Perceived Usefulness,Ease of Use,and Intention to Use Telemedicine Among Dermatologists in Taiwan

Abstract

Introduction:

Telemedicine can be a vital tool for increasing health care access in dermatology. While dermatologists’ perceptions about telemedicine are critical for adoption; unfortunately, there is scant research on perceived usefulness, ease of use, and intention to use telemedicine—and factors associated with these perceptions—among dermatologists. With comprehensive reimbursement for tele-dermatology through its National Health Insurance, Taiwan offers a unique environment to study these critical adoption factors among dermatologists.

Methods:

A cross-sectional survey of dermatologists, developed based on the Technology Acceptance Model, was conducted between March and June 2022. Descriptive statistics were used to describe current use and perceptions. Multivariate generalized linear regressions were used to identify factors associated with perceptions on and intention to use tele-dermatology.

Results:

Among the 88 dermatologists surveyed, 60% reported prior use of tele-dermatology, and 77% noted that COVID-19 increased their willingness to use. Compatibility with current work practices was associated with greater perceived usefulness (β = 0.369; p = 0.015). Personal self-efficacy was associated with greater perceived ease of use (β = 0.339; p = 0.003). Finally, greater behavioral intention to use was associated with organizational facilitating conditions (β = 0.297; p = 0.005) and administrative policy and regulations (β = 0.425; p < 0.001).

Conclusions:

The perceived usefulness of tele-dermatology was associated with compatibility with dermatologists’ current work practices, while ease of use was associated with their self-efficacy. Despite the low perception on usefulness or ease of use, dermatologists’ intention to use tele-dermatology was influenced by facilitating conditions and external policies. Policy makers should prioritize maintaining supportive regulatory environments and enhancing organizational facilitating conditions.

Keywords

telemedicine telehealth dermatology perceived usefulness perceived ease of use intention to use Technology Acceptance Model

Introduction

Telemedicine can enhance health care access, reduce costs, and facilitate physicians’ professional education.^1–4 Particularly, telemedicine can address growing specialty care workforce shortages.^4–6 While telemedicine technology has been available for some time, COVID-19 accelerated uptake and underscored the potential for telemedicine to meet the need for accessible and efficient health care services.⁷

However, technology alone is insufficient for achieving these benefits. Successful implementation of telemedicine depends on five major factors: technology, user acceptance, financing, organization, and policy and legislation.⁸ Among these factors, user acceptance among clinicians is especially important because they dictate if and how telemedicine is offered and delivered to patients, often based on a number of considerations, including available reimbursement, incentives, and utility.⁹

Telemedicine is particularly well-suited for dermatology—a field that relies heavily on visual diagnosis and faces issues of workforce supply (insufficient numbers of clinicians) and maldistribution (concentration of clinicians in certain areas and absences or shortages in other areas). In turn, audiovisual tele-dermatology may provide a potential solution to address workforce issues and improve access to care while enabling the practice of dermatology through visual diagnosis.¹⁰

A number of factors can affect intention to use of providers—including those related to clinicians (e.g., individual values, experience with technology, education), perceptions of patient attitudes,⁸ and care delivery organizations (e.g., institutional acceptance, organizational strategy, infrastructure, training).^11–13 Effective communication, professional benefits, and health care service quality could promote telemedicine adoption, while usability and lack of educational training are barriers. In sum, physicians’ willingness, intention to use, and satisfaction are pivotal for the successful application of telemedicine.^14,15

While dermatologists’ perceptions about telemedicine—usefulness, ease of use, and intention to use—are potentially critical for promoting and sustaining telemedicine adoption, research on such perceptions is scarce. Factors associated with telemedicine adoption among dermatologists remain less clear. A study in Spain found perception of facilitators to using the technology as the only predictor for physician’s intention to use tele-dermatology, but the majority of the respondents were primary care physicians, and the survey was conducted more than a decade ago (2011), long before the COVID-19 pandemic.¹² Furthermore, their study did not specifically explore how policy and regulations affect dermatologists’ intention to use.

