131 GPS’ PERSPECTIVES ABOUT REMOTE DERMATOLOGY CARE DURING THE COVID-19 PANDEMIC After 1 week, nonresponding GPs received a reminder email. Participation was voluntary, and GPs could unsubscribe via email. In total, 4 gift cards worth €50 (US $53.65) were raffled among all responding health care providers in a large study. Questionnaire instrument The web-based GP questionnaire (Appendix 7.1) was available in Dutch only and consisted of 54 open-ended and closed-ended questions. The questionnaire included general background questions, questions from the validated SAF-TSUQ questionnaire [19], and newly added insight questions related to the pandemic and use of digital dermatology care in general practice (Figure 7.2). The SAF-TSUQ questions evaluated the service quality as experienced by GPs from a contracted telemedicine organization perspective, whereas in-depth insight questions were added to evaluate digital dermatology care as experienced by GPs from a broad sociotechnical perspective. Answers to the SAF-TSUQ questions were recorded on a 5-point Likert scale (range: 1=strongly disagree to 5=strongly agree) and the nonsubstantive options, “I do not know” and “not applicable.” Overall, 3 redundant items of the original SAF-TSUQ were discussed with a quality manager at Ksyos and were removed beforehand. In addition, the questions related to “organization, policy, and strategy” and “working conditions” were excluded because during the validation of the original SAF-TSUQ questionnaire among all health care providers, the Dutch GPs frequently reported that these questions were not applicable to them in the Dutch context. Furthermore, the newly added questions related to the pandemic were formulated based on questions that emerged out of interest from the researchers during the COVID-19 pandemic. The other additional in-depth insight questions were related to the use of teledermatology, teledermoscopy, and digital dermatology home consultation in general practice (Figure 7.2). These questions were also specifically formulated for this study and focused on training and image quality, as these factors are often mentioned as barriers to telemedicine use [21-23]. For some of the closed-ended questions, GPs were prompted in an open-ended follow-up question to explain why they chose a specific answer category. At the end of each section, a separate textbox was presented for additional free-text comments. Furthermore, 1 final open-ended feedback question was included to gather any feedback or suggestions from GPs for improvement of the questionnaire. All questions (except the additional free-text comments and open-ended follow-up questions) were mandatory. A GP resident and a GP reviewed the newly added questions and options in advance. Then, 2 researchers (ET and Femke van Sinderen) evaluated the questionnaire’s technical operation, and a data management consultant (Miranda Roskam-Mul) externally reviewed the questionnaire’s technical operation. 7
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