JMIR Publications

ABSTRACT

Background:

Teledermatology holds the promise to address access needs for dermatologic care; however, interest in using teledermatology is unknown in underserved populations with potential barriers to healthcare technology use.

Objective:

This study aimed to characterize the association between demographic characteristics with interest in exchanging digital images or videos of skin lesions with healthcare providers electronically.

Methods:

We examined data from the National Cancer Institute Health Information National Trends Survey (HINTS) 4 Cycle 4 from 2014. HINTS is a cross-sectional, nationally representative household survey conducted annually, which collects information on demographics, perceptions and use of health information, and provides information about how cancer risks are perceived. HINTS 4 Cycle 4 had a sample of 3,677. We examined the outcome: “How interested are you in exchanging digital images/video (e.g., photos of skin lesions) with a health care provider electronically?” We dichotomized the outcome by high level of interest (“very”), as compared to those who did not have a high level of interest in exchanging (“somewhat”, “a little”, or “not at all”). Analyses were conducted using SAS 9.4 (SAS Institute, Cary, NC). We conducted a multivariable logistic regression model developed using backwards selection, with all final covariates associated with varying levels of teledermatology use at P < 0.05. Sensitivity analysis was also performed by changing the outcome dichotomy to model those who were “not at all” interested. Two-sided tests with P <0.05 were considered significant.

Results:

Among 3,447 respondents, 888 were “very” interested in participating in teledermatology (weighted prevalence, 26.2%). Higher interest in using teledermatology was associated with younger age group, higher educational attainment, higher household income, any internet use, type of mobile device ownership, history of electronic medical information exchange with clinician within the past 12 months, and high level of trust in internet cancer information (each P < 0.01); but not with female gender, race/ethnicity, health insurance status, or having a regular medical provider.

Conclusions:

Modifiable access barriers to teledermatology adoption include trust, experience with teledermatology and use of health apps. Teledermatology program implementation should address these specific factors within the digital divide to promote equitable access to care across diverse patient populations.