Taiwan residents enjoy universal health care coverage through the publicly funded National Health Insurance (NHI) program. With respect to telemedicine, policy makers expanded coverage through the NHI and began reimbursing clinicians in 2021 for providing telemedicine for three types of specific specialty care—ophthalmology, otorhinolaryngology, and dermatology—in rural areas with specialty workforce shortage. However, insurance coverage does not necessarily equate to adoption and use, and telemedicine adoption among clinicians in target clinical areas, such as dermatologists, remains unknown. As one of the first regions to offer reimbursement for tele-dermatology through its NHI, Taiwan presents a unique setting to fill these knowledge gaps about dermatologists’ telemedicine perceptions. This is a particular critical issue for Taiwan’s health system, given budgetary pressures facing the NHI and the need to set coverage policy for services that clinicians will offer and patients will accept.

To address this gap, we sought to assess the use of tele-dermatology in Taiwan, and to identify factors affecting dermatologists’ perceptions of usefulness and intention to use tele-dermatology.

Materials and Methods

Study participants and data collection

This study adopted a cross-sectional design and collected data using a structured questionnaire (available in both the paper and online versions) from March to June of 2022. Study participants were dermatologists in Taiwan, recruited from the Taiwanese Dermatological Association, community dermatology clinics, and the dermatology department of teaching hospitals. This study was approved by the National Taiwan University Research Ethical Committee (202201HS026).

Questionnaire design and measures

The questionnaire for this study included questions assessing respondents’ behavioral intention to use tele-dermatology, along with three additional sections: (1) Tele-dermatology use and the impact of COVID-19 on use; (2) factors associated with the intention to use tele-dermatology; and (3) demographic and practice information. Please refer to Supplementary Data for the full questionnaire.

Section. Demographic and practice information

The questionnaire collected information about respondents’ demographic and practice characteristics. Demographic information included gender (female vs. male), age, and the highest level degree obtained. Practice information included practice setting (hospital vs. clinic) and managerial work (whether respondents had active management roles in their practices).

Information captured from the survey instrument was paired with publicly available data about the geographic supply of dermatologists, measured as the number of dermatologists per 10,000 residents in a region (city or county). Regions were categorized into quartiles of dermatologist supply (Q1 = high; Q2–Q4 = low).

Section. Tele-dermatology use and the impact of COVID-19

The first section of the survey aimed to understand the current situation of dermatologists’ use of tele-dermatology, including the frequency of using tele-dermatology, the equipment and information systems that were used, and the difficulties they might encounter. In addition, survey questions in this section sought to understand whether, and if so why, COVID-19 affected dermatologists’ willingness to use tele-dermatology. Operating definitions of telemedicine and tele-dermatology were both provided at the beginning of the questionnaire (Supplementary Data). Questions in this section included the following: 1.

Have you utilized tele-dermatology?

Have you utilized other telemedicine services other than tele-dermatology?

Have you utilized telemedicine or tele-dermatology within the past year? What hardware have you utilized to provide tele-dermatology services? What communication platform did you use when providing tele-dermatology services?

Has COVID-19 increased your willingness to utilize tele-dermatology services?

Regardless of whether you have used tele-dermatology, what do you consider major barriers to tele-dermatology implementation?

Intention to use tele-dermatology

The behavioral intention to use tele-dermatology was the outcome of interest in this analysis. We measured intention to use via 4 items through the following four questions: 1.

I am willing to use tele-dermatology services to provide patient education and care information.

I am willing to use tele-dermatology services to obtain patient information and their medical history.

I believe that the patient information obtained through tele-dermatology services (e.g., clinical images, medical history) allows me to make a correct diagnosis.

Overall, I will use tele-dermatology to provide health care service.

Section. Factors associated with perceived usefulness, perceived ease of use, and behavioral intention to use tele-dermatology

We used the Technology Acceptance Model (TAM) as theoretical framework for questions assessing factors associated with the intention to use tele-dermatology. A behavioral model based on the Theory of Reasoned Action, TAM assesses user acceptance of new information systems based on the influence of external factors (e.g., the system’s functionality) and internal factors (e.g., user characteristics), and how they affect user attitudes and ultimately behavioral intention to use technology. TAM has been applied to telemedicine studies, demonstrating that factors facilitating adoption of telemedicine service systems include compatibility, availability, perceived ease of use, and perceived usefulness, while factors impeding adoption include user inertia, technology anxiety, sunk costs, and transition costs.^16–18

Based on TAM and adapted from prior studies,^12,19 survey questions assessed factors associated with intention to use across three dimensions: individual context, organizational context, and administrative context (Fig. 1). Individual context included perceived usefulness (the degree to which dermatologists believed the use of telemedicine would enhance their job performance)²⁰ and perceived ease of use (the degree to which dermatologists believed that using telemedicine would be free of effort).²⁰ Additionally, survey questions assessed factors associated with perceived usefulness and perceived ease of use through two dimensions: self-efficacy (dermatologists’ confidence in their ability to use telemedicine)²¹ and compatibility (the degree of correspondence between the telemedicine use and dermatologists’ existing values, past experiences, and needs).²² Detailed descriptions of these constructs are described in Table 1.

