eHealth refers to the delivery of health services and information via the internet or other electronic technologies [1]. During the COVID-19 pandemic, the role of eHealth in medicine achieved its highest level of importance while combating the deadly virus [2]. The accompanying social distancing norms further expedited digital developments in this field [3]. eHealth has presented promising evidence for its effectiveness [4,5], improving care quality, while reducing health care costs [6]. During the pandemic, eHealth services facilitated communication between caregivers and patients while maintaining distancing policies, thereby reducing hospital visits and direct contact [3,7,8]. During the COVID-19 pandemic, patient–caregiver communication was conducted via webcam-enabled computers, smartphones, and telephone conferencing [9,10]. This assisted caregivers in making patient-centered clinical decisions [11].

Reflecting the growing emphasis on patient involvement in decision-making, eHealth has enabled patients to use the internet as a source of empowerment. Consequently, patients are able to play a more active role in their own medical care, for example, by presenting information during consultations [12] and making informed decisions [13]. Patients who use the internet to inform themselves about health are termed “e-patients” [14,15]. In this study, e-patients refer to patients who actively use digital technologies to seek health information, which distinguishes them from broader digital health users who may passively use online health services without engaging in informed decision-making.

As nonmedical experts, e-patients often seek practical advice on social media [16,17]. The use of these platforms is influenced by patients’ awareness of health problems and their attempts to reduce the risk of illness [3]. Apart from social media, e-patients use general search engines (eg, Google), medical sites (eg, UpToDate, WebMD), and medical journals (eg, BMJ, Lancet) for information [18-20]. Moreover, health apps and wearables provide relevant health-related information (eg, tracking COVID-19 infection) that has been incorporated into medical treatments [21]. This shift has resulted in a more informed e-patient population than in previous decades, as is evident in patient–physician interactions [22].

The growing literature on patients’ experiences with eHealth during COVID-19 indicates high satisfaction rates, including such factors as dealing with concerns, communication, usefulness, reliability, time savings, access, and cost-efficiency [23]. In managed care, eHealth is pivotal in promoting patient-focused care. However, challenges remain [24], particularly the technical demands of using eHealth [25]. To ensure that patient involvement remains a core element in the future implementation of eHealth after the COVID-19 pandemic [26], further investigation into patients’ preferences and behaviors is required.

Thus, this study aims to examine patient adoption of eHealth, changes in patients’ behavior, and patients’ explanations for those changes during and after the COVID-19 pandemic. Specifically, it focuses on the dimensions of preferences and experiences in communication, information acquisition and the use of health apps and wearables in a German psychosomatic outpatient clinic.

This study explored alterations in eHealth patients’ behavior and their inclinations towards eHealth throughout and following the COVID-19 pandemic. This investigation demonstrated slight variations in how patients and caregivers communicated, as well as the interactions between patients themselves. Two notable shifts due to the pandemic were evident: an increase in online obtaining of medication and an increasing deployment of eHealth technology. This study determined that age and gender were key factors influencing patients’ future decisions for in-person or virtual consultations. Older adults and female patients leaned towards on-site consultations, while male patients preferred online consultations. Furthermore, a preference for live video consultations predicted patients’ openness towards online consultations.

 eHealth reduces disease transmission and is especially suitable for self-isolating or high-risk patients [33]. Its growth, accelerated not only by the COVID-19 pandemic, presents several advantages, such as protection, time-saving, and cost reduction, yet it also carries disadvantages, such as difficulties in building a stable relationship between caregivers and patients, assessment challenges, technological issues, and data protection concerns [34,35].

This study’s findings underlined, on the one hand, a significant increase in using online-based communication but also showed no remarkable changes in its overall utilization. This resilience of communication indicated that patients made only minimal changes to their communication behavior even though social distancing was strongly regulated by the German government. This is in line with international discrete choice experiments indicating a top preference for in-person consultations for most clinical scenarios [36,37]. To sustain the eHealth revolution in health care delivery [38], an in-depth understanding of communication, currently lacking, is necessary.

The research identified crucial points for a successful implementation of eHealth. First, a clear differentiation in e-health applications is needed, as some authors suggest (eg, specific diseases, specialties, technologies, clinical problems [39]). Second, comprehensive investigations must be conducted to provide evidence (eg, chronic pain [40], oncology [41], palliative care [42]). Third, eHealth communication necessitates best practices (eg, use of plain language, reducing information overload, application of teach-back [43]), ideally provided by national or international organizations such as the World Health Organization [44].

