Evidence map›Paper›PMID 40117573›Full record

ArticleJMIR formative research2025

Exploring Laypersons' Experiences With a Mobile Symptom Checker App as an Interface Between eHealth Literacy, Health Literacy, and Health-Related Behavior: Qualitative Interview Study.

Roland Koch, Marie-Theres Steffen, Anna-Jasmin Wetzel, Christine Preiser, Malte Klemmt, Hans-Jörg Ehni, Regina Mueller, Stefanie Joos

Abstract read
In one paragraph

Article in JMIR formative research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
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  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Roland KochInstitute for General Practice and Interprofessional Care, Tübingen University Hospital, Tübingen, Germany.ORCID 0000-0002-6500-928X
Marie-Theres SteffenInstitute for General Practice and Interprofessional Care, Tübingen University Hospital, Tübingen, Germany.ORCID 0009-0006-6359-205X
Anna-Jasmin WetzelInstitute for General Practice and Interprofessional Care, Tübingen University Hospital, Tübingen, Germany.ORCID 0000-0002-7127-5867
Christine PreiserInstitute of Occupational and Social Medicine and Health Services Research, University Hospital Tübingen, Tübingen, Germany.ORCID 0000-0002-5549-6336
Malte KlemmtInstitute of Applied Social Science, University of Applied Science Würzburg-Schweinfurt, Würzburg, Germany.ORCID 0000-0001-9820-8253
Hans-Jörg EhniInstitute of Ethics and History of Medicine, University Hospital Tübingen, Tübingen, Germany.ORCID 0000-0001-5900-2228
Regina MuellerInstitute of Philosophy, University of Bremen, Bremen, Germany.ORCID 0000-0001-6821-6770
Stefanie JoosInstitute for General Practice and Interprofessional Care, Tübingen University Hospital, Tübingen, Germany.ORCID 0000-0002-5810-529X

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundSymptom checkers aim to help users recognize medical symptoms and recommend actions. However, they are not yet reliable for self-triage or diagnostics. Health literacy plays a role in their use, but the process from symptom recognition to health care consultation remains unclear.

objectiveThis qualitative observatory study explored how laypersons use symptom checkers, focusing on the process of use, entry points and outcomes, and the role of health literacy. Laypersons are defined as individuals who are neither medical professionals nor developers of such apps. Three research questions were addressed: (1) How do such users describe the process of using symptom checkers? (2) What are entry points and possible outcomes of symptom checker app use? (3) How are health literacy and eHealth literacy expressed during the use of symptom checker apps?

methodsAs part of the Ethical, Legal, and Social Implications of Symptom Checker Apps in Primary Health Care project, 15 laypersons (n=9, 60% female and n=6, 40% male; mean age 30.7, SD 13.6 years) were interviewed about their experiences with the symptom checker Ada. The interviews were analyzed using an integrative approach combining social positioning, agency, and the Rubicon model as a heuristic framework.

resultsApp use follows a cyclic process comprising 4 steps: motivation (influenced by biography and context), intention formation (assigning a purpose), intention implementation (recruiting resources), and evaluation (transforming interactions into health-related insights). Biographical, social, and contextual factors shape process initiation. Users use symptom checkers for 3 main purposes: understanding their condition, receiving recommendations for action, and documenting or communicating health-related information. Each purpose requires specific planning and integration into health-related behaviors drawing on personal, social, and technological resources. Evaluation depends on contextual factors, app outputs, and the outcomes of users' health-related actions. Users assess whether the app aligns with their expectations, condition severity, and previous experiences, with health literacy playing a critical role in validation processes.

conclusionsSymptom checker use is a complex, cyclic process shaped by context, biography, and health literacy. Users are motivated by health concerns influenced by personal, social, and contextual factors, with trust and attitudes impacting initial engagement. Intention formation reflects a balance between user skills and context, where app outputs inform decisions but may not always lead to action, especially in ambiguous situations. Users rely on personal resources and social networks to integrate app use into health-related behaviors, highlighting the limitations of symptom checkers in providing social or empathetic support. Symptom checkers have the potential to serve as an interface between users and health care, but future development must address the complexity of their use to unlock this potential. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/34026.

Indexed as

Health BehaviorHealth LiteracyMobile ApplicationsAdultFemaleHumansMaleMiddle AgedQualitative ResearchTelemedicineAIartificial intelligenceeHealth literacyhealth literacyinterview studyqualitative researchsymptom checker apps

Identifiers

PMID40117573
PMCPMC11971579

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.