FIG. 1.

Theoretical model based on Technology Acceptance Model (TAM).

Table 1.

Items Used for Measurement TAM

Construct	Definition	Number of items	Sample measurement item	Cronbach’s α	References
Perceived usefulness (PU)	The degree to which a dermatologist believes the use of telemedicine service would enhance his or her job performance.	5	Using tele-dermatology would positively affect the treatment plan for patients.	0.848	(Davis, 1989²⁰; Rho et al., 2014)¹⁹
Perceived ease of use (PEoU)	The degree to which a dermatologist believes that using telemedicine service would be free of effort.	4	It would be easy for me to become proficient in using telemedicine equipment.	0.849	(Davis, 1989)²⁰
Self-efficacy (SE)	The dermatologist’s confidence in his or her ability to use telemedicine.	4	I am able to use telemedicine equipment without any assistance.	0.825	(Bandura, 1982²¹; Hung et al., 2012; Rho et al., 2014)¹⁹
Compatibility (CB)	The degree of correspondence between the use of telemedicine and existing values, past experiences, and needs of dermatologists.	3	The use of tele-dermatology is compatible with my work habits.	0.830	(Chau & Hu, 2002; Gagnon et al., 2012²³; Rogers, 1995)²²
Facilitating conditions (FC)	The degree to which a dermatologist believes that an organizational and technical infrastructure exists to support the use of telemedicine.	4	I would use tele-dermatology if I receive appropriate training.	0.774	(Gagnon et al., 2012²³; Triandis, 1979)²⁴
Workflow (WF)	The degree to which a dermatologist believes the use of telemedicine has changed or disrupted the workflow and organization of work.	4	Using tele-dermatology would change my work pattern (e.g., change clinics, have to make extra visits).	0.625	(Jacob et al., 2020)²⁵
Policy and regulations (PR)	Dermatologists’ awareness of telemedicine reimbursement issues, policy, and regulations related to privacy, security, licensing, and credentialing.	3	The inclusion of telemedicine (including tele-dermatology) in the National Health Insurance has increased my willingness to use tele-dermatology.	0.788	(Jacob et al., 2020)²⁵
Behavioral intention to use (BIU)	The degree of a dermatologist’s behavioral intention to use the telemedicine service.	4	Overall, I will use tele-dermatology to provide health care service.	0.879	(Rho et al., 2014)¹⁹

The second dimension, organizational context, encompassed facilitating conditions (the degree to which dermatologists believed that organizational and technical infrastructure exists to support the use of telemedicine)²⁴ and workflow (the degree to which dermatologists believed the use of telemedicine changed or disrupted the workflow and organization of work)²⁵ (Table 1). As constructs, facilitating conditions and workflow have been reported as the most significant organizational factors influencing telemedicine use.²⁵

As the third dimension, the administrative context referred to the effect of the policy planning, regulatory restrictions, and infrastructure construction on telemedicine services (Table 1). Considering the implementation of new telemedicine policy, this study incorporated policy and regulations factors into the research framework, measured as dermatologists’ awareness of current telemedicine reimbursement issues, policy, and regulations related to privacy, security, licensing, and credentialing.²⁵

In sum, our survey questionnaire included questions assessing perceived usefulness (PU, 5 questions), perceived ease of use (PeoU, 4 questions), self-efficacy (SE, 4 questions), compatibility (CB, 3 questions), workflow (WF, 4 questions), policy and regulations (PR, 3 questions), and facilitating conditions (FC, 4 questions) related to tele-dermatology. For instance, 3 of the 4 items used to assess FC were: (1) “I have sufficient access to the software and hardware equipment required for using tele-dermatology,” (2) “I would use tele-dermatology if I have relevant technical assistance,” (3) “I would use tele-dermatology if I receive appropriate training.” As another example, three items were also used to assess PR: (1) “The inclusion of telemedicine (including tele-dermatology) in the National Health Insurance has increased my willingness to use tele-dermatology,” (2) “If the use of tele-dermatology is included as a bonus item in the hospital accreditation, it would increase my willingness to use tele-dermatology,” and (3) “If the use of tele-dermatology can increase the training capacity for dermatologists, it would increase my willingness to use tele-dermatology.” Each survey item was measured using a 5-point Likert-type scale (strongly disagree to strongly agree).

