Development of a digital tool for home-based monitoring of skin disease for older adults

ABSTRACT

The COVID-19 pandemic has accelerated the adoption of telemedicine. However, current tools pose substantial barriers for older adults and those with low digital literacy. By implementing user-centered design, we developed a digital tool, Dermatology for Older Adults (DORA), for home-based monitoring of skin disease, specifically designed for older adults. DORA is a virtual assistant based on REDCap and Twilio APIs that automates image and symptom collection and allows communication between patients and the research team. We evaluated the feasibility, usability, patient compliance, retention, and clinical utility of DORA. Eligibility criteria included patients >70 years with any skin disease, access to a smartphone, and no cognitive impairment. We recruited 62 patients aged 70-94 (mean age 77), 39% female, 81% white from Stanford’s Dermatology Clinic from August-December 2021. We asked patients to send weekly photos and answer a questionnaire of a single skin lesion for 4 weeks, then monthly for 4 months. We measured response time, photo quality, and participant satisfaction using mHealth app usability questionnaire (MAUQ). The median response time was 1.4 days (IQR 0.6-3.4). Four participants dropped out. 83% completed photo submission requests (48% at initial request, 19% after 1st reminder and 16% after 2nd reminder). 80% of all questionnaires requested (131 of 163) were completed. Four dermatology clinicians evaluated the quality of the first 88 images and reported good confidence in triaging skin diseases. MAUQ scores were high for ease of use (5.6 SD1.3), interface satisfaction (5.5 SD1.3), and usefulness (5.2 SD1.3). Patients were consistently able to use DORA to submit photos and symptoms and reported high usability and satisfaction. Patient retention was high, and clinicians felt confident making triage recommendations based on DORA images. This approach can be used in other settings where digital literacy barriers and unequal access to dermatologists contribute to healthcare disparities.