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Digital public health is an emerging field in population-based research and practice. The fast development of digital technologies provides a fundamentally new understanding of improving public health by using digitalization, especially in prevention and health promotion. The first step toward a better understanding of digital public health is to conceptualize the subject of the assessment by defining what digital public health interventions are. This is important, as one cannot evaluate tools if one does not know what precisely an intervention in this field can be. Therefore, this study aims to provide the first definition of digital public health interventions. We will merge leading models for public health functions by the World Health Organization, a framework for digital health technologies by the National Institute for Health and Care Excellence, and a user-centered approach to intervention development. Together, they provide an overview of the functions and areas of use for digital public health interventions. Nevertheless, one must keep in mind that public health functions can differ among different health care systems, limiting our new framework’s universal validity. We conclude that a digital public health intervention should address essential public health functions through digital means. Furthermore, it should include members of the target group in the development process to improve social acceptance and achieve a population health impact.
As digitization plays a large role in an increasing number of health systems, digital public health is an emerging field for population-based research and practice. The fast development of both hardware- and software-based digital technologies provides a fundamentally new understanding of improving public health, which can be achieved through digitalization, especially in prevention and health promotion. For example, digital technologies may improve physical activity levels, dietary intake, posture, and mental well-being via sensors and apps [
Although there is a need for evaluation methods that address the many challenges that arise with digitization (eg, fast-paced development), it is challenging to assess digital public health interventions as these may span from population health surveillance to the prevention of specific diseases, and they develop faster than analog interventions [
Before defining digital public health interventions, we need to explain the differences between eHealth, mobile health (mHealth), digital health, and digital public health. This is necessary to highlight the differences between digital health interventions (DHIs) and digital public health interventions. Following this, we will build a framework that might help to identify, structure, and classify digital public health interventions. Our definition and framework will rely on existing approaches from public health [
Terms such as eHealth, mHealth, or digital health are used in the context of the digitization of public health. Since 2019, few papers have also referred to the term digital public health. Given the multitude of terms and definitions in digital health, it is essential to understand the considerable heterogeneity of how such terms interrelate with each other and where digital public health might find its place in the terminological canon of digital health. Therefore, the following section will define the named terms and summarize their core fields of action and the target group’s level, as seen in
Core field of action and target group level of mHealth, eHealth, digital health, and digital public health [
An article on
Fatehi et al [
DiPH [...] focuses on the development, application, and knowledge interest on Public Health and thus on prevention, health promotion, and the related basic sciences such as epidemiology. Primary clinical and individual patient-related aspects are not in the foreground, unlike, for example, telemedicine with its concrete application in an individual treatment and care context. However, it should be noted that the term DiPH has not yet prevailed over others such as eHealth and mHealth. Also, this is hard to expect given the diversity and dynamics of the terms used to date. Where, however, the focus of digitization and health is on population, prevention, and health promotion, including a conscious analysis of health inequalities, DiPH can offer a clearer classification than some other terms in this field.
Although the definition by Zeeb et al [
To develop a first working definition and classification framework for digital public health interventions, established models for both digital health [
Following a narrative approach and based on the authors’ expertise and experience in the field of Public Health, three layers were identified: (1) overview, which is a larger operational layer where the central functions of digital public health are mapped; (2) structure, which is a layer that focuses on structuring digital public health activities (eg, by functions); and (3) improvement, which is a layer that specifically includes the individual perspective in the development and use of digital public health interventions. For each layer, a framework was identified based on the author’s expertise and previous experience with the frameworks and a nonsystematic literature search for alternative frameworks. The frameworks included are as follows: the EPHF by the WHO, which offers a macro view of public health topics [
Together, the EPHF and the NICE framework will build the base of mapping and structuring digital public health interventions. We then use the
Conceptual pyramid for a framework of digital public health interventions [
A way of addressing public health goals to affect population health is using
Governance (eg, public health management, policy, and planning or quality assurance in health services)
Financing: establishment of sustainable organizational structures, institutional capacity, and policy making
Human resources: development and management of human resources
Health information systems: population health surveillance and monitoring
Research: development of a national public health research agenda, allocation of resources for research, integration of research activities into public health, capacity building for innovation, and dissemination to translate research findings into policy and practice
Social participation and health communication: social participation, community partnership, community engagement and/or (digital) public health communication, and design public health services around people’s needs
Health protection: regulations and legal protections (for workers, patients, consumers, and the environment)
Health promotion: community and social participation, intersectoral collaboration, measures to address behavioral risk factors (tobacco, alcohol, diet, and physical activity), and the social determinants of health and health education
Disease prevention: services provided within the health care system and targeting communicable diseases
Health care: With specific functions for quality assurance and access, universal health coverage is a defining feature depending on the World Health Organization region or country (ie, the European region emphatically excludes most health care services from the public health remit because of strong roots in the principles of universal access as opposed to the United States or Western Pacific regions).