 While adhering to best communication practices, patients’ information level must be respected. Reasons for information-seeking vary widely, from discussing specific diseases to social and emotional support through peer-to-peer interactions [45]. The increasing health-related internet use by patients results in both positive and negative effects on the caregiver–patient relationship [46]. Positive effects were observed when patients openly discussed their findings with caregivers, thereby enabling active participation in decision-making, which alters traditional consultation models [47].

A primary objective of eHealth may also be a central aspect in guiding patients within the framework of managed care programs [48]. Conversely, misleading health information may have a serious impact on an individual’s health or mental state [49], such as the phenomenon of cyberchondria [50], which involves excessive fear of symptoms resulting from reviewing of search results and references on the Web, higher medical costs [51], and overall lower quality of life due to poor health care management [52]. This study’s analysis showed only a slight increase in online-based information-seeking; however, during the pandemic, most studies found an increased desire to understand the virus’s risk situation and to cope with uncertainty [53].

 Wearables and eHealth apps played a vital role in detecting the spread of the coronavirus [54], and their usage for monitoring physical activity has risen [55]. This aligns with an increase in the use of wearables and e-health apps in this sample. Wearables and health-related apps are promising tools for managing long COVID [56] and, in general, for empowering patients to take responsibility for their health and care [57,58]. In research, wearables have become essential for data collection in population-based research, experimental outcome assessment, prognostic forecasting, and explorative analysis of big data sets [59].

In addition to the rise of wearables, online medication procurement also increased, in line with recent research [60]. However, a large number of online pharmacies have failed to comply with regulations [61], leading to deaths [62] and emphasizing the need for greater awareness and stricter government laws [63].

 Despite substantial literature demonstrating high satisfaction with eHealth across all ages and genders [23,64], this investigation revealed a clear preference for on-site consultations, in line with recent findings [32]. This may be specific to the psychosomatic sector, where comprehensive examinations of both psyche and body are part of daily practice. To elaborate on these findings, regression analysis provided more insights: older adults and female patients expressed a preference for on-site consultations, highlighting the importance of personalized, in-person care. This aligns with findings from large and international surveys that especially older people prefer in-person consultations [65] and also supports the argument that e-health may not completely replace face-to-face consultations [38]. Conversely, male patients demonstrated greater openness towards online consultations. Recent studies have found a correlation between male sex and satisfaction with treatment plan or follow-up via eHealth [66], controversially also female sex was associated with higher satisfaction of eHealth services [67]. Further influencing factors, such as positive promotion of e-health by caregivers [68], as well as personality structure or cultural background, need to be further explored.

 Limitations of this study include its cross-sectional design, which captures a retrospective snapshot of patient behavior without enabling the tracking of changes over time. Moreover, while the ad hoc questionnaire addressed context-specific topics, it was not formally validated, which restricts the reliability and generalizability of its measures. Although the think-aloud method was used during development to improve clarity and content relevance, no psychometric evaluation was conducted prior to its use. This limitation may limit the generalizability and interpretability of the findings. However, evidence suggests that data from ad hoc clinician-generated patient questionnaires can be aggregated into valid factors [69] which indicates ad hoc questionnaires may still provide meaningful insights into patient behaviors and preferences.

Potential selection bias due to the voluntary participation of patients may also be a limitation. An additional limitation is missing data regarding the participants’ gender, which may have introduced bias or reduced the validity of gender-related analyses. While the regression model still identified significant associations with gender, the missing data may have affected the robustness of these results. Patients in psychosomatic medicine suffer from psychological disorders, which may have influenced their preferences and behavior. Nevertheless, recent studies have shown that eHealth services are an effective and appropriate therapeutic tool [70] to reduce mental complaints [71] and stress symptoms [72].

In conclusion, the study indicates that recognition and accommodation of diverse preferences is critical in designing and implementing future eHealth services, which might be central in managed care programs. Although this investigation focused on the pandemic context, eHealth services can be expected to remain an integral component of health care delivery [73]. By integrating these findings, especially accommodating the age and gender of patients, a potential rise in patient engagement can be anticipated within the transforming eHealth environment. These results highlight the need for a tailored approach to diverse patient requirements to improve health care outcomes as eHealth services continue to progress and evolve.