JMIR Publications

ABSTRACT

Background:

Symptom checker applications (SCA) are accessible tools that provide early symptom assessment for users. Ethical, legal, and social implications of SCA, their impact on the patient-physician relationship, the health care providers and the health care system have sparsely been examined. This study protocol describes an approach to investigate possible impacts and implications of SCA on different levels of health care provision. It considers the perspectives of users, non-users, general practitioners and health care experts.

Objective:

We aim to assess a comprehensive overview of the use of SCA and reveal problematic issues. The primary outcomes of this study are empirically informed, multi-perspective recommendations for different stakeholders on ethical, legal, and social implications of SCA.

Methods:

Quantitative and qualitative methods will be used in several consecutive and interconnected parts: In study part 1 a comprehensive literature review will be conducted, to assess ethical, legal, social and systemic impacts of SCA. Study part 2 comprises a survey that will be analyzed with a logistic regression. It aims to assess the user degree of SCA in Germany as well as predictors for SCA usage. Study part 3 will investigate self-observational diaries and user-interviews, which will be analyzed as integrated cases to assess the user perspectives, usage pattern and arising problems. Study part 4 will comprise GP interviews to assess their experiences, perspectives, self-image, and concepts and will be analyzed with the basic procedure by Kruse. Moreover, interviews with health care experts will be conducted in study part 3 and will be analyzed by using the reflexive thematical analysis by Braun and Clark.

Results:

Study part 1 will be finalized in November 2021. We expect results of study part 2 in December 2021 and February 2022. In study part 3 interviews are conducted momentarily. The final study endpoint will be in February 2023.

Conclusions:

Possible ethical, social and legal implications of a widespread use of SCA affect stakeholders and stakeholder groups on different levels of health care will be identified. The proposed methodological approach provides a multi-faceted and diverse empirical basis for a broad discussion on these implications. Clinical Trial: The study is registered in the German Clinical Trials Register (DRKS) with the ID: DRKS00022465 since the 7th of August 2020 https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00022465.