Survey In Europe Research Articles

3.X.1. Health literacy in Europe: Building a comparative database for shaping public health policy

Abstract Health literacy (HL) is a key determinant of health and a lever for health equity. It refers to the extent to which individuals are able to deal with health-related information, communicate with health professionals, and navigate the health care system to restore, maintain, protect, and improve their health and well-being. It is the result of an interplay between personal motivation, individual competencies and the health information and service environment. HL is strongly related to health behaviors and issues such as obesity, the social determinants of health, and the use of health systems, which have been under pressure since COVID-19. The development and implementation of targeted public health interventions to promote HL in the European Region require reliable and comparable data on population HL to identify the main HL challenges and the most affected population groups. The WHO Action Network on Measuring Population and Organizational Health Literacy (M-POHL) has started monitoring population HL and conducted the first M-POHL Health Literacy Survey (HLS19) in 17 countries in the WHO European Region between 2019 and 2021. In preparation for the 2nd M-POHL Health Literacy Survey (2024-2026; HLS24), the HLS19 instruments were further improved and supplemented by a new measure on mental HL. These instruments are also of interest to the European Joint Action PreventNCD with its specific task on HL and non-communicable diseases (7.4). The workshop will provide insights into the M-POHL HLS24, the largest HL survey in Europe, and the HL instruments used. It consists of four presentations, one describing the M-POHL HLS24 project and three on specific HL instruments used to assess different aspects of HL in the European general population: HLS24-DIGI for digital HL; HLS24-COM-P for communicative HL; HLS24-NAV for navigational HL. Each presentation will describe the revised item set and results from pretests. We invite the audience to ask questions and to engage in a (cross-cutting) discussion with the presenters. Expected impact: The presentations will provide a comprehensive overview of the advanced family of instruments used in the HLS24 study, their quality, and the expected HL data for Europe. They will provide a deeper understanding of how HL will be measured in the M-POHL HLS24 project. Key messages • The advanced family of HL instruments used in the M-POHL HLS24 project enables comprehensive HL monitoring in Europe. • The data collected in HLS24 will provide a solid database for shaping public health policy to strengthen population HL and promote health equity in Europe.

Exploring European Parents’ Attitudes Towards the Age Appropriateness of Digital Sexuality Education for Adolescents

We conducted a multinational cross-sectional survey in Europe to explore parental attitudes toward the appropriate age for adolescents to receive sexuality education through an app interface. This was delivered via an online survey across Belgium (n = 479), the United Kingdom (n = 445), and Italy (n = 454). Parents from Belgium consistently accepted their children accessing digital material at the youngest ages, whereas Italian participants selected the oldest age groups. Most parents, however,endorsed a spiral curriculum, whereby topics are introduced sequentially throughout adolescents’ school careers. Thus, whilst on average participants were comfortable with adolescents having access to content on body anatomy younger ages (from 9–12 years to 12–15 years), they approved virtual content on relationships and sex at older school ages (from 12–15 years to 15–18 years). European ethnicity, liberal sociosexual attitudes, lower religiosity, and higher educational attainment were associated with parents approving adolescent exposure to digital sex education at younger ages. To our knowledge, this exploratory study is the first to quantitatively examine parental attitudes toward digital sex education curricula, as well as explore the parental characteristics that relate to these attitudes. This work should inform educators internationally on their future efforts to deploy virtual sexuality learning.

Alopecia Areata Treatment Patterns and Satisfaction: Results of a Real-World Cross-Sectional Survey in Europe.

Alopecia areata (AA) is an autoimmune disease that causes scalp, face, and/or body hair loss. Recently, oral treatments with kinases inhibition became the first approved therapies for severe AA. An understanding of the use and effectiveness of traditional therapies in real-world treatment settings is needed to guide integration of novel therapies into the treatment paradigm. This study aimed to describe traditional treatment patterns, dermatologists' reasons for therapy choice, and dermatologists' satisfaction with disease control among patients with AA. Data were drawn from the 2021-2022 Adelphi Real World AA Disease Specific Programme™, a cross-sectional survey of dermatologists and adult patients with AA, conducted in France, Germany, Italy, Spain, and the UK. For each patient, using data from patient consultation and medical records, dermatologists reported % scalp hair loss (SHL), characteristics of current and prior AA therapies, and satisfaction with disease control. Overall, 239 dermatologists provided data for 1720 patients with AA. Mean (SD) patient age was 35.8 (11.6) years, and 51% were male. Based on dermatologist perception, among patients with ≤ 10% SHL, 74% were experiencing mild AA, while ≥ 95% of patients with ≥ 50% SHL were experiencing severe/very severe AA. In patients with ≥ 50% SHL, the most common therapies received included systemic immunosuppressants (31%), topical corticosteroids (24%), and oral corticosteroids (24%). Among all patients who had switched therapies, 49%, 26%, and 24% switched because of worsening AA, lack of initial efficacy with prior treatment, and loss of response over time, respectively. Among those with SHL ≥ 50%, dermatologists reported satisfaction with current therapy in < 30% of patients. Dermatologists reported low satisfaction with traditional AA therapies used in patients with extensive SHL, with some patients discontinuing treatment because of worsening disease. This suggests more effective treatments are needed for patients with severe AA.

