Usefulness of self-assessment of gastrointestinal symptoms: a web-based study in Anhui, China.

Abstract

Gastrointestinal symptoms (GISs) are highly prevalent worldwide caused by a combination of biopsychosocial factors. Given the complex nature coupled with ineffective communication of diagnosis by physicians, patients with intimate GISs often feel stigmatized which in turn can inhibit their ability to express their thoughts and feelings adequately and lead to either over or underreport of their symptoms. And selective service seeking for and reporting of GISs have direct bearing on the stage of disease at presentation, and consequently, on the overall prognosis. The study aimed to investigate the usefulness of a web-based self-assessment of GISs as a supplementary means to cope with potential over/under reporting during routine consultations. The study used data about GISs collected using a novel web-based self-assessment tool (n=475) and that from non-participative observation of doctor-patient consultations (n=447) and household survey (n=10552) in Anhui, China. The data analysis focused primarily on description of composition of respondents and occurrence rates of GISs by socio-demographics and by methods and settings of symptom solicitation. Chi-square power tests were used, when necessary, to compare the differences in the occurrence rates between relevant groups and the significance level of the two-sided test was set at α<0.05. Both the average occurrence rates of upper and lower GISs derived from the web-based self-assessment were higher than that from the observation, being 20.9% vs 14.2% (p<0.001) and 12.9% vs 10.8% (p=0.02) respectively. The differences in six out of the nine upper GISs and three out of the eleven lower GISs studied were tested with statistical significance (p<0.05), and all these symptoms witnessed higher self-assessed than observed frequency rates. For upper GISs, the self-assessed versus observed differences ranged from 17.1% for bloating to 100% for bad mood after meal; while for lower GISs, the differences ranged from -50.5% for hematochezia/melena to 100% for uncontrollable stool. Stomachache, regurgitation, and dysphagia displayed higher occurrence rates among participants of the self-assessment than those of the household survey, being 20% vs 13%, 14% vs 11% and 3% vs 2% respectively; while the opposite was observed for constipation (5% vs 11%), hematochezia or melena (4% vs 5%) and anorexia (4% vs 5%). All the differences in the self-assessed occurrence rates of specific persistent GISs between socio-graphic groups were tested non-significant (P>0.05); while the same rate of any of the six persistent GISs studied among the respondents aged 51-60 was statistically higher than that among other age groups (P=0.03). The web-based self-assessment tool piloted in this study is useful and acceptable. It helps in soliciting more comprehensive GISs, especially symptoms with concerns about stigmatization, privacy, shame etc. Further studies are needed to integrate the web-based self-assessment with routine consultations and evaluate its efficacy.