To the Editor: Dermatologic diseases are the fourth leading cause of nonfatal disease burden worldwide1 which is further emphasized in resource-poor settings with limited access to care. In Africa, there is less than 1 dermatologist per million people.2 Dermatologists are underrepresented to meet the needs of the population, and care is often provided by general clinicians and rural health care workers with limited dermatology training.3 Teledermatology has been demonstrated to increase access to care in African countries when developed through partnerships between local and afar providers.4 The use of a store-and-forward teledermatology consult service was implemented collaboratively with local clinicians to improve access to care and train clinicians in dermatology in Bagamoyo, Tanzania (Table I). Evaluating patient acceptability of teledermatology is important in determining feasibility of its implementation at Bagamoyo District Hospital.
Table I.
Key research events
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IRB, Institutional Review Board.
Patients who utilized teledermatology were offered an in-person survey that assessed their knowledge of and comfort with teledermatology, and factors related to quality of care. Descriptive statistical analysis was performed. A total of 130 surveys were obtained with a 100% response rate for consultations submitted over 6 months (Table II). Furthermore, 96.2% of patients had not previously heard of teledermatology. Regarding use of teledermatology, patients were equally concerned about quality of care, time to diagnosis, and privacy; however, 99.2% of patients felt comfortable having skin concerns diagnosed via teledermatology, 92.3% reported no quality of care concerns with teledermatology, and 100% believed that they would receive the same quality of care as a face-to-face interaction. Patients were generally comfortable with photographs being taken for teledermatology with most body parts (>90% acceptability) but were least comfortable with photographs of their genitals (29.2% acceptability). Most patients were willing to wait 1 week for a diagnosis. Lower cost was indicated as the top factor that would make it easier for patients, followed by less travel, reduced time away from home/work, and ease in scheduling (Table II).
Table II.
Survey results
| Sex | ||
| Male | 55 | 42.30% |
| Female | 75 | 57.70% |
| Age | ||
| <18 y old | 9 | 6.90% |
| 18-20 y old | 21 | 16.20% |
| 20-30 y old | 45 | 34.60% |
| 30-40 y old | 38 | 29.20% |
| 40-50 y old | 11 | 8.50% |
| >50 y old | 6 | 4.60% |
| Education | ||
| Primary school | 42 | 32.30% |
| Secondary school | 30 | 23.10% |
| Diploma | 45 | 34.60% |
| Completed some postgraduate | 1 | 80.00% |
| Master's degree | 0 | 0.00% |
| Graduate degree | 0 | 0.00% |
| None | 11 | 8.50% |
| Employment status | ||
| Employed | 59 | 45.40% |
| Unemployed | 54 | 41.50% |
| Student | 15 | 11.50% |
| Retired | 2 | 1.50% |
| Marital status | ||
| Single | 50 | 38.50% |
| Married | 80 | 61.50% |
| Widowed | 0 | 0.00% |
| Divorced | 0 | 0.00% |
| Separated | 0 | 0.00% |
| Average per clinic visit | ||
| Travel time | 105 min | |
| Distance traveled | 14 km | |
| Cost | 9.50 USD | |
| Factors that would make it easier for patients to receive dermatologic care (n = 130)∗ | ||
| Lower cost | 112 (86.2%) | |
| Less travel | 92 (70.8%) | |
| Reduced time away from home/work | 73 (56.2%) | |
| Ease in scheduling | 50 (38.5%) | |
| Other | 2 (1.5%) | |
| Concerns with teledermatology (n = 130)∗ | ||
| Quality of care | 120 (92.3%) | |
| Time to diagnosis | 116 (89.2%) | |
| Privacy | 110 (84.6%) | |
| Comfortable having skin concerns diagnosed via teledermatology consult service (n = 130) | ||
| Yes | 125 (96.2%) | |
| No | 5 (3.8%) | |
| Quality of care from teledermatology consult service will be the same as face-to-face interaction (n = 130) | ||
| Yes | 130 (100%) | |
| No | 0 (0%) | |
| Body parts patients felt comfortable being photographed for teledermatology consult service (n = 130)∗ | ||
| Arms | 130 (100%) | |
| Legs | 129 (99.2%) | |
| Head/Neck | 128 (98.5%) | |
| Face | 119 (91.5%) | |
| Genitals | 38 (29.2%) | |
| Length of time patient is willing to wait to receive follow-up treatment from teledermatology consult service (n = 130) | ||
| Same day | 26 (20%) | |
| Next day | 34 (26.2%) | |
| 1 wk | 63 (48.5%) | |
| Greater than 1 wk | 7 (5.4%) | |
Supplementary Fig 1, available via Mendeley at https://data.mendeley.com/datasets/dbyrjgpk2z/2.
Participants were able to choose multiple answers.
Overall, our study demonstrates patient comfort and acceptability of the teledermatology consult service and supports the feasibility of its implementation at Bagamoyo District Hospital in Bagamoyo, Tanzania. The discrepancy between quality of care concerns with teledermatology and the comparison with quality of care of face-to-face interactions may imply that surveyed patients may have concerns with face-to-face dermatologic care. We hope that the teledermatology can build trust within the clinician-patient relationship. Our goal is to support local clinicians in providing dermatologic care and further educate with teledermatology in a sustainable model while forming local partnerships with in-country dermatologists. With continued teledermatology use, clinicians will likely evaluate similar skin conditions and learn from the previous consults and management plans.4 This platform satisfies a clinical need and provides training opportunity for physicians while increasing patient satisfaction by mitigating identified barriers such as cost, travel, and time away from home/work. A key factor in the success of this model is the creation of a sustainable partnership, with a need initially identified with a pilot study and then supported by regular meetings to address any questions or concerns (Table I). Ensuring local Bagamoyo clinicians and stakeholders have an equal partnership in this research is crucial to decolonizing global health dermatology.5
Conflicts of interest
None disclosed.
Footnotes
Funding sources: The American Academy of Dermatology Skin Care in Developing Countries Grant.
IRB approval status: Reviewed and approved by MCW (approval # 00034342), Ifakara Health Institute (approval # 28-2021), and National Institute of Medical Research (approval #3816).
Patient consent: Consent for the publication of all patient photographs and medical information was provided by the authors at the time of article submission to the journal stating that all patients gave consent for their photographs and medical information to be published in print and online and with the understanding that this information may be publicly available.
References
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