gms | German Medical Science

Background: Symptom checker applications (SCA) provide early symptom assessment based on user input. They can be used on any device with internet access. Many are free, easy-to-find downloadable mobile-based applications. SCA provide a range of benefits such as positive health effects (1), but also carry the risk of unnecessary induced health-care seeking behavior (2). Moreover, users must be able to handle technical devices and to interpret the output of SCA. This could lead to a disadvantage of specific population groups e.g. seniors, people with disabilities (3) or people with limited economic resources (4). Little is known about SCA users and factors associated with SCA use (5).

Aims: The present study aims to describe SCA (non-) user and to determine the degree of use and the interest in SCA in Germany. It is embedded in the ELSA (Ethical Legal and Social Aspects) project “CHECK.APP”, funded by the German federal ministry of research and education.

Method: A cross-sectional questionnaire was conducted from November 2020 to May 2021. The questionnaire comprised sociodemographic variables as well as concepts from existing literature that were connected to usage of health apps: eHealth Literacy (6), personality (7, 8), hypochondria (9), self-efficacy (10, 11), need for cognition (12), affinity for technology (13), satisfaction with the general practitioner (GP) (14) and the overall life satisfaction (15). Parts of the questionnaire were developed based on n=3 interviews with SCA users and an eHealth expert.

Different recruiting strands (social media, mailing lists, patients in GP practices) were used to achieve a representative sample. From this sample (n=755), users and non-users were selected for a case-control study design, which matched user and non-users. The degree of SCA usage and the interest in SCA in the sample was examined with descriptive statistics. Moreover, univariate logistic regressions were used to identify meaningful predictors for SCA usage. A multivariate model was established on the case-control sample.

Results (Preliminary): In the survey, n=29 (4%) respondents already used SCA. N=255 (36%) respondents stated that they knew about SCA, but had never used them. N=411 (60%) were interested to try SCA. The four most common SCA were Net Doktor Symptom Checker (47%), Ada (30%), WebMD (8%) and Symptomate (6%). Preliminary results of the logistic regression will be presented at the conference

Discussion: Despite marketing efforts, SCA are rarely used in the German population. However, respondents commonly were conscious about their existence and interested in testing them. This indicates that SCA use will rise in the context of German health care.

Practical implications: As the interest in SCA in the population and the health care system (e.g. health insurance) is high, the impact of SCA on different levels of the health care system will rise. Therefore, an acquisition of the status quo enables prospective comparisons and may help to prevent over- and undersupply of specific population groups.

Plea for practice: Further research is necessary to assess the consequences and the ideal handling of the usage of SCA for primary care on the micro-, meso- and macro-level.