JMIR Publications

ABSTRACT

Background:

Digital health technologies—including online health information seeking, telemedicine, AI-assisted consultation, and self-testing, are increasingly shaping responses to acute respiratory infection (ARI) symptoms. However, how these digitally mediated behaviors relate to facility-based care remains insufficiently understood, complicating interpretation of surveillance data derived from both clinical and digital sources.

Objective:

This study aimed to quantify digital and out-of-facility care-seeking behaviors following ARI symptoms, characterize care-seeking pathways, and assess their implications for surveillanceinterpretation.

Methods:

We conducted a a nationwide cross-sectional survey survey across 11 cities in China using multistage stratified sampling. Participants reported ARI symptoms within the preceding 14 days and subsequent care-seeking behaviors, including digital health activities and facility-based care. Survey-weighted analyses were used to estimate population-level proportions. Behavioral sequences were reconstructed by ordering reported actions according to timing, and transitions between behaviors were summarized using a first-order Markov framework with probabilities estimated from observed sequential frequencies. The most frequent 2-step pathways were identified. Multivariable logistic regression was used to examine factors associated with facility-based care.

Results:

Among 247,530 participants, 68,650 reported ARI symptoms (crude prevalence 27.73%; weighted 27.40%). Among symptomatic individuals, 19.18% sought facility-based care. Any out-of-facility behavior was reported by 31.93% of symptomatic individuals, most commonly medication purchase (25.63%) and online health information seeking (12.42%). Behavioral sequence analysis showed that pathways ending without facility-based care were frequently observed, with the most common trajectory being medication purchase followed by non-facility management. Digital health behavior participation peaked among adults aged 18–59 years (23.6%) and declined among those aged ≥60 years (11.0%), whereas older adults had higher facility-based care use (21.8% vs 17.61%).

Conclusions:

ARI care-seeking is increasingly distributed across digital, nonfacility, and clinical pathways. Digital health behaviors often function as terminal self-management rather than steps toward clinical care. These findings highlight potential biases in both facility-based and digital surveillance systems and underscore the need for integrated approaches to accurately interpret population-level disease activity. Clinical Trial: NA