Cocreating a Digital Patient Preparedness Tool for International Students Accessing Primary Care in Germany: A...

Digital health interventions (DHIs) are a potential tool to address communication challenges in primary care medicine by improving patient participation, treatment adherence, and self-management of chronic diseases. However, Germany's digital health infrastructure remains underdeveloped compared to other Organization for Economic Cooperation and Development (OECD) countries. Designing tailored, context-sensitive tools requires a deep understanding of patient needs, particularly for underserved populations navigating complex health care systems. Participatory approaches that actively involve end-users and stakeholders can help ensure that digital health tools are responsive to these needs. Behavioral science frameworks such as the Behavior Change Wheel (BCW), which incorporates the Capability, Opportunity, Motivation-Behavior (COM-B) model, can further support this process. Such technologies, developed using cocreation and behavior change frameworks, may improve health outcomes for underserved patient populations by addressing context-specific needs. This study explores how cocreation and behavioral science can inform the adaptation of a digital patient preparedness tool for international students accessing primary care in Germany.

This study aimed to gain insight into international students' experiences with primary care in Germany and explore whether adapting an existing digital patient preparedness intervention could address communication challenges and improve the standard of care. Using cocreation methods and the Behavior Change Wheel (BCW), we identified key design specifications and behavior change levers to inform tool development.

A mixed methods design was used to identify design specifications for a DHI across 4 cocreation workshops with 12 students at an international university in Germany. Quantitative data were used for descriptive insights, and qualitative data were analyzed using qualitative content analysis. Workshops were informed by the BCW and the Health CASCADE cocreation methods selector tool.

Cocreators reported feeling misunderstood, anxious, and ill-informed during primary care interactions, with system-level barriers compounding communication difficulties. Despite this, many engaged in preparatory behaviors (eg, note-taking) to manage uncertainty and structure their consultations. Feedback on an existing digital intervention was mixed: while cocreators appreciated its intent, structured lesson formats were seen as too time-consuming. Cocreators preferred a concise, interactive design. Communication prompts, appointment scheduling, and personalized feedback were frequently requested features, though tool adoption was seen as contingent on addressing broader system-level frustrations.

International students' negative health care experiences, often stemming from unclear communication, perceived indifference, and difficulty navigating an unfamiliar medical system, may be mitigated through codesigned, personalized digital interventions. Frequently requested features, such as appointment scheduling, clinic directories, test result access, and interactive tools like chatbots, may help address barriers related to system navigation, communication, and access. This study demonstrates how cocreation methods can be integrated with the BCW to inform the development of context-sensitive digital health tools for specific target groups.