Ethical, Legal, and Social Implications of Symptom Checker Apps in Primary Health Care (CHECK.APP): Protocol for an Interdisciplinary Mixed Methods Study

Wetzel, Anna-Jasmin; Koch, Roland; Preiser, Christine; Mueller, Regina; Klemmt, Malte; Ranisch, Robert; Ehni, Hans‐Jörg; Wiesing, Urban; Henking, Tanja; Joos, Stefanie

doi:10.2196/34026

Cited by 14 publications

(6 citation statements)

References 47 publications

(59 reference statements)

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“…Even though the themes of our scoping review touched upon the factors identified in established models of work-related perceived stress such as work content or work organization, we did not find any results concerning HCPs’ job satisfaction or perceived work-related stress explicitly with regard to SCs. Against this background, a subproject of the current research network CHECK.APP [ 33 ] focuses on this topic using a qualitative research approach.…”

Section: Discussionmentioning

confidence: 99%

“…The results of the analysis were discussed by the research team (EÖ, NR, CP, and MAR) to find an agreement for the final set of findings. The themes were then validated by 2 researchers (NR and CP), and methodological questions were discussed with a research partner from the research network CHECK.APP (AJW) [ 33 ], with which this work is associated but not funded.…”

Section: Methodsmentioning

confidence: 99%

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Impacts of Symptom Checkers for Laypersons’ Self-diagnosis on Physicians in Primary Care: Scoping Review

Radionova¹,

Ög²,

Wetzel³

et al. 2023

J Med Internet Res

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Background Symptom checkers (SCs) for laypersons’ self-assessment and preliminary self-diagnosis are widely used by the public. Little is known about the impact of these tools on health care professionals (HCPs) in primary care and their work. This is relevant to understanding how technological changes might affect the working world and how this is linked to work-related psychosocial demands and resources for HCPs. Objective This scoping review aimed to systematically explore the existing publications on the impacts of SCs on HCPs in primary care and to identify knowledge gaps. Methods We used the Arksey and O’Malley framework. We based our search string on the participant, concept, and context scheme and searched PubMed (MEDLINE) and CINAHL in January and June 2021. We performed a reference search in August 2021 and a manual search in November 2021. We included publications of peer-reviewed journals that focused on artificial intelligence- or algorithm-based self-diagnosing apps and tools for laypersons and had primary care or nonclinical settings as a relevant context. The characteristics of these studies were described numerically. We used thematic analysis to identify core themes. We followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist to report the study. Results Of the 2729 publications identified through initial and follow-up database searches, 43 full texts were screened for eligibility, of which 9 were included. Further 8 publications were included through manual search. Two publications were excluded after receiving feedback in the peer-review process. Fifteen publications were included in the final sample, which comprised 5 (33%) commentaries or nonresearch publications, 3 (20%) literature reviews, and 7 (47%) research publications. The earliest publications stemmed from 2015. We identified 5 themes. The theme finding prediagnosis comprised the comparison between SCs and physicians. We identified the performance of the diagnosis and the relevance of human factors as topics. In the theme layperson-technology relationship, we identified potentials for laypersons’ empowerment and harm through SCs. Our analysis showed potential disruptions of the physician-patient relationship and uncontested roles of HCPs in the theme (impacts on) physician-patient relationship. In the theme impacts on HCPs’ tasks, we described the reduction or increase in HCPs’ workload. We identified potential transformations of HCPs’ work and impacts on the health care system in the theme future role of SCs in health care. Conclusions The scoping review approach was suitable for this new field of research. The heterogeneity of technologies and wordings was challenging. We identified research gaps in the literature regarding the impact of artificial intelligence– or algorithm-based self-diagnosing apps or tools on the work of HCPs in primary care. Further empirical studies on HCPs’ lived experiences are needed, as the current literature depicts expectations rather than empirical findings.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Impacts of Symptom Checkers for Laypersons’ Self-diagnosis on Physicians in Primary Care: Scoping Review

Radionova¹,

Ög²,

Wetzel³

et al. 2023

J Med Internet Res

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“…This study is embedded in the larger context of the joint project "Ethical, Legal, and Social Implications of Symptom Checker Apps in Primary Health Care" (Acronym CHECK.APP) [42]. The CHECK.APP project is based on a mixed-methods design and has four foci (1: Ethical, legal, and social issues, 2: Epidemiology of SCA use and predictors of use, 3: Patterns of SCA use and impact on individuals, 4: Impact of SCA use on the health care system and health care workers).…”

