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Research | DOI: https://doi.org/10.31579/2578-8949/088
1 Assistant Professor, Department of Dermatology, Venereology & Leprosy, Member of Telemedicine committee. ESIC Medical College & Hospital, Sanathnagar, Hyderabad, India.
2 Assistant Professor, Department of Preventive & Social Medicine, Member of Telemedicine committee. ESIC Medical College & Hospital, Sanathanagar, Hyderabad, India.
3 Assistant Professor, Department of General Medicine, Member of Telemedicine committee. ESIC Medical College & Hospital, Sanathnagar, Hyderabad, India
4 Assistant Professor, Departmemt of Obstetrics & Gynecology, Member of Telemedicine committee. ESIC Medical College & Hospital, Sanathnagar, Hyderabad, India
*Corresponding Author: Archana Mavoori, Assistant Professor, Department of Dermatology, Venereology & Leprosy, Member of Telemedicine committee. ESIC Medical College & Hospital, Sanathnagar, Hyderabad, India.
Citation: A Mavoori, Sudhabala, Rajiv K Bandaru, Aruna K Yerra. (2021) Knowledge, Attitude & Practice among psoriasis patients in India towards teledermatology during COVID-19 Pandemic. Dermatology and Dermatitis. 6(4); Doi:10.31579/2578-8949/088
Copyright: ©2021 Archana Mavoori, This is an open-acscess article distributed under the terms of The Creative Commons. Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 29 September 2021 | Accepted: 08 October 2021 | Published: 13 October 2021
Keywords: teledermatology; psoriasis; COVID-19
Background: The current COVID-19 pandemic has imposed upon the entire community norms of social distancing and home quarantine. Follow up consultations in these times can be made through teledermatology through smart phones. Success of this technology in these hours of crisis depends upon the knowledge, attitude and behaviour of patients towards teledermatology. Follow up consultations done through teleconsultations will decrease risk of exposure to COVID-19 among psoriasis patients who need frequent follow ups.
Aim: The main objective of this study is to assess the awareness, knowledge, attitude and practice of teledermatology through teledermatology among psoriasis patients at a tertiary care teaching hospital.
Materials and Methods: A cross-sectional survey, from Psoriasis Clinic registry maintained in the outpatient department of DVL of a tertiary care teaching hospital in India is conducted. A pre-validated self-administered questionnaire is used for the survey to assess knowledge, attitude and practice of teledermatology. Analysis will be done as per study objectives using descriptive statistics for quantitative data and content analysis for qualitative data.
Results: Out of 150 patients, 87(58%) were males and females were 63(42%). Most common age group to participate in the study was 36-45 years- 43(28.7%). Majority of participants were educated up to –graduate 53(35.3%). Males had higher knowledge and attitude scores compared to females. Most of the patients found using teleconsutations easy and convenient.
Conclusion: Teledermatology is the need of the hour to be implemented in these hours of COVID-19 pandemic.
A total of 150 patients were included in the study. Out of them, 87(58%) were males and females were 63(42%). Most common age group to participate in the study was 36-45 years- 43(28.7%) followed by 46-55 years- 36(24%). Majority of participants were educated upto –graduate level 53(35.3%). The mean duration of psoriasis was 7.43+5.46 years. 83(55.3%) patients had comorbidities like Diabetes mellitus, obesity, hypertension and hyperlipidaemia.
Knowledge about COVID-19 Score: The maximum knowledge score was 5. The mean score was 3.88 and standard deviation (SD) was 0.810. The study indicated that 103(68.7%) of participants had good knowledge regarding COVID-19. About 79.9% (n=119) of participants were worried about acquiring the corona virus. 120(80.5%) were maintain social distance and hand hygiene. 145(97.3%) think that the lockdown is useful in preventing the spread of corona virus. 80(53.7%) - think that most of patients with COVID-19 will have mild symptoms and 111(74.5%) think that the course of COVID-19 could be devastating. The study indicates that males 69(67%) had higher knowledge than females 34(33%). The patients in 36-45 years of age group had better knowledge 31(30%). Patients educated up to graduate level 39 (37.9%) had better knowledge compared to others.
Knowledge about Tele dermatology score: The maximum score in this category was 5. 76(51%) of patients were aware about tele dermatology. 124(83.2%) of patients were aware about the course of psoriasis. 96(64.4%) of patients reveal that they have been regularly using medications during lockdown even though they cannot come for regular follow up visits. 116(77.9%) of patients think that the course of psoriasis will worsen if they do not come for regular follow up visits. 141(94.6%) of patients think that tele dermatology consultations are useful for follow up visits during COVID-19 crisis. Figure 1.
Males had higher knowledge 67(67.7%) about tele dermatology and its benefits during COVID-19 crisis. 36-45 years of age group 27(27.3%) of patients had better knowledge in comparison to other groups. Graduate level of educated patients had good knowledge 42(42.4%) about COVID-19 and advantages of tele dermatology during lockdown period.
