Hidden Roles of Students and Digital Health Applications in the Field
of Mental Health: A Study Protocol for a Prospective Study on
Hidden Social Roles with Focus on Informal Relatives, Mental
Health, Sleep, and Digital Health Applications
Miriam Ines Füßer
, Thomas Ostermann
, Jan Ehlers
and Gregor Hohenberg
Hamm-Lippstadt University of Applied Sciences, Marker Allee 76-78, 59063 Hamm, Germany
Witten-Herdecke University, Alfred-Herrhausen-Straße 50, 58455 Witten, Germany
Keywords: Digital Health Applications, Students, Mental Health, Sleep, Insomnia, Hidden Lives, Hidden Roles,
Young-Carers, Informal Carers.
Abstract: Students take on various hidden roles in life - including as informal carers. Due to the multiple burdens, young
carers often suffer from psychological problems that cannot be treated due to a lack of therapeutic resources.
Germany was the first country worldwide to include digital health applications in its health insurance portfo-
lio. In this research project, which is to be carried out as part of a doctorate, the aim is to use an online survey
to record the level of knowledge and willingness to use digital health applications, to identify the social roles
as well as the associated activities and their amount of time, and to identify the mental health status of students
to query. A digital health application for insomnia should be tested, as insomnia is a common accompanying
symptom of psychological problems. It is expected that the level of knowledge about digital health applica-
tions is low, but there is a willingness to use them. It is also expected that a significant proportion of students
are young carers. The digital health application against insomnia is expected to improve the sleep of many
students. This doctorate is intended to give the included elements more visibility. The study is registered
The living conditions of the 21st century present peo-
ple with new challenges. The digital age is leading to
a change in user behaviour in society and its spheres
of influence. Science and technology are shaped by
digitalisation. Politics and business must deal with
new issues. Demographic change is changing the
structure of Germany. Society must adapt. The ever-
increasing pressure to perform is characterising the
younger generations - especially in terms of mental
The young generation is growing up in a volatile
time. Events and circumstances such as the
coronavirus pandemic, climate change, wars and
inflation have a formative influence. Added to this are
other factors such as high pressure to perform,
financial worries, limiting illnesses, private conflicts,
or responsibility towards others (Meyer et al., 2023).
The latter particularly affects students who work as
unpaid carers - so-called young carers. According to
the BARMER Care Report, around 6 million people
in Germany will need care by 2030. The Federal
Statistical Office of Germany forecasts similar
figures. Half of these are expected to be cared for
exclusively by family carers at home. The need for
care is increasing. This is due not only to
demographic ageing, but also to better access to
healthcare and the range of services on offer
(Rothgang & Müller, 2021; Federal Statistical Office,
In the 22nd Social Survey of Students in
Germany, just under 12 per cent of the students
surveyed stated that they were carers (Kroher et al.,
2023). An online survey by the Hamburg University
of Applied Sciences found that around 15 per cent of
students are informal carers (Mindermann et al.,
2021). An online survey conducted by Bremen
University of Applied Sciences produced similar
results. Here, it was also 15 per cent of the students
surveyed. They were also involved in caring activities
for an average of 19.86 hours per week (Dörmann et
Füßer, M., Ostermann, T., Ehlers, J. and Hohenberg, G.
Hidden Roles of Students and Digital Health Applications in the Field of Mental Health: A Study Protocol for a Prospective Study on Hidden Social Roles with Focus on Informal Relatives,
Mental Health, Sleep, and Digital Health Applications.
DOI: 10.5220/0012670800003699
Paper published under CC license (CC BY-NC-ND 4.0)
In Proceedings of the 10th International Conference on Information and Communication Technologies for Ageing Well and e-Health (ICT4AWE 2024), pages 198-203
ISBN: 978-989-758-700-9; ISSN: 2184-4984
Proceedings Copyright © 2024 by SCITEPRESS Science and Technology Publications, Lda.
al., 2023). This corresponds to almost the maximum
number of hours per week permitted for students
during the lecture period in Germany (Bundesagentur
für Arbeit, 2023).
Time resources are severely limited due to the
intensive care work and the multiple burdens mean
that the course of study is discontinuous. Affected
students are more likely to fail exams, social contacts
are reduced, and many feel lonely and overwhelmed.
They suffer from feelings of shame, financial
problems, fear of the future and emotional stress
(Dörmann et al., 2023; Haugland et al., 2022;
Knobloch et al., 2022; Wazinski et al., 2022).
Exhaustion, worries, and fears lead to chronic stress,
which in turn can have far-reaching consequences for
the person affected (Wazinski et al., 2022).
Stress results in physical and psychological
symptoms that can develop into manifest illnesses.
The stress leads to restrictions in daily life and quality
of life. Not only the individual themselves, but also
their environment is affected. This includes not only
social contacts, family, and friends, but also the
working environment and, more broadly, social
structures. This becomes clear in the example of
students who are also family carers. Conflicts within
the family and challenging study situations favour the
symptoms of stress. Young carers find it difficult to
prioritise their tasks and obligations because they
have a strong sense of obligation towards both their
relatives and their studies. The consequence: tasks
come to a standstill. The reasons are not visible to
third parties. Young carers lead "hidden lives". Their
obligatory social role remains hidden (Knobloch et
al., 2022).
