Genie in the Bottle? A Qualitative Study of General Practitioners’ Perspectives and Information Needs Concerning Digital Mental Health Applications in Germany

Genie in the Bottle? 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A Qualitative Study of General Practitioners’ Perspectives and Information Needs Concerning Digital Mental Health Applications in Germany Fatma Sahan, Karin Panitz, Charlotte Schoeren, Nadja Kairies-Schwarz, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7289079/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 09 Dec, 2025 Read the published version in BMC Primary Care → Version 1 posted 12 You are reading this latest preprint version Abstract Background The increasing prevalence of mental illnesses underscores the need for innovative solutions in outpatient care, such as prescription digital therapeutics (DTx) in terms of regulated software-based medical products for treatment and disease management. In Germany, approved DTx are called DiGAs (referring to “Digitale Gesundheitsanwendungen”) and can be prescribed since 2020 at the expense of statutory health insurance. However, DiGAs remain underutilized in general practice. Prior research indicated informational and attitudinal barriers among healthcare providers, yet little is known about tailored acceptance-facilitating strategies. This study explores general practitioners’ (GPs) perspectives on DiGAs for mental health, focusing on their needs regarding information strategies for routine use in primary care. Methods A qualitative descriptive exploratory using semi-structured interviews with GPs was conducted in fall 2024. Participants were recruited via GP networks, fax, and social media using a purposive sampling approach. Data was analyzed using qualitative content analysis with deductive-inductive category development. Results Thirteen GPs between 27 and 66 years (median: 54 years, female: n = 3; 23%) were interviewed. Twelve participants (92%) had prescribed DiGAs at least once, primarily for conditions such as depression, insomnia or obesity. Analysis revealed varying levels of perceived level of knowledge and differing attitudes toward digitalization. DiGA prescriptions were initiated both by GPs and by patients. Independent information sources, particularly from governmental and regulatory institutions, professional associations, and colleagues were mentioned. GPs reported a need for further information content on the evidence base, therapeutic indications, usability, and costs of DiGAs. In terms of delivery modes, online formats, in-person events, and traditional print media were named. Conclusions Although nearly all participating GPs had already prescribed DiGAs, the results reveal considerable uncertainties regarding central structural aspects such as the prescription process and budgetary impact. GPs expressed a need for concise information from central, independent institutions and highlighted the value of familiar and reliable formats such as print-media and lecturers. Information strategies should take limited time resources in primary care into account and be oriented toward established routines. Strengthening institutional support and integrating digital health topics into medical training may enhance the adoption of DiGAs in primary care. Physicians General Practitioners Digital Health Mental Health Telemedicine Mobile Applications Mental Health Services Qualitative Research Information Literacy Figures Figure 1 Figure 2 Introduction The prevalence of mental illnesses, including depression and anxiety disorders, burdens the healthcare systems worldwide and has increased significantly ( 1 – 3 ). Digital Mental Health Interventions (dMHI), including digital therapeutics (DTx) for mental disorders, have the potential to serve as a valuable resource for patients and the entire outpatient healthcare system. As gatekeepers in primary care, general practitioners (GPs) play a pivotal role in identifying suitable patients, initiating treatment pathways, and integrating DTx into routine care for individuals with mental health needs. In several European healthcare systems, the implementation of DTx has only recently been initiated or completed ( 4 ). In this context, Germany has taken a pioneering role with the digital health applications (Digitale Gesundheitsanwendungen, DiGAs), commonly referred to as “DTx on prescription”, supported by progressive regulatory frameworks and legislation ( 5 ). The legal basis for DiGAs was founded with the passing of the Digital Healthcare Act (Digitale-Versorgung-Gesetz, DVG) in December 2019, which led to the establishment of the DiGA directory by the Federal Institute for Drugs and Medical Devices (Bundesinstituf für Arzneimittel und Medizinprodukte, BfArM), where applications can be listed either permanently or on a provisional basis pending evidence of benefit ( 6 , 7 ). Since fall of 2020, DiGAs can be prescribed for adult patients with statutory health insurance in Germany, with costs reimbursed by the insurers. Although the initial restriction to adults has been lifted, DiGAs are not yet available for children and adolescents. In addition to prescription by physicians or psychotherapists, patients may also obtain access by requesting coverage from their statutory health insurance ( 8 ). An overview of the available access pathways to DiGAs is illustrated in Fig. 1 . Notes. Abbreviations: DiGAs = Digital health applications (German „Digitale Gesundheitsanwendungen“, i.e. prescription of digital therapeutics). This schematic illustrates the two official access pathways to a DiGA in Germany via medical prescription or via direct request to the statutory health insurance provider. In both cases the patient receives a time-limited activation code (usually valid for 90 days) and downloads the DiGA from an app store. A physician prescription is not mandatory as patients can also request access from their statutory health insurance particularly if they already have a documented indication or can self-report relevant symptoms. Since October 2024, physicians and psychotherapists in Germany are only allowed to prescribe DiGAs if their practice management software is certified by the National Association of Statutory Health Insurance Physicians. DiGAs are software-based Conformité Européenne (CE)-certified medical products approved for the detection, monitoring, treatment or alleviation of a broad range of diseases, including mental health conditions ( 9 ) and have increased their relevance in healthcare due to their potential to improve eHealth literacy, symptom management, and treatment adherence ( 8 , 10 ). For patients with mental health issues, primary care GPs often serve as the first point of contact or a compensatory resource. This role is especially important given the limited access to psychotherapy ( 11 ). DiGAs may support patient care by enhancing care quality and efficiency while reducing healthcare costs ( 12 ). Especially in rural settings, they can improve access, reduce travel and waiting times, and promote convenience without compromising care quality ( 13 , 14 ). Meta-analyses have confirmed the effectiveness of both therapist- and self-guided dMHI based on cognitive behavioral therapy (CBT), particularly for conditions such as depression and anxiety disorders ( 15 – 17 ). However, the uptake of DiGAs has not met the initial expectations. A survey conducted in 2021 by Dahlhausen et al. ( 18 ) revealed that less than 10% ( n = 103) of surveyed physicians and psychotherapists in Germany ( N = 1299) have ever prescribed any DiGA, and only around a third of them plan to prescribe one within the next year. Although DiGAs are increasingly recognized by internists for their potential to enhance patient care ( 19 ), actual use remains low. As of June 2023, only 12% of the approximately 185.000 physicians and psychotherapists participating in outpatient statutory care had issued a DiGA prescription to insured patients ( 20 ). These findings indicate that, while medical professionals acknowledge the promise of DiGAs, their propensity to prescribe it remains modest. The barriers to the prescription of DiGAs are multifactorial. Structural challenges such as time constraints, high workload, outdated IT infrastructure, and the resulting difficulties in integrating DiGAs into existing work processes are cited ( 19 , 21 , 22 ). In addition, uncertainties regarding specific DiGA related aspects, such as the prescription process, reimbursement regulations, and concerns about patient adherence point to a lack of information about DiGAs ( 19 , 21 , 22 ). Studies have shown that medical professionals report insufficient knowledge about available DiGAs, expressing issues with finding reliable, easily accessible information in case of need ( 10 , 23 ). However, little is known about how information on DiGAs should be designed and delivered to meet the needs of GPs and encourage their practical use in primary care. The role of information in GPs’ adoption of DiGAs Research indicates that greater perceived knowledge about DiGAs is positively associated with the frequency of prescriptions ( 19 ). Conversely, an insufficiency of information can engender a circumspect and dubious stance toward DiGA prescriptions ( 21 ). Despite the increased accessibility of digital information resources in contemporary medicine, studies have demonstrated that physicians primarily rely on memory for information retention ( 24 ). Given the continuous proliferation of medical knowledge, which is estimated to double every 20 years ( 25 , 26 ), maintaining up-to-date knowledge in routine clinical practice can be difficult. Furthermore, the mean age of German GPs is 54.1 years ( 27 ). This demographic factor has implications for the utilization of digital information sources and suggests that the medical training of physicians may not be commensurate with current developments. In conjunction with the high average age of general practitioners and their stance on new technologies ( 28 , 29 ), demographic shifts ( 30 ), the deficit of GPs, particularly in rural regions ( 31 ), and existing insufficiencies in the digital infrastructure of the healthcare system ( 32 ), the likelihood that clinical questions to remain unsolved during routine care is increased ( 33 ). This can hinder evidence-based decision-making, compromise treatment outcomes ( 34 ) and diminish GPs’ readiness to prescribe DiGAs. In addition, physicians continue to favor traditional media such as journals, textbooks, guidelines, continuing medical education (CME), and conferences, as well as peer-to-peer exchange, in their search for information ( 35 ). Conversely, digital, evidence-based information resources are used less frequently ( 35 ). These preferred information channels of physicians are only suitable for communicating innovative treatments such as DiGAs to a limited extent. The underutilization of digital information sources complicates the ongoing engagement with the rapidly evolving range of offerings, thereby constraining the capacity for evidence-based evaluation of novel applications. The barriers, related to information, can contribute significantly to the fact that, despite their potential, DiGAs have so far only been prescribed hesitantly for patients with mental health issues. Aim of the study Considering the discrepancy between the current prescription rates, the perceived potential of DiGAs and the physicians’ reported level of knowledge about DiGAs, the objective of this study is to explore the perspectives that GPs hold on DiGAs in the domain of digital Mental Health. A particular focus lies on their perspectives for information needs and preferred communication formats for accessing relevant content. The findings aim to enhance information dissemination and thereby foster the integration of digital applications into the healthcare system. Research Questions (RQ) : How do GPs perceive their current level of knowledge regarding DiGAs? What are GPs' attitudes toward digitalization in medical practice, including the diffusion of DiGAs and Artificial Intelligence (AI) into primary care? Whose initiative leads to the prescription of DiGAs in general practice? Which information sources do GPs consult when seeking information about DiGAs? What type of content do GPs consider most relevant when learning about DiGAs? Through which delivery modes do GPs want to receive information about DiGAs? How much time are GPs willing to invest in learning about DiGAs? Methods This qualitative study was conducted as part of a mixed-methods research project with different groups of health professionals (GPs, occupational physicians and psychotherapists) to shed light on the diverse perspective on underexplored information needs and preferences regarding DiGAs for mental disorders. Prior to data collection, the qualitative study was approved by the Ethics Committee of the Medical Faculty of Heinrich Heine University Düsseldorf (HHU; study number: 2023–2338, approval date: 06.03.2023). The reporting follows Consolidated Criteria for Reporting Qualitative Research (COREQ, see Supplementary Table 1; ( 36 )). Research team This qualitative study was conducted by an interdisciplinary research team. JAH (psychologist, postdoctoral qualification in health sciences) served as principal investigator (PI), in close with NKS (professor of behavioral health economics). Together with members of NKS’ research group, MV and MZ (economists specialized in preference research in primary care), they supported the preparatory work for this study. FS, a doctoral candidate in Public Health with a background in experimental psychology and neuroscience, was primarily responsible for data analysis. She collaborated closely with the PIs and received analytical feedback from LG and JB, both doctoral candidates with expertise in qualitative methods. Interviews were conducted by KP and CS, both doctoral researchers in Public Health and Medicine. KP is also conducting a related sub-study on psychotherapists’ DiGA information needs (37, submitted). FS, KP and CS received in-depth formal training in qualitative methods and analysis as part of their involvement in the project. AL, a health scientist with extensive quality research experience in mental health and stress, provided methodological guidance throughout the study. All team members contributed to the design, analysis, or interpretation in line with their disciplinary backgrounds in psychology (FS, KP, CP, JAH), medicine (CS), health economics (NKS, MV, MZ), public health (LG, JB, AL, CP), and occupational medicine (AL, JAH). Sampling strategy A purposive sampling strategy was used to recruit GPs with specialist certification in internal or general medicine, practical experience in primary care, and authorization to prescribe DiGAs in Germany. Eligibility criteria further included written informed consent, active clinical practice in Germany, proficiency in German, and either statutory health insurance accreditation or employment at an institution authorized to prescribe DiGAs (such as outpatient clinics or hospitals). Recruitment was conducted via multiple channels: social media platforms (e.g., Instagram and LinkedIn) using flyers and short informational videos; local academic and clinical networks of the Institute of General Practice (Institut für Arbeitsmedizin; IfAM; Primary Care Research Practice Network (Hausärztliches Forschungspraxennetzwerk, HAFO)) at HHU and its University Hospital, the mailing list of the Occupational Medicine Network of Ludwig Maximilian University Munich (ArbMedNet), and personal healthcare contacts of the research team. To increase the overall number of participants individuals with dual qualifications in internal and occupational medicine, as well as one resident in general medicine training, were also included. Recruitment continued until data and meaning saturation was achieved, indicating that no substantially new themes emerged during the final interviews. Study design and procedure Before participating, the recruited GPs received written study information, a consent form, and a short questionnaire capturing sociodemographic (e.g., age, gender, professional experience, federal state) and professional data (e.g., DiGA experience, employment type; see Supplementary Table 2). The study followed a qualitative research design using semi-structured interviews to explore GPs‘ information needs regarding DiGAs for mental health issues. The interview guide (see Supplementary Table 3) covered four thematic blocks: 1) perceived prior knowledge about DiGAs, 2) attitudes toward digitalization in medical practice, 3) experiences with DiGA use or prescription, 4) information needs regarding information sources, contents, and delivery modes when gathering information about DiGAs. The guide was developed grounded in empirical research and iteratively refined based on internal feedback. To ensure clarity and methodological quality, four pretest interviews were carried out: the first with a simulated participant to test technical and procedural elements, and three subsequent interviews with a former medical student, a junior physician, and a GP to evaluate clarity, interview structure, and overall understanding. Minor linguistic refinements were made based on this feedback. Interviews were conducted online from July 5 until August 16, 2024 using the general data protection regulations-compliant videoconferencing software Webex (California, USA ( 38 )), with access provided by the institution. Participants were informed of their option to decline the webcam usage. The interviewers introduced themselves as a psychologist (KP) and a medical graduate (CS) prior to the commencement of the interview, providing a concise explanation of their personal interest in dMHI. During the online interview, only the participant and the interviewer were present. The video was not recorded; rather, audio files were obtained using a voice recorder that was not connected to the internet. In total, 13 GPs were interviewed. Except for one participant who had a personal relationship with KP, no prior relationship existed between the researchers and the study participants. All participants received a reimbursement of €100 for completing the respective interview. Data analysis The transcription and qualitative content analysis of the interviews was conducted using MAXQDA 2024 software in the version 24.8.0 ( 39 ). The interviews were audio-recorded, pseudonymized, and transcribed verbatim using AI with manual control. This process was compliant with general data protection regulations. The transcriptions were subjected to a meticulous review process, during which they were revised and checked for accuracy by the respective interviewers. The qualitative content analysis followed the methodological approach of Kuckartz and Rädiker ( 40 ). Initial coding of the transcripts was performed by FS using a category system whose main categories were developed deductively based on the interview guide. This system was subsequently refined through the inductive development of subcategories grounded in the interview material. Preliminary findings were reviewed with JAH, LG and JB. Based on their feedback, the category system was revised, and FS conducted a second coding phase of coding. During this phase, existing categories were further differentiated, and additional categories were introduced where needed to adequately capture the diversity of the content. The coding scheme continued to evolve through an iterative process, with deliberate sessions held to assess clarity, completeness, and parsimony. The final coding system, including anchor examples, is presented in Supplementary Table 4. Results Sample characteristics A total of 13 GPs participated in the study, with the interviews lasting between 33:40 minutes and 51:40 minutes. The age of the interviewees ranged from 27 to 66 years, with an average age of 49 years ( M = 48.92, SD = 14.63, median = 54 years). The majority of the participants were male ( n = 10; 76.92%), worked in North Rhine-Westphalia ( n = 11; 84.62%), in an urban area ( n = 8; 61.54%), had a statutory health insurance license ( n = 9; 69.23%), and worked full-time ( n = 12; 92.31%). The mean professional experience was 20 years ( M = 20.08, SD = 12.55). Most of the GPs surveyed have already prescribed a DiGA ( n = 12; 92.31%). Regarding the DiGAs prescribed, GPs most frequently reported applications targeting obesity ( n = 10), depression ( n = 9), sleep disorders ( n = 3), anxiety disorders ( n = 2), smoking cessation ( n = 2), diabetes ( n = 1), migraine ( n = 1), panic attacks ( n = 1) and tinnitus ( n = 1). Explicitly named mental DiGAs were “Deprexis” ( n = 3), “HelloBetter” ( n = 1), and “Selfapy” ( n = 1) for depression, “Novego” ( n = 1) for anxiety disorders, and “Raucherhelden.de” ( n = 1) for smoking cessation. In the somatic domain, GPs named DiGAs, such as “Oviva” ( n = 3) and “Zanadio” ( n = 3) for weight reduction, as well as “Somnio” ( n = 3) for sleep disorders. The characteristics of GPs differed, for example, in terms of age, with male GPs ( n = 10) being older (median = 54) than female GPs ( n = 3, median = 34 years). As illustrated in Table 1 , the descriptive data is presented according to gender. Table 1 Descriptive data according to gender. Total ( N = 13) Men ( n = 10) Women ( n = 3) Age (years) M (SD) 48.92 (14.63) 53.4 (13.68) 34.0 (2.65) Median 54 58 34 Professional experience (years) M (SD) 20.08 (12.55) 23.50 (12.38) 8.67 (1.53) Median 20 24 9 Work area Rural (%) 5 (38.46) 3 (30.00) 2 (66.67) Urban (%) 8 (61.54) 7 (70.00) 1 (33.33) Health insurance license Yes (%) 9 (69.23) 8 (80.00) 1 (33.33) No (%) 4 (30.80) 2 (20.00) 2 (66.67) Employment type Full-time (%) 12 (92.31) 9 (90.00) 3 (100.00) Part-time (%) 1 (7.69) 1 (10.00) 0 Prescription of DiGAs in the past Yes (%) 12 (92.31) 9 (90.00) 3 (100.00) No (%) 1 (7.69) 1 (10.00) 0 Notes. Abbreviations: DiGAs = Digital health applications (Digitale Gesundheitsanwendungen, i.e. prescription of digital therapeutics). All male participants in this sample were general practitioners (GPs) practicing in North Rhine-Westphalia (NRW), the most populous federal state in Germany, with approximately 18 million inhabitants ( 41 ). This regional concentration likely reflects the recruitment strategy via a local research institute and may introduce a regional sampling bias. It should also be noted that DiGAs can be prescribed not only by office-based physicians with a statutory health insurance license, but also by physicians working in institutional or outpatient settings without an accreditation. Qualitative main results Eight main categories emerged from the qualitative data: perceived level of knowledge, attitudes toward digitalization in medical practice, initiation of DiGA prescriptions, perspectives regarding needed information sources, content, delivery modes, time investment related to DiGAs, and additional topics. Each of these categories was further divided into specific subcategories. Prior knowledge about DiGAs (RQ 1: How do GPs perceive their current level of knowledge regarding DiGAs?) To assess the perceived need for information, GPs were asked to self-evaluate their level of knowledge of DiGAs. Some participants described their knowledge as limited, noting that DiGAs had not yet been implemented in their practice. Others stated a high level of knowledge, articulating detailed insights into the regulatory status, therapeutic orientation, and applicability of specific DiGAs. “There are, of course, those very specifically, predominantly behavior therapy-oriented apps that do quite a lot themselves, interacting with the patients beyond psychoeducation. And this becomes relevant when patients are, firstly, familiar with the electronic devices required and can imagine using them. And when the app is at least on the official list of the Federal Institute for Drugs and Medical Devices. There are different stages of approval, and for me it’s important that they are permanently listed products” ( GP13, male ). Attitudes toward digitalization in medical practice (RQ2: What are GPs' attitudes toward digitalization in medical practice, including the diffusion of DiGA and AI into primary care?) An area of particular interest concerned attitudes toward digitalization in medical practice. In this context, participants were asked to evaluate their stance toward both DiGAs and the use of AI in healthcare. For both topics, participants classified their perception as positive, neutral/indecisive, or negative. 2a Attitudes toward DiGAs GPs who perceived DiGAs positively emphasized their relevance for everyday clinical challenges. Participants noted the potential to improve access to psychological therapy, especially in underserved areas or for patients on waiting lists. DiGAs were also seen as a helpful tool for bridging the waiting period until a therapy slot becomes available. Furthermore, the 24/7 availability of the applications was considered beneficial, allowing patients to engage with the content flexibly and independently of practice hours. Another commonly stated benefit was the potential of DiGAs to alleviate workforce shortages in healthcare by supporting therapeutic processes when human resources are limited. There was a general openness among GPs toward prescribing DiGAs, especially for mental health-related indications. “Especially in the field of mental health, I consider DiGAs very useful. Many patients need something urgently at that moment, but there simply isn’t the human or physical capacity to provide it. We general practitioners are also highly regulated and time-constrained in what we can offer. DiGAs are something patients can use independently of time constraints. That’s why I would say I’m fundamentally positive toward it.” (GP01, male). Respondents with a neutral/indecisive stance acknowledged the potential of DiGAs but expressed a lack of enthusiasm for their implementation in their own practice. While they did not question the general value of digital applications, they tended to prioritize other areas of care or innovation. Some described their perspective as open but reserved, indicating that DiGAs might be useful in theory, yet not sufficiently compelling or relevant for their current clinical context. „In everyday practice, DiGAs have so far played only a minor role. I’m not quite sure why that is.“ ( GP06, male ). Participants who expressed a negative attitude toward DiGAs raised concerns about the loss of human interaction, particularly the absence of direct contact between patients and healthcare professionals. They feared that replacing or supplementing therapy with digital tools could compromise the therapeutic relationship. “What makes DiGA unattractive to me is the fact that it shifts everything to an impersonal, ultimately AI-based level, where personal exchange, direct communication, and the emotional dimension between people no longer take place.” ( GP07, male ). In addition, GPs criticized the administrative burden associated with prescribing DiGAs, describing it as too time-consuming relative to the perceived benefit. Another common concern was that older patients, who are often less familiar or comfortable with digital technologies, might struggle to use such applications effectively. 2b Attitudes toward Artificial Intelligence (AI) Several participants expressed a favorable view of AI applications, particularly regarding their potential to reduce workload in diagnostics or administrative tasks. “I am very much in favor of AI, particularly when it contributes to reducing workload. This includes diagnostic support, of course, but also administrative tasks such as billing. Any form of relief that does not require additional personnel would be highly appreciated.” ( GP11, female ). Some interviewees also highlighted the potential of data-driven AI models to support medical decision-making, even though they had not yet used such tools themselves. “I believe that especially in areas where AI is about comparing a large number of findings with a current patient case, it could be extremely helpful.” ( GP10, male ). Others expressed ambivalence toward AI. While there was some acceptance of technological progress, the current added value of AI in general practice was questioned. “At the moment, I don’t see any advantage of AI, except maybe for radiology findings, standard findings.” ( GP04, male ). It was also noted that, given the existing structural challenges in the healthcare system, other issues are currently seen as more pressing. Some participants voiced skepticism or expressed generally negative attitudes toward the use of AI in medicine, emphasizing ethical concerns and a fundamental unease with new technology. “As I take a fundamentally critical stance toward AI and approach its development and use with a sense of caution, I do not believe that keeping medical staff informed about every latest innovation in this field should be a top priority.” ( GP07, male ). Initiators of DiGA prescription (RQ 3: Whose initiative leads to the prescription of DiGAs in general practice?) It became evident that DiGA prescriptions were initiated in different ways, namely both through GP initiative and patient initiative. GP-driven prescriptions reflected a more proactive approach, particularly in the context of mental health care. In contrast, some GPs stated that prescriptions were often based on patient requests. “Occasionally, I have patients, who explicitly request such applications. In those cases, I issue the prescription. I was fine with that.” (GP12, male) . However, it was also evident that GPs did not consistently respond positively to patient-initiated prescriptions, particularly in cases involving external service providers. “I received several faxes from a DiGA provider, naming my patients and asking me to return the completed form or prescription. I find that presumptuous and intrusive” ( GP06, male ). Information-related needs among general practitioners Perspectives regarding information sources (RQ 4: Which information sources do GPs consult when seeking information about DiGAs?) GPs indicated a preference for accessing a variety of sources when gathering information about DiGAs. The heterogeneity of these sources mirrors the contemporary intricacy of the digital health ecosystem. A structured categorization of these sources emerged based on institutional affiliation, practical relevance, and perceived credibility. A typology of information sources has emerged based on the structure of the Federal Ministry of Health (Bundesministerium für Gesundheit, BMG ( 42 )). 4.1 Governmental and regulatory bodies Participants expressed a clear interest in receiving information about DiGAs from central and authoritative institutions within the German healthcare system. Among the most frequently mentioned were the BfArM, the BMG, and the Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, IQWiG). These institutions were perceived as competent providers of up-to-date, evidence-based, and manufacturer-independent information. In addition, GPs highlighted the role of regional medical associations (Ärztekammer) and Associations of Statutory Health Insurance Physicians (Kassenärztliche Vereinigungen) as trustworthy sources for information regarding DiGAs. “I tend to rely on the Association of Statutory Health Insurance Physicians or the medical association. While they may also have certain interests, I still consider them official bodies that provide reliable information.” ( GP11, female ). Furthermore, interviewees pointed to the Federal Institute for Occupational Safety and Health (Bundesanstalt für Arbeitsschutz und Arbeitsmedizin, BAuA) as a trustworthy source. “In the field of occupational medicine, I fully trust the information provided by the Federal Institute for Occupational Safety and Health. I know that the content is reviewed up-to-date, and reliable.” ( GP01, male ). Overall, participants emphasized that information from these central institutions should be neutral and clearly distinguishable from industry communication. 4.2 Professional associations In addition to governmental and regulatory bodies, participants also considered professional associations as relevant sources of information regarding DiGAs. Among the organizations mentioned were the German Association of General Practitioners (Deutscher Hausärzteverband), the German Society for General Practice and Family Medicine (Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin; DEGAM), and the Association of Occupational and Industrial Physicians (Verband Deutscher Betriebs- und Werksärzte). “In my view, institutions such as DEGAM or the German Association for General Practitioners are trustworthy. In my opinion, they should be the ones providing information about DiGAs.” ( GP07, male ). A need for DiGA-related information in the form of guideline-like recommendations, comprehensive and evidence-based yet non-binding, was expressed by some respondents. This would support a more in-depth engagement with specific aspects of these applications within the scope of clinical discretion. 4.3 Statutory health insurances Some GPs expressed a need to receive information on DiGA from statutory health insurances who represent the funding bodies. Others, however, adopted a more critical stance, questioning the objectivity of such information due to perceived conflicts of interest. "I consider information from the statutory health insurances very critically. What they would like us to do is very much driven by their own interests." ( GP07, male ). 4.4 Industry – DiGA manufacturer/developers Participants expressed a need for more transparent and proactive information provision from DiGA manufacturers. At the same time, they also highlighted the tension between informative content and commercial interest. “I think DiGA manufacturers could do a bit more. They should bring us on board and explain what different DiGA are available. There is definitely room for improvement.” ( GP09, male ). “I really want to hear this from a neutral source. Whoever offers these programs clearly has a vested interest, of course. It's just like medication. I have not engaged with pharmaceutical representatives in my practice for decades because what they provide is advertising, and I prefer to get neutral information.” ( GP10, male ). 4.5 Journals In addition to these actors, GPs expressed a need to receive DiGA-related information through familiar and trusted journals such as the “Arznei-Telegramm” which was valued for its independent, critically reviewed pharmaceutical insights, and considered trustworthy for its lack of commercial bias. The GPs also recommended the German medical journal “Deutsches Ärzteblatt” as a source for obtaining information about DiGAs. “I would most appreciate information sources like the ‘Arznei-Telegramm, which is entirely independent, non-pharmaceutical journal. It takes a critical look at new medications, sometimes quite scathingly. If a neutral journal like that were to deal with DiGAs, I would find that very helpful. If someone who knows their way around studies and practical experiences could summarize the findings in a compact and structured way, especially tailored for primary care, that would be particularly helpful.” ( GP10, male ). 4.6 Clinical knowledge platforms Digital medical education platforms (learning software, electronic reference work) that offer evidence-based content such as CME courses for physicians, including “Amboss” for various medical professions and “Deximed” for general practice, which were considered as reliable and familiar sources of information. These platforms offer guideline-based information without advertisements but are usually not free of costs (subscription pay model). 4.7 Patients in their practice GPs considered their own patients as a meaningful and trustworthy source of information. When patients actively engage with a DiGA and approach their GP with materials such as flyers, this was considered as a possible contribution to GPs’ process for information acquisition. “When a patient approaches me and says something like ‘I found this DiGA and it might be suitable for me. Take a look’, while handling me a flyer, that draws my attention.” ( GP12, male ). 4.8 Peer networks and collegial exchange Colleagues represented an important source of information. Physicians expressed a need for exchange within quality circles or informal expert discussions. They also highlighted the value of interdisciplinary dialogue, for example with psychotherapists or psychiatrists. “I’ve been moderating quality circles for many years. There’s always collegial exchange in that context. We also discuss case studies. I could imagine doing that for DiGAs as well. Those are useful forums for sharing experiences. In addition, more extensive reports or expert assessments from psychiatrists, psychosomatic specialists, or psychotherapists would be desirable.” ( GP10, male ). Perspectives regarding information content (RQ 5: What type of content do GPs consider most relevant when learning about DiGAs?) 5.1 Evidence base A central concern regarding the content of information needed was the transparent presentation of scientific evidence. GPs expressed a need for controlled studies demonstrating the effectiveness of DiGAs compared to standard treatments or non-DiGA-based interventions. Ideally, such studies should be based on adequate sample size and methodological sound design, such as including comparisons with first-line treatments. “In the best case, studies that have shown effectiveness compared to standard treatments or non-DiGA-based digital interventions, based on a controlled study with a sufficient number of participants, would be optimal.” ( GP11, female ). Interestingly, GPs assumed that – unlike efficacy or effectiveness – data security as another criterion for the approval of DiGA was given due to the involvement of the BfArM. 5.2 Indications and contraindications Analogous to conventional drug information, participants emphasized the need for a clear and concise presentation of indications and potential contraindications for DiGAs. “Let me draw a parallel to medication prescriptions. For each drug, there is professional information covering its use. We don’t necessarily need dosing information here, but we do need to know exactly which indication is being addressed.” ( GP10, male ). 5.3 Structure, design and usability of DiGAs GPs indicated a need for information on the structure, usability, and design of the DiGA. Particular emphasis was placed on user-friendliness and accessibility for older or less tech-savvy patients. “The point is that we get to see what such an app actually looks like, just the interface and a brief description of the workflow. Is it complicated, or not? Is it understandable? Especially for older patients, which we often see. Or is it so complicated that only tech-savvy young people could figure it out?” ( GP07, male ). 5.4 Language availability Another relevant aspect concerned the availability of DiGAs in multiple languages, such as Englisch, Turkish, or Ukrainian. The participating GPs highlighted the importance of this criterion for the care of patients with deficits in the German language and multilingual patient groups for the optimal use of DiGAs. 5.5 User and peer feedback Authentic user experiences were also considered highly valuable. GPs reported an interest in obtaining authentic feedback and firsthand experiences from both patients and colleagues regarding the usability and perceived effectiveness of specific DiGA. “For instance, I would like to know how many people actually use this app and what kind of feedback it receives from patients. Such as how many stars it gets and whether it is considered helpful. If an app scores only 2 out of 10, I wouldn’t prescribe it.” ( GP09, male ). 5.6 Cost information Information regarding the costs associated with DiGA prescriptions was also identified as a relevant information need. GPs emphasized the importance of transparent information about the price of each DiGA, both for their own practice context and for patients. They expressed a need for clear cost breakdowns. “I want to know how much it costs to prescribe a DiGA once. Most of them run for one quarter, and ideally, I would like to have a table that shows: this DiGA costs this much, this amount of time is required, this is the benefit, and whether it affects the budget – not just the collective healthcare system, but also my own budget.” ( GP11, female ). The possibility of economically prescribing was considered essential, particularly given the wide range of DiGA prices and the responsibility to use healthcare resources efficiently. Furthermore, GPs highlighted the need to know whether prescribing a DiGA would affect their practice budget or lead to potential financial liabilities, such as regress claims. In this context, they also called for better integration of cost information into practice management software, similar to how prices of conventional medications are displayed. Perspectives regarding delivery modes (RQ 6: Through which delivery modes do GPs want to receive information about DiGAs?) GPs expressed diverse perspectives regarding how they would like to receive information about DiGAs highlighting the need for both flexible and content-rich offerings. Various formats and access channels were mentioned, ranging from digital to in-person options. 