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

Abstract

<title>Abstract</title> <underline>Background:</underline> 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 (international) health care experts. We aim to assess a comprehensive overview of the use of SCA and reveal problematic issues.<underline>Methods</underline>: The primary outcomes of this study are empirically informed, multi-perspective recommendations for different stakeholders on ethical, legal, and social implications of SCA. Quantitative and qualitative methods will be used in several consecutive and interconnected parts: Study part 1 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 2 will comprise self-observational diary and user-interviews, which will be analyzed as integrated cases to assess the user perspectives, usage pattern and arising problems. Study part 3 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. <underline>Discussion</underline>: Possible ethical, social and legal implications of a widespread use of SCA affect stakeholders and stakeholder groups on different levels of health care. The proposed methodological approach provides a multi-faceted and diverse empirical basis for a broad discussion on these implications.<underline>Trial registration:</underline> The study is registered in the German Clinical Trials Register (DRKS) with the ID: DRKS00022465 since the 7^th of August 2020.

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