Assessment of a Digital Symptom Checker Tool's Accuracy in Suggesting Reproductive Health Conditions: Clinical Vignettes Study

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • Kimberly Peven - , Flo Health UK Limited (Author)
  • Aidan P. Wickham - , Flo Health UK Limited (Author)
  • Octavia Wilks - , Flo Health UK Limited (Author)
  • Yusuf C. Kaplan - , Flo Health UK Limited (Author)
  • Andrei Marhol - , Flo Health UK Limited (Author)
  • Saddif Ahmed - , Flo Health UK Limited (Author)
  • Ryan Bamford - , Flo Health UK Limited (Author)
  • Adam C. Cunningham - , Flo Health UK Limited (Author)
  • Carley Prentice - , Flo Health UK Limited (Author)
  • András Meczner - , Your.MD Limited (Author)
  • Matthew Fenech - , Una Health GmbH (Author)
  • Stephen Gilbert - , Else Kröner Fresenius Center for Digital Health (Author)
  • Anna Klepchukova - , Flo Health UK Limited (Author)
  • Sonia Ponzo - , Flo Health UK Limited (Author)
  • Liudmila Zhaunova - , Flo Health UK Limited (Author)

Abstract

Background: Reproductive health conditions such as endometriosis, uterine fibroids, and polycystic ovary syndrome (PCOS) affect a large proportion of women and people who menstruate worldwide. Prevalence estimates for these conditions range from 5% to 40% of women of reproductive age. Long diagnostic delays, up to 12 years, are common and contribute to health complications and increased health care costs. Symptom checker apps provide users with information and tools to better understand their symptoms and thus have the potential to reduce the time to diagnosis for reproductive health conditions. Objective: This study aimed to evaluate the agreement between clinicians and 3 symptom checkers (developed by Flo Health UK Limited) in assessing symptoms of endometriosis, uterine fibroids, and PCOS using vignettes. We also aimed to present a robust example of vignette case creation, review, and classification in the context of predeployment testing and validation of digital health symptom checker tools. Methods: Independent general practitioners were recruited to create clinical case vignettes of simulated users for the purpose of testing each condition symptom checker; vignettes created for each condition contained a mixture of condition-positive and condition-negative outcomes. A second panel of general practitioners then reviewed, approved, and modified (if necessary) each vignette. A third group of general practitioners reviewed each vignette case and designated a final classification. Vignettes were then entered into the symptom checkers by a fourth, different group of general practitioners. The outcomes of each symptom checker were then compared with the final classification of each vignette to produce accuracy metrics including percent agreement, sensitivity, specificity, positive predictive value, and negative predictive value. Results: A total of 24 cases were created per condition. Overall, exact matches between the vignette general practitioner classification and the symptom checker outcome were 83% (n=20) for endometriosis, 83% (n=20) for uterine fibroids, and 88% (n=21) for PCOS. For each symptom checker, sensitivity was reported as 81.8% for endometriosis, 84.6% for uterine fibroids, and 100% for PCOS; specificity was reported as 84.6% for endometriosis, 81.8% for uterine fibroids, and 75% for PCOS; positive predictive value was reported as 81.8% for endometriosis, 84.6% for uterine fibroids, 80% for PCOS; and negative predictive value was reported as 84.6% for endometriosis, 81.8% for uterine fibroids, and 100% for PCOS. Conclusions: The single-condition symptom checkers have high levels of agreement with general practitioner classification for endometriosis, uterine fibroids, and PCOS. Given long delays in diagnosis for many reproductive health conditions, which lead to increased medical costs and potential health complications for individuals and health care providers, innovative health apps and symptom checkers hold the potential to improve care pathways.

Details

Original languageEnglish
Article numbere46718
JournalJMIR mhealth and uhealth
Volume11
Issue number1
Publication statusPublished - Jan 2023
Peer-reviewedYes

External IDs

PubMed 38051574

Keywords

ASJC Scopus subject areas

Keywords

  • accuracy, chatbot, clinical vignettes, digital health, digital health tool, eHealth apps, endometriosis, gynecology, mHealth, mobile health, mobile health app, mobile phone, polycystic ovary syndrome, symptom checker, symptom checkers, uterine, uterine fibroids, uterus, vignettes, women's health