Exploring the Perception of Digital Health Tools in Dermatology

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Skin diseases like atopic dermatitis, psoriasis, acne, skin cancer, and urticaria are prevalent in Europe, with around 26.75% of adults in Germany requiring dermatological care.¹ This high demand puts pressure on health care systems, leading to limited time for shared decision-making and access to timely care.²

Digital health interventions (DHIs), such as telemedicine and artificial intelligence, offer potential solutions by improving care provision, supporting diagnoses, and enhancing self-management and disease monitoring through apps.^3-4 However, despite the benefits and availability of DHIs, their adoption in dermatology is still limited. For instance, during the COVID-19 pandemic, only 40% of German dermatologists used teledermatology services, compared to over 80% in other countries, and real-time teledermatology use was even lower at 7.6%.^5-6

Barriers to DHI implementation include limited knowledge, unclear benefits, and issues with financing and reimbursement. Additionally, while patients generally show interest in digital health, dermatologists' acceptance of electronic health records is lower. Nurses, who play a crucial role in the integration of DHIs, are often inadequately addressed in the literature.⁷

With this in mind, a recent study aimed to explore and compare the attitudes, acceptability, and barriers of patients, dermatologists, and nurses toward DHIs in dermatology in order to identify factors that could improve DHI adoption and implementation.⁸

Methods

The study used web-based focus groups and utilized a semi-structured interview guide. The research investigated current dermatological care issues and evaluated 5 DHIs: treatment reminders, self-support tools, store-and-forward teledermatology, eHealth portals, and live-interactive consultations. Participants included 33 dermatologists, 34 nurses, and 41 patients, selected to represent diverse demographics and professional backgrounds. Each session was moderated and recorded for subsequent qualitative content analysis.

Results

The study found focus groups thought DHIs were acceptable as long as they complemented rather than replaced in-person consultations. They expressed concerns about data misuse, with dermatologists noting a lack of patient data protection standards and expressing both skepticism and interest in digitalization. Researchers stated all groups acknowledged the potential for DHIs to enhance patient engagement and care efficiency but raised issues such as the need for technical improvements, ease of use, and adequate reimbursement.

The challenges researchers found included digital literacy among older patients, integration into existing workflows, and concerns about data privacy and IT infrastructure. Despite these barriers, the study stated the COVID-19 pandemic has accelerated digitalization, with a preference for single, standardized apps for ease of use.

The study stated dermatologists’ hesitance to adopt DHIs, partly due to financial investments and the perceived lack of immediate benefits, hinders broader implementation. Despite these insights, the study’s limitations include potential biases due to the digital format and the hypothetical nature of the DHIs discussed, which may affect the validity of the findings to other contexts and health systems.

Conclusion

The study found that dermatologists' acceptance plays a pivotal role in facilitating the integration of DHIs into clinical practice, making their input during the development phase essential. Additionally, researchers stated that DHIs should be designed with varying levels of digital literacy in mind, including analog options to avoid excluding less tech-savvy patients. They found addressing data privacy and security concerns is vital to maintaining trust and preventing barriers to effective use. By considering these factors, the study stated that researchers, developers, and decision-makers can enhance the acceptability and implementation of DHIs, leading to better overall adoption and impact.

References

1. Cribier B, Aroman MS, Merhand S, et al. Prevalence of visible skin diseases: An international study of 13,138 people. J EurAcad Dermatol Venereol. 2023;37(2):e180-e182. doi:10.1111/jdv.18666
2. van der Kraaij GE, Vermeulen FM, Smeets PMG, et al. The current extent of and need for shared decision making in atopic dermatitis and psoriasis in the Netherlands: an online survey study amongst patients and physicians. J EurAcad Dermatol Venereol. 2020 Nov;34(11):2574-2583. doi: 10.1111/jdv.16340
3. Reinders P, Augustin M, Kirsten N, et al. Digital health interventions in dermatology-Mapping technology and study parameters of systematically identified publications. J EurAcad Dermatol Venereol. 2023;37(12):2440-2449. doi:10.1111/jdv.19392
4. Andrees V, Klein TM, Augustin M, et al. Live interactive teledermatology compared to in-person care - a systematic review. J EurAcad Dermatol Venereol. 2020;34(4):733-745. doi:10.1111/jdv.16070
5. Elsner P. Teledermatology in the times of COVID-19 - a systematic review. J Dtsch Dermatol Ges. 2020;18(8):841-845. doi:10.1111/ddg.14180
6. Augustin M, Reinders P, Janke TM, et al. Attitudes toward and use of eHealth technologies among german dermatologists: Repeated cross-sectional survey in 2019 and 2021. J Med Internet Res. 2024;26:e45817. Published 2024 Feb 12. doi:10.2196/45817
7. Schreiweis B, Pobiruchin M, Strotbaum V, et al. Barriers and facilitators to the implementation of eHealth services: Systematic literature analysis. J Med Internet Res. 2019;21(11):e14197. Published 2019 Nov 22. doi:10.2196/14197
8. Reinders P, Augustin M, Fleyder A, et al. Exploring acceptability, barriers, and facilitators for digital health in dermatology: Qualitative focus groups with dermatologists, nurses, and patients. JMIR Dermatol. 2024;7:e57172. Published 2024 Sep 3. doi:10.2196/57172