208 APPENDICES Part III: GPs’ perspectives about store-and-forward digital dermatology care The sudden worldwide demand for digital healthcare during the COVID-19 pandemic has been a driver to use digital dermatology as a way to relieve standard in-person dermatology care. Digital dermatology services facilitated it to provide a diagnosis remotely, thereby reducing the number of physical visits in GP practices and hospitals. However, it is unclear how Dutch GPs experienced this already existing digital dermatology care during the COVID-19 pandemic. In part III, we examined GPs’ perspectives about store-and-forward digital dermatology and how digital dermatology is incorporated into the GPs work practice. In Chapter 6 we described the development and validation of the Store-and-Forward Telemedicine Service User-satisfaction Questionnaire (SAF-TSUQ). This questionnaire aimed to assess experiences of healthcare providers with a contracted store-and-forward telemedicine organization (their services and the platform used). Development of the questionnaire consisted of four steps. First, an exploratory literature search was conducted on existing validated telemedicine satisfaction questionnaires. Second, in a focus group with a telemedicine domain and a human-factors engineering expert the questionnaire items acquired from the literature were tested for applicability within the research context. Third, a structured focus group was held with stakeholders to evaluate the relevance and formulation (wording) of the questionnaire items. Fourth, two questionnaire pre-testing rounds were performed. During these pre-testing rounds, 18 medical specialists, paramedics and GPs reviewed the questionnaire and evaluated the comprehensiveness and applicability of the questionnaire items. These four steps in questionnaire development eventually resulted in a 61-item questionnaire. This questionnaire was sent to 2179 healthcare providers for validation. In total, 224 of the 2179 (10%) invited healthcare providers completed the questionnaire. In 43 questionnaires, the respondents reported that they were not sure whether they worked with the telemedicine platform. These 43 questionnaires were therefore excluded from the data analyses. The remaining 181 questionnaires were included for psychometric analyses. We performed psychometric analyses to assess construct validity and the internal consistency of the questionnaire. Psychometric analyses of the questionnaire showed that internal consistency of the SAF-TSUQ was sufficient and factor analyses confirmed six reliable scales: training, communication, organization policy and strategy, interaction telemedicine platform, use of the telemedicine platform, and working conditions. This reliable and valid quality feedback tool could be used in the future as part of a continuous quality improvement cycle. In Chapter 7 we assessed during the pandemic the experiences of GPs with the use of teledermatology, teledermoscopy, and dermatology home consultation from a contracted telemedicine organization and a sociotechnical perspective. In December 2021, an online questionnaire was sent via email to approximately 3257 Dutch GPs. This online questionnaire included (1) general background questions, (2) the validated SAF-TSUQ questions from Chapter 6, (3) new in-depth insight questions on the use of digital dermatology care in general practice and specific questions on training and photo
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