6.1 Online formats Virtual formats, such as online information sessions or webinars, were frequently appreciated for their time-efficiency and geographical flexibility. Several GPs expressed a preference for hybrid models that permit attendance in either an online or in-person capacity. In addition, participants expressed a need for easily accessible digital channels, such as newsletters and a daily updated online news feed available via smartphone. "Ideally, I’d like an online news channel that you can access on your phone." ( GP07, male ). 6.2 In-person formats In contrast, others explicitly favored in-person formats, particularly for engaging with new topics such as DiGAs. In this context, participants also mentioned multimedia presentations (e.g., lectures with visual elements such as short videos or app screenshots) as helpful for understanding the structure and functions of DiGAs. Interactive settings, such as workshops or quality circles, were valued for enabling in-depth discussion, collegial exchange and peer learning. 6.3 Print formats Participants indicated a need for text-based information, highlighting the efficiency and ease of processing of written materials. Flyers and concise texts were considered as particularly effective, as they allow for rapid acquisition of information. Printed literature such as books and journals is especially prized among GPs due to its ability to enhance information access. These materials allow GPs to highlight and annotate content, facilitating ease of retrieval and reuse when necessary. “I still prefer non-digital media because I can flip through them multiple times and make annotations. I favor journals and textbooks. However, books tend to me more static and are updated infrequently, so journals are ultimately the more suitable source.” (GP10, male). However, traditional print media, especially journals strongly dominated by advertising, were criticized for being distracting and for diminishing trust in the content. Perspectives regarding time investment (RQ 7: How much time are GPs willing to invest in learning about DiGAs?) The participating GPs expressed varying expectations regarding the amount of time they would be willing to invest in training on DiGAs. Overall, there was a need for time-efficient formats, although the acceptable time investment varied greatly depending on the perceived benefit and the training format. Generally, GPs referred to their very limited time available for each patient, which makes it highly important to establish immediate access to up-to-date information in everyday clinical work (e.g., in the practice software, as with pharmaceutical prescriptions) and stated that they would invest from five to 30 minutes. Nonetheless, as GPs felt not well informed about DiGAs overall, they also indicated a readiness to invest more than one hour in a first in-depth information acquisition. Greater time investment was seen as justified when the practical benefit in everyday professional life was clearly recognizable. "If it’s practical training that genuinely supports my daily work, I would gladly invest three or four hours. But if it's only an overview and not directly relevant to practice, then just one hour would suffice." ( GP11, female ). 8 Additional topics Beyond the main themes, several general barriers emerged that appeared to influence the adoption of DiGAs. First, GPs reported experiencing an overwhelming volume of information in their daily routines, which can make it difficult to identify and evaluate new digital tools. Second, the rapid and constant flow of medical innovations led to a perception that DiGAs do not represent immediate priority. Moreover, participants noted the lack of technical integration of DiGAs into existing practice software, which was seen as a further obstacle to their practical implementation. In this context, participants reported a need for information on the prescription process, such as how to issue prescriptions or how to integrate DiGAs into practice software. In addition, participants discussed possible incentives to support DiGAs adoption in practice. Several GPs suggested that participation in DiGA-related training sessions should be rewarded with CME credits. Others emphasized the need for financial compensation for the additional effort associated with patient education and prescription. Some participants explicitly demanded that DiGA prescriptions be handled outside of regular practice budgets to prevent financial disadvantages. Discussion This study examined GPs’ perspectives on information needs related to DiGAs for mental health, addressing their perceived level of knowledge, attitudes toward digitalization, and requirements for effective information provision. A particular focus was placed on trusted sources, relevant content, and suitable delivery formats. Interestingly, 12 out of 13 participating GPs reported having prescribed DiGAs at least once for mental or somatic diseases. This proportion is notably higher than the overall adoption rates reported in previous studies ( 20 ). Despite this comparatively high prescribing behavior, many participants demonstrated limited familiarity with core aspects such as the evidence base, appropriate indications, and costs. GPs demonstrated a range of attitudes toward digitalization, reflecting both openness and skepticism concerning DiGAs and the use of AI in medical practice. The advantages of DiGAs, including their availability, flexibility, the ability to bridge waiting times for psychotherapy, and support for care during workforce shortages, were acknowledged. At the same time, GPs emphasized the continued importance of personal and face-to-face care for maintaining the therapeutic relationship. A similarly ambivalent stance was observed toward the use of AI. While its potential in medical practice was recognized, GPs also expressed reservations toward novel technological innovations. Notably, prescribing behavior did not always stem from strong personal conviction. In several cases, DiGAs were prescribed in response to patient requests rather than as part of an active therapeutic decision. While previous studies have emphasized the importance of knowledge in fostering prescribing intentions ( 19 ), the present findings suggest that, despite limited knowledge and ambivalent attitudes, actual prescribing may still occur. This suggests a complex interplay between internal readiness and external influences, such as patient-driven demand, which may play a critical role in adoption of DiGAs. The discrepancy between actual use, level of knowledge, and personal attitudes underscores the need for more targeted, accessible, and practice-oriented informational resources to support evidence-based decision-making in everyday care. In this context, the present findings highlight the importance of identifying concrete information strategies tailored to the needs of GPs. The qualitative interviews revealed a range of needs regarding information sources, content, and delivery modes. Information sources There was a clear need among GPs to obtain information on DiGAs from authoritative, independent, and centrally positioned institutions within the healthcare system. In particular, central institutions such as the BMG, BfArM, and the IQWiG were perceived as trustworthy sources. In line with previous findings, public institutional sources such as government-run information services are generally perceived as trustworthy by healthcare professionals ( 43 ). These findings underline the importance of integrating reliable, government-endorsed information regarding DiGAs into widely utilized clinical knowledge platforms, while also emphasizing the need to increase awareness and utilization of existing resources like the DiGA directory. Regional medical associations and statutory health insurance physicians’ associations were also named as relevant actors for communicating reliable and up-to-date information. These sources were regarded as independent of commercial interests, thereby enhancing their credibility. Given the importance of ensuring that GPs remain well-informed about emerging DTx, it is essential for these associations to engage more extensively with the topic of DiGAs. A stronger focus on DiGAs within the activities of these institutions could contribute to better equipping healthcare professionals to integrate such technologies into their clinical practice effectively. GPs further expressed a need for clear (mandatory) guidelines on how to handle DiGAs, such as those issued by the Association of the Scientific Medical Societies in Germany. These guidelines serve as a legal framework for clinical decision-making. Guidelines from professional associations are among the most frequently used sources of information ( 35 , 44 ). Similarly, previous research indicates that German cardiologists regularly consult clinical guidelines for patient-specific decisions ( 45 ). This underscores the broader relevance of authoritative guidance across specialties. In the context of dMHI, the S3 guideline for unipolar depression lists such tools as treatment options. However, DiGAs are not explicitly mentioned, despite constituting a specific subset of dMHI that are CE-certified and included in the official BfArM registry. This may contribute to the impression that DiGAs are currently not perceived as part of the routine primary care toolkit, particularly in the field of mental health, which some GPs viewed as outside their scope of responsibility. Additionally, statutory health insurances and DiGA manufacturers were mentioned as relevant sources of information. Similar to the findings in a sample of German rheumatologists ( 46 ), GPs held divided opinions regarding their perceived neutrality. While some expressed skepticism, others articulated a need for increased collaboration with these actors and emphasized the role of independent sources of information. Given the conflicting attitudes towards these sources, and in line with previous findings, it appears that these institutions may not be the most suitable primary sources for reliable DiGA-related information. This highlights the need for alternative, more trusted channels to ensure that GPs receive unbiased and credible information. The present findings indicate that GPs value independent medical journals as a reliable and familiar source of information on DiGAs. In particular, journals such as the “Arznei-Telegramm” were appreciated for their critical stance and lack of commercial bias. This underscores the relevance of independent editorial review and transparency in the evaluation of DTx. While clinical guidelines and governmental platforms offer structured information, journals may play an important role by providing independent commentary, critical appraisal of evidence, and practical implications tailored to general practice. Previous research has shown that journal articles are among the most frequently used sources of information by physicians ( 35 ). Integrating DiGA-related content into such established publications could therefore enhance credibility and promote informed decision-making in clinical practice. Furthermore, GPs expressed a need for information on DiGAs from clinical knowledge platforms. “Amboss” and “Deximed” were mentioned explicitly, with their structured and regularly updated content being particularly valued. These findings suggest that such platforms are perceived as reliable and accessible sources for obtaining clinically relevant information on DiGAs. Authentic and real-life experiences shared by colleagues and patients were deemed crucial. Reviews support the relevance of peers and experts as important information sources for GPs ( 35 , 47 ). The interest for interdisciplinary collaboration with other medical disciplines has also been previously reported ( 47 ). Due to limited time resources, GPs often feel they lack the capacity to stay current with all relevant medical topics ( 22 ). Peer exchange, particularly with colleagues encountered in daily professional routines, may serve as a valuable resource to remain informed about medical innovations. Therefore, it is important that exchange groups focused on internal medicine also allocate space to digital health interventions. In a qualitative study, 57% of insurance physicians stated they expected institutional support for implementing dMHI ( 28 ). However, most GPs in Germany are self-employed (i.e., n = 108.200 versus employed: n = 60.100 ( 48 )) and do not receive organizational support from higher institutions. For this reason, it is particularly important that self-employed GPs can rely on collegial support within their limited time constraints. Information content Regarding information content related to DiGAs, GPs reported a broad range of topics. In addition to evidence-based data on effectiveness, clearly structured and easily accessible information on indications and contraindications were mentioned as highly relevant in daily practice. Patient-centered information was also viewed as important. For example, content explaining the appropriate indications, structure and usability of DiGAs, helping physicians assess whether these applications are suitable to recommend. Information on the availability of DiGAs in multiple languages was also emphasized. In line with this, Posselt et al. ( 23 ) found that GPs emphasized the importance of reaching patients in their native language. They argued that this would improve the understanding and accessibility of DiGA services, particularly for non-German-speaking individuals. Notably, the need for authentic, real-life experience reports from colleagues and patients was not only reflected in the identified sources but also in the content itself. Previous studies have shown that perceived effectiveness and efficiency are the most important factors for the use of DTx among healthcare professionals ( 28 , 49 , 50 ). This may explain why GPs value both empirical evidence and experience-based accounts of effectiveness. Consistent with findings by Schroeder et al. ( 21 ), who surveyed physicians across medical specialties in Germany, GPs in our sample highlighted a need for more detailed information on the financial aspects of prescribing DiGAs, including patient-related costs and potential consequences for their own practice. Given that nearly all participants (12 out of 13) have already prescribed DiGAs, this suggests that existing information sources (such as the DiGA directory) may not yet be widely consulted or integrated into everyday practice. Delivery modes of information Given their limited time resources, GPs emphasized the need for fast and flexible delivery modes, including online formats and print materials. Notably, participants still placed a high value on traditional text-based formats, such as flyers, (scientific) journals, and books. One reason cited pertains to the capacity to add notes to printed texts, which was perceived as conducive to personal processing. Earlier studies confirm the relevance of such media for GPs, showing that journal articles are seen as current and reliable, while textbooks (even when partially outdated) are still considered trustworthy, relevant, and accessible (see review by Daei et al. ( 35 )). Additionally, interview responses indicated a need for quick and straightforward access to DiGA-related information via digital tools such as messaging services or chatbots. Nevertheless, GPs were also open to attending in-person events related to DiGAs such as lectures and workshops, if a clear benefit was perceived. In particular, workshops were valued for their interactive nature and the opportunity for collegial exchange. Previous studies confirm physicians’ interest in medical conferences and CME events focusing on pharmaceutical updates ( 51 ). Figure 2 illustrates an overview of the GPs multifactorial needs for information strategies about DiGAs. Notes . Abbreviations: DiGA = Digital health application (German „Digitale Gesundheitsanwendung“). Illustration of GPs’ information needs regarding digital health applications (DiGAs) with the four central components: ( 1 ) information sources, ( 2 ) information content, ( 3 ) information media ( 4 ) information channels. Additional factors The inclination toward efficiency was further reflected by the time participants were willing to allocate to information acquisition, which ranged from five minutes to several hours, contingent on the format and content. This illustrates that there is no one-size-fits-all approach for information strategies for GPs, as they depend on motivation (including perceived usefulness), prior experience or knowledge level, as well as structural factors, including limited time, and IT infrastructure. Accordingly, information strategies should take into account the limited time resources of GPs in primary care and provide information in formats that can be flexibly accessed over different time spans, enabling GPs to engage with the content according to their schedules. During several interviews, it became evident that acquiring information regarding DiGAs was not a priority for some GPs. These GPs indicated that other medical topics were deemed more pressing in their daily practice and mentioned information overload as a barrier. In light of the rapidly evolving medical information landscape ( 25 , 26 ) and the varied responses of GPs to the integration of AI in healthcare, the early integration of digital innovations into medical education may help address such barriers. Despite the incorporation of DiGAs into the German healthcare system five years prior, they remain predominantly taught as elective subjects within the domain of medical education ( 52 , 53 ). This is indicative of the gradual and delayed adaptation of medical curricula to digital innovations in Germany. A recent meta-analysis found that training interventions for healthcare professionals can enhance knowledge and self-efficacy, and increase the frequency of DTx prescriptions ( 54 ). In accordance with previous and present findings, a robust knowledge base concerning DiGAs has the potential to augment physicians' willingness to prescribe them and to enhance their acceptance ( 19 ). To ensure the successful integration of novel medical approaches, it is essential to incorporate them at the early stages of medical training. This is not only applicable to DiGAs but also to subjects such as AI in medical practice. Furthermore, since older patients tend to consult their GPs more frequently than younger ones ( 55 ) and are at the same time often perceived as less likely to benefit from DiGAs ( 21 ) due to presumed difficulties with digital technologies, GPs may be less inclined to consider these tools for older age patient group. Finally, several participants emphasized that appropriate incentives, such as financial compensation or CME credits for training, could play a crucial role in fostering motivation to engage with DiGAs and to invest the additional effort required for their implementation. Strengths, limitations, and implications This study provides valuable insights into the information needs and preferences of GPs regarding DiGAs in the context of digital Mental Health. The mean age of participants (49 years) is close to the national average for German GPs in 2024 (54.1 years), suggesting a reasonable variation in demographic characteristics ( 27 ). Furthermore, most participants had previously prescribed DiGAs, which likely contributed to the depth and specificity of the data collected. Their experience allowed for informed reflections on barriers and facilitators in real-world practice. The heterogeneity of the needs identified in the interviews, in terms of content, source, and format of DiGA-related information, suggests that a future Discrete Choice Experiment (DCE), preceded by pretests to validate and refine the identified attributes and response options ( 56 ), could be used to systematically structure these characteristics and assess their relevance from GPs' perspective. This, in turn, could inform the development of more targeted information strategies for GPs. Nevertheless, several limitations must be considered when interpreting the findings. Although the sample was approximately representative in terms of age, potential age-related bias cannot be ruled out, as older GPs may hold more critical views on digital applications ( 28 ). The high proportion of participants with prior DiGA experience (12 out of 13) may reflect a self-selection bias toward GPs with a particular interest in digital health, potentially limiting transferability to less engaged or more skeptical GPs. Additionally, the overrepresentation of participants from North Rhine-Westphalia, resulting from the IfAM mailing list, may have introduced regional influences, which should be considered. Future research should address these limitations by including a more diverse sample exploring possible differences by experience with DiGA prescription, region, and gender. In particular, it would be valuable to investigate the specific barriers faced by physicians who have not yet prescribed DiGAs, including perceived limitations in their knowledge, resources, or concerns about patient acceptance. Understanding these barriers could provide a deeper insight into the reasons behind low prescription rates and inform strategies aimed at increasing adoption. Further, future research should focus on identifying the most effective information formats and communication strategies for educating physicians about DiGAs. Experimental methods, such as randomized controlled trials or A/B testing, could be employed to identify the most effective strategies for conveying prescription procedures, costs, and evidence of efficacy. Identifying optimal ways to present this information could help improve the implementation process. From an implementation standpoint, considering the expressed interest in DiGA development ( 46 ) and the perceived knowledge gap ( 22 ), it is crucial that educational institutions adapt their curricula early to promote innovation-friendly integration of digital technologies within Germany’s healthcare system ( 53 ). Incorporating DiGAs into medical curricula would allow students to become familiar with these technologies during their training, ensuring they are better equipped to apply them in clinical practice. In this context, future studies should examine physicians who have been exposed to DiGA content during their training to determine whether early exposure to these topics influences their willingness and frequency of prescribing DiGAs. Additionally, examining differences in perspectives between GPs and specialists could provide valuable insights for designing targeted educational materials tailored to the needs of different healthcare providers. Finally, future research should systematically investigate physicians’ attitudes and acceptance of AI, exploring both the individual (provider-patient) and structural (infrastructure) factors that may facilitate or inhibit digital integration. This will inform the development of more targeted strategies for supporting healthcare professionals in adopting and implementing digital health solutions effectively. Conclusions The digital transformation of healthcare poses significant challenges for medical practices amid continuous change. To adequately prepare physicians across different levels of digital maturity, promoting digital competencies and providing tailored information must become integral components of CME. Consequently, it is the medical professions’ responsibility to develop digital health training that is forward-looking and responsive to the specific needs and challenges faced by physicians prescribing DiGAs. Declarations Ethics approval and consent to participate The study was approved by the Ethics Committee of the Medical Faculty of Heinrich Heine University Düsseldorf (approval number: 2023–2338, approval date: 06.03.2023) and was conducted in accordance with the principles of the Declaration of Helsinki. All participants provided written informed consent prior to participation. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Funding This formative qualitative study, conducted as part of a mixed-methods research project, was funded by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation; project no. 528399867). Author Contribution FS: Writing – original draft, Conceptualization, Methodology, Data curation, Formal analysis, Investigation, Visualization; KP: Writing – review & editing, Conceptualization, Methodology, Data curation, Formal analysis, Investigation; CS: Writing – review & editing, Data curation, Formal analysis, Investigation; NKS: Writing – review & editing; Funding acquisition, Resources, Project administration, Supervision; MV: , Writing – review & editing; Methodology; MZ: Writing – review & editing, Methodology; LG: Writing – review & editing, Formal analysis; JB: Writing – review & editing; AL: Writing – review & editing, Conceptualization, Methodology; CP: Writing – review & editing, Conceptualization; JAH: Writing – review & editing. Funding acquisition, Conceptualization, Methodology, Project administration, Resources, Supervision, Validation. All authors contributed to the manuscript and approved the submitted version. Acknowledgement The authors thank the DFG for supporting this formative qualitative study within the broader mixed-methods project “Needs and preferences regarding information strategies on digital Mental Health interventions among health professionals” (grant number: 528399867). We also thank the Institute of Occupational, Social and Environmental Medicine (IfAM, Heinrich Heine University Düsseldorf; Dr. Wilm and Dr. Dr. Franken) for their support in participant recruitment.The publication fees were covered by the Open Access Fund of the Heinrich Heine University Düsseldorf, supported by the University Library and the Medical Faculty.We further thank Yasemin Sahan-Indeck for her valuable support in refining the language and wording of the manuscript and Jennifer Alissa Müller for help with the formality check of the paper.The authors also sincerely thank all participants for their time and valuable contributions to this research. 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Panitz K, Schroeren C, Sahan F, Kairies-Schwarz N, Guthardt L, Bau JT et al. Perspectives on digital therapeutic prescribing: A qualitative study among German psychological psychotherapists. 2025. Cisco Systems Inc. Webex. San Jose, California, USA; 2024. VERBI Software. MAXQDA 2024 [Internet]. Berlin, Germany: VERBI Software. 2024. Available from: https://www.maxqda.com Kuckartz U, Rädiker S. Qualitative Content Analysis: Methods, Practice and Software. Second Edition. SAGE Publications Ltd.; 2023. Statistisches Bundesamt. Bevölkerung nach Nationalität und Bundesländern [Internet]. 2023 Dec. Available from: https://www.destatis.de/DE/Themen/Gesellschaft-Umwelt/Bevoelkerung/Bevoelkerungsstand/Tabellen/bevoelkerung-nichtdeutsch-laender.html Bundesministerium für Gesundheit. Unser Gesundheitssystem [Internet]. 2025 [cited 2025 Jul 15]. Available from: https://www.bundesgesundheitsministerium.de/fileadmin/Dateien/5_Publikationen/Ministerium/Flyer_Poster_Etc/BMG_Infografik_Gesundheitssystem_bf.pdf Kostagiolas P, Korfiatis N, Kourouthanasis P, Alexias G. Work-related factors influencing doctors search behaviors and trust toward medical information resources. Int J Inf Manag. 2014;34(2):80–8. Videbæk Le J. Implementation of evidence-based knowledge in general practice [Internet]. [Denmark]: University of Southern Denmark; 2017. Available from: https://content.ugeskriftet.dk/sites/default/files/scientific_article_files/2018-08/b5405.pdf Arnold C, Hennrich P, Wensing M, Ullrich C. Keeping up with evidence-based recommendations – a qualitative interview study with general practitioners in Germany on information-seeking behaviour in cardiovascular care. BMC Prim Care [Internet]. 2023 May 25 [cited 2025 Jul 18];24(1). Available from: https://bmcfampract.biomedcentral.com/articles/ 10.1186/s12875-023-02069-7 Richter JG, Chehab G, Stachwitz P, Hagen J, Larsen D, Knitza J, et al. One year of digital health applications (DiGA) in Germany – Rheumatologists’ perspectives. Front Med. 2022;9:1000668. Van Der Keylen P, Tomandl J, Wollmann K, Möhler R, Sofroniou M, Maun A, et al. The Online Health Information Needs of Family Physicians: Systematic Review of Qualitative and Quantitative Studies. J Med Internet Res. 2020;22(12):e18816. Bundesärztekammer Bundesärztekammer. 2023 Dec. Available from: https://www.bundesaerztekammer.de/fileadmin/user_upload/BAEK/Ueber_uns/Statistik/AErztestatistik_2023_Update_Juni_2024.pdf Feijt MA, De Kort YA, Bongers IM, IJsselsteijn WA. Perceived Drivers and Barriers to the Adoption of eMental Health by Psychologists: The Construction of the Levels of Adoption of eMental Health Model. J Med Internet Res. 2018;20(4):e153. Han KJ, Subramanian R, Cameron GT. Listen before you leap: Sri Lankan health professionals’ perspectives on m-health. Health Inf J. 2019;25(3):858–66. Zielińska M, Hermanowski T. Sources of Information on Medicinal Products Among Physicians – A Survey Conducted Among Primary Care Physicians in Poland. Front Pharmacol. 2022;12:801845. Aulenkamp J, Mikuteit M, Löffler T, Schmidt J. Overview of digital health teaching courses in medical education in Germany in 2020. GMS Journal for Medical Education; 38(4):Doc80 [Internet]. 2021 Apr 15 [cited 2025 Jul 21]; Available from: https://www.egms.de/en/journals/zma/2021-38/zma001476.shtml Sahan F, Guthardt L, Panitz K, Siegel-Kianer A, Eichhof I, Schmitt BD, et al. Enhancing Digital Health Awareness and mHealth Competencies in Medical Education: Proof-of-Concept Study and Summative Process Evaluation of a Quality Improvement Project. JMIR Med Educ. 2024;10:e59454. Alkhaldi O, McMillan B, Maddah N, Ainsworth J. Interventions Aimed at Enhancing Health Care Providers’ Behavior Toward the Prescription of Mobile Health Apps: Systematic Review. JMIR Mhealth Uhealth. 2023;11:e43561. Kassenärztliche Bundesvereinigung. Versichertenbefragung der Kassenärztlichen Bundesvereinigung 2019 [Internet]. Mannheim, Deutschland. 2019 Jul [cited 2025 Jun 26]. Available from: https://www.kbv.de/media/sp/Berichtband_Ergebnisse_der_Versichertenbefragung_2019.pdf Campoamor NB, Guerrini CJ, Brooks WB, Bridges JFP, Crossnohere NL. Pretesting Discrete-Choice Experiments: A Guide for Researchers. Patient. 2024;17(2):109–20. Additional Declarations No competing interests reported. Supplementary Files SupplementaryTable14.docx Cite Share Download PDF Status: Published Journal Publication published 09 Dec, 2025 Read the published version in BMC Primary Care → Version 1 posted Editorial decision: Revision requested 01 Oct, 2025 Reviews received at journal 24 Sep, 2025 Reviews received at journal 18 Sep, 2025 Reviewers agreed at journal 10 Sep, 2025 Reviewers agreed at journal 10 Sep, 2025 Reviews received at journal 09 Sep, 2025 Reviewers agreed at journal 08 Sep, 2025 Reviewers agreed at journal 20 Aug, 2025 Reviewers invited by journal 18 Aug, 2025 Editor assigned by journal 08 Aug, 2025 Submission checks completed at journal 08 Aug, 2025 First submitted to journal 08 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7289079","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":503073008,"identity":"134b63e2-fa7f-4f9c-91e3-d93b54b18c22","order_by":0,"name":"Fatma Sahan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA30lEQVRIiWNgGAWjYBAC+wNgqo7BgIGB8TFjA5B9gIAWAwZmEHUYpIXZmBQtB0Ba2KSJ08J+/uiGHwwH5M3Zzx6rLtxxmIHveAN+LfY8yWw3exjqDHf25KXdnnnmMIPkGQLWGDAks93gYWBm3HAgx+w2bxvQUzcSCGjhf8x28w8Ds/2G82/MisFa7j8goEUime020JbEDTdyzJghtuDXAdTy2Oy2jMHh5A033hhL87al80ieIeiwxGc331TU2W44n2P4mbfNWo7v+AEC1kA0Ipg8xKgfBaNgFIyCUUAAAABvlkatSRKVwgAAAABJRU5ErkJggg==","orcid":"","institution":"Heinrich Heine University Düsseldorf and University Hospital Düsseldorf","correspondingAuthor":true,"prefix":"","firstName":"Fatma","middleName":"","lastName":"Sahan","suffix":""},{"id":503073009,"identity":"8a1e621f-c660-40c7-b2ff-8921a3d5ba11","order_by":1,"name":"Karin Panitz","email":"","orcid":"","institution":"Heinrich Heine University Düsseldorf and University Hospital Düsseldorf","correspondingAuthor":false,"prefix":"","firstName":"Karin","middleName":"","lastName":"Panitz","suffix":""},{"id":503073010,"identity":"f1f89705-f1dd-475b-adce-fd83e08ab60b","order_by":2,"name":"Charlotte Schoeren","email":"","orcid":"","institution":"Heinrich Heine University Düsseldorf and University Hospital Düsseldorf","correspondingAuthor":false,"prefix":"","firstName":"Charlotte","middleName":"","lastName":"Schoeren","suffix":""},{"id":503073011,"identity":"fabc70d0-b7e6-4226-acdd-6d569e476bef","order_by":3,"name":"Nadja Kairies-Schwarz","email":"","orcid":"","institution":"Heinrich Heine University Düsseldorf and University Hospital Düsseldorf","correspondingAuthor":false,"prefix":"","firstName":"Nadja","middleName":"","lastName":"Kairies-Schwarz","suffix":""},{"id":503073012,"identity":"438cfa83-cf69-45ca-aa47-99c7279e6ab1","order_by":4,"name":"Markus Vomhof","email":"","orcid":"","institution":"Heinrich Heine University Düsseldorf and University Hospital Düsseldorf","correspondingAuthor":false,"prefix":"","firstName":"Markus","middleName":"","lastName":"Vomhof","suffix":""},{"id":503073014,"identity":"f6bfdee5-17a7-4ac3-b614-2886abc770f9","order_by":5,"name":"Maximilian Zinn","email":"","orcid":"","institution":"Heinrich Heine University Düsseldorf and University Hospital Düsseldorf","correspondingAuthor":false,"prefix":"","firstName":"Maximilian","middleName":"","lastName":"Zinn","suffix":""},{"id":503073015,"identity":"8fff4cdc-8085-4518-b1c0-9c775ae77a22","order_by":6,"name":"Lisa Guthardt","email":"","orcid":"","institution":"Heinrich Heine University Düsseldorf and University Hospital Düsseldorf","correspondingAuthor":false,"prefix":"","firstName":"Lisa","middleName":"","lastName":"Guthardt","suffix":""},{"id":503073019,"identity":"4be05c20-f527-44a3-b498-542f655103ac","order_by":7,"name":"Jessica Bau","email":"","orcid":"","institution":"Heinrich Heine University Düsseldorf and University Hospital Düsseldorf","correspondingAuthor":false,"prefix":"","firstName":"Jessica","middleName":"","lastName":"Bau","suffix":""},{"id":503073020,"identity":"9842e992-bb9e-4f7b-9702-af872935c0eb","order_by":8,"name":"Adrian Loerbroks","email":"","orcid":"","institution":"Heinrich Heine University Düsseldorf and University Hospital Düsseldorf","correspondingAuthor":false,"prefix":"","firstName":"Adrian","middleName":"","lastName":"Loerbroks","suffix":""},{"id":503073021,"identity":"ff8e5a7c-149c-44b4-aa2d-350950ab94d7","order_by":9,"name":"Claudia R. Pischke","email":"","orcid":"","institution":"Heinrich Heine University Düsseldorf and University Hospital Düsseldorf","correspondingAuthor":false,"prefix":"","firstName":"Claudia","middleName":"R.","lastName":"Pischke","suffix":""},{"id":503073022,"identity":"bf936be8-41d5-402a-bd4e-d05f4d73155a","order_by":10,"name":"Jennifer Apolinário-Hagen","email":"","orcid":"","institution":"Heinrich Heine University Düsseldorf and University Hospital Düsseldorf","correspondingAuthor":false,"prefix":"","firstName":"Jennifer","middleName":"","lastName":"Apolinário-Hagen","suffix":""}],"badges":[],"createdAt":"2025-08-04 09:08:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7289079/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7289079/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12875-025-03115-2","type":"published","date":"2025-12-09T15:56:54+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":89984030,"identity":"ace6eed0-f8e2-4090-ae0c-0ecc69e975d4","added_by":"auto","created_at":"2025-08-27 06:35:36","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":258066,"visible":true,"origin":"","legend":"\u003cp\u003eAccess to digital health applications (DiGAs) in Germany via physician or psychotherapist prescription versus health insurance proposal.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7289079/v1/c212e451b7ca86388d24fd29.jpeg"},{"id":89985753,"identity":"878cde18-aa92-4512-9b0e-0a6c0bdeb91a","added_by":"auto","created_at":"2025-08-27 06:51:36","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":153804,"visible":true,"origin":"","legend":"\u003cp\u003eGeneral practitioners’ multifactorial needs for information strategies about digital health applications (DiGAs).\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7289079/v1/358ae13015381f7ed3766f1c.png"},{"id":98243461,"identity":"f966f552-1ae2-4193-9790-5bbc32192a3f","added_by":"auto","created_at":"2025-12-15 16:03:48","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1939273,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7289079/v1/b8f39d46-98fd-4094-aad1-9a441f88e40c.pdf"},{"id":89984033,"identity":"6efb93c9-440a-4eac-8113-ef9dce89a2c8","added_by":"auto","created_at":"2025-08-27 06:35:36","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":88054,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryTable14.docx","url":"https://assets-eu.researchsquare.com/files/rs-7289079/v1/a302e3c9eb5a8e4f418cd2f0.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Genie in the Bottle? A Qualitative Study of General Practitioners’ Perspectives and Information Needs Concerning Digital Mental Health Applications in Germany","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe prevalence of mental illnesses, including depression and anxiety disorders, burdens the healthcare systems worldwide and has increased significantly (\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Digital Mental Health Interventions (dMHI), including digital therapeutics (DTx) for mental disorders, have the potential to serve as a valuable resource for patients and the entire outpatient healthcare system. As gatekeepers in primary care, general practitioners (GPs) play a pivotal role in identifying suitable patients, initiating treatment pathways, and integrating DTx into routine care for individuals with mental health needs.\u003c/p\u003e\u003cp\u003eIn several European healthcare systems, the implementation of DTx has only recently been initiated or completed (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). In this context, Germany has taken a pioneering role with the digital health applications (Digitale Gesundheitsanwendungen, DiGAs), commonly referred to as \u0026ldquo;DTx on prescription\u0026rdquo;, supported by progressive regulatory frameworks and legislation (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). The legal basis for DiGAs was founded with the passing of the Digital Healthcare Act (Digitale-Versorgung-Gesetz, DVG) in December 2019, which led to the establishment of the DiGA directory by the Federal Institute for Drugs and Medical Devices (Bundesinstituf f\u0026uuml;r Arzneimittel und Medizinprodukte, BfArM), where applications can be listed either permanently or on a provisional basis pending evidence of benefit (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Since fall of 2020, DiGAs can be prescribed for adult patients with statutory health insurance in Germany, with costs reimbursed by the insurers. Although the initial restriction to adults has been lifted, DiGAs are not yet available for children and adolescents. In addition to prescription by physicians or psychotherapists, patients may also obtain access by requesting coverage from their statutory health insurance (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). An overview of the available access pathways to DiGAs is illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eNotes.\u003c/em\u003e Abbreviations: DiGAs\u0026thinsp;=\u0026thinsp;Digital health applications (German \u0026bdquo;Digitale Gesundheitsanwendungen\u0026ldquo;, i.e. prescription of digital therapeutics). This schematic illustrates the two official access pathways to a DiGA in Germany via medical prescription or via direct request to the statutory health insurance provider. In both cases the patient receives a time-limited activation code (usually valid for 90 days) and downloads the DiGA from an app store. A physician prescription is not mandatory as patients can also request access from their statutory health insurance particularly if they already have a documented indication or can self-report relevant symptoms. Since October 2024, physicians and psychotherapists in Germany are only allowed to prescribe DiGAs if their practice management software is certified by the National Association of Statutory Health Insurance Physicians.\u003c/p\u003e\u003cp\u003eDiGAs are software-based Conformit\u0026eacute; Europ\u0026eacute;enne (CE)-certified medical products approved for the detection, monitoring, treatment or alleviation of a broad range of diseases, including mental health conditions (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) and have increased their relevance in healthcare due to their potential to improve eHealth literacy, symptom management, and treatment adherence (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). For patients with mental health issues, primary care GPs often serve as the first point of contact or a compensatory resource. This role is especially important given the limited access to psychotherapy (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). DiGAs may support patient care by enhancing care quality and efficiency while reducing healthcare costs (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Especially in rural settings, they can improve access, reduce travel and waiting times, and promote convenience without compromising care quality (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eMeta-analyses have confirmed the effectiveness of both therapist- and self-guided dMHI based on cognitive behavioral therapy (CBT), particularly for conditions such as depression and anxiety disorders (\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). However, the uptake of DiGAs has not met the initial expectations. A survey conducted in 2021 by Dahlhausen et al. (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) revealed that less than 10% (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;103) of surveyed physicians and psychotherapists in Germany (\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1299) have ever prescribed any DiGA, and only around a third of them plan to prescribe one within the next year. Although DiGAs are increasingly recognized by internists for their potential to enhance patient care (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), actual use remains low. As of June 2023, only 12% of the approximately 185.000 physicians and psychotherapists participating in outpatient statutory care had issued a DiGA prescription to insured patients (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). These findings indicate that, while medical professionals acknowledge the promise of DiGAs, their propensity to prescribe it remains modest.