A Teledermatology Scale-Up Framework and Roadmap for Sustainable Scaling: Evidence-Based Development

Area of Science:

• Digital Health and Health Informatics
• Public Health and Epidemiology
• Dermatology and Skin Health

Background:

• South Africa's eHealth strategy acknowledges telemedicine's potential for healthcare referrals, but lacks formal scale-up, hindering benefit realization.
• Existing synchronous and asynchronous teledermatology solutions are localized and not widely implemented.
• Inefficient dermatology referrals in South Africa, critical for diagnosing HIV/AIDS, necessitate improved systems.

Purpose of the Study:

• To develop and present an evidence-based Teledermatology Scale-Up Framework (TDSF).
• To create a supporting Teledermatology Scale-Up Framework Implementation Roadmap (TDSF-IR).

Main Methods:

• A qualitative design science research process model was employed, involving 5 phases: Awareness, Suggestion, Development, Evaluation/Validation, and Conclusion.
• Framework development included identifying design requirements, critiquing existing related frameworks, and defining 5 TDSF components and 36 subcomponents.
• Validation involved 4 senior teledermatology stakeholders using a 5-point Likert scale questionnaire, with a mean rating of 4.0 (SD 0.53).

Main Results:

• The study identified 5 key components and 36 subcomponents for the TDSF, providing detailed descriptions for design.
• An implementation roadmap (TDSF-IR) was developed to guide the application of the TDSF.
• Validation showed strong stakeholder agreement, with 33 out of 36 responses indicating agreement or strong agreement with the TDSF and TDSF-IR's usefulness.

Conclusions:

• An evidence-based Teledermatology Scale-Up Framework (TDSF) and Implementation Roadmap (TDSF-IR) were successfully developed.
• The developed framework and tools offer a scalable and sustainable approach for teledermatology implementation.
• The proposed methodology can be adapted for scaling other eHealth initiatives in diverse settings.