More health literacy via app

Wednesday morning at the University Square in Fulda. Demian Frank and Verena Krah give the final instructions. 106 pupils from the Eduard Stieler School, the Marianum and the Domschule are about to set off in search of Emma. The 16-year-old has been missing for several days. Her best friend Mike is very worried. What happened? Where is she? With the help of the app Nebolus, developed in Fulda and funded by the Federal Centre for Health Education, the pupils go on a search. Over the next two days, the path will lead them in small groups to seven facilities in the city of Fulda that offer help and support for mental health problems. These are all places the young people can go to if they need help themselves.

The pupils are also part of a research project on these two days. The researchers want to find out whether the app Nebolus and the fictional story of the missing Emma can strengthen the health literacy of the rally participants. "The participants anonymously answer a questionnaire about health before and after the rally. In parallel, we survey a control group - those who will complete the rally in June," explains Demian Frank, research assistant in the Nebolus project. He developed the app together with Verena Krah, Fabrice Pöhlmann, software developers and the head of the project, Professor Dr Kevin Dadaczynski. Dadaczynski had the idea for the app. He deals with health communication and researches at Fulda University of Applied Sciences on the question of how gamification, i.e. a playful approach, can be used for prevention and health promotion, among other things.

Why health literacy is so important

The app is designed to help young people find, understand, evaluate and apply health information in their living environment using playful means and on the basis of an exciting story. Experts refer to these skills as health literacy. What sounds a bit unwieldy is a problem for many people. Because within a few minutes, countless digital information can be found on health-related questions and concerns - in addition to good and technically correct information, there is also information whose content is unclear, doubtful or incorrect. As a result, it is becoming increasingly difficult to find one's way through the information jungle and to make appropriate decisions for one's own health.

"Health literacy should be promoted as early as possible in the life course, i.e. already in adolescence."Demian Frank, project collaborator

According to studies, more than half of adults have difficulties in finding and dealing with health-related information. Adolescents also have difficulties and show knowledge deficits in the area of health. "Health literacy should be promoted as early as possible in life, i.e. already in adolescence. Knowledge, attitudes and health-related skills develop and consolidate at a young age," says Frank, adding, "We are convinced that promoting health literacy can be fun."

Entering the lifeworld of young people

With Nebolus, the researchers go directly into the students' lifeworld. "In order for young people to learn about and use the regional health promotion and prevention services, it is important to break down barriers and bring them into contact with the help and support services," they emphasise. By means of voice messages, which can be called up via a QR code, they guide the young people to various facilities in Fulda that offer help and support. There, integrated into the story of the missing Emma, they find out which counselling services they can access if necessary.

"In order for young people to make use of the regional health promotion and prevention services, it is important to bring them into contact with these."Demian Frank, project worker

"Young people are increasingly looking for health-related information digitally. But these have to be transferred into everyday life and applied outside the digital world," Frank explains. This requires good orientation in the local environment. After all, sports clubs, counselling centres, youth clubs and institutions that provide support in problematic health situations offer a wide range of help and support services. How well the interaction with the professional actors works depends not least on what experiences the adolescents have had with the support system and the professional actors.

Getting to know local services at a low threshold

In the meantime, the first pupils have arrived at the specialist counselling centre Kinderschutz AKTIV of the Social Service of Catholic Women. It is a contact point for children and young people who experience sexualised violence. Emma, they learned, was recommended to the centre by a staff member of a youth club. The 16-year-old had told her about an initially nice male acquaintance who then developed in a questionable direction. At the counselling centre, the students now get to know the rooms and the professional staff and can ask questions about sexualised violence - without taboos.

"It helps to have seen the counselling centre before and to know the people there."Elli (16)

"It is very important to us that children and young people are sensitised and that they have a place where they can talk about the topic," says Alexandrina Prodan, who accompanies the young people during the rally. This is easier if you are not only familiar with the help on offer, but have also been there and seen the contact persons. Elli, one of the participants, confirms this: "It helps to have seen the counselling centre before and to know the people there," she says. It is good to know that someone will help you if you need help - and that you can call anonymously. She also finds it good to be out and about in a group. "I probably wouldn't do it alone."

"It's quite important to us that children and young people are made aware and that they have a place where they can talk about the issue."Alexandrina Prodan, Child Protection ACTIVE

The pupils also get to know the Child Protection Association, the Ostend Youth Club, the Diakonie, the advice centre for parents, children and young people and the Youth Culture Factory. "In order to be able to realise the rally on the two days, many people have made their contribution, and we are happy to see how that is now paying off," emphasises Frank. "The constant exchange with the professional stakeholders was indispensable for this. When we now see the individual, sometimes very creative concepts of the professional actors at the rally, we are particularly pleased. Because a Nebolus rally lives from the ideas of the participating institutions."

Local actors were involved in the development

Local actors from the health, education and social sectors were involved in the design of the rally at an early stage. A youth advisory board was actively involved in the development of the app. "Nebolus is the result of a participatory and agile development process. The young people not only provided important impulses for the storytelling, i.e. for the story of the missing Emma. We also regularly asked for their feedback during the technical implementation and took this into account in the planning and implementation with IT experts," explains Frank. "We learned from the young people how important it is to have an exciting story they can identify with. And we learned that they want to hear a voice." So the team replaced the originally planned text messages with voice messages. The project team also incorporated small graphic icons that provide feedback on a task into the app when requested.

"We learned from the young people how important an exciting story is."Demian Frank, project team member

Conversely, the researchers also hope to use the app to provide an impetus for local prevention and health promotion services. "We also want to promote cooperation between local professional actors and stimulate the development of a coordinated municipal prevention strategy," says Frank. "Our goal is to have a long-term effect beyond the rally. "In June, another 70 students from Fulda will complete the same rally. Afterwards, the researchers will evaluate all the information collected. The results will be published in the summer. The app is already available nationwide. "We are already in contact with many municipalities," Frank is pleased to say. Feedback from the Fulda pupils is also encouraging for the project: "The rally is fun."

About the app Nebolus:
The app is designed in the form of a story-based location-based game, which means that the focus is on a map of the respective location and the stations that have to be completed. Nebolus is designed as a group activity and can therefore be completed by small teams. The app runs on Android and iOS smartphones and can be downloaded free of charge from Google Play and the App Store. The Nebolus app was developed according to the principle of data minimisation. No data is collected that could be attributed to a person.
www.nebolus.net