\u003c/p\u003e\u003cp\u003eThe barriers to the prescription of DiGAs are multifactorial. Structural challenges such as time constraints, high workload, outdated IT infrastructure, and the resulting difficulties in integrating DiGAs into existing work processes are cited (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). In addition, uncertainties regarding specific DiGA related aspects, such as the prescription process, reimbursement regulations, and concerns about patient adherence point to a lack of information about DiGAs (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Studies have shown that medical professionals report insufficient knowledge about available DiGAs, expressing issues with finding reliable, easily accessible information in case of need (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). However, little is known about how information on DiGAs should be designed and delivered to meet the needs of GPs and encourage their practical use in primary care.\u003c/p\u003e\n\u003ch3\u003eThe role of information in GPs’ adoption of DiGAs\u003c/h3\u003e\n\u003cp\u003eResearch indicates that greater perceived knowledge about DiGAs is positively associated with the frequency of prescriptions (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Conversely, an insufficiency of information can engender a circumspect and dubious stance toward DiGA prescriptions (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Despite the increased accessibility of digital information resources in contemporary medicine, studies have demonstrated that physicians primarily rely on memory for information retention (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Given the continuous proliferation of medical knowledge, which is estimated to double every 20 years (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e), maintaining up-to-date knowledge in routine clinical practice can be difficult. Furthermore, the mean age of German GPs is 54.1 years (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). This demographic factor has implications for the utilization of digital information sources and suggests that the medical training of physicians may not be commensurate with current developments. In conjunction with the high average age of general practitioners and their stance on new technologies (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e), demographic shifts (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e), the deficit of GPs, particularly in rural regions (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e), and existing insufficiencies in the digital infrastructure of the healthcare system (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e), the likelihood that clinical questions to remain unsolved during routine care is increased (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). This can hinder evidence-based decision-making, compromise treatment outcomes (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e) and diminish GPs\u0026rsquo; readiness to prescribe DiGAs. In addition, physicians continue to favor traditional media such as journals, textbooks, guidelines, continuing medical education (CME), and conferences, as well as peer-to-peer exchange, in their search for information (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). Conversely, digital, evidence-based information resources are used less frequently (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). These preferred information channels of physicians are only suitable for communicating innovative treatments such as DiGAs to a limited extent. The underutilization of digital information sources complicates the ongoing engagement with the rapidly evolving range of offerings, thereby constraining the capacity for evidence-based evaluation of novel applications. The barriers, related to information, can contribute significantly to the fact that, despite their potential, DiGAs have so far only been prescribed hesitantly for patients with mental health issues.\u003c/p\u003e\n\u003ch3\u003eAim of the study\u003c/h3\u003e\n\u003cp\u003eConsidering the discrepancy between the current prescription rates, the perceived potential of DiGAs and the physicians\u0026rsquo; reported level of knowledge about DiGAs, the objective of this study is to explore the perspectives that GPs hold on DiGAs in the domain of digital Mental Health. A particular focus lies on their perspectives for information needs and preferred communication formats for accessing relevant content. The findings aim to enhance information dissemination and thereby foster the integration of digital applications into the healthcare system.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResearch Questions (RQ)\u003c/b\u003e:\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eHow do GPs perceive their current level of knowledge regarding DiGAs?\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eWhat are GPs' attitudes toward digitalization in medical practice, including the diffusion of DiGAs and Artificial Intelligence (AI) into primary care?\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eWhose initiative leads to the prescription of DiGAs in general practice?\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eWhich information sources do GPs consult when seeking information about DiGAs?\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eWhat type of content do GPs consider most relevant when learning about DiGAs?\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eThrough which delivery modes do GPs want to receive information about DiGAs?\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eHow much time are GPs willing to invest in learning about DiGAs?\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis qualitative study was conducted as part of a mixed-methods research project with different groups of health professionals (GPs, occupational physicians and psychotherapists) to shed light on the diverse perspective on underexplored information needs and preferences regarding DiGAs for mental disorders. Prior to data collection, the qualitative study was approved by the Ethics Committee of the Medical Faculty of Heinrich Heine University D\u0026uuml;sseldorf (HHU; study number: 2023\u0026ndash;2338, approval date: 06.03.2023). The reporting follows Consolidated Criteria for Reporting Qualitative Research (COREQ, see Supplementary Table\u0026nbsp;1; (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e)).\u003c/p\u003e\n\u003ch3\u003eResearch team\u003c/h3\u003e\n\u003cp\u003eThis qualitative study was conducted by an interdisciplinary research team. JAH (psychologist, postdoctoral qualification in health sciences) served as principal investigator (PI), in close with NKS (professor of behavioral health economics). Together with members of NKS\u0026rsquo; research group, MV and MZ (economists specialized in preference research in primary care), they supported the preparatory work for this study. FS, a doctoral candidate in Public Health with a background in experimental psychology and neuroscience, was primarily responsible for data analysis. She collaborated closely with the PIs and received analytical feedback from LG and JB, both doctoral candidates with expertise in qualitative methods. Interviews were conducted by KP and CS, both doctoral researchers in Public Health and Medicine. KP is also conducting a related sub-study on psychotherapists\u0026rsquo; DiGA information needs (37, submitted). FS, KP and CS received in-depth formal training in qualitative methods and analysis as part of their involvement in the project. AL, a health scientist with extensive quality research experience in mental health and stress, provided methodological guidance throughout the study. All team members contributed to the design, analysis, or interpretation in line with their disciplinary backgrounds in psychology (FS, KP, CP, JAH), medicine (CS), health economics (NKS, MV, MZ), public health (LG, JB, AL, CP), and occupational medicine (AL, JAH).\u003c/p\u003e\n\u003ch3\u003eSampling strategy\u003c/h3\u003e\n\u003cp\u003eA purposive sampling strategy was used to recruit GPs with specialist certification in internal or general medicine, practical experience in primary care, and authorization to prescribe DiGAs in Germany. Eligibility criteria further included written informed consent, active clinical practice in Germany, proficiency in German, and either statutory health insurance accreditation or employment at an institution authorized to prescribe DiGAs (such as outpatient clinics or hospitals).\u003c/p\u003e\u003cp\u003e Recruitment was conducted via multiple channels: social media platforms (e.g., Instagram and LinkedIn) using flyers and short informational videos; local academic and clinical networks of the Institute of General Practice (Institut f\u0026uuml;r Arbeitsmedizin; IfAM; Primary Care Research Practice Network (Haus\u0026auml;rztliches Forschungspraxennetzwerk, HAFO)) at HHU and its University Hospital, the mailing list of the Occupational Medicine Network of Ludwig Maximilian University Munich (ArbMedNet), and personal healthcare contacts of the research team.\u003c/p\u003e\u003cp\u003eTo increase the overall number of participants individuals with dual qualifications in internal and occupational medicine, as well as one resident in general medicine training, were also included. Recruitment continued until data and meaning saturation was achieved, indicating that no substantially new themes emerged during the final interviews.\u003c/p\u003e\n\u003ch3\u003eStudy design and procedure\u003c/h3\u003e\n\u003cp\u003eBefore participating, the recruited GPs received written study information, a consent form, and a short questionnaire capturing sociodemographic (e.g., age, gender, professional experience, federal state) and professional data (e.g., DiGA experience, employment type; see Supplementary Table\u0026nbsp;2).\u003c/p\u003e\u003cp\u003eThe study followed a qualitative research design using semi-structured interviews to explore GPs\u0026lsquo; information needs regarding DiGAs for mental health issues. The interview guide (see Supplementary Table\u0026nbsp;3) covered four thematic blocks: 1) perceived prior knowledge about DiGAs, 2) attitudes toward digitalization in medical practice, 3) experiences with DiGA use or prescription, 4) information needs regarding information sources, contents, and delivery modes when gathering information about DiGAs. The guide was developed grounded in empirical research and iteratively refined based on internal feedback. To ensure clarity and methodological quality, four pretest interviews were carried out: the first with a simulated participant to test technical and procedural elements, and three subsequent interviews with a former medical student, a junior physician, and a GP to evaluate clarity, interview structure, and overall understanding. Minor linguistic refinements were made based on this feedback. Interviews were conducted online from July 5 until August 16, 2024 using the general data protection regulations-compliant videoconferencing software Webex (California, USA (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e)), with access provided by the institution. Participants were informed of their option to decline the webcam usage. The interviewers introduced themselves as a psychologist (KP) and a medical graduate (CS) prior to the commencement of the interview, providing a concise explanation of their personal interest in dMHI. During the online interview, only the participant and the interviewer were present. The video was not recorded; rather, audio files were obtained using a voice recorder that was not connected to the internet. In total, 13 GPs were interviewed. Except for one participant who had a personal relationship with KP, no prior relationship existed between the researchers and the study participants. All participants received a reimbursement of \u0026euro;100 for completing the respective interview.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eData analysis\u003c/h2\u003e\u003cp\u003eThe transcription and qualitative content analysis of the interviews was conducted using MAXQDA 2024 software in the version 24.8.0 (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). The interviews were audio-recorded, pseudonymized, and transcribed verbatim using AI with manual control. This process was compliant with general data protection regulations. The transcriptions were subjected to a meticulous review process, during which they were revised and checked for accuracy by the respective interviewers.\u003c/p\u003e\u003cp\u003eThe qualitative content analysis followed the methodological approach of Kuckartz and R\u0026auml;diker (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). Initial coding of the transcripts was performed by FS using a category system whose main categories were developed deductively based on the interview guide. This system was subsequently refined through the inductive development of subcategories grounded in the interview material. Preliminary findings were reviewed with JAH, LG and JB. Based on their feedback, the category system was revised, and FS conducted a second coding phase of coding. During this phase, existing categories were further differentiated, and additional categories were introduced where needed to adequately capture the diversity of the content. The coding scheme continued to evolve through an iterative process, with deliberate sessions held to assess clarity, completeness, and parsimony. The final coding system, including anchor examples, is presented in Supplementary Table\u0026nbsp;4.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eSample characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 13 GPs participated in the study, with the interviews lasting between 33:40 minutes and 51:40 minutes. The age of the interviewees ranged from 27 to 66 years, with an average age of 49 years (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;48.92, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;14.63, median\u0026thinsp;=\u0026thinsp;54 years). The majority of the participants were male (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;10; 76.92%), worked in North Rhine-Westphalia (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;11; 84.62%), in an urban area (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;8; 61.54%), had a statutory health insurance license (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;9; 69.23%), and worked full-time (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;12; 92.31%). The mean professional experience was 20 years (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;20.08, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;12.55). Most of the GPs surveyed have already prescribed a DiGA (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;12; 92.31%).\u003c/p\u003e\n\u003cp\u003eRegarding the DiGAs prescribed, GPs most frequently reported applications targeting obesity (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;10), depression (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;9), sleep disorders (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3), anxiety disorders (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2), smoking cessation (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2), diabetes (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1), migraine (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1), panic attacks (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1) and tinnitus (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1). Explicitly named mental DiGAs were \u0026ldquo;Deprexis\u0026rdquo; (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3), \u0026ldquo;HelloBetter\u0026rdquo; (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1), and \u0026ldquo;Selfapy\u0026rdquo; (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1) for depression, \u0026ldquo;Novego\u0026rdquo; (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1) for anxiety disorders, and \u0026ldquo;Raucherhelden.de\u0026rdquo; (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1) for smoking cessation. In the somatic domain, GPs named DiGAs, such as \u0026ldquo;Oviva\u0026rdquo; (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3) and \u0026ldquo;Zanadio\u0026rdquo; (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3) for weight reduction, as well as \u0026ldquo;Somnio\u0026rdquo; (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3) for sleep disorders.\u003c/p\u003e\n\u003cp\u003eThe characteristics of GPs differed, for example, in terms of age, with male GPs (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;10) being older (median\u0026thinsp;=\u0026thinsp;54) than female GPs (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3, median\u0026thinsp;=\u0026thinsp;34 years). As illustrated in Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e, the descriptive data is presented according to gender.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDescriptive data according to gender.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal (\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;13)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMen (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eWomen (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eM (SD)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48.92 (14.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53.4 (13.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34.0 (2.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMedian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003eProfessional experience (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eM (SD)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20.08 (12.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.50 (12.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.67 (1.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMedian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003eWork area\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRural (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (38.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (30.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (66.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUrban (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (61.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (70.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (33.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003eHealth insurance license\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9 (69.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (80.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (33.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (30.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (20.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (66.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmployment type\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFull-time (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12 (92.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9 (90.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePart-time (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (7.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (10.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrescription of DiGAs in the past\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12 (92.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9 (90.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (7.