Chronic kidney disease–associated pruritus: a comparison of instruments and associations with patient-reported outcomes using an electronic patient-reported outcome survey in Europe

ABSTRACT Background The associations between self-reported chronic kidney disease–associated pruritus (CKD-aP) and patient-reported outcomes (PROs) have been reported using various instruments to assess itch. Data collection via multiple CKD-aP instruments allows the evaluation of different domains and measurements of CKD-aP burden and may help tailor data capture for future research or clinical care. Methods An electronic PRO (ePRO) survey was distributed to European hemodialysis (HD) patients enrolled in the Dialysis Outcomes and Practice Patterns Study (DOPPS) in 2021–23. The DOPPS is an international cohort study that aims to investigate practice patterns and outcomes in HD patients. The ePRO survey included multiple CKD-aP instruments: Average Itch and Worst Itching Intensity Numerical Rating Scales (AI-NRS, WI-NRS) and a Kidney Disease Quality of Life (KDQOL)-36 single question. Linear and logistic regression were used to estimate adjusted associations between CKD-aP instruments and various PROs. Results This analysis included 769 patients who completed the WI-NRS from HD facilities in France, Germany, Italy, Spain, Sweden and the UK. The correlation between WI-NRS and the KDQOL-36 itch question was 0.88 overall and 0.46 among patients at least somewhat bothered by itch. Mean WI-NRS scores stratified by response to the KDQOL-36 itch question were 8.1, 6.4, 4.1 and 3.1 for extremely, very much, moderately and somewhat bothered, respectively. Patients with worse WI-NRS scores reported worse sleep quality, greater fatigue, more depressive symptoms, and lower mental and physical quality of life; these associations were similar to those observed for the KDQOL-36 itch question. Conclusion Correlation between CKD-aP instruments was high overall, but moderate among the subgroup of patients bothered by itch; differences can be partially attributed to the recall period for the KDQOL-36 (4 weeks) vs the AI- and WI-NRS (24 h). The consistent associations of these instruments with poor outcomes underscores the importance to identify and effectively treat HD patients suffering from pruritus.

Nocebo belief and attitudes towards side effect disclosure: A general population-based online survey in Europe and North America.

With evidence for large nocebo effects in pain, guidelines for nocebo-minimizing strategies regarding side effect disclosure are emerging. While the ethical implications and effectiveness of such strategies have been the subject of investigations, the perspective of healthcare users are missing despite the stakes for patient autonomy. In an online survey, 2766 adults (≥18 years) from a general population sample in Europe and North America responded to questions related to nocebo familiarity, nocebo beliefs and attitudes towards side effect disclosure. Only 474 (17%) were familiar with nocebo terminology, while 1379 (50%) were familiar with the concept of nocebo side effects. Belief in nocebo side effects was not well-established; 738 (31%) agreed that side effect information could increase side effect occurrence. Nocebo belief was associated with more negative attitudes towards side effect disclosure and 1962 (73%) indicated that positive framing was an acceptable way of disclosing side effect information. In general, the majority of participants (65-76%) held positive attitudes towards the disclosure of all potential side effects and 2309 (84%) favoured patient autonomy over nonmaleficence. Although the general patterns were similar in the European and North American sample, the latter showed stronger nocebo belief and stronger positive attitudes towards side effect disclosure. The study found a consistent, moderate association between nocebo belief and attitudes towards nondisclosure, alongside positive attitudes towards the use of framing. Together with the discovered discrepancy between nocebo familiarity and nocebo belief, these findings have implications for the implementation of nocebo education and risk framing strategies. This is the first large-scale, general population-based study to contribute to the scientific discussion about nocebo side effects from the perspective of healthcare users. The findings have implications for the discussion on how to handle the medical and ethical problem of nocebo side effects in clinical practice.

