JMIR Publications

ABSTRACT

Background:

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 (SHI) for mental health conditions. However, adoption remains uneven. General practitioners (GPs) issue most mental health DiGA prescriptions while psychotherapists (PSYs) 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.

Objective:

To quantify and compare GPs' and PSYs' preferences for DiGA characteristics using best-worst scaling.

Methods:

A cross-sectional best-worst scaling study was conducted among outpatient GPs and PSYs. Eleven DiGA objects were evaluated using balanced incomplete block design. Preferences were analysed using conditional logit regression. Likelihood ratio tests assessed differences between professional groups, with stratified models estimating group-specific odds ratios (OR) and 95% confidence intervals.

Results:

Of 484 respondents (244 GPs, 240 PSYs), 408 completed the BWS experiment. Professional role was identified as a source of heterogeneity (χ² = 328.76, P<.001), justifying stratified analysis. Relative to the reference object (intuitive usability for patients), GPs most strongly preferred scientific recommendations (OR 1.72) and patients' interest in DiGA (OR 1.70), while significantly showing lower preferences for cross-device availability (OR 0.57) and access to patient-entered data (OR 0.47). PSYs showed different preference patterns, most strongly preferring device availability (OR 1.47) and contact points for technical support (OR 1.36), while showing significantly lower preference for alignment with scientific recommendations (OR 0.75).

Conclusions:

Professional role is a driver of preference heterogeneity for DiGA characteristics. GPs assigned comparatively greater weight to evidence-based recommendations and patient interest, while PSYs 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.