Adapting the digital health navigator role for prescription based digital therapeutics in Germany: a modified Delphi study with participatory design elements
This study utilized a modified Delphi process with participatory design elements to adapt the US-based Digital Health Navigator training for Germany's prescription digital therapeutics (DiGA) context, resulting in a comprehensive catalogue of 174 competency and implementation recommendations that emphasize contextualizing an established model over creating a new role.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
In recent years, the number of people struggling with mental health conditions has grown significantly, driven by global crises and a shifting world. In Germany, this rise has outpaced the ability of traditional therapists and clinics to provide care, leaving many patients waiting months for an appointment. To bridge this gap, the country introduced a unique system called prescription-based digital health applications. These are not just random wellness apps; they are evidence-based tools, vetted by government regulators, that doctors can write on a prescription pad just like a pill. Once prescribed, health insurance covers the cost, allowing patients to use them immediately while they wait for face-to-face therapy. However, having access to a tool is different from knowing how to use it effectively. Many people, regardless of age or tech-savviness, find it difficult to navigate these digital treatments on their own. This is where a new kind of helper comes in: the Digital Health Navigator. Originally developed in the United States, this role involves a member of the medical team who guides patients through the technical and emotional challenges of using digital health tools, ensuring they stay engaged and get the most out of the treatment.
A team of researchers in Germany set out to see if this American model could work in their specific healthcare landscape. They knew that simply copying a training program from one country to another rarely works because laws, insurance rules, and medical cultures differ. Their goal was to adapt the existing American training curriculum to fit the German system and to create a clear set of rules for how these navigators should be trained and how they should fit into a doctor's office. To do this, they brought together a diverse group of people, including patients who had used these apps, doctors, nurses, and medical assistants who would eventually become the navigators themselves. They used a structured process called a Delphi study, which involves multiple rounds of discussion and voting to build a shared agreement on complex topics.
The researchers found that the core idea of the Digital Health Navigator was surprisingly robust. They discovered that they did not need to invent a new job from scratch. The American training program, which covers skills like troubleshooting technical issues and understanding how to talk to patients, required only minor tweaks to work in Germany. The most significant changes were not about the human skills themselves, but about the rules surrounding them. For instance, the training had to swap out American privacy laws for German data protection regulations and update the medical conditions covered to match the specific list of approved German applications. The team added new sections on how to handle emergencies and how to manage the specific permissions required by German apps, but the fundamental structure of the role remained the same. This suggests that the ability to guide someone through a digital health journey is a universal skill, even if the specific laws and apps change from country to country.
However, the study revealed a striking gap between what people thought was important and what they felt capable of doing. When the participants rated the importance of different skills, they agreed that the ability to critically evaluate an app—checking if it is safe, if the science behind it is real, and how it handles personal data—was the most vital skill a navigator could have. Yet, when asked to rate their own confidence in these areas, they gave themselves the lowest scores. They felt much more comfortable with basic tasks, like knowing how to play music on a phone or create a playlist, even though the group was less certain that these basic skills were actually necessary for the job. This finding suggests that future training programs should focus less on teaching people how to hold a smartphone and more on teaching them how to be critical judges of digital health tools.
The group also debated how these navigators should fit into a medical practice. They agreed that navigators should not be isolated tech support staff working in a corner. Instead, they must be woven into the daily flow of patient care, communicating regularly with doctors and therapists. There was a strong consensus that navigators should help patients choose from the wide range of available apps, but they do not need to be experts on every single one. Instead, they should have a broad overview of the options and deep knowledge of at least one app for each type of mental health condition they might encounter. On the question of how to ensure navigators are actually good at their jobs, the group rejected the idea of a formal written exam. Instead, they decided that competence should be proven through the training process itself, using practical exercises and real-world simulations, and maintained through ongoing learning rather than a single test.
Ultimately, this research provides a practical roadmap for bringing digital health navigation to German clinics. It shows that the role is ready to be implemented, provided that the training focuses on the right skills: the ability to evaluate evidence, the knowledge of local regulations, and the capacity to connect patients with the right tools. The study does not claim that this will solve the mental health crisis on its own, but it offers a concrete framework for testing whether these navigators can help patients stick with their digital treatments and improve their outcomes. By defining exactly what these navigators need to know and how they should work, the researchers have laid the groundwork for a future where digital health tools are not just available, but are actually used effectively by the people who need them most.
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