Background Teledermatology is a conduit for patients communicating with dermatologists on the internet, which bypasses in-person visits. It holds promise to address access needs for dermatologic care; however, the interest in using teledermatology is unknown in underserved populations with potential barriers to the use of health care technology. Objective This study aimed to characterize the association between demographic characteristics with interest in exchanging digital images or videos of skin lesions with health care providers electronically. Methods We examined data from the Health Information National Trends Survey (HINTS) 4 cycle 4 (2014) of the National Cancer Institute. 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 on how cancer risks are perceived. HINTS 4 cycle 4 had a sample of 3677 participants. We examined the outcome to the question, “how interested are you in exchanging digital images or videos (eg, photos of skin lesions) with a health care provider electronically?” We dichotomized the outcome by a high level of interest (responding with “very”) and those who did not have a high level of interest (responding with “somewhat,” “a little,” or “not at all”) in exchanging images or videos. We used a multivariable logistic regression model developed through backwards selection, with all final covariates associated with varying levels of teledermatology use at P<.05. Sensitivity analysis was performed by changing the outcome dichotomy to model those who were “not at all” interested. Two-sided tests were performed with P<.05 considered significant. Results Among 3447 respondents, 888 (weighted prevalence=26.2%) were “very” interested in participating in teledermatology. A higher interest in using teledermatology was associated with a younger age, higher educational attainment, higher household income, internet usage, type of mobile device ownership, history of electronic medical information exchange with a clinician within the past 12 months, and high level of trust in web-based information on cancer (for all, P<.01), but not with the female gender, race or 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.
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.
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