Motivating factors and possible barriers to participation in digital prevention courses of two statutory health insurance funds in Germany: a qualitative interview study.

内容摘要

Digital prevention courses offered by statutory health insurance funds in Germany represent a low-threshold opportunity to support health-promoting behaviors through pre-recorded, video-based programs focusing on exercise, nutrition, or stress management. However, little is known about insured individuals' motivations and barriers to participation. This study aimed to identify relevant motivating and obstructive factors for participation in digital prevention courses and to explore differences compared to on-site formats. We conducted semi-structured telephone interviews with 20 insured members of two large regional statutory health insurance funds in Germany (AOK North-East and AOK North-West) who had recently completed digital prevention courses. Participants were recruited via e-mail invitations sent by the health insurance funds following course participation. Five additional interviews were conducted with participants of on-site courses for contextual comparison. Interviews were conducted between February and December 2023, transcribed verbatim, and analyzed using qualitative content analysis with a deductive-inductive coding approach based on the study objectives and interview guide. The sample included 20 participants (mean age 41 years, range 25-72; 19 women and 1 man) who had completed digital prevention courses. Participants emphasized temporal flexibility, home-based access, and low preparation effort as key facilitators of participation. Additional motivators included health-related goals, free access, practical content, reminders, and the possibility to repeat sessions. Reported barriers included a lack of discipline, reduced social interaction and commitment compared to on-site formats, and work- and family-related demands. The availability of recorded sessions was perceived as a major advantage that facilitated course completion. Participants also valued competent instructors, but called for clearer differentiation of difficulty levels, broader course options, continued access to materials, and follow-up opportunities. The contextual comparison showed that on-site course participants particularly valued the sense of community and the possibility of individual corrections by instructors. Digital prevention courses are well accepted and can promote participation due to their flexibility and accessibility. However, challenges such as reduced social interaction and the need for self-discipline limit their full potential. To enhance their effectiveness and reach, digital prevention programs should integrate more tailored content, structured follow-up offers, and interactive or hybrid elements that foster engagement and social connectedness. German Clinical Trial Register DRKS00029761; Registration date 27.07.2022; https://drks.de/search/de/trial/DRKS00029761 .