Section: Study Design and Sampling Strategymentioning

confidence: 99%

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

Koch,

Steffen,

Wetzel

et al. 2024

Preprint

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BACKGROUND Symptom checkers are designed to support their users in recognizing medical symptoms and recommending courses of action. The applications are not yet reliable for self-triage and diagnostics. Users (e-)health literacy plays a role in how symptom checkers are used, but it is unclear how the process from symptom via application input to consulting health care works. OBJECTIVE The aim of this study is to describe symptom checker use from the perspective of laypersons. Three research questions are addressed: 1) How do users describe the process of using symptom checkers? 2) What are entry points and possible outcomes of symptom checker app use? 3) How are health literacy and e-health literacy expressed during the use of SCA? METHODS As part of the CHECK.APP project, 15 medical laypersons were interviewed about their experiences with a specific symptom checker using an interview guideline. The transcripts of the interviews were analyzed using the integrative basic procedure. It combined an analysis of social positioning and agency with Achtziger and Gollwitzer's Rubicon model as concrete heuristics. RESULTS App use corresponds to a cyclic process. Its initiation depends on biographical, social and contextual factors. Users employed symptom checkers for three purposes: Information gathering, action recommendation and communication. They integrate various social, personal and digital resources in their health-related behavior. Their evaluation of the use process depends on context factors, app output and the result of their health-related behavior. CONCLUSIONS Health literacy and e-health literacy are expressed at each step of the process, showing that symptom checkers rely heavily on users’ health literacy. To be more effective, symptom checkers should be more transparently integrated in health care. CLINICALTRIAL German Clinical Trials Register (DRKS) DRKS00022465 INTERNATIONAL REGISTERED REPORT RR2-10.2196/34026

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“…As such, people increasingly turn to the internet for health information [41][42][43] and demand exists for health screening mobile apps to assist with condition diagnosis (e.g. check user symptoms against common condition symptoms) [44][45][46] .…”

Section: Introductionmentioning

confidence: 99%

Assessing the accuracy of a digital symptom checker tool for suggestion of reproductive health conditions: a clinical vignettes study

Peven¹,

Wickham²,

Wilks³

et al. 2023

Preprint

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Background Reproductive health conditions such as endometriosis, uterine fibroids and polycystic ovary syndrome affect a large proportion of women and people who menstruate worldwide. Prevalence estimates for these conditions range from 5-40% of women of reproductive age. Long diagnostic delays, up to 12 years, are common and contribute to health complications and increased healthcare costs. Symptom checker apps provide users with information and tools to better understand their symptoms and thus have the potential to reduce the time to diagnosis for reproductive health conditions. Objective This study aims to evaluate the accuracy of three symptom checkers developed by Flo Health assessing symptoms of endometriosis, uterine fibroids and polycystic ovary syndrome (PCOS) against current medical guidelines. Methods Independent general practitioners were recruited to create clinical case vignettes of simulated users with and without the conditions of interest. Vignettes were reviewed, modified and approved by separate general practitioners. A further independent panel of general practitioners reviewed the cases and designated a final classification. Vignettes were entered into the symptom checkers and the outcomes were compared with the final classification from the panel using accuracy metrics including percent agreement, sensitivity and specificity. Results A total of 24 cases were created per condition. Overall, exact matches between the vignette classification and the symptom checker outcome was 83.3% for endometriosis and uterine fibroids, and 87.5% for PCOS. While sensitivity was high for all conditions (>81%) and very high (100%) for PCOS, specificity was >81% for endometriosis and uterine fibroids and 75% for PCOS. Conclusion The single condition symptom checkers have high levels of accuracy for endometriosis, uterine fibroids and PCOS. Given long delays in diagnosis for many reproductive health conditions, which lead to increased medical costs and potential health complications for individuals and healthcare providers, innovative health apps and symptom checkers hold the potential to improve care pathways.

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Ethical, Legal, and Social Implications of Symptom Checker Apps in Primary Health Care (CHECK.APP): Protocol for an Interdisciplinary Mixed Methods Study

Cited by 14 publications

References 47 publications

Impacts of Symptom Checkers for Laypersons’ Self-diagnosis on Physicians in Primary Care: Scoping Review

Impacts of Symptom Checkers for Laypersons’ Self-diagnosis on Physicians in Primary Care: Scoping Review

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

Assessing the accuracy of a digital symptom checker tool for suggestion of reproductive health conditions: a clinical vignettes study

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