Ethical approval was obtained from the ethics committee of UW/H, Germany (approval code: S-198/2022). Participants did not receive compensation for their participation.

All participants provided informed consent prior to participation. For the online survey conducted via LimeSurvey, participants were presented with detailed study information and were required to confirm that they had read and understood the information and agreed to participate before accessing the questionnaire. Participation was voluntary, and respondents could discontinue the survey at any time without disadvantage.

For the qualitative data collection, participants were likewise informed that their responses would be anonymized and used exclusively for research purposes. They were instructed to provide qualitative responses only if they agreed to the anonymized use of their data for scientific analysis.

The lecture series was also held in conjunction with a lecture series on transformative education in Germany, organized by the Planetary Health Academy, which, however, did not focus on digitalization [14]. DMgPH wanted to include the themes in the curriculum and move away from focusing on the personal footprint in relation to the climate crisis and toward increasing the handprint [15]. The handprint is a concept that focuses on actions and the possibility of changing things as an individual [16].

DMgPH was delivered digitally using Zoom meeting software (Zoom Communications, Inc) during the winter term of 2022-2023. Students at UW/H and medical students at RUB were eligible to receive 2 European Credit Transfer and Accumulation System credits in the DMgPH. This was tracked via logins using personalized links; therefore, there was no need to register in advance with real names on Zoom. Students from other universities were given the opportunity to have their participation in the lecture series confirmed and to submit this to their respective examination offices for credit.

Sessions 1 to 11 were characterized by 1 or 2 keynotes by experts from various fields (eg, hospitals and nongovernmental organizations). Each session was followed by a subsequent discussion (chat or video). Work in breakout sessions, surveys, and encouragement to join discussions were used to improve attendee participation. The lecturers moderated the discussions in turn.

At the 12th session, a bar camp was held. Bar camps are characterized by questions from the participants or concrete input [17] and designed to create learning spaces together with the participants [18] where they meet as equals [19]. In DMgPH, the participants were asked in advance to indicate possible areas of interest on Moodle (Moodle Pty Ltd) or to offer their own sessions in the lecture series. Six sessions were offered in which both the lecturers and other experts presented certain topics with a short keynote speech, and discussion arose through joint work assignments (Table 1).

The final session was designed as a quiz in which questions were asked about all previous dates in the lecture series. The 207 participants had 30 seconds to answer each question. Three winners (for the quickest right answers) were awarded prizes as a pleasant incentive (eg, stickers, socks, and a hip bag).

A total of 215 participants took part in the T1 survey, and 105 participants took part in the T2 survey. To ensure data quality, all incomplete data records were excluded during the data cleaning process. Only data records containing complete information on the relevant variables were included. A total of 180 participants from T1 and 79 participants from T2 were included in the final analysis (Table 2). The mean age in the T1 survey was 27.92 (SD 10.95) years, with a minimum age of 18 years and a maximum age of 77 years. The mean age in the T2 survey was 29.22 (SD 12.78) years, with a minimum age of 18 years and a maximum age of 78 years.

The majority of participants were women. In the T1 survey (n=180), 137 (76.1%) participants were women and 43 (23.9%) participants were men. In the T2 survey (n=79), 52 (65.8%) participants were women and 27 (34.2%) participants were men. The “nonbinary” option was not selected.

In the T1 survey, 155 (86.1%) participants were students. Of those, 76.8% (119/155) were students at UW/H and 4% (6/155) were students at RUB. The remaining 19.4% (30/150) were from 13 other national and international universities. Twenty-five (13.9%) participants in the T1 survey were nonstudents.

In the T2 survey, 68 (86.1%) participants were students. About 86.8% (59/68) of them were at UW/H, 2.9% (2/68) at RUB, and 10.3% (7/68) at 3 other national universities (Table 2). In the T2 survey, 11 (13.9%) participants were nonstudents.

In terms of household size, most participants lived in 2-person households, with 68 (37.8%) participants in T1 and 32 (40.5%) participants in T2. Single-person households were the second most common category, comprising 50 (27.8%) participants in T1 and 22 (27.8%) participants in T2. Three-person households comprised 32 (17.8%) participants in T1 and 13 (16.5%) participants in T2. Four-person households were reported by 23 (12.8%) participants in T1 and 10 (12.7%) participants in T2. Households with 5 participants were only marginally represented, with 7 (3.9%) participants in T1 and 2 (2.5%) participants in T2.