Bridging the Green Gap in Homesharing: How Platforms Can Increase Hosts’ Sustainability Intentions and Behavior

Homesharing platforms are under substantive pressure to become more environmentally sustainable. Key to this challenge is these platforms’ homesharing hosts, who have the opportunity to introduce new sustainability innovations (e.g., water-saving measures). However, knowledge of what drives hosts’ sustainability behavior is currently limited. We address this gap and investigate antecedents for hosts’ sustainability intentions. Our study is based on a survey in Europe (conducted in 12 languages), resulting in a sample of 1,392 hosts. Building on the theory of planned behavior, we perform three analyses: (a) quantitative and theory testing, (b) quantitative and explorative, and (c) qualitative and explorative. Notably, we find that attitude and norms, as well as financial resources and time, are the main drivers of hosts’ sustainability intentions. In addition, the presence of local service offices (i.e., a platform business model that internalizes service operations from hosts) moderates the effects of sustainability antecedents.

Disease landscape of advanced HER2-breast cancer patients by treatment line in three EU countries and USA.

Aim: To report treatment patterns and quality of life (QoL) in HER2-negative advanced breast cancer patients.Methods: Data were drawn from a cross-sectional survey in Europe and USA.Results: Hormone plus targeted therapy was the most frequent first-line (1L, 62%) and second-line (2L, 45%) treatment for HR+/HER2-patients. Chemotherapy was most frequent at third-line or greater (3L+, 39%) for HR+/HER2- patients, 2L (51%) and 3L+ (48%) for triple negative breast cancer (TNBC) patients. Time to progression was 13.8 (2L) and 11.0 (3L+) months for HR+/HER2- patients. No comparisons were observed for TNBC patients. EQ-5D-5L scores were highest in patients at 1L and lowest at 3L+.Conclusion: Reduced QoL and treatment response were reported in patients at later lines of therapy.

Dose-Dependent Association Between Body Mass Index and Mental Health and Changes Over Time

Overweight and obesity affect 340 million adolescents worldwide and constitute a risk factor for poor mental health. Understanding the association between body mass index (BMI) and mental health in adolescents may help to address rising mental health issues; however, existing studies lack comprehensive evaluations spanning diverse countries and periods. To estimate the association between BMI and mental health and examine changes over time from 2002 to 2018. This was a repeated multicountry cross-sectional study conducted between 2002 and 2018 and utilizing data from the Health Behaviour in School-aged Children (HBSC) survey in Europe and North America. The study population consisted of more than 1 million adolescents aged 11 to 15 years, with all surveyed children included in the analysis. Data were analyzed from October 2022 to March 2023. Mental health difficulties were measured by an 8-item scale for psychological concerns, scoring from 0 to 32, where a higher score reflects greater psychosomatic issues. BMI was calculated using weight divided by height squared and adjusted for age and sex. Data were fitted by multilevel generalized additive model. Confounders included sex, living with parents, sibling presence, academic pressure, the experience of being bullied, family affluence, screen time, and physical activity. Our analysis of 1 036 869 adolescents surveyed from 2002 to 2018, with a mean (SD) age of 13.55 (1.64) years and comprising 527 585 girls (50.9%), revealed a consistent U-shaped association between BMI and mental health. After accounting for confounders, adolescents with low body mass and overweight or obesity had increased psychosomatic symptoms compared to those with healthy weight (unstandardized β, 0.14; 95% CI, 0.08 to 0.19; unstandardized β, 0.27; 95% CI, 0.24 to 0.30; and unstandardized β, 0.62; 95% CI, 0.56 to 0.67, respectively), while adolescents with underweight had fewer symptoms (unstandardized β, -0.18; 95% CI, -0.22 to -0.15). This association was observed across different years, sex, and grade, indicating a broad relevance to adolescent mental health. Compared to 2002, psychosomatic concerns increased significantly in 2006 (unstandardized β, 0.19; 95% CI, 0.11 to 0.26), 2010 (unstandardized β, 0.14; 95% CI, 0.07 to 0.22), 2014 (unstandardized β, 0.48; 95% CI, 0.40 to 0.56), and 2018 (unstandardized β, 0.82; 95% CI, 0.74 to 0.89). Girls reported significantly higher psychosomatic concerns than boys (unstandardized β, 2.27; 95% CI, 2.25 to 2.30). Compared to primary school, psychosomatic concerns rose significantly in middle school (unstandardized β, 1.15; 95% CI, 1.12 to 1.18) and in high school (unstandardized β, 2.12; 95% CI, 2.09 to 2.15). Our study revealed a U-shaped association between adolescent BMI and mental health, which was consistent across sex and grades and became stronger over time. These insights emphasize the need for targeted interventions addressing body image and mental health, and call for further research into underlying mechanisms.