Preparedness for public health emergencies: encompass any sudden, large-scale, negative impact on public health arising from outbreaks, natural disasters, severe weather events, migratory flows, accidents, terrorism, or other environmental or human causes
Other vertical functions: A wide variety of specific vertical functions are given importance in different countries. In part, this reflects an overall approach to developing frameworks that list essential services rather than broader functions per se. At the same time, the vertical positions were chosen to reflect national priorities.
These are just a few examples of fields for action in both (analog) public health interventions and digital public health interventions. However, we could not apply all EPHF to every setting. They depend strongly on specific health care systems, which differ among countries. In general, the WHO regards public health interventions primarily as an effort or policy that attempts to improve mental, social, and physical health at the population level by including and addressing EPHF [
Analogous to public health interventions, digital public health interventions have the potential to include and address horizontal as well as vertical functions. The governmental regulation of mHealth apps as medical devices with the possibility of reimbursement, as started in Germany in December 2020 [
Applying EPHF as a cornerstone for the identification and mapping of digital public health interventions provides an initial overview of the field of digital public health. The next step is to further structure such interventions based on their functional classification proposed by NICE’s
Preventive behavior change: address public health issues (eg, smoking, eating, alcohol, sexual health, sleeping, and exercise)
Self-manage: allows people to self-manage a specific condition; may include behavior change techniques
Treat: provides treatment and guides treatment
Active monitoring: tracking patient location, using wearables to measure, record, and/or transmit data about a specific condition
Calculate: a calculator that affects treatment, diagnosis, or care
Diagnose: diagnose a specific condition; guides diagnosis
Inform: provides information (about a condition or general health and lifestyle), resources, or activities to the public, patients, or clinicians
Simple monitoring: includes general health monitoring using fitness wearables and simple symptom diaries
Communicate: allows 2-way communication among citizens, patients, or health care professionals
System service: digital health interventions with no measurable patient outcomes but which provide services to the health and social care system
The abovementioned evidence tiers serve as concrete examples in digital health for the EPHF. For instance, level A refers to the vertical EPHF
As seen, there is an interrelation between the NICE framework and EPHF, supporting the argument that digital public health interventions can address EPHF. The critical part here is that the NICE framework, unlike the WHO EPHF, provides a structure for the degree of complexity (ie, level of interaction) based on the user’s risk. Following the understanding of complex and multicomponent interventions that act and interact on different levels, benefits, and acceptance of digital public health interventions, depending on the users of such interventions and their specific perspectives. Any digital public health intervention can ultimately fail if the population does not accept or use it. Thus, it is essential to involve target groups in the development of these interventions. We propose a participatory and user-centered approach for intervention development as the third cornerstone of digital public health interventions.