Attitude Score: The maximum score was 25 for 5 questions on attitude. 60(40.3%) of patients took the entire responsibility of psoriasis skin care upon themselves. 51(34.2%) of patients moderately agreed and 47(31.5%) were neutral that their comorbidities will worsen the course of psoriasis. 55(36.9%) of patients strongly agreed and 49(32.9%) moderately agreed that the influence of family and friend’s behaviour towards them was influenced by COVID-19 crisis and social distancing. Almost 99(66.4%) strongly agreed that tele consultation is better than direct consultation during the COVID-19 crisis. Strongly agreed were 67(45%) and 31(20.8%) were neutral and 25(16.8%) moderately agreed that they were satisfied if the doctor does not examine them personally. It can be noted that 36-45 years of age group and male gender is associated with positive attitude.
Practice score: The maximum practice score was 5. 102(68%) of psoriasis patients reported that they would frequently come for follow up visits, 105(70%) took prescribed medicines, applied creams, lotions regularly. 117(78%) found using the tele consultation app easy. 148(98.7%) reported tele consultations saved their time, avoiding travelling. And 148(98.7%) reported decreasing chances of risk of exposure to corona virus due to tele consultations. Figure 2. On one-way ANOVA we found statistically significant association of sex and education with knowledge related to COVID-19, knowledge about tele dermatology, their practices and attitude where males had higher mean score and as education increased the score also increased. Table 1 and Table 2. Attitude mean scores were found to be insignificant. This was reconfirmed with binary logistic regression analysis using Enter method. Table 3
No study was found assessing the Knowledge, Attitude and Practices (KAP) of teledermatology among psoriasis patients during COVID-19 crisis. Thus, it was difficult to compare the current results with others.
The results showed that participants with better knowledge also had a better attitude score. In the practice section, 78% found using the app easy. Inadequate knowledge regarding spread of corona virus tends to decrease awareness and may lead to poor practices leading to increased risk of acquiring the virus. Good knowledge about teledermatology, and better attitude decreases chances of patients’ risk of exposure to corona virus.
It was found that males are more knowledgeable about teleconsultations than females. Subgroup analysis revealed that age and educational level were significantly associated (p < 0>
Good knowledge of COVID-19 was significant among psoriasis patients, who had higher socioeconomic status. This finding was consistent with study by Hofstede et al [11]. This could be explained by the fact that participants with higher socioeconomic status have better access to education and alternative private check-ups without waiting for conservative treatment facilities in the health system. In the current study, controlling other variables, educational status had a significant association with good knowledge. This might be because educated participants are able to read necessary information easily compared to the illiterates.
Majority of patients had no previous experience with telemedicine. This finding is like a study conducted by Jayakody et al [12]. In the current study, duration of psoriasis was a significant predictor of practice. This may be due to regular counselling and contact with health professionals.
It was also observed that among female patients, follow up visits were not regular, treatment routine and self-care was poor. This could be because of elderly female patients’ limited access to health care. Females were not maintaining social distancing and hand hygiene during lockdown. This could be because of overburden due to increase in work at home, pressure to meet demands of all family members who are at home due to lockdown.
The COVID-19 crisis and social distancing had further added to the stigma faced by psoriasis patients who are treated as untouchables by some family members.
Evidence suggests that regular follow up visits are a core part of the treatment of psoriasis [13]. Patient education is the most constructive track that could assist with early detection, lessen the complications, and assist with the management of psoriasis. This study reemphasized the fact that properly designed and implemented telemedicine apps would be fruitful for patients with psoriasis. Provided complete information on COVID-19 characteristics, healthcare professionals could effectively implement tele dermatology, according to the psoriasis patients’ needs who need regular follow ups due to chronic course and frequent relapses. Proper implementation of lockdown measures and effective maintenance of social distancing and hand hygiene go a long way in preventing transmission of novel corona virus among patients.
The COVID-19 pandemic proved that telemedicine and teledermatology which were just an option before are indeed essential in crisis times. As most of the patients do not have the facility of computers, laptops and internet to have teledermatology consultations, we are implementing teledermatology through a unique android app. As most of the patients have smart phones with 4G/3G internet facilities, using tele consultations and follow up visits would be tested for simplicity and convenience. Widespread use of smartphones and android/iOS apps; ease of use; increased availability of health care professionals; reduced need for travelling; decreased exposure to the corona virus are all the advantages that make patients with chronic dermatological problems who require regular follow ups choose teledermatology as the preferred means of consultations. Widespread propaganda will help teledermatology penetrate deeper among society and will soon emerge as the most convenient means of consultations.
The authors are grateful to the Dean, and the entire telemedicine committee members for their guidance and cordial support. Special mention to all participants who took time during the covid-19 crisis and participated in this study with enthusiasm.
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