{
    "abstract": "Symptom 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.\nThis 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?\nAs 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.\nApp 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.\nSymptom 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.\nRR2-10.2196/34026.",
    "authors": [
        {
            "affiliation": "Institute for General Practice and Interprofessional Care, T\u00fcbingen University Hospital, T\u00fcbingen, Germany.",
            "firstname": "Roland",
            "initials": "R",
            "lastname": "Koch"
        },
        {
            "affiliation": "Institute for General Practice and Interprofessional Care, T\u00fcbingen University Hospital, T\u00fcbingen, Germany.",
            "firstname": "Marie-Theres",
            "initials": "MT",
            "lastname": "Steffen"
        },
        {
            "affiliation": "Institute for General Practice and Interprofessional Care, T\u00fcbingen University Hospital, T\u00fcbingen, Germany.",
            "firstname": "Anna-Jasmin",
            "initials": "AJ",
            "lastname": "Wetzel"
        },
        {
            "affiliation": "Institute of Occupational and Social Medicine and Health Services Research, University Hospital T\u00fcbingen, T\u00fcbingen, Germany.",
            "firstname": "Christine",
            "initials": "C",
            "lastname": "Preiser"
        },
        {
            "affiliation": "Institute of Applied Social Science, University of Applied Science W\u00fcrzburg-Schweinfurt, W\u00fcrzburg, Germany.\nInstitute for General Practice and Palliative Care, Medizinische Hochschule Hannover, Hanover, Germany.",
            "firstname": "Malte",
            "initials": "M",
            "lastname": "Klemmt"
        },
        {
            "affiliation": "Institute of Ethics and History of Medicine, University Hospital T\u00fcbingen, T\u00fcbingen, Germany.",
            "firstname": "Hans-J\u00f6rg",
            "initials": "HJ",
            "lastname": "Ehni"
        },
        {
            "affiliation": "Institute of Philosophy, University of Bremen, Bremen, Germany.",
            "firstname": "Regina",
            "initials": "R",
            "lastname": "Mueller"
        },
        {
            "affiliation": "Institute for General Practice and Interprofessional Care, T\u00fcbingen University Hospital, T\u00fcbingen, Germany.",
            "firstname": "Stefanie",
            "initials": "S",
            "lastname": "Joos"
        }
    ],
    "conclusions": null,
    "copyrights": "\u00a9Roland Koch, Marie-Theres Steffen, Anna-Jasmin Wetzel, Christine Preiser, Malte Klemmt, Hans-J\u00f6rg Ehni, Regina Mueller, Stefanie Joos. Originally published in JMIR Formative Research (https://formative.jmir.org), 21.03.2025.",
    "doi": "10.2196/60647\n10.2196/jmir.8.2.e9\n10.3390/ijerph15081643\n10.1007/s11019-022-10114-y\n10.2196/22637\n10.2196/13445\n10.1136/bmjinnov-2020-000498\n10.2196/14679\n10.1186/s12911-024-02430-5\n10.1186/s12911-024-02430-5\n10.1177/20552076241231555?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub0pubmed\n10.1177/20552076241231555\n10.1186/s12910-024-01011-5\n10.1186/s12910-024-01011-5\n10.2196/35219\n10.2196/19713\n10.1136/bmjopen-2018-027743\n10.1371/journal.pone.0259547\n10.1371/journal.pone.0259547\n10.2196/jmir.2924\n10.2196/55161\n10.2196/36322\n10.1038/s41746-022-00667-w\n10.1038/s41746-022-00667-w\n10.2196/31810\n10.1136/bmj.h3480\n10.3389/fmed.2022.1040926\n10.1371/journal.pone.0254088\n10.1371/journal.pone.0254088\n10.3389/fpubh.2022.844669\n10.1371/journal.pone.0199284\n10.1371/journal.pone.0199284\n10.1093/heapro/15.3.259\n10.1146/annurev-publhealth-090419-102529?crawler=true&mimetype=application/pdf\n10.1146/annurev-publhealth-090419-102529\n10.1080/10810730.2019.1691292\n10.1080/10810730.2010.501094\n10.1177/1090198108322819\n10.1027/1016-9040/a000350\n10.5555/ajhb.2007.31.supp.S19\n10.1093/heapro/day062\n10.11124/JBISRIR-D-18-00023\n10.1111/hex.12093\n10.1093/eurpub/ckv043\n10.7326/0003-4819-155-2-201107190-00005\n10.1016/j.socscimed.2020.113174\n10.1371/journal.pone.0279636\n10.1371/journal.pone.0279636\n10.2196/34026\n10.2196/57360\n10.1097/ACM.0000000000000388\n10.1177/1049732315617444\n10.1111/j.1468-5914.1990.tb00174.x\n10.3310/hsdr09210\n10.2196/46231\n10.1016/j.anr.2016.01.005\n10.2196/jmir.1619\n10.1001/jamainternmed.2023.1838\n10.2196/24475\n10.3389/fpubh.2022.906089",
    "journal": "JMIR formative research",
    "keywords": [
        "AI",
        "artificial intelligence",
        "eHealth literacy",
        "health literacy",
        "interview study",
        "qualitative research",
        "symptom checker apps"
    ],
    "methods": null,
    "publication_date": "2025-03-21",
    "pubmed_id": "40117573\n16867972\n30081465\n36181620\n33404515\n31042151\n34192014\n32012052\n38262993\n38434790\n38365749\n35503248\n32540836\n31375610\n34731217\n24434479\n39652845\n35984690\n35977992\n35536633\n26157077\n36687416\n34265845\n35273944\n29944708\n33035427\n31752603\n20845190\n18728119\n17931132\n30107564\n32813388\n23773311\n25843827\n21768583\n32659512\n36574438\n35576570\n39556813\n24979285\n26613970\n37338970\n27021840\n22357448\n37115527\n33688845\n35991040",
    "results": "App 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.",
    "title": "Exploring Laypersons' Experiences With a Mobile Symptom Checker App as an Interface Between eHealth Literacy, Health Literacy, and Health-Related Behavior: Qualitative Interview Study.",
    "xml": "<Element 'PubmedArticle' at 0x788503aed990>"
}