Characteristics of Users and Nonusers of Symptom Checkers in Germany: Cross-Sectional Survey Study

Abstract

Background Previous studies have revealed that users of symptom checkers (SCs, apps that support self-diagnosis and self-triage) are predominantly female, are younger than average, and have higher levels of formal education. Little data are available for Germany, and no study has so far compared usage patterns with people’s awareness of SCs and the perception of usefulness. Objective We explored the sociodemographic and individual characteristics that are associated with the awareness, usage, and perceived usefulness of SCs in the German population. Methods We conducted a cross-sectional online survey among 1084 German residents in July 2022 regarding personal characteristics and people’s awareness and usage of SCs. Using random sampling from a commercial panel, we collected participant responses stratified by gender, state of residence, income, and age to reflect the German population. We analyzed the collected data exploratively. Results Of all respondents, 16.3% (177/1084) were aware of SCs and 6.5% (71/1084) had used them before. Those aware of SCs were younger (mean 38.8, SD 14.6 years, vs mean 48.3, SD 15.7 years), were more often female (107/177, 60.5%, vs 453/907, 49.9%), and had higher formal education levels (eg, 72/177, 40.7%, vs 238/907, 26.2%, with a university/college degree) than those unaware. The same observation applied to users compared to nonusers. It disappeared, however, when comparing users to nonusers who were aware of SCs. Among users, 40.8% (29/71) considered these tools useful. Those considering them useful reported higher self-efficacy (mean 4.21, SD 0.66, vs mean 3.63, SD 0.81, on a scale of 1-5) and a higher net household income (mean EUR 2591.63, SD EUR 1103.96 [mean US $2798.96, SD US $1192.28], vs mean EUR 1626.60, SD EUR 649.05 [mean US $1756.73, SD US $700.97]) than those who considered them not useful. More women considered SCs unhelpful (13/44, 29.5%) compared to men (4/26, 15.4%). Conclusions Concurring with studies from other countries, our findings show associations between sociodemographic characteristics and SC usage in a German sample: users were on average younger, of higher socioeconomic status, and more commonly female compared to nonusers. However, usage cannot be explained by sociodemographic differences alone. It rather seems that sociodemographics explain who is or is not aware of the technology, but those who are aware of SCs are equally likely to use them, independently of sociodemographic differences. Although in some groups (eg, people with anxiety disorder), more participants reported to know and use SCs, they tended to perceive them as less useful. In other groups (eg, male participants), fewer respondents were aware of SCs, but those who used them perceived them to be more useful. Thus, SCs should be designed to fit specific user needs, and strategies should be developed to help reach individuals who could benefit but are not aware of SCs yet.

An interface between ehealth, health literacy and health-related behavior: Qualitative interview study on laypersons experiences with a mobile symptom checker app (Preprint)

“…In a substudy of the CHECK.APP project, Müller distinguished between user expectations and motivations for app use and found that these factors play a role in SCA use [34]. In fact, according to Kopka's sample, 33% of SCA users reported that SCA's usefulness varied [52]. Turner et al conducted a study on an online SCA and found that users were dissatisfied with SCA, because too little information on about what to do themselves was given [51].…”

symptomcheckR: an R package for analyzing and visualizing symptom checker performance

“…Symptom checkers--systems in which laypeople input symptoms to receive potential diagnoses and triage advice (1)-are gaining popularity and drawing attention among health professionals and lay users as well as in the research community (2)(3)(4). Research in this field focuses, on one hand, on the potential impact of symptom checkers on individual users and healthcare systems (5)(6)(7)(8)(9)(10)(11)(12)(13), and on the accuracy of these systems on the other (2,3,(14)(15)(16)(17). For users, it is crucial that symptom checkers give safe advice and prevent potential harm (18), whereas for healthcare systems overtriage could inflate costs and strain scarce resources (e.g., due to unnecessary emergency department visits) (5,14).…”

Evaluating self-triage accuracy of laypeople, symptom-assessment apps, and large language models: A framework for case vignette development using a representative design approach (RepVig)

“…Symptom-assessment applications (SAAs) are digital health tools that assist medical laypeople in self-diagnosing and determining whether and where to seek health care (self-triage) 1,2 . Whereas some research in this domain focuses on how SAAs impact health systems or on how to improve their usability and user experience 2–7 , a significant portion of studies investigates the accuracy of SAAs 8,9 . This line of research started with Semigran et al in 2015, 10 who developed 45 case vignettes to systematically test and compare the accuracy of SAAs.…”