JMIR Publications

ABSTRACT

Background:

Public health agencies (PHAs) in Germany are increasingly exploring digital communication channels to improve citizen engagement and responsiveness. However, little is known about citizens' preferences for such digital services, especially concerning who initiates contact - whether citizens reach out to agencies or vice versa - and the conditions under which different digital channels are accepted or rejected. Privacy concerns and perceived benefits of digital services may jointly shape citizens' willingness to engage, consistent with a privacy calculus perspective.

Objective:

This study investigates citizens' preferences for digital information and advisory channels offered by PHAs in Germany. Specifically, we experimentally examine how service attributes (contact reason, channel, and perceived benefit) shape usage intentions for citizen-to-agency versus agency-to-citizen communication. Additionally, we explore the moderating roles of urban/rural residence, privacy attitudes, and sociodemographic characteristics.

Methods:

We conducted two factorial survey experiments in Saxony (Germany). The vignette experiments were embedded in a population-representative mixed-mode survey (N=2,133) of residents in a rural district (District of Bautzen (BZ), n=1,034) and an urban area (City of Dresden, n=1,099). Each experiment comprised a 3×3×3 design (27 vignettes), with usage intention rated on a 7-point scale. Multilevel regression models assessed the relative effects of vignette dimensions and respondent characteristics on usage intention, separately by region and experiment.

Results:

Across both experiments and regions, the digital channel was the strongest predictor of usage intention. In experiment 1 (citizen contacts the PHA), online appointment booking was strongly preferred over electronic medical history forms, while video consultation was consistently rejected. In experiment 2 (PHA contacts the citizen), a dedicated PHA app was strongly preferred over video consultations, while social media channels were strongly rejected. The reason of contact and stated benefits played comparatively minor roles. Greater informational privacy concerns significantly reduced usage intention among urban respondents in Dresden, not in the rural municipalities. Older respondents reported slightly lower usage intentions in both regions. Gender and residential context within the rural district were not associated with usage intention, indicating no systematic exclusion of specific population groups. Subjective social status (SSS) showed small regionally varying positive effects.

Conclusions:

Citizens reported higher usage intentions for digital PHA services such as online appointment bookings and dedicated apps, than for video consultations and social media. This pattern suggests a preference for familiar, self-directed services, requiring less personal disclosure. Limited sociodemographic differences in stated preferences suggest that equitable adoption may depend primarily on service design rather than user characteristics, while privacy concerns represent a relevant but regionally variable barrier. PHAs should prioritize low-threshold, autonomous digital services and avoid relying on social media or unsolicited general health information in saturated information environments.