Neurosonology Survey in Europe and Beyond.

Purpose To provide an overview on education, training, practice requirements, and fields of application of neurosonology in Europe and beyond. Materials and Methods National representatives and experts in neurosonology were surveyed regarding neurosonology requirements and practice in their countries. Descriptive statistics were used to report the data. Results Between February 1 and March 31, 2023, 42/46 (91.3%) national representatives responded to our questionnaire and the completion rate was 100%. Most countries (71.4%) offer a neurosonology training program during neurology residency, but it is part of the undergraduate medical program only in 30.9%. National certification is available in 47.6% of the countries surveyed and most countries (76.2%) require certification to practice. In 50% of the countries, candidates are assessed by a board examination, while in 26.2% they just need to document their practice. There is no formal accreditation of neurosonology centers in 78.6% of the countries surveyed. Only a few require certified personnel and appropriate equipment. Adequate teaching and research activities are only rarely necessary elements for laboratory accreditation. Conclusion Our results indicate that there is a substantial need for transnational harmonization of neurosonological standards to guarantee uniformity and quality of performance. This survey will also provide guidance to promote an international accrediting council and create a quality-controlled laboratory network for implementing neurosonology in clinical trials.

Shared Decision-Making in the Treatment of Multiple Sclerosis: Results of a Cross-Sectional, Real-World Survey in Europe and the United States.

Multiple sclerosis (MS) is a neurodegenerative disease characterized by progressive deterioration of cognitive and physical functioning, reducing activities of daily living and quality of life (QoL). Several treatments are available that modify the course of the disease and reduce the frequency of relapses. Although effective, all treatment options are accompanied by adverse events, and this study aimed to assess the extent to which patients were involved in the choice of treatment. Data were drawn from the Adelphi Multiple Sclerosis Disease Specific Program (DSP)™, a cross-sectional survey of healthcare practitioners (HCP) and their patients with MS in real-world clinical settings in Europe and the United States (US) between December 2020 and July 2021. HCPs reported patient demographics, clinical characteristics, current and previous treatment, and treatment outcomes. Patients voluntarily completed questionnaires reporting the physical and psychological impact of their MS and its treatment. Regression analysis with inverse probability of treatment weighting was used to compare treatment outcomes in patients actively involved in their current treatment choice with those who were not. Of a total of 692 patients, median age 40 years and 64% female, mostly diagnosed with relapsing-remitting MS, those who were involved in shared decision-making tended to choose oral therapies such as dimethyl fumarate more often than HCPs. MS had greater impact on physical and psychological functioning in patients whose HCP made treatment decisions solely. Patients involved in decision-making reported greater satisfaction with their treatment and a better QoL. Because no single optimal therapy exists for patients with MS, treatments should be individualized with consideration of patients' preferences. Our study shows that shared decision-making is under-utilized in the management of MS and supports the benefits of patient involvement. Patients who have an active role in treatment decision-making show improved wellbeing and QoL, and overall treatment satisfaction.

PCR141 The Impact of Duchenne Muscular Dystrophy on Caregiver Employment: A Survey in Europe, Japan, and the United States

PCR141 The Impact of Duchenne Muscular Dystrophy on Caregiver Employment: A Survey in Europe, Japan, and the United States

Wellbeing at home: a mediation analysis of residential satisfaction, comfort, and home attachment

AbstractIn the study of residential satisfaction in architectural design different physical comfort domains have received the most attention. But with this comfort-driven approach, residential satisfaction is reduced to a psychophysical relationship. Adding psychological substance to the design process, the paper argues that a distinction should be made between residential satisfaction and home attachment and that we need to consider home attachment as a mediator variable for comfort. The aim of the paper is to empirically assess whether the mediation, if it exists at all, is partial or complete. Distinguishing different forms of comfort, a set of alternative structural equation models are tested with data from a 14-nation population survey in Europe. The result of the model tests is that our wellbeing at home comes in two forms—satisfaction and attachment—and that there is partial as well as complete mediation of home attachment on satisfaction depending on the kind of comfort studied.