Content validity and reliability

We assessed the content validity of survey items using the Item-Content Validity Index (I-CVI) and Scale-Content Validity Index (S-CVI), based on the responses of five experts with abundant experience in dermatology and telemedicine services. All experts responded on a 4-point scale (from strongly disagree to strongly agree) regarding the importance, appropriateness, and accuracy of each item. The I-CVI was calculated as the average score for each item, and the S-CVI was the average of I-CVI for each construct. The questionnaire reached the recommended I-CVI value of 0.78, and S-CVI value of 0.9.²⁶ Additionally, we calculated Cronbach’s alpha to assess internal construct reliability for each construct. All constructs’ Cronbach’s alphas were >0.5, the minimum recommended threshold, and 7 of 8 constructs’ Cronbach’s alpha were >0.7, the preferred threshold.²⁷ These processes yielded a final questionnaire consisting of 31 questions measuring 8 different constructs.

Statistical analysis

We calculated average scores for each construct and Spearman correlation coefficients between constructs. Following prior work, we further categorizing scores of all constructs. Scores >3 were categorized as “high score,” while scores of lesser or equal to 3 were categorized as “low score.”²³

Counts and percentages were used to describe categorical variables, while means, standard deviations, and medians were used to describe continuous variables. Chi-squared and t-tests were used to assess associations between intention to use tele-dermatology and categorical and continuous variables, respectively, reflecting different survey constructs and respondents’ demographic and practice information.

Three multivariate generalized linear models were used to evaluate the relationship between the five survey constructs and respondents’ intention to use tele-dermatology. Model 1 and Model 2 included SE and compatibility as independent variables, and PU (model 1) and perceived ease of use (model 2) as dependent variables. Model 3 estimated the effect of PU, perceived ease of use, FC, workflow, and PR on the probability of high behavioral intention to use tele-dermatology as the dependent variable. All regression models controlled for respondents’ demographic and practice characteristics, including gender (female/male), age (≥50 or <50), whether the respondent had any other graduate-level degrees (yes/no), practice region with high dermatologist supply(yes/no), practice setting (hospital/clinic), and managerial work (yes/no). All data analyses were conducted using SPSS version 22.

Results

Demographic and practice information

There were 96 dermatologists (representing 7.9% of 1163 dermatologists in Taiwan) responding to our survey. Among them, 8 were excluded due to incomplete information in one of the constructs, yielding 88 complete responses. Among the 88 respondents, almost all (96.6%) filled out the questionnaire by themselves, with only 3.4% being proxy respondents (Table 2). Most of the respondents were males (72.7%), aged between 40 and 49 (40.9%), and with an MD degree only (80.6%). Nearly one in every four respondents practiced in Taipei City (22.7%), followed by similar proportions practicing in Taichung City (21.6%) and Tainan City (20.5%). The majority of the respondents worked in clinics (64.8%), did not perform managerial work (73.9%), and practiced in a region with a high supply of dermatologists (61.4%).

Table 2.

Demographic Characteristics of the Dermatologists (n = 88)

Variables	n	%
Gender
Male	63	71.6
Female	25	28.4
Age
20–29 Years	9	10.2
30–39 Years	21	23.9
40–49 Years	36	40.9
50–59 Years	14	15.9
60–64 Years	3	3.4
65 or more years	5	5.7
Respondent
Dermatologist self	85	96.6
Assistant or others	3	3.4
Highest educational grade
Bachelor (md) only	71	80.6
Master/PhD	17	19.4
Region of practice
Taipei city	20	22.7
New Taipei city	4	4.5
Taoyuan city	8	9.1
Taichung city	19	21.6
Tainan city	18	20.5
Kaohsiung city	10	11.4
Other cities	9	10.3
Category of medical institutions
Clinic	57	64.8
Hospital	31	35.2
Management role
Yes	23	26.1
No	65	73.9
Regional dermatologist supply (city or county)
High (Q1)	54	61.4
Low (Q2–Q4)	34	38.6

Tele-dermatology use and the impact of COVID-19

Among the respondents, 60% reported having used tele-dermatology in the past, and 57% reported use within the past year, with the majority (98%) reporting using it through computers or tablets/cell phones and approximately a quarter (26%) through electronic cameras (Table 3). Meanwhile, LINE (the most popular messaging app in Taiwan) was the most used communication platform while providing tele-dermatology services (88%). Most (67%) dermatologists did not utilize telemedicine services other than tele-dermatology.