Many develop mental health problems as a result,
but these are easily treatable, especially if they are
recognised early and intervention is swift. Early
treatment is crucial to the success of therapy
(Klosterkötter & Maier, 2003). Symptoms are
alleviated, quality of life improves, and the affected
person can once again participate in social life.
However, more and more resources will be needed in
the coming years to cover the need for therapy, but
these are limited (Jacobi et al., 2014; Mack et al.,
2014). The number of people with mental health
problems and sleep disorders is increasing. Students
are also affected (Hildebrandt et al., 2023; Meyer et
al., 2023).
The goals of classic somatic or psychotherapeutic
treatment vary depending on the clinical picture, but
they have the alleviation of symptoms in common.
The service provider assumes the main responsibility
and guides the patient through the treatment.
However, to ensure long-term therapeutic success, it
is essential to involve the patient and evaluate all
possible measures. The combination of various
interventions can be advantageous for complex
disease patterns. A good doctor-patient relationship is
essential for this (André Posenau, 2021).
In Germany, there are long waiting times for
psychotherapeutic measures due to a lack of resources
(Mack et al., 2014). In the long term, this can lead to
a worsening of symptoms for those affected. One
solution to this problem could be digital health
applications. Digital health applications are
prescription-only medical devices of a low-risk class
that have a medical benefit and are tested by the
Federal Institute for Drugs and Medical Devices for
their positive proof of supply (Bundesinstitut für
Arzneimittel und Medizinprodukte [BfArM], 2023).
They are listed for various diseases according to the
ICD classification in the digital health application
directory and thus represent an additional supportive
treatment method (Bundesinstitut für Arzneimittel
und Medizinprodukte [BfArM], 2020). Digital health
applications promote patient participation and
strengthen the personal sense of responsibility for
one's own health.
There is a change in awareness through active
participation in treatment. Patients also have free
access to their health data. Furthermore, the
continuous generation of data makes it easier to
understand, plan and adjust the course of illness as
required. At the same time, emerging illnesses can be
recognised and treated at an early stage. In addition,
the doctor-patient relationship is improved by the
reflective exchange between both parties (André
Posenau, 2021; Gregor Hohenberg, 2021).
Various studies confirm the efficacy and thus the
medical benefits of digital health applications in
mental health and sleep (Berger et al, 2017; Heber et
al, 2016; Klein et al, 2016; Lorenz et al, 2019; Meyer
et al, 2015; Moritz et al, 2012; Twomey et al, 2020).
However, service providers criticise the available
evidence because of the rapid approval process. In
addition, digital health applications are less well
known among healthcare providers and patients than
traditional treatment methods due to a lack of
information (Dahlhausen et al., 2021; Radic et al.,
2021; Stiftung Gesundheit, 2022).
Although the effectiveness of digital health
applications has been proven, they are not well known
among the population. Digital treatment approaches
can support patient care in the future and contribute
to better healthcare. The planned study therefore aims
to record the level of knowledge and willingness to
use digital health applications and at the same time
the mental health status and sleep of students via an
Hidden Roles of Students and Digital Health Applications in the Field of Mental Health: A Study Protocol for a Prospective Study on
Hidden Social Roles with Focus on Informal Relatives, Mental Health, Sleep, and Digital Health Applications
online survey. The "hidden lives" of the students are
also to be determined and quantified. In addition, a
digital health application is to be tested via the Hamm
Telemedicine Centre once the initial findings have
been obtained. The digital health application is
intended to improve sleep disorders. A good night's
sleep has a positive effect on mental health (Roberts
& Duong, 2014).
Students take on many social roles with different
levels of performance. Young carers, who are active
as family carers, play an important role here. In view
of demographic change and social developments, it is
necessary to pay more attention to the burdens and
concerns of students and to categorise them socially.
Research plays an important part in understanding
and recognising the relevance of mental health and
sleep in this context. The current study situation for
these possible connections is limited. The aim of this
research project is on the one hand to create more
visibility in the form of quantitative and qualitative
data for these topics and on the other hand to test
digital health applications for their qualities.
The schematic illustration of the problem
formulation is shown in Figure 1.
Figure 1: Schematic representation of the problem formula-
This study protocol for a prospective study on the
social roles of students and digital health applications
in the field of mental health is to be conducted as part
of a doctorate.
The study design provides for an online survey as the
data collection method. The data is collected via non-
probability sampling at Hamm-Lippstadt University
of Applied Sciences and Witten Herdecke University.
All students are invited to participate. The online sur-
vey is anonymous and available in German and
English. No prior knowledge or specific skills are re-
The data analysis provides for both quantitative
and qualitative analyses and will work according to
the mixed methods approach. The study includes
questions in the areas of role theory and role
distribution, digital health applications, mental
health, sleep, and socio-demographics and is based on
the Copenhagen Psychosocial Questionnaire to be
able to adequately assess aspects such as emotional
exhaustion. The aim of the survey is to record the
level of knowledge about digital health applications
and the willingness to use digital health applications.
