The Effect of Remote Digital Services on Health Care Inequalities Among People Under Long-Term Dermatology Follow-Up: Cross-Sectional Questionnaire Study

Serena Ramjee; Hanen Mohamedthani; Aditya Umeshkumar Patel; Rebeca Goiriz; Catherine A Harwood; Richard H Osborne; Christina Cheng; Zeeshaan-Ul Hasan

doi:10.2196/48981

The Effect of Remote Digital Services on Health Care Inequalities Among People Under Long-Term Dermatology Follow-Up: Cross-Sectional Questionnaire Study

JMIR Dermatol. 2023 Dec 8:6:e48981. doi: 10.2196/48981.

Authors

Serena Ramjee¹, Hanen Mohamedthani¹, Aditya Umeshkumar Patel¹, Rebeca Goiriz², Catherine A Harwood^{1

2}, Richard H Osborne^{3

4}, Christina Cheng³, Zeeshaan-Ul Hasan²

Affiliations

¹ Barts and the London School of Medicine and Dentistry, Queen Mary University London, London, United Kingdom.
² Dermatology Department, Barts Health NHS Trust, London, United Kingdom.
³ Centre for Global Health and Equity, School of Health Sciences, Swinburne University of Technology, Hawthorn, Australia.
⁴ Department of Public Health, University of Copenhagen, Copenhagen, Denmark.

PMID: 38064259
PMCID: PMC10746975
DOI: 10.2196/48981

Abstract

Background: Given the expansion of remote digital dermatology services from the National Health Service, particularly during the COVID-19 pandemic, there is a need for methods that identify patients at risk of digital exclusion to guide equitable representation in service co-design processes and tailor remote services to the needs of their patient population.

Objective: This quality improvement project aims to inform the redesign of remote services to optimally support the ongoing needs of patients with chronic skin diseases, ensuring that the services are tailored to patients' digital health literacy requirements.

Methods: We profiled the digital health literacy of 123 people with chronic skin conditions who require long-term surveillance in 2 specialist clinics (London, United Kingdom) using the Multidimensional Readiness and Enablement Index for Health Technology (READHY) questionnaire alongside the Optimizing Health Literacy and Access (Ophelia) process for hierarchical cluster analysis.

Results: The cluster analysis of READHY dimensions in responding participants (n=116) revealed 7 groups with distinct digital and health literacy characteristics. High READHY scores in groups 1 (n=22, 19%) and 2 (n=20, 17.2%) represent those who are confident with managing their health and using technology, whereas the lower-scoring groups, 6 (n=4, 3.4%) and 7 (n=12, 10.3%), depended on traditional services. Groups 3 (n=27, 23.3%), 4 (n=23, 19.8%), and 5 (n=8, 6.9%) had varying digital skills, access, and engagement, highlighting a population that may benefit from a co-designed dermatology service.

Conclusions: By identifying patient groups with distinguishable patterns of digital access and health literacy, our method demonstrates that 63.8% (n=74) of people attending specialist clinics in our center require support in order to optimize remote follow-up or need an alternative approach. Future efforts should streamline the READHY question profile to improve its practicality and use focus groups to elicit strategies for engaging patients with digital services.

Keywords: chronic; cluster analysis; dermatologist; dermatologists; dermatology; digital health literacy; digital literacy; eHealth literacy; health literacy; innovation; quality improvement; remote care; service; services; skin; telehealth; telemedicine.

©Serena Ramjee, Hanen Mohamedthani, Aditya Umeshkumar Patel, Rebeca Goiriz, Catherine A Harwood, Richard H Osborne, Christina Cheng, Zeeshaan-ul Hasan. Originally published in JMIR Dermatology (http://derma.jmir.org), 08.12.2023.