Hochmuth et al [
Interactions between technological components (eg, sensors for data acquisition)
Different requirements for users in the implementation of the intervention (eg, knowledge of data security)
Involvement of other groups or organizational levels (eg, patients or researchers)
Degree of adaptation or flexibility of the intervention (eg, further agile development through software updates) [
To follow a user-centered approach, developers must integrate the users (ie, the target group) in the development process. A way of structuring the involvement of users is the
A way of including target groups in the development of new digital public health interventions could be to apply user-centered approaches to the development process [
The 9 different steps for including participant perspectives [
Participation and steps | Descriptions | ||
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Step 1: instrumentalization |
1.1 The interests of the target group are not necessary 1.2 Production team makes decisions outside the target group 1.3 The interests of the decision-makers are the focus of attention 1.4 Target group members as decoration |
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Step 2: instruction |
2.1 The situation of the target group is perceived 2.2 The problem is defined exclusively from the perspective of the decision-makers (professionals) 2.3 The opinion of the target group is not considered 2.4 Communication is direct |
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Step 3: information |
3.1 The decision-makers tell the target group what problems the group has and what help they need 3.2 Recommendation of various courses of action 3.3 Explanation and justification of the procedure of the decision-makers 3.4 The point of view of the target group is considered to increase the acceptance of the messages |
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Step 4: consultation |
4.1 The decision-makers are interested in the view of the target group. 4.2 The members of the target group are listened to |
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Step 5: involvement |
5.1 The decision-makers are advised by (selected persons from) the target group |
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Step 6: co-determination |
6.1 The decision-makers consult with the target group 6.2 Negotiations between target group representatives and decision-makers 6.3 The target group members have a say |
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Step 7: partial transfer of decision-making authority |
7.1 A right of participation in the decision-making process 7.2 Decision-making authority is limited to certain aspects |
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Step 8: decision-making power |
8.1 The target group itself determines all essential aspects 8.2 Partnership-based cooperation between all parties involved 8.3 Accompaniment or support of others |
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Step 9: self-organization |
9.1 The responsibility for a measure or a project is entirely in the hands of the target group |
Schematic representation of the user-centered design process [
The aim of this viewpoint paper was to define digital public health interventions and provide an exemplary classification framework for digital public health interventions. Such an approach may help identify core areas of digital public health interventions, which in turn might be helpful during the development and evaluation phases of digital public health interventions. We argue that it is crucial to examine digital public health interventions from 3 different perspectives. The first one should be the WHO framework for EPHF [
Our current approach relates to a single and, to the best of our knowledge, the only definition of digital public health. As it is natural for such definitions to evolve over time as the field evolves, our suggestion for a definition of digital public health interventions might also evolve, as one cannot talk about a definition for digital public health interventions without defining the borders of digital public health. Although the suggested EPHF in this perspective piece refers to a summary of the WHO, some readers of this paper might find it hard to apply it to their specific context. This may very much depend on the health care system in which the digital public health intervention is developed. Therefore, the EPHF listed in this study should not be seen as a final list of public health functions or classification frameworks but rather as examples of core functions and goals. Similarly, the NICE framework might not be applied directly in other countries with different health systems and contexts; however, it might provide a helpful starting point for identifying relevant frameworks for such systems or developing their own frameworks that focus on interaction and functional classifications. Possible steps for participation to include user perspectives and methods (eg, user stories) might differ depending on the format and content of a specific intervention. For example, one cannot expect an app that facilitates communication between physicians and patients to unfold its full potential when the development team does not consider both perspectives regarding design, functions, and content [
The following example aims to display the connections among the 3 analyzed frameworks and models. Since the beginning of the SARS-CoV-2 pandemic in early 2020, various countries have developed contact-tracing apps for monitoring and surveillance [
As previously mentioned, participation in the development process is key to a successful intervention. Germany introduced the
This study aimed to provide the first definition and classification framework for digital public health interventions. Here, we suggest that digital public health, as a complex intervention, should be viewed from different perspectives. As such, our proposed classification is a combination of the elements of already existing models, specifically, the EPHF by the WHO, which provided us with an overview of the necessary core functions of public health that might also be addressed by digital means. The NICE framework gave us an overview of different areas for digital technologies and potential evaluation requirements. Both models together form a framework for describing digital public health interventions. However, without the inclusion of target groups in user-centered processes during the development, these interventions may lack efficiency and the acceptance of potential users. Therefore, we propose an established user-centered design process to be included in the development of digital public health interventions. Nevertheless, users of our definition and framework must check the validity of our criteria within their setting (eg, population structure, understanding of public health, and health care system). Taking the different strains of research that together might provide a better understanding of the term
A Digital Public Health Intervention addresses at least one essential Public Health function through digital means. Applying a framework for functional classification and stratification categorizes its interaction level with the user. The developmental process of a digital public health intervention includes the user perspective by applying participatory methods to support its effectiveness and implementation with the goal to achieve a population health impact.
The first step toward a potential intervention classification framework was developed based on this definition and its underlying frameworks (
Digital public health intervention classification framework.
digital health intervention
Essential Public Health Function
mobile health
National Institute for Health and Care Excellence
World Health Organization
The authors gratefully acknowledge Leibniz Science Campus Bremen Digital Public Health (lsc-diph.de) support, jointly funded by the Leibniz Association (W4/2018), the Federal State of Bremen, and the Leibniz Institute for Prevention Research and Epidemiology–BIPS.
JW provided the idea for the manuscript, defined the criteria for digital public health interventions, prepared the first definition for such interventions, came up with the first draft of the manuscript, and revised the final draft of the manuscript. JW and LM contributed equally to the manuscript and further developed the draft for the final paper. TJ provided critical feedback and contributed to reviewing and editing the final draft.
None declared.