125P Real-world treatment patterns in patients with biliary tract cancer (BTC): Retrospective chart review survey in Europe (GARNET-2)

125P Real-world treatment patterns in patients with biliary tract cancer (BTC): Retrospective chart review survey in Europe (GARNET-2)

Employment over the life course and post-retirement social networks: a gendered perspective.

The present study examines how different lifelong employment patterns are related to social relationships in old age, and whether there are gender differences in the impact of lifelong employment patterns. The study was based on data collected among European adults as part of the Health, Aging and Retirement Survey in Europe (SHARE) and focuses on retired adults. The study combines data on social relationships, collected in 2015, with retrospective data on employment history (number of jobs and years of employment) collected in 2017. The findings show that adults who worked in more jobs had overall better structural characteristics of their later life networks - they had larger social networks and were more likely to include children and friends within those networks but less likely to include their spouse. On the other hand, working in more jobs was related to less emotional closeness with the network. These results varied between men and women; women who were involved in the labor market over their life had larger social networks and tended to include friends as confidants. Among men, working for more years was related to higher emotional closeness with the social network. The study may indicate a gendered pattern of social advantages and disadvantages to involvement in the labor market over the work course. Practitioners should consider the lifelong employment of adults to identify those who might be at risk of social isolation.

Consumers' sensory-based cognitions of currently available and ideal plant-based food alternatives: A survey in Western, Central and Northern Europe

Sensory experiences of plant-based (PB) food alternatives play a crucial role in the acceptance and, thus, growth of this market. To facilitate improvements and to better direct the PB food product development, it is important to identify potential gaps in consumers' sensory-based cognition between currently available and their ideal version of PB food and beverage alternatives. Sensory benchmarking of PB alternatives to chicken, beef, semi-hard cheese, cream cheese, yoghurt and milk was studied via (part 1) a sensory vocabulary development and, subsequently, (part 2) an online survey (n = 416–1829) in Central, Western and Northern European countries using the rapid sensory descriptive method Rate-All-That-Apply. For the PB milk and yoghurt categories, consumers demanded only minor sensory modifications, specifically, towards a less beany and sweet taste. In addition, PB milk and yoghurt alternatives received high liking scores (7.1 and 7.0 out of 9, respectively). Lower liking scores were reported for PB semi-hard cheese alternatives (5.3 out of 9). Sensory improvements of PB semi-hard cheese alternatives should be directed towards more cheese-like, less artificial and less bland attributes. For PB beef alternatives, the products in the category should have a more umami taste and beef-like taste and odour. A more chicken-like taste, texture and odour is desired for PB chicken alternatives. A more balanced, cheesier, less artificial taste and odour is desired for cream cheese alternatives. These findings provide strategic insights to direct the product development of PB food alternatives, which constitutes a pathway for creating new market opportunities considering consumer demand and sensory preferences.

Assessing the performance of marine plastics cleanup technologies in Europe and North America

This study fills an important gap in policymaker understanding of the effectiveness and implementation costs of marine plastic cleanup technologies. Previous studies have mainly listed inventories of different plastic litter cleanup technologies, not systematically examined their cost-effectiveness. Through a survey in Europe and North America that asked for cost and cleanup capacity data, per kilogram cost figures were calculated for several categories of cleanup technologies, ranging from fixed-in-place filters in stormwater drainage systems to mobile skimmers on water. Mobile skimmers and dredgers appear to be most cost-effective. Adding performance criteria related to operational conditions and ease of use, such as energy use and economies of scale, dredgers and stormwater filters rank higher. Litter traps in drainage systems are most preferred when furthermore considering weather sensitivity and whether technologies operate standalone, making them an interesting complementary technology to skimmers and dredgers to prevent plastic litter from entering water courses. These results show how sensitive the outcome of the ranking is to the inclusion of additional operational criteria, how different categories of technologies can effectively be combined in the plastic waste supply chain, and what the cost implications are for the future upscaling of plastic litter cleanup technologies.

