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. 2022 Jul 27;5(3):e35254.
doi: 10.2196/35254.

Evaluation of WhatsApp as a Platform for Teledermatology in Botswana: Retrospective Review and Survey

Erika Koh #  1 , Abena Maranga #  2 , Tshepo Yane  3 , Kagiso Ndlovu  4 , Bwanali Jereni  5   6 , Maitseo Kuno Nwako-Mohamadi  7 , Carrie Kovarik  8 , Amy Forrestel  8 , Victoria L Williams  8
Affiliations

Evaluation of WhatsApp as a Platform for Teledermatology in Botswana: Retrospective Review and Survey

Erika Koh et al. JMIR Dermatol. .

Abstract

Background: In emerging market countries in sub-Saharan Africa, access to specialty services such as dermatology is limited. Teledermatology is an innovative solution to address this issue; however, many initiatives have been tried without sustained success. Recently, WhatsApp has been used as a store-and-forward telemedicine communication platform for consultation and education in Botswana.

Objective: This study aims to describe the utilization of WhatsApp for teledermatology and the satisfaction levels of participating providers.

Methods: A 2-part pilot study was conducted. First, a retrospective review was performed of WhatsApp communications received by participating dermatologists in Gaborone, Botswana, from January 2016 to December 2019. Sender information, patient demographics and history, response time, diagnoses made, and follow-up recommendations were collected. Second, a 12-question cross-sectional survey was distributed to health care providers who utilized WhatsApp for teledermatology during this period. Descriptive statistics were then performed.

Results: There were 811 communication threads over the study period. The majority (503/811, 62%) of communications were consultations from providers inquiring about a specific patient, followed by multidisciplinary care coordination communications (90/811, 11%). Our in-depth analysis focused on the former. In 323 (64%) provider consultations, dermatologists responded within 1 hour. A diagnosis was made in 274 (55%) consultations. Dermatologists gave treatment recommendations remotely in 281 (56%) consultations and recommended an in-person dermatology visit in 163 (32%). Of the 150 health care providers surveyed, 23 (15%) responded. All respondents (100%) felt that there was a need for teledermatology and improved teledermatology education in Botswana. Moreover, 17 (74%) respondents strongly felt that the guidance received via WhatsApp was high quality, and 22 (96%) were satisfied with WhatsApp as a platform for teledermatology.

Conclusions: This retrospective review and survey demonstrated that WhatsApp is a quick, well-received, and sustainable method of communication between dermatologists and providers across Botswana. The app may offer a solution to the challenges providers face in accessing specialty referral systems, point-of-care education, and medical decision-making support for complex dermatologic cases in Botswana. The information gained from this pilot study can serve as the basis for future telemedicine studies to improve the implementation of teledermatology in Botswana and other resource-limited countries.

Keywords: Africa; Botswana; WhatsApp; dermatology; developing countries; eHealth; instant messaging; low income; mHealth; retrospective review; teledermatology; telehealth.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Locations of providers that utilized WhatsApp for teledermatology in Botswana, with number of providers in each location.
Figure 2
Figure 2
Example of a consultation sent from a nondermatologist provider to a dermatologist.
Figure 3
Figure 3
Responses to the Provider Satisfaction Survey questions assessing the overall utility of WhatsApp as a teledermatology platform.
See this image and copyright information in PMC

References

    1. Azfar RS, Weinberg JL, Cavric G, Lee-Keltner IA, Bilker WB, Gelfand JM, Kovarik CL. HIV-positive patients in Botswana state that mobile teledermatology is an acceptable method for receiving dermatology care. J Telemed Telecare. 2011 Aug 15;17(6):338–40. doi: 10.1258/jtt.2011.110115. http://europepmc.org/abstract/MED/21844175 jtt.2011.110115 - DOI - PMC - PubMed
    1. Crisp N, Chen L. Global supply of health professionals. N Engl J Med. 2014 Mar 06;370(10):950–957. doi: 10.1056/nejmra1111610. - DOI - PubMed
    1. Ncube B, Mars M, Scott RE. The need for a telemedicine strategy for Botswana? A scoping review and situational assessment. BMC Health Serv Res. 2020 Aug 26;20(1):794. doi: 10.1186/s12913-020-05653-0. https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-020-0... 10.1186/s12913-020-05653-0 - DOI - DOI - PMC - PubMed
    1. Tsang Matthew W, Kovarik Carrie L. The role of dermatopathology in conjunction with teledermatology in resource-limited settings: lessons from the African Teledermatology Project. Int J Dermatol. 2011 Feb;50(2):150–6. doi: 10.1111/j.1365-4632.2010.04790.x. http://europepmc.org/abstract/MED/21244377 - DOI - PMC - PubMed
    1. Littman-Quinn R, Mibenge C, Antwi C, Chandra A, Kovarik CL. Implementation of m-health applications in Botswana: telemedicine and education on mobile devices in a low resource setting. J Telemed Telecare. 2013 Feb 01;19(2):120–5. doi: 10.1177/1357633x12474746.1357633X12474746 - DOI - PubMed

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