133 GPS’ PERSPECTIVES ABOUT REMOTE DERMATOLOGY CARE DURING THE COVID-19 PANDEMIC Data analysis This study excluded the responses of GPs who responded that they did not use digital dermatology consultation in the Ksyos platform and did not consent in the questionnaire to anonymously process their answers for scientific purposes. Furthermore, incomplete questionnaires, vague or incomprehensible free-text or open-ended responses, and comments that related to a care path other than dermatology were excluded from data analysis. Incomplete questionnaires were excluded, as this was the only way to prevent the inclusion of questionnaires submitted by the same GP. Descriptive statistics were used to analyze the single-choice, multiple-choice, and Likert scale responses, using numbers and percentages (R software, version 4.0.3; R Foundation for Statistical Computing) [24]. Overall, 2 researchers (ET and Bibiche Groenhuijzen) independently read all open-ended and free-text responses line by line and applied (thematic) content analysis to get a deep understanding of the issues GPs experience when using remote digital dermatology care. The sociotechnical model was developed by Sittig and Singh [25] to identify the sociotechnical issues that arise during the design, development, implementation, use, and evaluation of health IT within complex health care systems. We applied their model to group the open and free-text responses into 8 interrelated dimensions: (1) hardware and software; (2) clinical content; (3) human-computer interface; (4) people; (5) workflow and communication; (6) internal organizational policies, procedures, and culture; (7) external rules, regulations, and pressures; and (8) system measurement and monitoring. During axial coding, 1 coder (Bibiche Groenhuijzen) applied a subcode for each answer, and main codes were formulated (LWP and Bibiche Groenhuijzen) and assigned to each subcode. Most answers were short; however, some answers contained more detailed information and were assigned to multiple codes. The codes were applied to categorize the open-ended responses systematically and to compare the data with other similar parts of the data set. The second coder (ET), a Ksyos expert, assigned a subcode and main code to each response and, if necessary, added additional subcodes. After coding the first few responses, an informative meeting between the researchers (ET and Bibiche Groenhuijzen) was conducted to discuss how coding proceeded till then and any uncertainties about the process and definitions of the codes. Then, the second coder (ET) finalized the coding. This second coder had access to the list of predefined subcodes and main codes but was blinded to the previous codes assigned to free-text and open-ended responses by the first coder. Both researchers (ET and Bibiche Groenhuijzen) classified the responses as facilitating, impeding the use of digital care, or neutral and assigned a sociotechnical dimension of the 8-dimensional model by Sittig and Singh [25] to the responses. 7
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