy. By item-reduction, the 2 factors information seeking and information appraisal were measured with 8 items reaching acceptable-to-good model fits (comparative fit index [CFI]: 0.942, Tucker Lewis index [TLI]: 0.915, root mean square error of approximation [RMSEA]: 0.127, and standardized root mean square residual [SRMR]: 0.055). Convergent validity was comprehensively confirmed by significant correlations of information seeking and information appraisal with health literacy, internet confidence, and internet anxiety. Discriminant and criterion validity were examined by correlation analyses with various scales and could partly be confirmed. Scalar level of measurement invariance for gender (CFI: 0.932, TLI: 0.923, RMSEA: 0.122, and SRMR: 0.068) and educational level (CFI: 0.937, TLI: 0.934, RMSEA: 0.112, and SRMR: 0.063) were confirmed. Measurement invariance of age was rejected. Following scientific guidelines for translation and test validation, we developed a revised German eHealth Literacy Scale (GR-eHEALS). Our factor analyses confirmed an acceptable-to-good model fit. Construct validation in terms of convergent, discriminant, and criterion validity could mainly be confirmed. Our findings provide evidence for measurement invariance of the instrument regarding gender and educational level. The newly revised GR-eHEALS questionnaire represents a valid instrument to measure the important health-related construct eHealth literacy.

Pretesting survey questions via cognitive interviewing is based on the assumptions that the problems identified by the method truly exist in a later survey and that question revisions based on cognitive interviewing findings produce higher-quality data than the original questions. In this study, we empirically tested these assumptions in a web survey experiment (n = 2,200). Respondents received one of two versions of a question on self-reported financial knowledge: either the original draft version, which was pretested in ten cognitive interviews, or a revised version, which was modified based on the results of the cognitive interviews. We examined whether the cognitive interviewing findings predicted problems encountered in the web survey and whether the revised question version was associated with higher content-related and criterion-related validity than the draft version. The results show that cognitive interviewing is effective in identifying real question problems, but not necessarily in fixing survey questions and improving data quality. Overall, our findings point to the importance of using iterative pretesting designs, that is, carrying out multiple rounds of cognitive interviews and also testing the revisions to ensure that they are indeed of higher quality than the draft questions.

Growing up in a family with one member being affected by mental health problems or substance abuse is an adverse childhood experience which can lead to socioeconomic and health-related impairments in later life. Furthermore, the risk of child maltreatment is increased in affected families, which often adds to the individual risk factors. However, the interdependence between the particular risk factors is not well understood. To examine the correlation between mental health problems or substance abuse and child maltreatment within families and long term consequences for affected children, a cross sectional population representative survey in Germany (N = 2,531) has been conducted. The risk of child maltreatment was 5 to 5.6 times higher if mental illness and 4.9 to 6.9 times higher if substance abuse of a family member was reported. Furthermore, the risk of health problems, including obesity, decreased life satisfaction, lower income, low educational achievement, unemployment and living without a partner was increased if participants grew up in a family affected by mental health problems or substance abuse. All associations were mediated significantly by child maltreatment. These results point towards an urgent need for greater awareness for child protection issues in families affected by mental health problems or substance abuse.

Objectives Medical residency is a challenging phase that puts the mental health of resident physicians at risk. This study explores the effects of a tailored mindfulness-based program on the positive mental health of resident physicians. Methods We conducted a longitudinal randomized controlled trial with an active control group. The intervention group took part in an 8-week mindfulness-based program (MBP) that included a course book and was followed by a 4-month maintenance phase. The control group only received the course book for self-study. Participants were assessed at 0, 2, 6, and 12 months. Assessments included self-report measures (positive affect, life-satisfaction, self-compassion, flourishing, self-esteem, feeling loved, self-attributed mindfulness, time perception, “Muße” (i.e., feeling at ease and free of pressure), thriving at work, job satisfaction, self-efficacy, self-esteem), as well as Goal Attainment Scaling. Results A total of 147 resident physicians were randomly assigned to either the intervention or the control group. In linear mixed models, we found small to medium effects for the interaction of time × group across various time points for self-compassion, flourishing, mindfulness, Muße, thriving at work, and indirect negative affect with effect sizes ranging between d  = 0.25 and 0.88. Goal Attainment Scaling revealed a greater goal attainment in the intervention group compared to the control group ( d  = 1.50). Conclusions We conclude that a tailored MBP may improve certain aspects of resident physicians’ positive mental health. Trial Registration DRKS00014015 05/24/2018.

(1) Obesity has emerged as a major public health challenge with increasing prevalence globally. The General Dietary Behavior Inventory (GDBI) was developed based on official dietary recommendations. However, little is known about whether general dietary recommendations also apply to people affected by obesity and whether the GDBI can be used appropriately. (2) A cross-sectional study was conducted. A total of 458 people meeting the inclusion criteria participated in the study. The assessment consisted of the GDBI and behavioral, dietary, and health-related variables. We used descriptive analysis to examine the item characteristics of the GDBI and inferential statistics to investigate the associations between the GDBI score and behavioral, dietary, and health-related outcomes. (3) Several items of the GDBI were concerned by ceiling effects. A higher GDBI score (indicating a higher adherence to dietary recommendations) was related to higher age, higher nutrition knowledge, more restrained eating behavior, lower impulsivity, and higher body mass index. There were no associations between the GDBI score and reported physical and mental health or quality of life. (4) The GDBI showed inconsistent relationships with the study outcomes. General dietary recommendations do not appear to be applicable to people with obesity. Hence, there is an urgent need for specific recommendations and subsequent assessments of behavioral adherence for people affected by obesity.