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (10.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003e\u003cem\u003eNotes.\u003c/em\u003e Abbreviations: DiGAs\u0026thinsp;=\u0026thinsp;Digital health applications (Digitale Gesundheitsanwendungen, i.e. prescription of digital therapeutics). All male participants in this sample were general practitioners (GPs) practicing in North Rhine-Westphalia (NRW), the most populous federal state in Germany, with approximately 18 million inhabitants (\u003cspan class=\"CitationRef\"\u003e41\u003c/span\u003e). This regional concentration likely reflects the recruitment strategy via a local research institute and may introduce a regional sampling bias. It should also be noted that DiGAs can be prescribed not only by office-based physicians with a statutory health insurance license, but also by physicians working in institutional or outpatient settings without an accreditation.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003ch3\u003eQualitative main results\u003c/h3\u003e\n\u003cp\u003eEight main categories emerged from the qualitative data: perceived level of knowledge, attitudes toward digitalization in medical practice, initiation of DiGA prescriptions, perspectives regarding needed information sources, content, delivery modes, time investment related to DiGAs, and additional topics. Each of these categories was further divided into specific subcategories.\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrior knowledge about DiGAs (RQ 1: How do GPs perceive their current level of knowledge regarding DiGAs?)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003eTo assess the perceived need for information, GPs were asked to self-evaluate their level of knowledge of DiGAs. Some participants described their knowledge as limited, noting that DiGAs had not yet been implemented in their practice. Others stated a high level of knowledge, articulating detailed insights into the regulatory status, therapeutic orientation, and applicability of specific DiGAs.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;There are, of course, those very specifically, predominantly behavior therapy-oriented apps that do quite a lot themselves, interacting with the patients beyond psychoeducation. And this becomes relevant when patients are, firstly, familiar with the electronic devices required and can imagine using them. And when the app is at least on the official list of the Federal Institute for Drugs and Medical Devices. There are different stages of approval, and for me it\u0026rsquo;s important that they are permanently listed products\u0026rdquo;\u003c/em\u003e (\u003cem\u003eGP13, male\u003c/em\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAttitudes toward digitalization in medical practice (RQ2: What are GPs\u0026apos; attitudes toward digitalization in medical practice, including the diffusion of DiGA and AI into primary care?)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003eAn area of particular interest concerned attitudes toward digitalization in medical practice. In this context, participants were asked to evaluate their stance toward both DiGAs and the use of AI in healthcare. For both topics, participants classified their perception as positive, neutral/indecisive, or negative.\u003c/p\u003e\n\u003ch3\u003e2a Attitudes toward DiGAs\u003c/h3\u003e\n\u003cp\u003eGPs who perceived DiGAs positively emphasized their relevance for everyday clinical challenges. Participants noted the potential to improve access to psychological therapy, especially in underserved areas or for patients on waiting lists. DiGAs were also seen as a helpful tool for bridging the waiting period until a therapy slot becomes available. Furthermore, the 24/7 availability of the applications was considered beneficial, allowing patients to engage with the content flexibly and independently of practice hours. Another commonly stated benefit was the potential of DiGAs to alleviate workforce shortages in healthcare by supporting therapeutic processes when human resources are limited. There was a general openness among GPs toward prescribing DiGAs, especially for mental health-related indications.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;Especially in the field of mental health, I consider DiGAs very useful. Many patients need something urgently at that moment, but there simply isn\u0026rsquo;t the human or physical capacity to provide it. We general practitioners are also highly regulated and time-constrained in what we can offer. DiGAs are something patients can use independently of time constraints. That\u0026rsquo;s why I would say I\u0026rsquo;m fundamentally positive toward it.\u0026rdquo; (GP01, male).\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eRespondents with a neutral/indecisive stance acknowledged the potential of DiGAs but expressed a lack of enthusiasm for their implementation in their own practice. While they did not question the general value of digital applications, they tended to prioritize other areas of care or innovation. Some described their perspective as open but reserved, indicating that DiGAs might be useful in theory, yet not sufficiently compelling or relevant for their current clinical context.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026bdquo;In everyday practice, DiGAs have so far played only a minor role. I\u0026rsquo;m not quite sure why that is.\u0026ldquo;\u003c/em\u003e (\u003cem\u003eGP06, male\u003c/em\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eParticipants who expressed a negative attitude toward DiGAs raised concerns about the loss of human interaction, particularly the absence of direct contact between patients and healthcare professionals. They feared that replacing or supplementing therapy with digital tools could compromise the therapeutic relationship.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;What makes DiGA unattractive to me is the fact that it shifts everything to an impersonal, ultimately AI-based level, where personal exchange, direct communication, and the emotional dimension between people no longer take place.\u0026rdquo;\u003c/em\u003e (\u003cem\u003eGP07, male\u003c/em\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eIn addition, GPs criticized the administrative burden associated with prescribing DiGAs, describing it as too time-consuming relative to the perceived benefit. Another common concern was that older patients, who are often less familiar or comfortable with digital technologies, might struggle to use such applications effectively.\u003c/p\u003e\n\u003ch3\u003e2b Attitudes toward Artificial Intelligence (AI)\u003c/h3\u003e\n\u003cp\u003eSeveral participants expressed a favorable view of AI applications, particularly regarding their potential to reduce workload in diagnostics or administrative tasks.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;I am very much in favor of AI, particularly when it contributes to reducing workload. This includes diagnostic support, of course, but also administrative tasks such as billing. Any form of relief that does not require additional personnel would be highly appreciated.\u0026rdquo;\u003c/em\u003e (\u003cem\u003eGP11, female\u003c/em\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eSome interviewees also highlighted the potential of data-driven AI models to support medical decision-making, even though they had not yet used such tools themselves.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;I believe that especially in areas where AI is about comparing a large number of findings with a current patient case, it could be extremely helpful.\u0026rdquo;\u003c/em\u003e (\u003cem\u003eGP10, male\u003c/em\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eOthers expressed ambivalence toward AI. While there was some acceptance of technological progress, the current added value of AI in general practice was questioned.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;At the moment, I don\u0026rsquo;t see any advantage of AI, except maybe for radiology findings, standard findings.\u0026rdquo;\u003c/em\u003e (\u003cem\u003eGP04, male\u003c/em\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eIt was also noted that, given the existing structural challenges in the healthcare system, other issues are currently seen as more pressing.\u003c/p\u003e\n\u003cp\u003eSome participants voiced skepticism or expressed generally negative attitudes toward the use of AI in medicine, emphasizing ethical concerns and a fundamental unease with new technology.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;As I take a fundamentally critical stance toward AI and approach its development and use with a sense of caution, I do not believe that keeping medical staff informed about every latest innovation in this field should be a top priority.\u0026rdquo;\u003c/em\u003e (\u003cem\u003eGP07, male\u003c/em\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cspan\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInitiators of DiGA prescription (RQ 3: Whose initiative leads to the prescription of DiGAs in general practice?)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003eIt became evident that DiGA prescriptions were initiated in different ways, namely both through GP initiative and patient initiative. GP-driven prescriptions reflected a more proactive approach, particularly in the context of mental health care. In contrast, some GPs stated that prescriptions were often based on patient requests.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;Occasionally, I have patients, who explicitly request such applications. In those cases, I issue the prescription. I was fine with that.\u0026rdquo; (GP12, male)\u003c/em\u003e.\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eHowever, it was also evident that GPs did not consistently respond positively to patient-initiated prescriptions, particularly in cases involving external service providers.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;I received several faxes from a DiGA provider, naming my patients and asking me to return the completed form or prescription. I find that presumptuous and intrusive\u0026rdquo;\u003c/em\u003e (\u003cem\u003eGP06, male\u003c/em\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eInformation-related needs among general practitioners\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePerspectives regarding information sources (RQ 4: Which information sources do GPs consult when seeking information about DiGAs?)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003eGPs indicated a preference for accessing a variety of sources when gathering information about DiGAs. The heterogeneity of these sources mirrors the contemporary intricacy of the digital health ecosystem. A structured categorization of these sources emerged based on institutional affiliation, practical relevance, and perceived credibility. A typology of information sources has emerged based on the structure of the Federal Ministry of Health (Bundesministerium f\u0026uuml;r Gesundheit, BMG (\u003cspan class=\"CitationRef\"\u003e42\u003c/span\u003e)).\u003c/p\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003e4.1 Governmental and regulatory bodies\u003c/h2\u003e\n \u003cp\u003eParticipants expressed a clear interest in receiving information about DiGAs from central and authoritative institutions within the German healthcare system. Among the most frequently mentioned were the BfArM, the BMG, and the Institute for Quality and Efficiency in Health Care (Institut f\u0026uuml;r Qualit\u0026auml;t und Wirtschaftlichkeit im Gesundheitswesen, IQWiG). These institutions were perceived as competent providers of up-to-date, evidence-based, and manufacturer-independent information.\u003c/p\u003e\n \u003cp\u003eIn addition, GPs highlighted the role of regional medical associations (\u0026Auml;rztekammer) and Associations of Statutory Health Insurance Physicians (Kassen\u0026auml;rztliche Vereinigungen) as trustworthy sources for information regarding DiGAs.\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;I tend to rely on the Association of Statutory Health Insurance Physicians or the medical association. While they may also have certain interests, I still consider them official bodies that provide reliable information.\u0026rdquo;\u003c/em\u003e (\u003cem\u003eGP11, female\u003c/em\u003e).\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003eFurthermore, interviewees pointed to the Federal Institute for Occupational Safety and Health (Bundesanstalt f\u0026uuml;r Arbeitsschutz und Arbeitsmedizin, BAuA) as a trustworthy source.\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;In the field of occupational medicine, I fully trust the information provided by the Federal Institute for Occupational Safety and Health. I know that the content is reviewed up-to-date, and reliable.\u0026rdquo;\u003c/em\u003e (\u003cem\u003eGP01, male\u003c/em\u003e).\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003eOverall, participants emphasized that information from these central institutions should be neutral and clearly distinguishable from industry communication.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n \u003ch2\u003e4.2 Professional associations\u003c/h2\u003e\n \u003cp\u003eIn addition to governmental and regulatory bodies, participants also considered professional associations as relevant sources of information regarding DiGAs. Among the organizations mentioned were the German Association of General Practitioners (Deutscher Haus\u0026auml;rzteverband), the German Society for General Practice and Family Medicine (Deutsche Gesellschaft f\u0026uuml;r Allgemeinmedizin und Familienmedizin; DEGAM), and the Association of Occupational and Industrial Physicians (Verband Deutscher Betriebs- und Werks\u0026auml;rzte).\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;In my view, institutions such as DEGAM or the German Association for General Practitioners are trustworthy. In my opinion, they should be the ones providing information about DiGAs.\u0026rdquo;\u003c/em\u003e (\u003cem\u003eGP07, male\u003c/em\u003e).\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003eA need for DiGA-related information in the form of guideline-like recommendations, comprehensive and evidence-based yet non-binding, was expressed by some respondents. This would support a more in-depth engagement with specific aspects of these applications within the scope of clinical discretion.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n \u003ch2\u003e4.3 Statutory health insurances\u003c/h2\u003e\n \u003cp\u003eSome GPs expressed a need to receive information on DiGA from statutory health insurances who represent the funding bodies. Others, however, adopted a more critical stance, questioning the objectivity of such information due to perceived conflicts of interest.\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026quot;I consider information from the statutory health insurances very critically. What they would like us to do is very much driven by their own interests.\u0026quot;\u003c/em\u003e (\u003cem\u003eGP07, male\u003c/em\u003e).\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\n \u003ch2\u003e4.4 Industry \u0026ndash; DiGA manufacturer/developers\u003c/h2\u003e\n \u003cp\u003eParticipants expressed a need for more transparent and proactive information provision from DiGA manufacturers. At the same time, they also highlighted the tension between informative content and commercial interest.\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;I think DiGA manufacturers could do a bit more. They should bring us on board and explain what different DiGA are available. There is definitely room for improvement.\u0026rdquo;\u003c/em\u003e (\u003cem\u003eGP09, male\u003c/em\u003e).\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;I really want to hear this from a neutral source. Whoever offers these programs clearly has a vested interest, of course. It\u0026apos;s just like medication. I have not engaged with pharmaceutical representatives in my practice for decades because what they provide is advertising, and I prefer to get neutral information.\u0026rdquo;\u003c/em\u003e (\u003cem\u003eGP10, male\u003c/em\u003e).\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\n \u003ch2\u003e4.5 Journals\u003c/h2\u003e\n \u003cp\u003eIn addition to these actors, GPs expressed a need to receive DiGA-related information through familiar and trusted journals such as the \u0026ldquo;Arznei-Telegramm\u0026rdquo; which was valued for its independent, critically reviewed pharmaceutical insights, and considered trustworthy for its lack of commercial bias. The GPs also recommended the German medical journal \u0026ldquo;Deutsches \u0026Auml;rzteblatt\u0026rdquo; as a source for obtaining information about DiGAs.\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;I would most appreciate information sources like the \u0026lsquo;Arznei-Telegramm, which is entirely independent, non-pharmaceutical journal. It takes a critical look at new medications, sometimes quite scathingly. If a neutral journal like that were to deal with DiGAs, I would find that very helpful. If someone who knows their way around studies and practical experiences could summarize the findings in a compact and structured way, especially tailored for primary care, that would be particularly helpful.\u0026rdquo;\u003c/em\u003e (\u003cem\u003eGP10, male\u003c/em\u003e).\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\n \u003ch2\u003e4.6 Clinical knowledge platforms\u003c/h2\u003e\n \u003cp\u003eDigital medical education platforms (learning software, electronic reference work) that offer evidence-based content such as CME courses for physicians, including \u0026ldquo;Amboss\u0026rdquo; for various medical professions and \u0026ldquo;Deximed\u0026rdquo; for general practice, which were considered as reliable and familiar sources of information. These platforms offer guideline-based information without advertisements but are usually not free of costs (subscription pay model).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\n \u003ch2\u003e4.7 Patients in their practice\u003c/h2\u003e\n \u003cp\u003eGPs considered their own patients as a meaningful and trustworthy source of information. When patients actively engage with a DiGA and approach their GP with materials such as flyers, this was considered as a possible contribution to GPs\u0026rsquo; process for information acquisition.\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;When a patient approaches me and says something like \u0026lsquo;I found this DiGA and it might be suitable for me. Take a look\u0026rsquo;, while handling me a flyer, that draws my attention.\u0026rdquo;\u003c/em\u003e (\u003cem\u003eGP12, male\u003c/em\u003e).\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\n \u003ch2\u003e4.8 Peer networks and collegial exchange\u003c/h2\u003e\n \u003cp\u003eColleagues represented an important source of information. Physicians expressed a need for exchange within quality circles or informal expert discussions. They also highlighted the value of interdisciplinary dialogue, for example with psychotherapists or psychiatrists.\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;I\u0026rsquo;ve been moderating quality circles for many years. There\u0026rsquo;s always collegial exchange in that context. We also discuss case studies. I could imagine doing that for DiGAs as well. Those are useful forums for sharing experiences. In addition, more extensive reports or expert assessments from psychiatrists, psychosomatic specialists, or psychotherapists would be desirable.\u0026rdquo;\u003c/em\u003e (\u003cem\u003eGP10, male\u003c/em\u003e).\u003c/p\u003e\n \u003c/div\u003e\u003cspan\u003e\n \u003cp\u003e\u003cstrong\u003ePerspectives regarding information content (RQ 5: What type of content do GPs consider most relevant when learning about DiGAs?)\u003c/strong\u003e\u003c/p\u003e\n \u003c/span\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\n \u003ch2\u003e5.1 Evidence base\u003c/h2\u003e\n \u003cp\u003eA central concern regarding the content of information needed was the transparent presentation of scientific evidence. GPs expressed a need for controlled studies demonstrating the effectiveness of DiGAs compared to standard treatments or non-DiGA-based interventions. Ideally, such studies should be based on adequate sample size and methodological sound design, such as including comparisons with first-line treatments.\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;In the best case, studies that have shown effectiveness compared to standard treatments or non-DiGA-based digital interventions, based on a controlled study with a sufficient number of participants, would be optimal.\u0026rdquo;\u003c/em\u003e (\u003cem\u003eGP11, female\u003c/em\u003e).