key: cord-0777444-t27tfi1g
authors: Ellie, Choi CE.; Wei, Heng Li; Sean, Tan YL.; Phillip, Phan HC.; Chandran, Nisha Suyien
title: Factors Influencing Willingness to Pay and Show Images with Teledermatology during the COVID-19 pandemic
date: 2022-03-09
journal: J Am Acad Dermatol
DOI: 10.1016/j.jaad.2022.02.053
sha: 811a487a5e35b60cdf1b8dd505a361759ebb28ec
doc_id: 777444
cord_uid: t27tfi1g

nan

To the Editor, 4 5 We read with interest the article by Linggonegoro et al. 1 discussing limited English proficiency as a 6 barrier toward uptake of teledermatology. We conducted a convergent parallel mixed method study 7 to explore the willingness to use teledermatology during the COVID-19 pandemic. 2 942 8 questionnaires and 26 in-depth interviews were administered to dermatology outpatients or their 9 primary caregivers. Questionnaire responses were consolidated and used in multivariable regression 10 analyses, while interview transcripts were coded and analyzed using grounded theory. Quantitative 11 and qualitative findings were cross-validated for convergence. 2 We found that the willingness to use 12 teledermatology was strongly correlated with barriers such as the willingness to show images of the 13 body on photo/video and financial costs. In this letter, we provide secondary analysis to build upon 14 the discussion of barriers in the Linggonegoro et al. paper. 15 16 In our data, females and ethnic Malays (who lean religiously conservative) and one's concerns over 17 data security and privacy were associated with lower willingness to show body images over 18 photo/video (Table 1) . These concerns were specific to "zoom bombing" and inappropriate 19 recording. Conversely, a higher perceived quality of telemedicine was associated with increased 20 willingness to show body images. The findings suggest that appropriate technology use and 21 reassurance on security features be added to a telemedicine pre-consult instructional package for 22 patients. 23 24 47.3% of participants were unwilling to pay more than half of the standard in-person consultation 25 fee for a teledermatology consult. Females, prior experience with teledermatology, willingness to 26 J o u r n a l P r e -p r o o f show body images, higher perceived quality, diagnostic accuracy of teledermatology, usage for social 27 distancing, faster appointment times, and reduced commuting were associated with increased 28 willingness to pay ( Table 2 ). The qualitative data suggested that patients believed telemedicine 29 should be priced lower because it was inferior in quality and perceived to be less costly for the 30 provider to use. Some patients considered their participation an assistance to the provider and 31 should be compensated by a reduced fee. Yet at the same time, the same interviewees also 32 acknowledged that doctor's time employed was similar, and so were more willing to pay the same as 33 an in-person experience. 34

Teledermatology is a growing mode of service delivery. We urge providers to pre-identify and 36 address the barriers to adoption, rather than confront them after implementation, to ensure a 37 positive experience and service sustainability. can consider exploring provider-related barriers to uptake, which we did not assess in this study. Nonuse as concern about data privacy 

Sig. Nonuse as concern about diagnostic accuracy of telemedicine Nonuse as concern about data privacy 0.010 (0.049) 0.838 -0.006 (0.055) -0.005 0.900 †Willingness to pay was assessed as a composite outcome comprising the self-reported willingness 83

to pay for teledermatology before COVID-19 pandemic, during the pandemic and after the 84 pandemic, expressed as a percentage relative to a standard in-person consult. 85

Adjusted R square of the model was 0.125 86

How telemedicine may exacerbate disparities in 57 patients with limited English proficiency

Factors influencing use and perceptions of 60 teledermatology: A mixed-methods study of 942 participants. JAAD International

A Framework-Driven Systematic Review of the Barriers and 63

Facilitators to Teledermatology Implementation. Curr Derm Rep

Optimizing teledermatology: looking beyond the 65 COVID-19 pandemic

Patient 67 Characteristics Associated With Telemedicine Access for Primary and Specialty Ambulatory Care 68 During the COVID-19 Pandemic