Background The pandemic and the associated consequences have been ongoing stressors with severe impacts on the population and particularly on families. Research focusing on groups dealing well with the challenges of the pandemic is scarce. Here, we aimed to identify groups being well-adjusted during the pandemic and associated predictors. Methods A representative sample of the German population ( N  = 2,515, 51.6% women, 50.09 years), and a subsample of persons with children or adolescents under the age of 18 ( N  = 453, 60.3% women, 40.08 years) was assessed from July to October 2021. As huge differences in coping with the pandemic are seen, cluster analysis was performed. Results Persons in the “well-adjusted cluster” were characterized by higher quality of life, better coping with the pandemic and lower burden of the pandemic. The family subsample well-adjusted cluster was characterized by lower pandemic-associated burden, lower parental stress compared to before the pandemic and a better relationship with the child. Fewer mental health symptoms and less pandemic-associated negative impact on career predicted membership of the well-adjusted cluster in both samples. An interaction between mental health symptoms and the negative impact of COVID-19 on the career was found. Conclusions Our results underscore the importance of mental health and work-related factors for coping with the pandemic.

Background: Substance-related and addictive disorders are among the most common mental disorders in adolescence and young adulthood. Vocational school students are a risk group for problematic substance use and addictive behavior. However, the availability of evidence-based prevention concepts and programs is underdeveloped in the vocational school setting. Methods/design: A two-arm cluster randomized waitlist-controlled trial will be conducted to evaluate the effectiveness of an app-based intervention to decrease substance use, gambling, and digital media use in vocational school students in Germany. Vocational students will participate in an app-based intervention that is designed to support voluntary commitment to abstain from or reduce substance or digital media use over a period of 2 weeks. The \"education-as-usual\" control arm will have access to the intervention after data collection is completed. One of the primary outcome measures will be the use of alcohol, nicotine, and digital media 30 days after the intervention. Several secondary outcome measures will also be included, such as cannabis consumption, gambling, symptoms of stress, physical activity, mindfulness, well-being, impulsivity and sensation seeking, and readiness to change. A total of 4500 vocational students from 225 classes will be recruited and randomized across three German federal states. Discussion: This study protocol describes the design of an RCT testing the effectiveness of an app-based intervention to reduce addictive behaviors in vocational school students. It is expected that this approach will be feasible for and effective in the vocational school setting and that the study provides comprehensive information on the key factors involved in temporary abstaining or reducing substance or digital media use. Trial registration: German Clinical Trials Register DRKS00023788. Registered on 20 January 2021.

The study contributes to research on Universal Basic Income (UBI) by examining mental health trajectories in working individuals who received a monthly UBI payment of €1,000 for the duration of one year. We assessed data from 357 recipients of additional income provided by a crowdfunding association in Germany. Participants reported their life satisfaction, well-being, work motivation, and needs satisfaction at up to three semi-annual measurement occasions, the first of which was scheduled at the onset of UBI payments. Specifically, we focused on the effects of autonomous work motivation as (a) a predictor of change in life satisfaction and well-being and (b) a mediator between needs satisfaction at work and mental health. We conducted Latent Growth Curve Models (LGCM) and Random Intercept Cross-Lagged Panel Models (RI-CLPM). Results of the LGCM indicated growth in life satisfaction and well-being during UBI payment. Autonomous motivation was a robust, positive predictor of initial levels of life satisfaction and well-being, both as time-invariant covariate (TIC) and time-varying covariate (TVC). Moreover, low initial autonomous motivation was associated with greater increase of life satisfaction and well-being. Using a RI-CLPM, we found strong support for the mediating effect of autonomous motivation. Furthermore, gender and income were significant predictors of initial life satisfaction and well-being in most of our models. Women and low-income earners tended to report lower levels of life satisfaction and well-being. The results are discussed focusing on the role of autonomous motivation for psychological health in the context of UBI and occupational health promotion more generally.

Background Stress is a widespread phenomenon and reality of everyday life, entailing negative consequences for physical and psychological wellbeing. Previous studies have indicated that exposure to greenspaces and nature-based interventions are promising approaches to reducing stress and promoting restoration. However, an increasing percentage of the population lives in urban regions with limited opportunities to spend time in greenspaces. In addition, urban settings typically feature increased levels of noise, which represents a major environmental stressor. Although various studies have compared the effects of exposure to greenspaces versus urban built environments, evidence of the effects of noise in this context is very limited. Psychophysiological benefits of exposure to greenspaces compared to urban built environments reported in earlier studies might be less (or at least not only) due to features of the greenspaces than to additional stressors, such as road traffic noise in the urban built environment. Hence, differences in the effects attributed to greenness in previous studies may also be due to potentially detrimental noise effects in comparison settings. This paper reports the study protocol for a randomized, controlled intervention study comparing the effects of walking in forest versus urban built environments, taking road traffic noise exposure during walks in the respective settings into account. Methods The protocol envisages a field study employing a pretest–posttest design to compare the effects of 30-min walks in urban built environments and forests with different road traffic noise levels. Assessments will consist of self-reported measures, physiological data (salivary cortisol and skin conductance), an attention test, and noise, as well as greenness measurements. The outcomes will be restoration, stress, positive and negative affect, attention, rumination, and nature connectedness. Discussion The results will inform about the restorative effect of walking in general, of exposure to different types of environments, and to different noise levels in these sites. The study will provide insights into the benefits of walking and nature-based interventions, taking into account the potential detrimental effects of noise exposure. It will thus facilitate a better understanding of low-threshold interventions to prevent stress and foster wellbeing. Trial registration ISRCTN48943261 ; Registered 23.11.2023.

(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.