“That’s just Future Medicine” - a qualitative study on users’ experiences of symptom checker apps

Abstract

Background Symptom checker apps (SCAs) are mobile or online applications for lay people that usually have two main functions: symptom analysis and recommendations. SCAs ask users questions about their symptoms via a chatbot, give a list with possible causes, and provide a recommendation, such as seeing a physician. However, it is unclear whether the actual performance of a SCA corresponds to the users’ experiences. This qualitative study investigates the subjective perspectives of SCA users to close the empirical gap identified in the literature and answers the following main research question: How do individuals (healthy users and patients) experience the usage of SCA, including their attitudes, expectations, motivations, and concerns regarding their SCA use? Methods A qualitative interview study was chosen to clarify the relatively unknown experience of SCA use. Semi-structured qualitative interviews with SCA users were carried out by two researchers in tandem via video call. Qualitative content analysis was selected as methodology for the data analysis. Results Fifteen interviews with SCA users were conducted and seven main categories identified: (1) Attitudes towards findings and recommendations, (2) Communication, (3) Contact with physicians, (4) Expectations (prior to use), (5) Motivations, (6) Risks, and (7) SCA-use for others. Conclusions The aspects identified in the analysis emphasise the specific perspective of SCA users and, at the same time, the immense scope of different experiences. Moreover, the study reveals ethical issues, such as relational aspects, that are often overlooked in debates on mHealth. Both empirical and ethical research is more needed, as the awareness of the subjective experience of those affected is an essential component in the responsible development and implementation of health apps such as SCA. Trial registration German Clinical Trials Register (DRKS): DRKS00022465. 07/08/2020.

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

“…This association with user satisfaction indicates that users' expectations also play a role in how they validate the app [40]. 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].…”

“…a health symptom), laypersons enter health-related information into the SCA. Curiosity about one's health status or the desire to rule out possibly dangerous conditions, the availability of health care services, trust in SCA as well as certain symptoms are known factors associated with SCA use [2,8,10,[32][33][34][35][36]. Further engaging with SCA warrants distinct user experiences that are shaped by the confidence in one's ability for selfassessment [8][9][10]34], personal illness experiences [2,8,9], proficiency in navigating informational sources [8,9], age [32,37] and the ability to process and understand health-related information [1,[8][9][10]37], all of which are part of the abovementioned concepts.…”

“…In the sample, IPs considered the abovementioned factors in their decision to use the app, but did not specify whether they were facilitators or enablers. Although many of the listed factors have been identified in previous research, their role in SCA use is ambiguous since they can act as both barriers and enablers [1,7,34]. As both situational and individual factors shape when and to what purpose SCA are used, the term 'context factors' seems much more appropriate than 'barriers and enablers' [1,16,17,34].…”

“…If the recommendations do not align with user's concepts and expectations, they are sometimes discarded as unrealistic. However, this mismatch between concept and recommendation can also cause anxiety and create the need for more information or confirmation by healthcare professionals [33][34][35]. Turner also observed the rejection of app recommendations, especially if they were given in a context where the action could not be implemented (eg out-of-hours) [51].…”

“…This sets up SCA as a possible interface between the user and health care services. This purpose and possible use in health care has not been described yet, apart from the CHECK.APP project [34]. SCA can increase patient autonomy, as other research has postulated [39].…”