Table 3.

Descriptive Analysis of Current Use of Tele-Dermatology and the Impact of COVID-19 (n = 88)

Questions on the current use of tele-dermatology	n	%
Have utilized tele-dermatology
Yes	53	60.2
No	35	39.8
Have utilized other telemedicine
Yes	27	30.7
No	59	67.1
Unknown	2	2.2
Have utilized tele-dermatology within the past year
Yes	50	56.9.
No	38	43.1
Hardware used to provide tele-dermatology services (n = 50)
Computers, tablets/cell phones	49	98.0
Assistant or others	13	26.0
Communication platform used to provide tele-dermatology services (n = 50)
Line	44	88.0
Google meet	6	12.0
Others	10	20.0
Has COVID-19 increased willingness to use tele-dermatology
Yes	68	77.2
No	20	22.8
Major barriers to tele-dermatology implementation overall
Diagnostic accuracy	71	80.7
Patients’ limited access to technology	69	78.4
Patients’ privacy concerns	45	51.1

The majority (77%) of respondents reported that COVID-19 increased their willingness to use tele-dermatology. The majority of dermatologists believed that barriers to tele-dermatology implementation included diagnostic accuracy (81%), patients’ limited access to technology (78%), and patients’ privacy concerns (51%) (Table 3). Among respondents reporting diagnostic accuracy as a barrier, some mentioned the inability to perform physical examination (e.g., to palpate a skin lesion) or provide instrument-based treatments as concerns. In addition, some of them also reported that poor photo quality and resolution of images provided through tele-dermatology might impact diagnostic accuracy.

Factors associated with PU, perceived ease of use, and behavioral intention to use tele-dermatology

Across factors, the scores for PU, PeoU, SE, and CB were lower than 3, while FC and WF were higher on average (>3) among all dermatologists (Table 4). This result holds by comparing both the mean and median scores. The Spearman correlation coefficients demonstrated that WF had a weak negative correlation with behavioral intention to use (BIU, r_s = −0.07) while FC (r_s = 0.56) and policy and regulations (PR, r_s = 0.62) were more strongly and positively correlated with BIU.

Table 4.

Descriptive Analysis of the TAM Constructs

	PU	PEoU	SE	CB	FC	WF	PR	BIU
Mean	2.85	3.09	2.83	2.51	3.27	3.64	3.19	3.27
SD	0.71	0.66	0.72	0.77	0.72	0.65	0.84	0.75
Median	3.00	3.00	2.75	2.50	3.33	3.83	3.33	3.25
Correlation coefficient with BIU	0.44	0.36	0.23	0.25	0.56	−0.07	0.62	1.00

BIU, behavioral intention to use; CB, compatibility; FC, facilitating conditions; PEoU, perceived ease of use; PR, policy and regulations; PU, perceived usefulness; SD, standard deviation; SE, self-efficacy; WF, workflow.

In multivariate analyses, compatibility was associated with greater PU of tele-dermatology (CB, β = 0.369, p = 0.015), while female gender was associated with lower PU (β = −0.273, p = 0.019) (Table 5). In analyses of perceived ease of use, self-efficacy was positively associated with perceptions about greater ease to use (SE, β = 0.339, p = 0.003) (Table 5). Conversely, female gender was associated with perceptions about lower ease of use. In analyses of BIU, FC (β = 0.297, p = 0.005) and PR (β = 0.425, p < 0.001) were observed to be associated with greater BIU tele-dermatology (Table 6). Dermatologists’ demographic and practice characteristics were not significantly associated with intention to use.

Table 5.

