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

Clinical Snapshot

Key Findings

• P Value: Not applicable — qualitative study

• Effect Size: Not applicable — qualitative study; no quantitative effect sizes reported

• Primary Outcome: Key facilitators of participation in digital prevention courses: temporal flexibility, home-based access, low preparation effort, health-related goals, free access, practical content, session reminders, and the ability to repeat sessions. Key barriers: lack of self-discipline, reduced social interaction and accountability compared to on-site formats, and competing work and family demands.

• Nnt Or Sensitivity: Not applicable — qualitative study; transferability of findings is the relevant analogue to generalisability

• Confidence Interval: Not applicable — qualitative study

Clinical Application

Findings are directly actionable for program designers and health insurers. Recommendations for tailored difficulty levels, structured follow-up, hybrid (digital plus in-person) elements, and continued post-course access to materials are feasible within existing digital health infrastructure. Integration of social features (peer groups, live sessions) addresses the identified barrier of reduced social connectedness. In Australia, private health insurers and Medicare-funded programs increasingly offer digital health promotion and chronic disease prevention courses. The findings are relevant to: (1) Private Health Insurance (PHI) wellness programs under the Private Health Insurance Act 2007, where digital prevention offerings are expanding; (2) The Australian Government's My Health Record and digital health strategy, which supports remote and flexible health service delivery; (3) RACGP guidelines on preventive care (Red Book, 10th edition), which emphasise low-barrier access to lifestyle modification programs; (4) The National Preventive Health Strategy 2021–2030, which prioritises digital health tools for prevention; (5) Rural and remote health equity — the flexibility and home-based access identified as key facilitators are particularly relevant to Australians in regional and remote areas where on-site programs are scarce. The identified barriers (self-discipline, social isolation) align with known challenges in Australian telehealth and digital health engagement literature. Program designers at health funds such as Medibank, Bupa, and HCF, as well as Primary Health Networks commissioning digital prevention programs, should consider these findings when structuring digital offerings. Adults enrolled in or considering digital health promotion programs delivered via statutory or private health insurance funds; particularly relevant for working-age adults with time constraints, those in geographically remote areas, and individuals with caring responsibilities. Findings are most directly applicable to women aged 25–72 given the sample composition.

Abstract

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. TRIAL REGISTRATION: German Clinical Trial Register DRKS00029761; Registration date 27.07.2022; https://drks.de/search/de/trial/DRKS00029761 .

References

1. 1.Brodski, M., Twelkmeyer, T., Bruch, D., May, S., Muehlensiepen, F., Seifert, F., Spethmann, S., Fleige, G., & Lehnen, M. (2026). Motivating factors and possible barriers to participation in digital prevention courses of two statutory health insurance funds in Germany: a qualitative interview study. BMC Public Health. https://doi.org/10.1186/s12913-025-13284-6