The technology solution embedding the clinical decision algorithm for screening and counselling individuals with suspicious COVID-19 developed by the startup company Hi! Healthcare Intelligence presented high satisfaction in experience, recommendation, and general satisfaction. In addition, the adoption of the technology solution was reasonable, since a quarter of the participants who had the intention to use the tool actually used it. Our sample size was mostly composed of individuals from the state of São Paulo, the state was the authors are based at the moment of the data collection.

The high satisfaction of end-users could be explained for: (1) it was a fast and simple technology solution for the end-users; (2) it was based in the main symptoms of the COVID-19; (3) it was accessible via smartphone, tablets and computers; and (4) it was given an instantaneous counselling for end-users. Several online self-triage tools were developed to tackle the COVID-19 pandemic [15,16,17,18]. The satisfaction of end-users was evaluated by one of this tools [17], which also presented a high satisfaction (7.93; SD 1.60 – Likert scale 0 to 10) regarding information on COVID-19 education, self-assessment, and symptom tracking diary [17]. The present findings corroborate a previous systematic review, which showed that patients who used online technology solutions reported high levels of satisfaction [19]. Despite the sudden regulation of telehealth in Brazil [20, 21] and the particular context of public health inequities, individuals present high satisfaction when interacting with a technology solution. A cross-sectional study shows high levels of acceptability (60%, 95% CI 55 to 65%) with telerehabilitation by the general population, a similar implementation outcome to satisfaction [22]. A systematic review shows that 57.14% of internet-based screening of health conditions was offered using an algorithm-based system, and individuals were highly satisfied with internet-based screening services [23].

We considered ‘reasonable’ the adoption of the technology solution herein evaluated due to: (1) the data collection was performed on the onset of the outbreak; (2) the contradictory information disseminated by the federal government to tackle the COVID-19 pandemic, discouraging the population to search for advice and preventive information; [24, 25] (3) until COVID-19 pandemic, the use of telehealth was not integrated into Brazilian healthcare systems and the Brazilian population´s routine, and the Internet access for health was focused on sending instant messages and social media; [26] (4) intense dissemination of fake news about prevention and treatment of COVID-19 [27] discrediting real initiatives aimed at improving the health of the population [28]; (5) poor digital literacy in Brazil [29]; and (6) with the social distancing imposed by the COVID-19 pandemic, the Brazilian population increased the use of telehealth services; however, after two years users still show concerns about the security of personal data [30].

Our data collection was performed during the onset of the pandemic in Brazil. The technology solution herein evaluated was simple, online, not requiring the creation of an account, and it was free of charge. These characteristics are important to implementation in a large scale. Participants did not have an established relationship with the developers of either the technology solution or the clinical decision algorithm. Therefore, satisfaction measures presented a low risk of detection bias. One the other hand, this was a cross sectional study which does not allow to explore the reasons for adoption, the factors influencing the end-users’ experiences, adherence to the recommendations, and the confirmation of COVID-19 suspicious cases. Additionally, our results could present context bias.

Online algorithms for screening and counselling may be helpful in healthcare. The use of social media to disseminate information about COVID-19, although rapid, it also created an abundance of misinformation, the so called ‘infodemic’, that may cause more harm than good [31]. Hence, having online evidence-based clinical counselling tools based on algorithms may help in disseminating evidence-based information, resulting in more reliable services to the population.

The use of telehealth has increased in the past 20 years [32]. However, the COVID-19 pandemic limited face-to-face contact and the use of telehealth strategies became crucial and increased drastically worldwide [33]. Moreover, ‘Health and Care Professions Councils’ have regulated the use of telehealth for a variety of health conditions [20, 21]. However, it is unknown whether online screening and counselling tools are acceptable for individuals seeking for health management during periods of social restrictions that pandemics and other conditions may employ. Thus, future studies are warranted for the development and/or adaptation of existing tools for health screening and counselling using an online approach. Online approaches may mitigate the community exposure and the saturation of health systems [34]. Future studies are needed to map the determinants (sociodemographic factors, health factors, service factors, and experiences) to patient satisfaction regarding technology solutions.