Linear Probability Regression Model: Perceived Usefulness and Perceived Ease of Use (n = 88)

	Model 1: Perceived usefulness			Model 2: Perceived ease of use
Independent variables	Coefficient	95% CI	p	Coefficient	95% CI	p
Self-efficacy (low^a as reference)	−0.006	−0.232 to 0.220	0.958	0.339^**	0.118 to 0.560	0.003
Compatibility (low^a as reference)	0.369^*	0.074 to 0.664	0.015	0.278	−0.010 to 0.567	0.059
Female (male as reference)	−0.273^*	−0.500 to −0.047	0.019	−0.304^**	−0.526 to −0.083	0.008
Age ≥50 (>50 as reference)	−0.218	−0.447 to 0.010	0.061	0.026	−0.197 to 0.250	0.817
Having any other graduate-level degrees (MD only as reference)	0.023	−0.225 to 0.272	0.852	0.007	−0.236 to 0.250	0.953
Practice region with high dermatologist supply^b (no as reference)	0.048	−0.161 to 0.256	0.651	−0.122	−0.326 to 0.081	0.235
Practicing in a hospital (a clinic as reference)	−0.068	−0.290 to 0.154	0.545	0.022	−0.195 to 0.240	0.838
On a management role (no as reference)	−0.140	−0.374 to 0.093	0.236	−0.226	−0.454 to 0.003	0.053

F = 4.556, p < 0.001, R² = 0.316.

High score is defined as an average score higher than 3 on a 5-point Likert Scale, while a low score is defined as an average score lower than or equal to 3.

High supply of dermatologists is defined as a city with a high number of dermatologists per 10,000 residents, ranking the top 25%. Cities with a low supply of dermatologists are defined by the number of dermatologists per 10,000, ranking the second to fourth quartile as a reference among all cities in Taiwan. Cities ranked as top 25% in supply of dermatologists are Taipei City, Chiayi City, Hsinchu City, Taichung City, Kaohsiung City, and New Taipei City, and the rest of the cities or counties are ranked below 25%.

*Significant at 0.05 level. **Significant at 0.01 level.

Table 6.

Linear Probability Regression Model 3: Behavioral Intention to Use

Independent variables	Coefficients	95% CI	p
Constant	0.065	−0.223 to 0.353	0.654
Perceived usefulness (low^a as reference)	0.130	−0.067 to 0.327	0.193
Perceived ease of use (low^a as reference)	0.093	−0.087 to 0.272	0.308
Facilitating conditions (low^a as reference)	0.297^**	0.093 to 0.500	0.005
Workflow (low^a as reference)	−0.083	−0.296 to 0.130	0.441
Policy and regulations (low^a as reference)	0.425^***	0.232 to 0.618	<0.001
Female (male as reference)	−0.002	−0.209 to 0.205	0.984
Age ≥50 (>50 as reference)	0.043	−0.152 to 0.238	0.658
Having any other graduate-level degrees (MD only as reference)	−0.182	−0.390 to 0.027	0.087
Practice region with high dermatologist supply^b (no as reference)	0.166	−0.007 to 0.339	0.060
Practicing in a hospital (a clinic as reference)	0.082	−0.102 to 0.266	0.377
On a management role (no as reference)	−0.019	−0.216 to 0.177	0.846

High score is defined as an average score higher than 3 on a 5-point Likert Scale, while low score is defined as an average score lower than or equal to 3.

High supply of dermatologists is defined as a city with a high number of dermatologists per 10,000 residents, ranking in the top 25%. Cities with a low supply of dermatologists are defined by the number of dermatologists per 10,000, ranking the second to fourth quartile as a reference among all cities in Taiwan. Cities ranked as top 25% in supply of dermatologists are Taipei City, Chiayi City, Hsinchu City, Taichung City, Kaohsiung City, and New Taipei City, and the rest of the cities or counties are ranked below 25%.

**Significant at 0.01 level; ***significant at 0.001 level.

Discussion

In contrast to prior work evaluating perspectives mostly from primary care clinicians, this study is, to the best of our knowledge, the first to directly assess PU, ease of use, and intention to use tele-dermatology among dermatologists.

