JMIR Publications

ABSTRACT

Background:

Digital health interventions (DHIs) are a potential tool to address communication challenges in primary care by improving engagement, adherence, and chronic disease self-management. However, Germany’s digital health infrastructure remains underdeveloped compared to other OECD countries. Designing fit-for-purpose and context-sensitive tools requires a deep understanding of patient needs, using participatory approaches that actively involve end-users and relevant stakeholders to ensure the tools are better tailored to their needs. Behavioural science frameworks such as the Behaviour Change Wheel (BCW), can further support this process. Such technologies, developed using co-creation and behaviour change frameworks, can improve health outcomes for underserved patient populations, such as migrants, by addressing their unique needs. This study explores how co-creation and behavioural science can inform the adaptation of a digital preparedness tool for primary care patients with intercultural backgrounds.

Objective:

This study aimed to gain insight into international students’ experiences with primary care in Germany and explore whether adapting an existing digital patient preparedness intervention could address communication challenges. Using co-creation methods and the Behaviour Change Wheel (BCW), we identified key design specifications and behaviour change levers to inform tool development.

Methods:

A mixed-methods design was used to identify design specifications for a DHI across four co-creation workshops with 12 students at an international university in Germany. Quantitative data were used for descriptive insights, and qualitative data were analysed using qualitative content analysis. Workshops were informed by the BCW and the Health CASCADE co-creation methods selector tool.

Results:

Co-creators reported feeling misunderstood, anxious, and ill-informed during primary care interactions, with system-level barriers compounding communication difficulties. Despite this, many engaged in preparatory behaviours (e.g., note-taking) to manage uncertainty and structure their consultations. Feedback on an existing digital intervention was mixed: while co-creators appreciated its intent, structured lesson formats were seen as too time-consuming. Participants preferred a concise, interactive design. Communication prompts, appointment scheduling, and personalised feedback were frequently requested features, though tool adoption was seen as contingent on addressing broader system-level frustrations.

Conclusions:

In addition to identifying the needs of the target group and the design requirements for an effective digital intervention, the study also demonstrates how co-creation methods can be integrated with the BCW to inform the development of digital health tools for clinical settings. Migrants’ negative experiences, often stemming from unclear communication, perceived indifference, and difficulty navigating the complexities of a foreign healthcare system, may be mitigated through co-designed, personalised digital interventions. Frequently requested features, such as appointment scheduling, clinic directories, test result access, and interactive tools like chatbots, could help bridge gaps caused by limited healthcare access, language barriers, and intercultural differences.