Design Requirements for a Teledermatology Scale-up Framework

Abstract

<jats:p>The value proposition of full-scale teledermatology is evidenced in the literature. The public health sector of South Africa’s KwaZulu-Natal province began synchronous teledermatology in 2003, followed by spontaneous asynchronous (mobile) teledermatology in 2013. No scale-up has been formally planned. This paper establishes design requirements that will inform the identification or de novo development of a teledermatology scale-up framework.&#x0D; &#x0D; Methods: A requirements definition process with inductive reasoning approaches was applied. Analysis of semi-structured interviews (19) with key teledermatology stakeholders (17) and observations from two teledermatology programmes, informed by lessons learned from prior teledermatology implementation attempts, eHealth scale-up literature and authors’ expert opinion, led to identification of Themes, and iterative reflection gave rise to Categories and Requirements.&#x0D; &#x0D; Results: Teledermatology scale-up framework design requirements emerged comprised of themes (4), categories (12), and specific design requirements (30). &#x0D; &#x0D; Discussion: This paper describes a process and resulting evidence-based (stakeholder interviews; programme observations; literature) and experience-based (expert opinion) design requirements to inform the identification and adoption / adaptation or de novo development of a teledermatology scale-up framework (TDSF) for KwaZulu-Natal’s public health sector. The proposed approach is recommended as a pre-requisite for scaling, including in other settings and for other telehealth applications.</jats:p>

Methods for Human-Centered eHealth Development: Narrative Scoping Review

“…First of all, authors stated that requirements should be elicited in a systematic way. Ideally, multiple sources of data should be combined, such as scientific literature and qualitative data collected from multiple types of stakeholders [ 91 , 114 , 115 ]. When combining sources, development teams need to be aware of conflicting requirements, for example, a discrepancy between user needs and scientific literature [ 91 , 92 ].…”

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

“…The entire process from conception to completion is reflected in Figure 2 . Steps numbered 1, 2, and 3 have been previously published [ 8 , 11 , 12 ] but are included in Figure 2 for completeness. Only results for Steps 4 onwards are described below, that is, those gained through the iterative and reflective process used within the context of the design science research process model and giving rise to specific content.…”

“…Also, the scale-up phases allow for a phased scaling compared to a big-bang approach where all the activities need to be completed in one implementation cycle. A phased approach to scaling is supported [ 23 ] as previously recommended for the TDSF [ 11 ]. The scale-up drivers provide the momentum and energy required to push the scaling process.…”

“…Except for the eHealth researcher, the key stakeholders represented the current teledermatology management team from the KwaZulu-Natal Department of Health and the Department of Dermatology at the University of KwaZulu-Natal. The management team had also participated in semistructured interviews that identified the TDSF design requirements from an earlier study [ 11 ].…”

“…A previous study identified the minimum design requirements to inform a conceptual teledermatology scale-up framework (TDSF) using key stakeholder interviews, literature review, program observations, and expert opinion [ 11 ]. The minimum requirements were grouped into 4 themes (framework organization, eHealth building blocks, eHealth planning, and eHealth action), which were further separated into 12 categories with 30 requirements [ 11 ]. Another study reported that no TDSF existed, and that no eHealth-related scale-up framework met all the design requirements [ 12 ].…”