\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003eInterestingly, GPs assumed that \u0026ndash; unlike efficacy or effectiveness \u0026ndash; data security as another criterion for the approval of DiGA was given due to the involvement of the BfArM.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\n \u003ch2\u003e5.2 Indications and contraindications\u003c/h2\u003e\n \u003cp\u003eAnalogous to conventional drug information, participants emphasized the need for a clear and concise presentation of indications and potential contraindications for DiGAs.\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;Let me draw a parallel to medication prescriptions. For each drug, there is professional information covering its use. We don\u0026rsquo;t necessarily need dosing information here, but we do need to know exactly which indication is being addressed.\u0026rdquo;\u003c/em\u003e (\u003cem\u003eGP10, male\u003c/em\u003e).\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec23\" class=\"Section2\"\u003e\n \u003ch2\u003e5.3 Structure, design and usability of DiGAs\u003c/h2\u003e\n \u003cp\u003eGPs indicated a need for information on the structure, usability, and design of the DiGA. Particular emphasis was placed on user-friendliness and accessibility for older or less tech-savvy patients.\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;The point is that we get to see what such an app actually looks like, just the interface and a brief description of the workflow. Is it complicated, or not? Is it understandable? Especially for older patients, which we often see. Or is it so complicated that only tech-savvy young people could figure it out?\u0026rdquo;\u003c/em\u003e (\u003cem\u003eGP07, male\u003c/em\u003e).\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec24\" class=\"Section2\"\u003e\n \u003ch2\u003e5.4 Language availability\u003c/h2\u003e\n \u003cp\u003eAnother relevant aspect concerned the availability of DiGAs in multiple languages, such as Englisch, Turkish, or Ukrainian. The participating GPs highlighted the importance of this criterion for the care of patients with deficits in the German language and multilingual patient groups for the optimal use of DiGAs.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec25\" class=\"Section2\"\u003e\n \u003ch2\u003e5.5 User and peer feedback\u003c/h2\u003e\n \u003cp\u003eAuthentic user experiences were also considered highly valuable. GPs reported an interest in obtaining authentic feedback and firsthand experiences from both patients and colleagues regarding the usability and perceived effectiveness of specific DiGA.\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;For instance, I would like to know how many people actually use this app and what kind of feedback it receives from patients. Such as how many stars it gets and whether it is considered helpful. If an app scores only 2 out of 10, I wouldn\u0026rsquo;t prescribe it.\u0026rdquo;\u003c/em\u003e (\u003cem\u003eGP09, male\u003c/em\u003e).\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec26\" class=\"Section2\"\u003e\n \u003ch2\u003e5.6 Cost information\u003c/h2\u003e\n \u003cp\u003eInformation regarding the costs associated with DiGA prescriptions was also identified as a relevant information need. GPs emphasized the importance of transparent information about the price of each DiGA, both for their own practice context and for patients. They expressed a need for clear cost breakdowns.\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;I want to know how much it costs to prescribe a DiGA once. Most of them run for one quarter, and ideally, I would like to have a table that shows: this DiGA costs this much, this amount of time is required, this is the benefit, and whether it affects the budget \u0026ndash; not just the collective healthcare system, but also my own budget.\u0026rdquo;\u003c/em\u003e (\u003cem\u003eGP11, female\u003c/em\u003e).\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003eThe possibility of economically prescribing was considered essential, particularly given the wide range of DiGA prices and the responsibility to use healthcare resources efficiently. Furthermore, GPs highlighted the need to know whether prescribing a DiGA would affect their practice budget or lead to potential financial liabilities, such as regress claims. In this context, they also called for better integration of cost information into practice management software, similar to how prices of conventional medications are displayed.\u003c/p\u003e\u003cspan\u003e\n \u003cp\u003e\u003cstrong\u003ePerspectives regarding delivery modes (RQ 6: Through which delivery modes do GPs want to receive information about DiGAs?)\u003c/strong\u003e\u003c/p\u003e\n \u003c/span\u003e\n \u003cp\u003eGPs expressed diverse perspectives regarding how they would like to receive information about DiGAs highlighting the need for both flexible and content-rich offerings. Various formats and access channels were mentioned, ranging from digital to in-person options.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec27\" class=\"Section2\"\u003e\n \u003ch2\u003e6.1 Online formats\u003c/h2\u003e\n \u003cp\u003eVirtual formats, such as online information sessions or webinars, were frequently appreciated for their time-efficiency and geographical flexibility. Several GPs expressed a preference for hybrid models that permit attendance in either an online or in-person capacity.\u003c/p\u003e\n \u003cp\u003eIn addition, participants expressed a need for easily accessible digital channels, such as newsletters and a daily updated online news feed available via smartphone.\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026quot;Ideally, I\u0026rsquo;d like an online news channel that you can access on your phone.\u0026quot;\u003c/em\u003e (\u003cem\u003eGP07, male\u003c/em\u003e).\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec28\" class=\"Section2\"\u003e\n \u003ch2\u003e6.2 In-person formats\u003c/h2\u003e\n \u003cp\u003eIn contrast, others explicitly favored in-person formats, particularly for engaging with new topics such as DiGAs. In this context, participants also mentioned multimedia presentations (e.g., lectures with visual elements such as short videos or app screenshots) as helpful for understanding the structure and functions of DiGAs. Interactive settings, such as workshops or quality circles, were valued for enabling in-depth discussion, collegial exchange and peer learning.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec29\" class=\"Section2\"\u003e\n \u003ch2\u003e6.3 Print formats\u003c/h2\u003e\n \u003cp\u003eParticipants indicated a need for text-based information, highlighting the efficiency and ease of processing of written materials. Flyers and concise texts were considered as particularly effective, as they allow for rapid acquisition of information. Printed literature such as books and journals is especially prized among GPs due to its ability to enhance information access. These materials allow GPs to highlight and annotate content, facilitating ease of retrieval and reuse when necessary.\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;I still prefer non-digital media because I can flip through them multiple times and make annotations. I favor journals and textbooks. However, books tend to me more static and are updated infrequently, so journals are ultimately the more suitable source.\u0026rdquo; (GP10, male).\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003eHowever, traditional print media, especially journals strongly dominated by advertising, were criticized for being distracting and for diminishing trust in the content.\u003c/p\u003e\u003cspan\u003e\n \u003cp\u003e\u003cstrong\u003ePerspectives regarding time investment (RQ 7: How much time are GPs willing to invest in learning about DiGAs?)\u003c/strong\u003e\u003c/p\u003e\n \u003c/span\u003e\n \u003cp\u003eThe participating GPs expressed varying expectations regarding the amount of time they would be willing to invest in training on DiGAs. Overall, there was a need for time-efficient formats, although the acceptable time investment varied greatly depending on the perceived benefit and the training format. Generally, GPs referred to their very limited time available for each patient, which makes it highly important to establish immediate access to up-to-date information in everyday clinical work (e.g., in the practice software, as with pharmaceutical prescriptions) and stated that they would invest from five to 30 minutes. Nonetheless, as GPs felt not well informed about DiGAs overall, they also indicated a readiness to invest more than one hour in a first in-depth information acquisition. Greater time investment was seen as justified when the practical benefit in everyday professional life was clearly recognizable.\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026quot;If it\u0026rsquo;s practical training that genuinely supports my daily work, I would gladly invest three or four hours. But if it\u0026apos;s only an overview and not directly relevant to practice, then just one hour would suffice.\u0026quot;\u003c/em\u003e (\u003cem\u003eGP11, female\u003c/em\u003e).\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003ch3\u003e8 Additional topics\u003c/h3\u003e\n\u003cp\u003eBeyond the main themes, several general barriers emerged that appeared to influence the adoption of DiGAs. First, GPs reported experiencing an overwhelming volume of information in their daily routines, which can make it difficult to identify and evaluate new digital tools. Second, the rapid and constant flow of medical innovations led to a perception that DiGAs do not represent immediate priority. Moreover, participants noted the lack of technical integration of DiGAs into existing practice software, which was seen as a further obstacle to their practical implementation. In this context, participants reported a need for information on the prescription process, such as how to issue prescriptions or how to integrate DiGAs into practice software.\u003c/p\u003e\n\u003cp\u003eIn addition, participants discussed possible incentives to support DiGAs adoption in practice. Several GPs suggested that participation in DiGA-related training sessions should be rewarded with CME credits. Others emphasized the need for financial compensation for the additional effort associated with patient education and prescription. Some participants explicitly demanded that DiGA prescriptions be handled outside of regular practice budgets to prevent financial disadvantages.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study examined GPs\u0026rsquo; perspectives on information needs related to DiGAs for mental health, addressing their perceived level of knowledge, attitudes toward digitalization, and requirements for effective information provision. A particular focus was placed on trusted sources, relevant content, and suitable delivery formats.\u003c/p\u003e\u003cp\u003eInterestingly, 12 out of 13 participating GPs reported having prescribed DiGAs at least once for mental or somatic diseases. This proportion is notably higher than the overall adoption rates reported in previous studies (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Despite this comparatively high prescribing behavior, many participants demonstrated limited familiarity with core aspects such as the evidence base, appropriate indications, and costs.\u003c/p\u003e\u003cp\u003eGPs demonstrated a range of attitudes toward digitalization, reflecting both openness and skepticism concerning DiGAs and the use of AI in medical practice. The advantages of DiGAs, including their availability, flexibility, the ability to bridge waiting times for psychotherapy, and support for care during workforce shortages, were acknowledged. At the same time, GPs emphasized the continued importance of personal and face-to-face care for maintaining the therapeutic relationship. A similarly ambivalent stance was observed toward the use of AI. While its potential in medical practice was recognized, GPs also expressed reservations toward novel technological innovations.\u003c/p\u003e\u003cp\u003eNotably, prescribing behavior did not always stem from strong personal conviction. In several cases, DiGAs were prescribed in response to patient requests rather than as part of an active therapeutic decision. While previous studies have emphasized the importance of knowledge in fostering prescribing intentions (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), the present findings suggest that, despite limited knowledge and ambivalent attitudes, actual prescribing may still occur. This suggests a complex interplay between internal readiness and external influences, such as patient-driven demand, which may play a critical role in adoption of DiGAs.\u003c/p\u003e\u003cp\u003eThe discrepancy between actual use, level of knowledge, and personal attitudes underscores the need for more targeted, accessible, and practice-oriented informational resources to support evidence-based decision-making in everyday care. In this context, the present findings highlight the importance of identifying concrete information strategies tailored to the needs of GPs. The qualitative interviews revealed a range of needs regarding information sources, content, and delivery modes.\u003c/p\u003e\n\u003ch3\u003eInformation sources\u003c/h3\u003e\n\u003cp\u003eThere was a clear need among GPs to obtain information on DiGAs from authoritative, independent, and centrally positioned institutions within the healthcare system. In particular, central institutions such as the BMG, BfArM, and the IQWiG were perceived as trustworthy sources. In line with previous findings, public institutional sources such as government-run information services are generally perceived as trustworthy by healthcare professionals (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e). These findings underline the importance of integrating reliable, government-endorsed information regarding DiGAs into widely utilized clinical knowledge platforms, while also emphasizing the need to increase awareness and utilization of existing resources like the DiGA directory.\u003c/p\u003e\u003cp\u003eRegional medical associations and statutory health insurance physicians\u0026rsquo; associations were also named as relevant actors for communicating reliable and up-to-date information. These sources were regarded as independent of commercial interests, thereby enhancing their credibility. Given the importance of ensuring that GPs remain well-informed about emerging DTx, it is essential for these associations to engage more extensively with the topic of DiGAs. A stronger focus on DiGAs within the activities of these institutions could contribute to better equipping healthcare professionals to integrate such technologies into their clinical practice effectively. GPs further expressed a need for clear (mandatory) guidelines on how to handle DiGAs, such as those issued by the Association of the Scientific Medical Societies in Germany. These guidelines serve as a legal framework for clinical decision-making. Guidelines from professional associations are among the most frequently used sources of information (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e). Similarly, previous research indicates that German cardiologists regularly consult clinical guidelines for patient-specific decisions (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e). This underscores the broader relevance of authoritative guidance across specialties. In the context of dMHI, the S3 guideline for unipolar depression lists such tools as treatment options. However, DiGAs are not explicitly mentioned, despite constituting a specific subset of dMHI that are CE-certified and included in the official BfArM registry. This may contribute to the impression that DiGAs are currently not perceived as part of the routine primary care toolkit, particularly in the field of mental health, which some GPs viewed as outside their scope of responsibility.\u003c/p\u003e\u003cp\u003eAdditionally, statutory health insurances and DiGA manufacturers were mentioned as relevant sources of information. Similar to the findings in a sample of German rheumatologists (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e), GPs held divided opinions regarding their perceived neutrality. While some expressed skepticism, others articulated a need for increased collaboration with these actors and emphasized the role of independent sources of information. Given the conflicting attitudes towards these sources, and in line with previous findings, it appears that these institutions may not be the most suitable primary sources for reliable DiGA-related information. This highlights the need for alternative, more trusted channels to ensure that GPs receive unbiased and credible information.\u003c/p\u003e\u003cp\u003eThe present findings indicate that GPs value independent medical journals as a reliable and familiar source of information on DiGAs. In particular, journals such as the \u0026ldquo;Arznei-Telegramm\u0026rdquo; were appreciated for their critical stance and lack of commercial bias. This underscores the relevance of independent editorial review and transparency in the evaluation of DTx. While clinical guidelines and governmental platforms offer structured information, journals may play an important role by providing independent commentary, critical appraisal of evidence, and practical implications tailored to general practice. Previous research has shown that journal articles are among the most frequently used sources of information by physicians (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). Integrating DiGA-related content into such established publications could therefore enhance credibility and promote informed decision-making in clinical practice.\u003c/p\u003e\u003cp\u003eFurthermore, GPs expressed a need for information on DiGAs from clinical knowledge platforms. \u0026ldquo;Amboss\u0026rdquo; and \u0026ldquo;Deximed\u0026rdquo; were mentioned explicitly, with their structured and regularly updated content being particularly valued. These findings suggest that such platforms are perceived as reliable and accessible sources for obtaining clinically relevant information on DiGAs.\u003c/p\u003e\u003cp\u003eAuthentic and real-life experiences shared by colleagues and patients were deemed crucial. Reviews support the relevance of peers and experts as important information sources for GPs (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e). The interest for interdisciplinary collaboration with other medical disciplines has also been previously reported (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e). Due to limited time resources, GPs often feel they lack the capacity to stay current with all relevant medical topics (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Peer exchange, particularly with colleagues encountered in daily professional routines, may serve as a valuable resource to remain informed about medical innovations. Therefore, it is important that exchange groups focused on internal medicine also allocate space to digital health interventions. In a qualitative study, 57% of insurance physicians stated they expected institutional support for implementing dMHI (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). However, most GPs in Germany are self-employed (i.e., \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;108.200 versus employed: \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;60.100 (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e)) and do not receive organizational support from higher institutions. For this reason, it is particularly important that self-employed GPs can rely on collegial support within their limited time constraints.\u003c/p\u003e\n\u003ch3\u003eInformation content\u003c/h3\u003e\n\u003cp\u003eRegarding information content related to DiGAs, GPs reported a broad range of topics. In addition to evidence-based data on effectiveness, clearly structured and easily accessible information on indications and contraindications were mentioned as highly relevant in daily practice. Patient-centered information was also viewed as important. For example, content explaining the appropriate indications, structure and usability of DiGAs, helping physicians assess whether these applications are suitable to recommend. Information on the availability of DiGAs in multiple languages was also emphasized. In line with this, Posselt et al. (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) found that GPs emphasized the importance of reaching patients in their native language. They argued that this would improve the understanding and accessibility of DiGA services, particularly for non-German-speaking individuals.