At the time of the survey, 83 (46.1%) participants in T1 and 40 (50.6%) participants in T2 were working in the health care sector. In contrast, 97 (53.9%) participants in T1 and 39 (49.4%) participants in T2 were not working in the health care sector. The average length of professional experience in the health care sector among those currently employed was 7.78 (SD 7.98) years in T1 and 10.17 (SD 10.37) years in T2. In addition, 35 (19.4%) participants in T1 and 16 (20.3%) participants in T2 stated that they had previously worked in the health care sector.

As part of the T1 measurement, participants were asked whether they were already actively involved in climate protection (eg, in a Campus for Future activist group). This made it possible to estimate the participants’ handprints. One hundred seventeen (65%) participants in T1 and 47 (59.5%) participants in T2 reported low to no engagement. A moderate level of engagement was reported by 41 (22.8%) participants in T1 and 20 (25.3%) participants in T2. A high level of engagement was reported by 22 (12.2%) participants in T1 and 12 (15.2%) participants in T2.

The results of the T1 and T2 surveys using the NEP scale can be found in Table 3.

To examine differences between T1 and T2, descriptive statistics in the form of means and SDs were reported for individual items of the NEP scale (Table 3) and for the assessment of health problems (Table 4). Across most items, there were only minor differences between the 2 measurement points, with the means generally falling within comparable ranges and similar variation in responses.

The descriptive statistics in Table 3 showed a broadly similar pattern of responses at both measurement points. Particularly high mean scores were found for the items “Humans are seriously abusing the environment” (T1: mean 5.22, SD 1.03; T2: mean 5.34, SD 1.05) and “If things continue on their present course, we will soon experience a major ecological catastrophe” (T1: mean 5.33, SD 1.03; T2: mean 5.41, SD 1.01). Comparatively high scores were also observed for “Plants and animals have as much right as humans to exist” (T1: mean 5.02, SD 1.20; T2: mean 5.13, SD 1.23) and for “Despite our special abilities, humans are still subject to the laws of nature” (T1: mean 5.04, SD 1.15; T2: mean 5.03, SD 1.33).

In contrast, the mean scores were lower for statements formulated in a more anthropocentric or techno-optimistic manner. This applied, for example, to “Human ingenuity will ensure that we do not make the Earth uninhabitable” (T1: mean 3.50, SD 1.19; T2: mean 3.24, SD 1.22) and “Humans were meant to rule over the rest of nature” (T1: mean 1.72, SD 1.10; T2: mean 1.54, SD 1.00). The item “The so-called ecological crisis facing humankind has been greatly exaggerated” also showed comparatively low levels of agreement (T1: mean 1.55, SD 0.97; T2: mean 1.41, SD 0.91).

The descriptive statistics in Table 4 showed a broadly similar pattern of responses for both T1 and T2. For the assessment of current health problems, the mean scores at both measurement points were predominantly in the range of approximately 0.66 to 1.01. Particularly high values were observed, for example, for mental health conditions, with mean 1.00 (SD 0.33) in T1 and mean 0.99 (SD 0.38) in T2, as well as for malnutrition, with mean 1.01 (SD 0.67) in T1 and mean 1.09 (SD 0.57) in T2. Comparatively lower mean values were reported, among other things, for water-borne infectious diseases, which stood at mean 0.66 (SD 1.02) in T1 and mean 0.84, SD (1.01) in T2.

Similar values were also observed across both measurement points for the assessment of health problems in 20 years. Here, the mean values generally ranged between 0.79 and 0.99. For example, the mean for mental health conditions was 0.88 (SD 0.52) in T1 and mean 1.00 (SD 0.28) in T2. Malnutrition also showed relatively high values, with mean 0.99 (SD 0.50) in T1 and mean 0.95 (SD 0.57) in T2. By contrast, slightly lower mean values were observed for food-borne disease, with mean 0.82 (SD 0.78) in T1 and mean 0.97 (SD 0.67) in T2, as well as for other climate change–related health impacts, with mean 0.79 (SD 0.63) in T1 and mean 0.92 (SD 0.48) in T2.

