JMIR Publications

ABSTRACT

Background:

The implementation of digital health interventions (DHIs) has been proposed as a solution to enhance dermatological care by improving quality, empowering patients, and increasing efficiency. In this regard, Germany lags other European countries.

Objective:

To investigate one potential reason, this study aimed to explore the acceptability towards, current use and potential future use of DHIs among dermatologists and to identify and describe clusters based on their level of acceptability. Additionally, our aim was to explore differences among clusters in terms of socio-demographic characteristics and their current and potential future use of DHIs.

Methods:

We conducted a cross-sectional survey, randomly inviting 1,000 dermatologists in Germany to participate. The questionnaire consisted of Likert scale items rating the acceptability of DHIs from 1 – 5. Items on the current and future use of DHIs were also included. Exploratory factor analysis (EFA) was employed to identify factors and reduce data as input for a two-step clustering algorithm.

Results:

The survey with 170 dermatologists (mean age 50.8 years, SD 10.3; 55.7% female) identified four factors through the EFA: (1) "Positive Expectancies and Acceptability of DHIs", (2) "Dermatologists’ Digital Competencies" (3) "Negative Expectancies and Barriers", and (4) "Dermatologists' Perspectives on Patients’ Acceptability and Competencies”. The cluster analysis resulted in a three-cluster solution. Cluster 1 (Indecisives; n = 69) had moderate intentions to use (F1; M 3.2; SD 0.6) and negative expectations about DHIs (F3; M 3.5; SD 0.6). Cluster 2 (Adopters; n = 60) had high usage intentions (F1; M 4.1; SD 0.3) and digital competencies (F2; M 4.3; SD 0.4). Cluster 3 (Rejectors; n = 26) had low intentions (F1; M 2.0; SD 0.6) and low digital competencies (F3; M 1.9; SD 0.7). The majority in all clusters agreed that no adequate reimbursements or incentives exist for DHIs. Adopters were significantly younger compared to the other clusters and had the highest adoption rates of DHIs. Still, only one third of the Adopters utilized DHIs including teledermatology or artificial intelligence.

Conclusions:

A substantial group of dermatologists demonstrated a willingness to use DHIs more often. However, structural barriers (e.g., inadequate reimbursement) may hinder the adoption of DHIs among dermatologists and need to be addressed. The varying rates of DHI adoption and acceptability among the identified clusters may contribute to health inequalities and require careful consideration while implementing DHIs.