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

Anna-Jasmin Wetzel; Roland Koch; Christine Preiser; Regina Müller; Malte Klemmt; Robert Ranisch; Hans-Jörg Ehni; Urban Wiesing; Monika A Rieger; Tanja Henking; Stefanie Joos

doi:10.2196/34026

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

JMIR Res Protoc. 2022 May 16;11(5):e34026. doi: 10.2196/34026.

Authors

Affiliations

¹ Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany.
² Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tübingen, Tübingen, Germany.
³ Institute of Ethics and History of Medicine, University Tübingen, Tübingen, Germany.
⁴ Institute of Applied Social Science, University of Applied Science Würzburg-Schweinfurt, Würzburg, Germany.
⁵ Faculty of Health Science Brandenburg, University of Potsdam, Potsdam, Germany.

^# Contributed equally.

PMID: 35576570
PMCID: PMC9152714
DOI: 10.2196/34026

Abstract

Background: Symptom checker apps (SCAs) are accessible tools that provide early symptom assessment for users. The ethical, legal, and social implications of SCAs and 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 the possible impacts and implications of SCAs on different levels of health care provision. It considers the perspectives of the users, nonusers, general practitioners (GPs), and health care experts.

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

Methods: Quantitative and qualitative methods will be used in several overlapping and interconnected study phases. In study phase 1, a comprehensive literature review will be conducted to assess the ethical, legal, social, and systemic impacts of SCAs. Study phase 2 comprises a survey that will be analyzed with a logistic regression. It aims to assess the user degree of SCAs in Germany as well as the predictors for SCA usage. Study phase 3 will investigate self-observational diaries and user interviews, which will be analyzed as integrated cases to assess user perspectives, usage pattern, and arising problems. Study phase 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 phase 3 and will be analyzed by using the reflexive thematical analysis approach of Braun and Clark.

Results: Study phase 1 will be completed in November 2021. We expect the results of study phase 2 in December 2021 and February 2022. In study phase 3, interviews are currently being conducted. The final study endpoint will be in February 2023.

Conclusions: The possible ethical, legal, social, and systemic impacts of a widespread use of SCAs that affect stakeholders and stakeholder groups on different levels of health care will be identified. The proposed methodological approach provides a multifaceted and diverse empirical basis for a broad discussion on these implications.

Trial registration: German Clinical Trials Register (DRKS) DRKS00022465; https://tinyurl.com/yx53er67.

International registered report identifier (irrid): DERR1-10.2196/34026.

Keywords: app; mobile app; primary care; self-diagnosis, self-triage, digitalization in primary care, general practitioners; symptom checker; symptom checker apps.

©Anna-Jasmin Wetzel, Roland Koch, Christine Preiser, Regina Müller, Malte Klemmt, Robert Ranisch, Hans-Jörg Ehni, Urban Wiesing, Monika A Rieger, Tanja Henking, Stefanie Joos. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 16.05.2022.