Sabrina Berzins

Sabrina Berzins

Master's Thesis

Increasing Health Literacy through Patient-centered Knowledge Transfer within a Digital Health Application

Madeleine Flaucher (M.Sc.), Katharina Jäger (M.Sc.), Dr.-Ing. Heike Leutheuser, Prof. Dr. Björn Eskofier, Jana Rolny (ProCarement GmbH), Dr. Sebastian Eckl

06 / 2022 – 12 / 2022


During the past decade, health literacy has received increasing attention in European public health research due to its association with health outcomes, preventive behaviors, and health care expenditures [1]. Health literacy entails the personal, cognitive, and social skills enabling individuals to gain access to, understand, and use information to promote and maintain good health [2]. In the context of heart failure, health literacy is crucial as the condition requires a high level of patient involvement [3]. Patients need to know how to monitor key signs and symptoms, understand medication instructions, communicate information to health care providers, and make well informed decisions concerning their health [3]. Regarding the growing trend for mobile health, digital health applications represent a future-oriented opportunity to support heart failure patients in the management of their health and the promotion of their health literacy [4, 5].
Recent research indicates that digital health applications targeted at managing various diseases have the potential to increase health literacy through health knowledge transfer [6,7]. There exist insights into approaches for promoting health literacy within mobile health apps in general [8, 9], and into health knowledge transfer for heart failure patients [3, 10, 11]. Nevertheless, there is a lack of evidence for the improvement of health literacy within mobile health applications for heart failure patients [12]. Additionally, there is only limited data available from existing mobile health interventions regarding the theoretical approach in developing a health knowledge transfer concept [13].

Therefore, this thesis aims to develop a concept for mobile health knowledge transfer for heart failure patients within an existing digital health application. The overarching goal thereby is to improve the health literacy of heart failure patients. Applying the knowledge transfer concept to the case of the ProHerz app represents an interesting perspective for research, as the long-term impact of an increased health literacy on the health status may be investigated in future projects based on the patient’s vital parameters recorded in the app. In the final stage, the concept is implemented as a prototype and evaluated on a user group to ensure a user-centered design and high patient satisfaction.

[1] Boudewijn B. Visscher, Bas Steunenberg, Monique Heijmans, Jolien M. Hofstede, Walter Devillé, Iris van der Heide, and Jany Rademakers. Evidence on the effectiveness of health literacy interventions in the EU: a systematic review. BMC Public Health, 18(1):1414, December 2018.
[2] Don Nutbeam. Health literacy as a public health goal: A challenge for contemporary health education and communication strategies in the 21st century. Health Promotion International, 15, September 2000.
[3] Patrick Dunn, Vasileios Margaritis, and Cheryl Anderson. Understanding Health Literacy Skills in Patients with Cardiovascular Disease and Diabetes. The Qualitative Report, 22(1):33–46, January 2017.
[4] IQVIA Institute. The Growing Value of Digital Health: Evidence and Impact on Human Health and the Healthcare System, November 2017.
[5] WHO Global Observatory for eHealth. mHealth: new horizons for health through mobile technologies: second global survey on eHealth. Technical report, World Health Organization, 2011. ISBN: 9789244564257 ISSN: 2305-0934 (Online) number-of-pages: viii, 102.
[6] Parisa Farzi Karamolahi, Zahra Bostani Khalesi, and Maryam Niknami. Efficacy of mobile app-based training on health literacy among pregnant women: A randomized controlled trial study. European Journal of Obstetrics & Gynecology and Reproductive Biology: X, 12:100133, October 2021.
[7] Kay Sundberg, Veronica Lindström, Lena-Marie Petersson, and Ann Langius-Eklöf. Supporting health literacy using an interactive app for symptom management during radiotherapy for prostate cancer. Patient Education and Counseling, 104(2):381–386, February 2021.
[8] Jordan Broderick, Theresa Devine, Ellen Langhans, Andrew J. Lemerise, Silje Lier, and Linda Harris. Designing Health Literate Mobile Apps. NAM Perspectives, January 2014.
[9] Henna Kim and Bo Xie. Health literacy in the eHealth era: A systematic review of the literature. Patient Education and Counseling, 100(6):1073–1082, June 2017.
[10] Scott Conard. Best practices in digital health literacy. International Journal of Cardiology, 292:277–279, October 2019.
[11] Patrick Dunn and Scott FAAFP. Improving health literacy in patients with chronic conditions: A call to action. International Journal of Cardiology, August 2018.
[12] Sabine Allida, Huiyun Du, Xiaoyue Xu, Roslyn Prichard, Sungwon Chang, Louise D. Hickman, Patricia M. Davidson, and Sally C. Inglis. mHealth education interventions in heart failure. Cochrane Database of Systematic Reviews, 18(7), 2020. Publisher: John Wiley & Sons, Ltd.
[13] Nazli Bashi, Farhad Fatehi, Mina Fallah, Darren Walters, and Mohanraj Karunanithi. Self-Management Education Through mHealth: Review of Strategies and Structures. JMIR mHealth and uHealth, 6(10):e10771, October 2018. Company: JMIR mHealth and uHealth Distributor: JMIR mHealth and uHealth Institution: JMIR mHealth and uHealth Label: JMIR mHealth and uHealth Publisher: JMIR Publications Inc., Toronto, Canada.