What Will it Take to Scale-Up Teledermatology? Providers' Perspectives in Kenya and Uganda

A shortage of dermatologists in resource-limited settings often results in patients' receiving dermatologic management from other providers, who may lack expertise. In East Africa, teledermatology (TD) has recently emerged as a potential solution to improve dermatologic care and patient outcomes. In February 2023, TD was implemented at 12 ambulatory clinics in Kenya and Uganda with variable uptake. We explored the barriers and facilitators of TD uptake among primary care providers in these clinics.

To elucidate user perceptions of factors affecting successful TD uptake.

Between August and November 2024, we conducted focus group discussions (FGDs) among providers recruited via purposive sampling. Providers included nurses, clinical officers, and physicians. FGDs were guided by the Theoretical Domains Framework, coded using an abductive approach, and analyzed using a Thematic Framework.

We conducted six FGDs across eight clinics with 23 participants in Kenya and 10 in Uganda. We found that TD use was generally influenced by its perceived degree of integration into routine care. Facilitating this integration was the perception of TD a professional duty that created learning opportunities for providers, improved patient care, and was supported by clinic leadership and culture. Technological integration was facilitated by factors such as TD software compatibility with providers' mobile devices. Conversely, TD was perceived as burdensome when poorly integrated into existing workflows. This included non-integration into existing electronic medical record systems, non-availability on the clinics' computers, and the absence of automated reminders about TD feedback. Participant recommendations included providing professional incentives for TD use - such as Continuing Medical Education credit - and integrating TD into the clinics' electronic medical record systems and devices.

Among primary care providers in Kenya and Uganda, TD use was facilitated by integration into routine care and hindered by technological and structural barriers that increased workload burden. The challenges of TD non-integration represented an "activation energy" that could be overcome by drivers of professional obligation, including perceptions of TD as a professional duty. Thus, enhancing TD use should target context-specific interventions, provider motivations, and technological infrastructures. Future studies should also assess patients' perspectives on TD.