\u003c/p\u003e\u003cp\u003eNotably, the need for authentic, real-life experience reports from colleagues and patients was not only reflected in the identified sources but also in the content itself. Previous studies have shown that perceived effectiveness and efficiency are the most important factors for the use of DTx among healthcare professionals (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e). This may explain why GPs value both empirical evidence and experience-based accounts of effectiveness. Consistent with findings by Schroeder et al. (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e), who surveyed physicians across medical specialties in Germany, GPs in our sample highlighted a need for more detailed information on the financial aspects of prescribing DiGAs, including patient-related costs and potential consequences for their own practice. Given that nearly all participants (12 out of 13) have already prescribed DiGAs, this suggests that existing information sources (such as the DiGA directory) may not yet be widely consulted or integrated into everyday practice.\u003c/p\u003e\n\u003ch3\u003eDelivery modes of information\u003c/h3\u003e\n\u003cp\u003eGiven their limited time resources, GPs emphasized the need for fast and flexible delivery modes, including online formats and print materials. Notably, participants still placed a high value on traditional text-based formats, such as flyers, (scientific) journals, and books. One reason cited pertains to the capacity to add notes to printed texts, which was perceived as conducive to personal processing. Earlier studies confirm the relevance of such media for GPs, showing that journal articles are seen as current and reliable, while textbooks (even when partially outdated) are still considered trustworthy, relevant, and accessible (see review by Daei et al. (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e)). Additionally, interview responses indicated a need for quick and straightforward access to DiGA-related information via digital tools such as messaging services or chatbots.\u003c/p\u003e\u003cp\u003eNevertheless, GPs were also open to attending in-person events related to DiGAs such as lectures and workshops, if a clear benefit was perceived. In particular, workshops were valued for their interactive nature and the opportunity for collegial exchange. Previous studies confirm physicians\u0026rsquo; interest in medical conferences and CME events focusing on pharmaceutical updates (\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e). Figure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e illustrates an overview of the GPs multifactorial needs for information strategies about DiGAs.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eNotes\u003c/em\u003e. Abbreviations: DiGA\u0026thinsp;=\u0026thinsp;Digital health application (German \u0026bdquo;Digitale Gesundheitsanwendung\u0026ldquo;). Illustration of GPs\u0026rsquo; information needs regarding digital health applications (DiGAs) with the four central components: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) information sources, (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) information content, (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) information media (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) information channels.\u003c/p\u003e\n\u003ch3\u003eAdditional factors\u003c/h3\u003e\n\u003cp\u003eThe inclination toward efficiency was further reflected by the time participants were willing to allocate to information acquisition, which ranged from five minutes to several hours, contingent on the format and content. This illustrates that there is no one-size-fits-all approach for information strategies for GPs, as they depend on motivation (including perceived usefulness), prior experience or knowledge level, as well as structural factors, including limited time, and IT infrastructure. Accordingly, information strategies should take into account the limited time resources of GPs in primary care and provide information in formats that can be flexibly accessed over different time spans, enabling GPs to engage with the content according to their schedules.\u003c/p\u003e\u003cp\u003eDuring several interviews, it became evident that acquiring information regarding DiGAs was not a priority for some GPs. These GPs indicated that other medical topics were deemed more pressing in their daily practice and mentioned information overload as a barrier. In light of the rapidly evolving medical information landscape (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e) and the varied responses of GPs to the integration of AI in healthcare, the early integration of digital innovations into medical education may help address such barriers. Despite the incorporation of DiGAs into the German healthcare system five years prior, they remain predominantly taught as elective subjects within the domain of medical education (\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e). This is indicative of the gradual and delayed adaptation of medical curricula to digital innovations in Germany. A recent meta-analysis found that training interventions for healthcare professionals can enhance knowledge and self-efficacy, and increase the frequency of DTx prescriptions (\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e). In accordance with previous and present findings, a robust knowledge base concerning DiGAs has the potential to augment physicians' willingness to prescribe them and to enhance their acceptance (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). To ensure the successful integration of novel medical approaches, it is essential to incorporate them at the early stages of medical training. This is not only applicable to DiGAs but also to subjects such as AI in medical practice.\u003c/p\u003e\u003cp\u003eFurthermore, since older patients tend to consult their GPs more frequently than younger ones (\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e) and are at the same time often perceived as less likely to benefit from DiGAs (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) due to presumed difficulties with digital technologies, GPs may be less inclined to consider these tools for older age patient group. Finally, several participants emphasized that appropriate incentives, such as financial compensation or CME credits for training, could play a crucial role in fostering motivation to engage with DiGAs and to invest the additional effort required for their implementation.\u003c/p\u003e\n\u003ch3\u003eStrengths, limitations, and implications\u003c/h3\u003e\n\u003cp\u003eThis study provides valuable insights into the information needs and preferences of GPs regarding DiGAs in the context of digital Mental Health. The mean age of participants (49 years) is close to the national average for German GPs in 2024 (54.1 years), suggesting a reasonable variation in demographic characteristics (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Furthermore, most participants had previously prescribed DiGAs, which likely contributed to the depth and specificity of the data collected. Their experience allowed for informed reflections on barriers and facilitators in real-world practice. The heterogeneity of the needs identified in the interviews, in terms of content, source, and format of DiGA-related information, suggests that a future Discrete Choice Experiment (DCE), preceded by pretests to validate and refine the identified attributes and response options (\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e), could be used to systematically structure these characteristics and assess their relevance from GPs' perspective. This, in turn, could inform the development of more targeted information strategies for GPs.\u003c/p\u003e\u003cp\u003eNevertheless, several limitations must be considered when interpreting the findings. Although the sample was approximately representative in terms of age, potential age-related bias cannot be ruled out, as older GPs may hold more critical views on digital applications (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). The high proportion of participants with prior DiGA experience (12 out of 13) may reflect a self-selection bias toward GPs with a particular interest in digital health, potentially limiting transferability to less engaged or more skeptical GPs. Additionally, the overrepresentation of participants from North Rhine-Westphalia, resulting from the IfAM mailing list, may have introduced regional influences, which should be considered. Future research should address these limitations by including a more diverse sample exploring possible differences by experience with DiGA prescription, region, and gender. In particular, it would be valuable to investigate the specific barriers faced by physicians who have not yet prescribed DiGAs, including perceived limitations in their knowledge, resources, or concerns about patient acceptance. Understanding these barriers could provide a deeper insight into the reasons behind low prescription rates and inform strategies aimed at increasing adoption.\u003c/p\u003e\u003cp\u003eFurther, future research should focus on identifying the most effective information formats and communication strategies for educating physicians about DiGAs. Experimental methods, such as randomized controlled trials or A/B testing, could be employed to identify the most effective strategies for conveying prescription procedures, costs, and evidence of efficacy. Identifying optimal ways to present this information could help improve the implementation process.\u003c/p\u003e\u003cp\u003eFrom an implementation standpoint, considering the expressed interest in DiGA development (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e) and the perceived knowledge gap (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e), it is crucial that educational institutions adapt their curricula early to promote innovation-friendly integration of digital technologies within Germany\u0026rsquo;s healthcare system (\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e). Incorporating DiGAs into medical curricula would allow students to become familiar with these technologies during their training, ensuring they are better equipped to apply them in clinical practice. In this context, future studies should examine physicians who have been exposed to DiGA content during their training to determine whether early exposure to these topics influences their willingness and frequency of prescribing DiGAs. Additionally, examining differences in perspectives between GPs and specialists could provide valuable insights for designing targeted educational materials tailored to the needs of different healthcare providers.\u003c/p\u003e\u003cp\u003eFinally, future research should systematically investigate physicians\u0026rsquo; attitudes and acceptance of AI, exploring both the individual (provider-patient) and structural (infrastructure) factors that may facilitate or inhibit digital integration. This will inform the development of more targeted strategies for supporting healthcare professionals in adopting and implementing digital health solutions effectively.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe digital transformation of healthcare poses significant challenges for medical practices amid continuous change. To adequately prepare physicians across different levels of digital maturity, promoting digital competencies and providing tailored information must become integral components of CME. Consequently, it is the medical professions\u0026rsquo; responsibility to develop digital health training that is forward-looking and responsive to the specific needs and challenges faced by physicians prescribing DiGAs.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cp\u003e The study was approved by the Ethics Committee of the Medical Faculty of Heinrich Heine University D\u0026uuml;sseldorf (approval number: 2023\u0026ndash;2338, approval date: 06.03.2023) and was conducted in accordance with the principles of the Declaration of Helsinki. All participants provided written informed consent prior to participation.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eCompeting interests\u003c/h2\u003e\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThis formative qualitative study, conducted as part of a mixed-methods research project, was funded by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation; project no. 528399867).\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eFS: Writing \u0026ndash; original draft, Conceptualization, Methodology, Data curation, Formal analysis, Investigation, Visualization; KP: Writing \u0026ndash; review \u0026amp; editing, Conceptualization, Methodology, Data curation, Formal analysis, Investigation; CS: Writing \u0026ndash; review \u0026amp; editing, Data curation, Formal analysis, Investigation; NKS: Writing \u0026ndash; review \u0026amp; editing; Funding acquisition, Resources, Project administration, Supervision; MV: , Writing \u0026ndash; review \u0026amp; editing; Methodology; MZ: Writing \u0026ndash; review \u0026amp; editing, Methodology; LG: Writing \u0026ndash; review \u0026amp; editing, Formal analysis; JB: Writing \u0026ndash; review \u0026amp; editing; AL: Writing \u0026ndash; review \u0026amp; editing, Conceptualization, Methodology; CP: Writing \u0026ndash; review \u0026amp; editing, Conceptualization; JAH: Writing \u0026ndash; review \u0026amp; editing. Funding acquisition, Conceptualization, Methodology, Project administration, Resources, Supervision, Validation. All authors contributed to the manuscript and approved the submitted version.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors thank the DFG for supporting this formative qualitative study within the broader mixed-methods project \u0026ldquo;Needs and preferences regarding information strategies on digital Mental Health interventions among health professionals\u0026rdquo; (grant number: 528399867). We also thank the Institute of Occupational, Social and Environmental Medicine (IfAM, Heinrich Heine University D\u0026uuml;sseldorf; Dr. Wilm and Dr. Dr. Franken) for their support in participant recruitment.The publication fees were covered by the Open Access Fund of the Heinrich Heine University D\u0026uuml;sseldorf, supported by the University Library and the Medical Faculty.We further thank Yasemin Sahan-Indeck for her valuable support in refining the language and wording of the manuscript and Jennifer Alissa M\u0026uuml;ller for help with the formality check of the paper.The authors also sincerely thank all participants for their time and valuable contributions to this research.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eAnonymized interview transcripts generated and analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eNational Institute of Mental Health. 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Patient. 2024;17(2):109\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-primary-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"famp","sideBox":"Learn more about [BMC Primary Care](https://bmcprimcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12875","title":"BMC Primary Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Physicians, General Practitioners, Digital Health, Mental Health, Telemedicine, Mobile Applications, Mental Health Services, Qualitative Research, Information Literacy","lastPublishedDoi":"10.21203/rs.3.rs-7289079/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7289079/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eThe increasing prevalence of mental illnesses underscores the need for innovative solutions in outpatient care, such as prescription digital therapeutics (DTx) in terms of regulated software-based medical products for treatment and disease management. In Germany, approved DTx are called DiGAs (referring to \u0026ldquo;Digitale Gesundheitsanwendungen\u0026rdquo;) and can be prescribed since 2020 at the expense of statutory health insurance. However, DiGAs remain underutilized in general practice. Prior research indicated informational and attitudinal barriers among healthcare providers, yet little is known about tailored acceptance-facilitating strategies. This study explores general practitioners\u0026rsquo; (GPs) perspectives on DiGAs for mental health, focusing on their needs regarding information strategies for routine use in primary care.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA qualitative descriptive exploratory using semi-structured interviews with GPs was conducted in fall 2024. Participants were recruited via GP networks, fax, and social media using a purposive sampling approach. Data was analyzed using qualitative content analysis with deductive-inductive category development.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThirteen GPs between 27 and 66 years (median: 54 years, female: \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3; 23%) were interviewed. Twelve participants (92%) had prescribed DiGAs at least once, primarily for conditions such as depression, insomnia or obesity. Analysis revealed varying levels of perceived level of knowledge and differing attitudes toward digitalization. DiGA prescriptions were initiated both by GPs and by patients. Independent information sources, particularly from governmental and regulatory institutions, professional associations, and colleagues were mentioned. GPs reported a need for further information content on the evidence base, therapeutic indications, usability, and costs of DiGAs. In terms of delivery modes, online formats, in-person events, and traditional print media were named.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eAlthough nearly all participating GPs had already prescribed DiGAs, the results reveal considerable uncertainties regarding central structural aspects such as the prescription process and budgetary impact. GPs expressed a need for concise information from central, independent institutions and highlighted the value of familiar and reliable formats such as print-media and lecturers. Information strategies should take limited time resources in primary care into account and be oriented toward established routines. Strengthening institutional support and integrating digital health topics into medical training may enhance the adoption of DiGAs in primary care.\u003c/p\u003e","manuscriptTitle":"Genie in the Bottle? A Qualitative Study of General Practitioners’ Perspectives and Information Needs Concerning Digital Mental Health Applications in Germany","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-27 06:35:31","doi":"10.21203/rs.3.rs-7289079/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-01T05:51:21+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-24T14:17:30+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-18T13:45:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"234450318953050670335027743058854600153","date":"2025-09-10T11:40:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"333662128451029964444092663157860543638","date":"2025-09-10T05:22:49+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-09T10:54:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"1102487567294754504204360474590466322","date":"2025-09-08T09:53:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"195705073836290871318533739113969483328","date":"2025-08-20T10:54:35+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-18T10:25:41+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-08T13:14:17+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-08T11:05:59+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Primary Care","date":"2025-08-08T11:02:17+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-primary-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"famp","sideBox":"Learn more about [BMC Primary Care](https://bmcprimcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12875","title":"BMC Primary Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a03c09bf-f115-4fa6-9354-0e1b3977d431","owner":[],"postedDate":"August 27th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-15T16:00:10+00:00","versionOfRecord":{"articleIdentity":"rs-7289079","link":"https://doi.org/10.1186/s12875-025-03115-2","journal":{"identity":"bmc-primary-care","isVorOnly":false,"title":"BMC Primary Care"},"publishedOn":"2025-12-09 15:56:54","publishedOnDateReadable":"December 9th, 2025"},"versionCreatedAt":"2025-08-27 06:35:31","video":"","vorDoi":"10.1186/s12875-025-03115-2","vorDoiUrl":"https://doi.org/10.1186/s12875-025-03115-2","workflowStages":[]},"version":"v1","identity":"rs-7289079","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7289079","identity":"rs-7289079","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}