Overall, the descriptive values suggested that respondents assessed the various health impacts of climate change to a similar extent, both currently and in the future. The SDs varied across the items but were moderate overall, indicating a certain degree of variation within the sample. Descriptively, there were only minor differences between T1 and T2.

The results from T1 and T2 regarding the assessment of health problems at the time of the survey and in 20 years’ time are shown in Table 4.

A total of 78 codes were identified in the qualitative analysis of this section.

Overall, participants described the lecture series positively and highlighted both the interdisciplinary perspective and the digital format as particular strengths.

Participants frequently characterized the sessions as interactive, engaging, and informative. The atmosphere and moderation were described as pleasant, while the invited speakers were perceived as competent and knowledgeable. Participants particularly appreciated the combination of digital health and planetary health perspectives, which many had not previously encountered in an integrated educational format:

The digital format was also perceived as increasing flexibility and enabling exchange among participants and experts from diverse backgrounds. Participants valued the broad overview of the field and described the lecture series as successfully connecting prior knowledge with new perspectives.

Beyond knowledge acquisition, several participants reported that the lecture series stimulated personal reflection and discussions within their social environments regarding the climate crisis and environmental responsibility:

Critical feedback mainly focused on the desire for greater inclusion of topics related to animals and plants, more opportunities for participants’ own research activities, and, in some cases, a more neutral stance from lecturers.

Participants also suggested expanding interactive and research-oriented elements in future iterations of the lecture series.

This study explored participants’ perceptions, attitudes, and knowledge related to digital planetary health before and after participation in a fully digital lecture series. Overall, the findings suggest a high perceived relevance of integrating digital planetary health into higher education curricula. Participants particularly emphasized the importance of addressing climate-related health impacts within university education and highlighted the potential of digital technologies. The survey responses from T1 and T2 further indicate that participation in the lecture series may have contributed to increased awareness of specific climate-related health risks, particularly regarding water- and food-borne diseases. At the same time, qualitative findings revealed a differentiated understanding of digitalization, as participants described both opportunities and challenges associated with digital transformation in relation to sustainability.

In their feedback on the lecture series, the participants stated that the lecture series was positive and encouraged them to reflect on their own behavior and talk about it with friends and family. This finding is particularly important in the training of researchers, as the body of research on the twin transformation, sustainability, and digitalization in the health care sector is rather limited [31]. The survey results underline the relevance of interdisciplinary educational approaches that connect planetary health, digital health, and societal transformation. Universities do not merely have a duty to highlight problems; they must also make their own efforts, for example, by operating within planetary boundaries [32]. McGeown and Barry [33] put it in strong terms: “As producers and gatekeepers of knowledge, and as providers of education and training, our universities play a key role in the reproduction of unsustainability.” To overcome this, it seems sensible to develop new and open formats that bring students and society together to discuss problems and solutions.

The results of the T1 survey show that the participants started the lecture series with a high level of knowledge and awareness of the climate crisis. This self-selection bias has been identified in various studies and must be explicitly addressed and overcome through curriculum planning [34]. For future similar formats, it is of great relevance to reach people who are also active outside this focus and who have been less involved in the field of planetary health to date, for example, by incorporating it directly into the compulsory curriculum of the degree programs. This is consistent with the data collected on engagement in climate protection among the participants in the lecture series: an extrapolation to the whole population in Germany aged 14 years and older, based on a survey of 23,524 participants, reveals that 23% of the population is engaged in climate protection [35]. Of the 180 participants, 63 (35%) in the T1 survey stated that they are engaged in climate protection groups at a moderate or high level.

Another challenge here is that some prior knowledge was necessary to be able to follow the event fully. Both nationally in Germany [36] and internationally [37,38], there are already various educational offerings in the field of planetary health for HCPs. It is now crucial to network these programs, create synergies, and channel existing activism. This requires strategically oriented education, supported by integration into curricula, to increase awareness and reach people who are not yet aware of the issue. It could also be worth considering advertising the event on social media, in print media (daily newspapers), and on the radio. Particularly at a time when AI is being used more and more, the call for a digital planetary health perspective is becoming increasingly urgent [39]. It is desirable that this be implemented jointly by academia and society in the form of transformative science [40].