We found that the majority of dermatologists have used tele-dermatology, with increased willingness to use tele-dermatology due to COVID-19. However, the main challenges hindering wider adoption are likely technological issues, such as diagnostic accuracy and patients’ privacy concerns. Although the diagnostic accuracy of tele-dermatology was found to be lower compared to face-to-face consultation in some cases (e.g., skin cancer),²⁸ this disadvantage may still be outweighed by the potential benefits for patients with limited access to dermatological care. Furthermore, while diagnostic accuracy is important, its relevance is arguably reduced if the treatment prescribed is ultimately the same as that resulting from an in-person visit. Future research could prioritize determining the acceptable level of diagnostic accuracy necessary for tele-dermatology to serve as a viable alternative to traditional face-to-face visits.

LINE emerged as the most widely used communication platform. Ironically, despite being Taiwan’s most popular messenger app, LINE is not certified for secure health information exchange, immediately raising patient privacy and data security concerns when used for tele-dermatology. This conflicting usage highlights the critical importance of developing tele-dermatology solutions that are compatible with existing clinical workflows while ensuring compliance.

Other study findings are also notable. In particular, despite low overall PU and ease of use, perception was associated with certain factors. For instance, PU was positively associated with compatibility: when dermatologists felt tele-dermatology aligned with their existing work patterns, habits, and beliefs, they were more likely to believe it could assist in treatment planning and provide comprehensive care. Similarly, perceived ease of use was significantly associated with SE: Greater confidence and experience in operating dermatology-related telemedicine equipment made the technology seem easier to apply. Notably, female dermatologists reported lower perceived ease of use and lower PU of telemedicine, implying potential cultural or experiential differences between different gender groups. This finding also warrants the development of gender-specific strategies to effectively promote telemedicine adoption in dermatology.

Finally, both FC (e.g., provision of necessary hardware and software equipment, education and training, and technical assistance within the organization) and PR (e.g., privacy, security, health care regulations, and specific guidelines and policies²⁵) were associated with dermatologists’ intention to use tele-dermatology. These findings not only corroborate prior work among primary care and other physicians^{12,17,23,29–34}; they go beyond previous research to demonstrate that the more dermatologists perceive organizational or policy support, the more willing they are to use tele-dermatology. Even if they do not find the technology inherently “easy” or “useful” on its own, dermatologists are still motivated to use telemedicine if surrounding systems are appropriately set up to support use. Future longitudinal research is required to determine whether this observed phenomenon is specific to the COVID-19 pandemic by conducting a follow-up survey among dermatologists.

Study limitations

This study had limitations. First, the sample size of 88 respondents is relatively small. This modest sample size is likely to impact the external validity and generalizability of our results. However, similar studies among medical specialists often feature comparable response rates or sample sizes,^12,35,36 and the demographic distribution of our sample mirrors Taiwan’s nationwide dermatologist population, suggesting adequate representativeness. Second, potential heterogeneity between respondents and nonrespondents (e.g., in prior telemedicine experience) may also limit the generalizability of our results. Nonetheless, we found that intention to use was most strongly associated with external factors (FC and policy/regulations), which are less dependent on individual physicians’ prior experience. Finally, the small sample size prevented us from distinguishing between the intention to use different types of tele-dermatology services or different modalities (e.g., synchronous vs. asynchronous), which limits the applicability of our findings for specific service promotion policies.

Conclusion

Despite low PU and perceived ease of tele-dermatology among dermatologists, such perceptions are associated with factors such as compatibility, while BIU tele-dermatology is associated with external organizational and policy/regulatory factors rather than individual physician factors. Promoting long-term success and benefits of telemedicine may involve policy makers prioritizing and maintaining favorable government reimbursement and regulations, along with excellent technical and logistical support within clinics and hospitals.

Footnotes

Acknowledgments

The authors thank Wei-Ming Wang, Ming-Chin Yang, Jhih-Hong Li, Nan-Lin Wu, Wei-Yu Chen, Chi-Hui Wang, Ching-Wei Li, Shan-Han Chang, Kuang-Yu Niu, and Chao-Jen Shih for serving as expert advisors in this study, providing valuable suggestions on the research and questionnaire, and assisting in participant recruitment.

Author Disclosure Statement

No competing financial interests exist.

Funding Information

This study was partly supported by Taiwan’s National Science and Technology Council (grant numbers MOST111-242-H-002-002 and NSTC 112-2410-H-002-012-MY3) and Population Health and Well-being Research Center from Featured Areas Research Center Program within the framework of the Higher Education Sprout Project by the Ministry of Education in Taiwan (grant number NTU-114L900401).

Supplemental Material

Abbreviations

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