Zusammenfassung
Digitale Gesundheitstechnologien wie Gesundheits- und Medizin-Apps können potenziell große Teile der Bevölkerung mit evidenzbasierten Inhalten erreichen und so Gesundheitsförderung und Prävention verbessern. Unerwünschte Effekte, die durch den Gebrauch solcher Technologien entstehen können (z. B. Nebenwirkungen), werden aber bislang nur wenig in Public Health diskutiert.
In diesem Beitrag werden anhand einer narrativen Literaturübersicht mögliche unerwünschte Effekte dieser digitalen Technologien dargestellt. Sie werden gemäß einem sozialökologischen Ansatz für Gesundheit drei verschiedenen Wirkungsebenen zugeordnet: der individuellen Ebene, der Beziehungsebene und der Versorgungsebene. Die individuelle Ebene beinhaltet unerwünschte gesundheitliche, affektive, finanzielle und datenbezogene Effekte. Auf der Beziehungsebene wird zwischen Effekten auf das direkte soziale Umfeld und das Onlineumfeld unterschieden. Auf der Versorgungsebene zeigen sich Effekte, die durch Gebrauch und Missbrauch persönlicher Gesundheitsdaten, durch soziale Stratifizierung und mangelnde Inklusivität (Barrierefreiheit) entstehen.
Wir schlagen vor, solche unerwünschten Effekte präziser zu konzipieren, besser zu erfassen und zu dokumentieren und den Fokus von einer entwicklungszentrierten Diskussion von Risiken und Herausforderungen zu einer umfassenden Konzeption von Neben- und unerwünschten Wirkungen digitaler Gesundheitstechnologien zu verschieben. Die vorgeschlagene Einteilung in drei Wirkungsebenen kann hierbei hilfreich sein.
Abstract
The discussion of digital health technologies, in particular medical and health apps, is currently dominated by a focus on their potential to reach large parts of the population for the dissemination of evidence-based health promotion and prevention content. However, potentially unintended consequences, side effects, and negative effects of digital health technologies are rarely discussed in public health.
In this paper, via a narrative literature review, we propose a perspective on unintended consequences and side-effects of digital health technologies on multiple hierarchical levels of a socio-ecological model of health. Unintended consequences and side-effects of digital health technologies can be identified on an individual level, a level of social relationships, and a health services level.
We propose a broader conceptualization of unintended consequences and side-effects of digital health technology together with a more thorough documentation of such effects using multiple levels in a socio-ecological approach. This would build a cumulative evidence base of unintended effects and shift the focus from development-centered discussion of risks and challenges to a comprehensive conception of side effects and undesirable effects of digital health technologies. The proposed division into three effect levels may be helpful here.
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B. Schüz und M. Urban geben an, dass kein Interessenkonflikt besteht.
Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.
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Schüz, B., Urban, M. Unerwünschte Effekte digitaler Gesundheitstechnologien: Eine Public-Health-Perspektive. Bundesgesundheitsbl 63, 192–198 (2020). https://doi.org/10.1007/s00103-019-03088-5
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DOI: https://doi.org/10.1007/s00103-019-03088-5