With regard to the selection of guest lecturers, it should be noted that they were recruited from the lecturers’ network. The involvement of guest experts in lectures ensures a good balance between theory and practice, thereby fostering both a love of learning and the application of knowledge [41]. While there was a lack of remuneration, lecturers gained value through interaction with the participants. To prevent excessive subjectification, a meeting with the lecturers and guest lecturers took place beforehand, and a guideline on scientific working methods and gender-sensitive formulations was provided. The possibility of offering a wide variety by inviting experts in combination with its own sessions was judged to outweigh the risk of subjectification in the previous consideration. In addition, the discussion offered the opportunity to organize the content at any time. It has also become apparent in other fields that the multiperspective approach offered by various guest lecturers leads to holistic learning success among lecture attendees [42].

From a behavioral psychology perspective, the changes observed in participants following a lecture series such as this can be explained by several mechanisms. For instance, a review by Dolcos et al [43] shows that emotions, or emotionally charged content, can significantly enhance both attention and episodic long-term memory. Building on this, Immordino-Young and Damasio [44] emphasize that the close link between emotion and cognition, which is continuously at work in the processing of external stimuli, forms a central basis for moral and ethical judgment.

Against this backdrop, the lecture series focused thematically on future prospects and the risks of the climate crisis. At the same time, the program was deliberately designed to highlight not only problem areas but also concrete solutions and individual opportunities for action to strengthen a sense of collective efficacy. This approach aligns with the guiding principles of Education for Sustainable Development, which aim to empower people to actively shape sustainable transformation processes. The results indicate possible starting points for these changes, but they should be viewed as trends.

A clear example of the link described above is provided by the third session, in which the German Sustainability Code and its practical implementation were presented. Overall, the lecture series thus aims to foster students’ moral judgment and values through engagement with ethical issues. At the same time, they are encouraged to develop their own positions and to critically engage with different perspectives [45].

In addition to the individual options for action identified, a dynamic also developed during the lecture series that led to further synergies. Several ideas for qualification projects have emerged and are being actively worked on today [46]. There have been various invitations and opportunities at conferences to present the lecture series and engage in discussions about it [47]. In December 2023, the team received the 1st Humboldtⁿ Prize for Sustainability ( 1. Humboldtⁿ-Preis für Nachhaltigkeit) for the lecture series itself. A concept for a lecture series on human-animal relationships was developed based on course discussions and implemented in subsequent semesters to revisit the many facets of this topic. Accompanying research was also carried out, focusing particularly on changes in participants’ attitudes and knowledge [48,49].

When looking at the results, several limitations should be considered. First, it is important to note that 86.1% (155/180) of the participants in the T1 survey were students. Opening up the event and promoting it to the wider community proved challenging during implementation. While students from various universities were attracted, the proportion of citizens as participants was very low. In addition, more people from the field of health care were reached. The target group of the lecture series—(future) HCPs—consists of trusted contact persons for their patients and communities. They are, therefore, an important and critical target group to inform and educate about the complex dynamics of climate change [50]. Second, participation in the lecture series was voluntary, so self-selection bias is likely, as individuals already interested in planetary health, sustainability, or digital medicine may have been more likely to participate. Third, reliable longitudinal matching between T1 and T2 was not possible, thereby limiting the assessment of a causal effect of the lecture series. Moreover, the study lacked a control group, which limits causal interpretation. Possible ceiling effects due to high baseline awareness, as well as social desirability in self-reported responses, may also have influenced the findings.

Future surveys should track whether students also take advantage of other learning opportunities on the topics of planetary health and digital medicine outside of the lecture series during the survey period.

This study shows that attendees of the digital lecture series perceived digital planetary health as highly relevant to university education. The lecture series was positively received, particularly regarding its interdisciplinary perspective, digital accessibility, and the integration of planetary health and digital medicine. The comparison of T1 and T2 responses showed exploratory group-level differences in selected perceptions of climate-related health impacts. These findings support the importance of further integrating digital planetary health into university teaching.