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Currently accepted at: Journal of Medical Internet Research

Date Submitted: Feb 11, 2020
Open Peer Review Period: Feb 11, 2020 - Mar 23, 2020
Date Accepted: Aug 11, 2020
(closed for review but you can still tweet)

This paper has been accepted and is currently in production.

It will appear shortly on 10.2196/18200

The final accepted version (not copyedited yet) is in this tab.

Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.

Applying digital information delivery to convert habits of antibiotics use in primary care in Germany: Mixed-methods study

  • Regina Poss-Doering; 
  • Lukas Kuehn; 
  • Martina Kamradt; 
  • Katharina Glassen; 
  • Michel Wensing; 



Antimicrobial resistance remains high on the global health agenda. In Germany, the national agenda supports various interventions to convert habits of antibiotics use. The CHANGE-3 study (‘Converting Habits of Antibiotic Use for Respiratory Tract Infections in German Primary Care’, 2017-2020) applied digital information delivery using tablet computers in primary care practices, e-learning platforms for medical professionals and a website for the public to promote awareness and health literacy among primary care physicians, their teams and patients.


Embedded in the process evaluation of the CHANGE-3 study, this present study aimed at evaluating the acceptance and uptake of digital devices for the delivery of health-related information to enhance awareness and change habits of antibiotics use in primary care in Germany.


For this study, audio-recorded telephone interviews were conducted with physicians, non-physician health professionals and patients in the CHANGE-3 program. Pseudonymized verbatim transcripts were coded using thematic analysis. In-depth analysis was based on the inductive category ‘information provision via digital information tools’. Identified themes were related to main postulates of the Diffusion of Innovation Theory. In addition, data generated through a structured survey with physicians and non-physician health professionals in the program were analyzed descriptively.


Findings regarding acceptance and uptake of digital devices mirrored in three postulates of the Diffusion of Innovation Theory: innovation characteristics, communication channels and unanticipated consequences. Participants considered the provided digital educative solutions as supportive for promoting health literacy regarding a conversion of habits of antibiotics use. However, health care professionals also found it challenging to integrate these into existing routines in primary care and to align these with their professional values. Low technology affinity was a major barrier to the use of digital information in primary care as well. Patients welcomed the general idea of introducing health-related information in digital formats, but had concerns about device-related hygiene and their appropriateness for older patients.


Patients and medical professionals in primary care are reluctant to use digital devices that aim to promote awareness and health literacy regarding a rational use of antibiotics. Using a Diffusion of Innovation approach can support assessment of existing barriers and provide information about setting-specific pre-conditions necessary for future tailoring of implementation strategies Clinical Trial: ISRCTN, ISRCTN15061174. Registered 13 July 2018 – Retrospectively registered


Please cite as:

Poss-Doering R, Kuehn L, Kamradt M, Glassen K, Wensing M

Applying digital information delivery to convert habits of antibiotics use in primary care in Germany: Mixed-methods study

JMIR Preprints. 11/02/2020:18200

DOI: 10.2196/preprints.18200


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