Management of comatose survivors of out-of-hospital cardiac arrest in Europe: current treatment practice and adherence to guidelines. A joint survey by the Association for Acute CardioVascular Care (ACVC) of the ESC, the European Resuscitation Council (ERC), the European Society for Emergency Medicine (EUSEM), and the European Society of Intensive Care Medicine (ESICM).

International guidelines give recommendations for the management of comatose out-of-hospital cardiac arrest (OHCA) survivors. We aimed to investigate adherence to guidelines and disparities in the treatment of OHCA in hospitals in Europe. A web-based, multi-institutional, multinational survey in Europe was conducted using an electronic platform with a predefined questionnaire developed by experts in post-resuscitation care. The survey was disseminated to all members of the societies via email, social media, websites, and newsletters in June 2021. Of 252 answers received, 237 responses from different units were included and 166 (70%) were from cardiac arrest centres. First-line vasopressor used was noradrenaline in 195 (83%) and the first-line inotrope was dobutamine in 148 (64%) of the responses. Echocardiography is available 24/7 in 204 (87%) institutions. Targeted temperature management was used in 160 (75%) institutions for adult comatose survivors of OHCA with an initial shockable rhythm. Invasive or external cooling methods with feedback were used in 72 cardiac arrest centres (44%) and 17 (24%) non-cardiac arrest centres (P < 0.0003). A target temperature between 32 and 34°C was preferred by 46 centres (21%); a target between 34 and 36°C by 103 centres (52%); and <37.5°C by 35 (16%). Multimodal neuroprognostication was poorly implemented and a follow-up at 3 months after discharge was done in 71 (30%) institutions. Post-resuscitation care is not well established and varies among centres in European hospitals. Cardiac arrest centres have a higher coherence with guidelines compared with respondents from non-cardiac arrest centres. The overall inconsistency in approaches and deviation from recommendations could be a focus for improvement.

Relationship between Health Literacy and Simulation Learning in Korean Nursing Students

BackgroundNurses’ health literacy (HL) may be related to communication and patient safety. This study aimed to identify nursing students’ HL and determine its relationship with learning via simulation. MethodSelf-reported questionnaires, including the HL Survey in Europe, Student Satisfaction and Self-Confidence in Learning, Simulation Design Scale (objectives and information support, problem-solving, feedback, guided reflection, and fidelity/realism), and Nursing Educational Practices Questionnaire (active learning, collaboration, diverse way of learning, and high expectation), were used to collect data from 123 nursing students from four colleges in Korea. ResultsThe average HL index was 37.36 (sufficient); however, 33.3% of the participants had limited HL. Nursing students’ HL was related to simulation design, educational practices, and learners’ confidence. ConclusionIn nursing education, higher HL among nursing students is associated with effective design and teaching methods of simulation.

Occupational Therapists and COVID-19 Pandemic: An Observational Survey in Europe

Background: The COVID-19 pandemic has resulted in a health care emergency in Europe since the first wave in 2020. Several challenges have arisen for occupational therapists, as well as all the health care professionals. The aim of this study was to determine what occupational therapists have changed to adapt their therapeutic processes for this catastrophic situation.

Toward enhancing the information base on costs of cyber incidents: implications from literature and a large-scale survey conducted in Germany

PurposeLiterature repeatedly complains about the lack of empirical data on the costs of cyber incidents within organizations. Simultaneously, managers urgently require transparent and reliable data in order to make well-informed and cost-benefit optimized decisions. The purpose of this paper is to (1) provide managers with differentiated empirical data on costs, and (2) derive an activity plan for organizations, the government and academia to improve the information base on the costs of cyber incidents.Design/methodology/approachThe authors analyze the benchmark potential of costs within existing literature and conduct a large-scale interview survey with 5,000 German organizations. These costs are directly assignable to the most severe incident within the last 12 months, further categorized into attack types, cost items, employee classes and industry types. Based on previous literature, expert interviews and the empirical results, the authors draft an activity plan containing further research questions and action items.FindingsThe findings indicate that the majority of organizations suffer little to no costs, whereas only a small proportion suffers high costs. However, organizations are not affected equally since prevalence rates and costs according to attack types, employee classes, and other variables tend to vary. Moreover, the findings indicate that board members and IS/IT-managers show partly different response behaviors.Originality/valueThe authors present differentiated insights into the direct costs of cyber incidents, based on the authors' knowledge, this is the largest empirical survey in continental Europe and one of the first surveys providing in-depth cost information on German organizations.