In addition, the mental health status and sleep of the
students are to be documented. Furthermore, the
social roles of the students are to be determined and
quantified to draw conclusions about possible
correlations. Multiple choice questions and Likert
scales are used for this purpose. In optional free
fields, participants can list further aspects if these are
not given in the selection options.
Descriptive statistics are carried out on the
individual topics. Subgroup analyses are then runned
in relation to the socio-demographic characteristics of
the participants. Finally, correlation calculations are
carried out to show connections between the elements
discussed. The qualitative data will be reviewed and
analyzed. The study results are processed, evaluated,
and visualized using the survey provider's online
program and the statistical and analysis software
IBM® SPSS Statistics from the technology company
IBM. If required, the spreadsheet programme Excel
365 from Microsoft can also be used.
As this is a study protocol, the choice of method
is not yet final and will be adapted to new
circumstances if necessary.
Digital health applications represent an innovative,
evidence-based intervention for various clinical pic-
tures that can be used at different health levels. The
low-threshold therapy offers many advantages, such
as strengthening patient participation, saving time and
financial resources, or closing gaps in care. Despite
the various benefits, digital health applications have
not yet been used much in practice because, on the
one hand, awareness of them is too low and, on the
other, service providers are not convinced of the ef-
fectiveness of these digital interventions.
Students are under immense stress for various
reasons. Informal carers - the young carers - are
particularly in focus due to the additional burden. The
ICT4AWE 2024 - 10th International Conference on Information and Communication Technologies for Ageing Well and e-Health
social visibility of this problem is low. Statistics show
that there is a great need for support services among
students and that demand is increasing. Digital health
applications are a possible solution to meet this need.
The study is intended to record the status quo of
this topic in a defined sample and contribute new
results to the study situation. No to little knowledge,
but a positive willingness to use digital health
applications is expected. This expectation is based on
the novelty of digital interventions and the limited
knowledge of service providers in this area. Service
providers are essential for establishing new measures.
It is also expected that many of the students will take
on several social roles in their lives - many of them as
young carers. Accordingly, it is assumed that the
resulting stress and pressure has a negative impact on
mental health and sleep and that there is a need for
action in this area. This need is underpinned by
various studies that address the rise in mental health
Various stakeholders will benefit from this
research. Students are encouraged in dealing with
their own health and informed about additional
treatment options. They also have the opportunity to
draw attention to their mental health. In addition, the
visibility of their social roles in society is increased.
Many people are not aware of what other obligations
and tasks students have outside of their studies.
Hamm-Lippstadt University of Applied Sciences and
Witten/Herdecke University can strive for health-
promoting measures to improve the well-being of
students in everyday university life. The provider of
the digital health application receives information
about the effectiveness of its application and direct
feedback about the needs and opinions of users. The
Federal Ministry of Health will also gain an
impression of the spread and acceptance of digital
health applications among the population. Based on
the results, other measures for implementation in
standard care can be considered if necessary.
Furthermore, the expert association and economic
players receive additional information and current
evidence on the topic.
On the one hand, the results of the study
contribute to important aspects in the research area of
hidden lives and the associated mental health status
and sleep and, on the other hand, provide findings in
the research area of digital health applications
regarding acceptance and willingness to use them.
Based on the collected data, further research can aim
to conduct comparative research - for example
regarding socio-demographic characteristics. With
regard to study programs, medical and psychology
students could be asked about the educational
offerings in the field of digital medicine. Future
healthcare providers are essential for establishing
new measures, but they need to be sufficiently
informed to do so. In terms of the acceptance and
willingness to use digital health applications, it may
be useful to ask for background information to draw
attention to hurdles in the implementation of
measures in standard care.
The data collected is intended to provide an overview
of the topics of hidden lives, mental health, sleep, and
digital health applications to increase visibility with
both quantitative and qualitative data. Students are
not only students, but are involved in many social
structures, which creates a lot of pressure and stress
that can be at the expense of mental health and sleep.
The need for information on digital health applica-
tions and health measures in relation to mental health
and sleep needs to be identified. Furthermore, the ef-
fectiveness of the digital health application should be
clarified, and future interventions should be further
developed with the feedback of the students.
Even if it is expected that digital health
applications are largely unknown, it can be assumed
that students are willing to use them. Due to the many
social roles, it is assumed that the level of stress and
pressure is very high and that there is a need for help.
Mental problems are often accompanied by insomnia.
This work makes an important contribution to
closing the research gap around hidden lives and their
links as well as the research gap in the area of digital
health applications in terms of acceptance and
willingness to use.
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Hidden Roles of Students and Digital Health Applications in the Field of Mental Health: A Study Protocol for a Prospective Study on
Hidden Social Roles with Focus on Informal Relatives, Mental Health, Sleep, and Digital Health Applications