Smartphone photography by patients in telemedical wound assessment 153 2.3 Taking and Uploading Pictures Patients received specific instructions on how to make and upload lateral and frontal pictures of the intervention related wound at day 6 after hospital discharge. For puncture sites, 1 frontal, 1 lateral right-sided, and 1 lateral left-sided pictures were needed. A feature phone is a mobile phone with basic multimedia capabilities such as an integrated camera, without the ability to install third-party software and limited Internet capabilities. Examples are Nokia 2230, Motorola Razr, or Sony K700i. In contrast, a smartphone can install third-party software (apps) and has seamless integration of multimedia and Internet capabilities. The investigator gave a 10- to 20minute explanation on the actual device used and provided a detailed written brand- and model-specific protocol for uploading, detailing the steps as practiced. During this training, patients practiced uploading a picture to the laptop of the investigator. Smartphone users could also directly email to the specified address. Furthermore, they were given the chance to practice taking and uploading pictures during their clinical stay. Sending emails was not explicitly practiced. When patients suspected a complication, additional pictures could be sent within the existing telecare. Relatives were also allowed to make pictures. The picture should be taken at a distance of 50 cm, in a room with adequate daylight (no artificial lighting or flash), and include the provided label specifying the date, study number, and a ruler of 37 mm. Patients were instructed to check the quality of the pictures before sending them to the secure email address. All patients received a leaflet with these instructions and the dedicated email address. In addition, patients were asked to complete a questionnaire, which was developed in a focus group of 2 nurse practitioners and 2 epidemiologists and showed good validity. The purpose of the questionnaire was to evaluate the perceived difficulty in using the camera function, feelings toward the intervention, and whether taking photos required help from a caregiver. If no pictures were received at day 7 after discharge, patients received a telephonic reminder. For privacy reasons, patients were asked not to include a name or date of birth on the provided label or sent email and restrict to a header containing the study number. Emails were received on a secure email server. 9
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