Teledermatological solution to improve patient management in psoriasis: a participatory design study

Research output: ThesisPh.D. thesis

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Psoriasis is a chronic inflammatory disease that affects 2-4% of the Western population and is associated with various comorbidities, including arthritis, depression and cardiovascular disease. Furthermore, psoriasis has a major negative impact on quality of life. In Denmark, these patients have regular follow-ups, typically every three months. This may be a challenge for patients who live far away from the hospital, especially when their disease is well controlled. mHealth has been shown to be a promising and reliable tool for the long-term management of patients with psoriasis on biological treatment. Despite recent strides, the full potential of mHealth remains to be tapped by newer, more attractive forms of services that are focused on both patients’ and health care professionals’ needs.
The aim of this study was to explore, identify and develop patient-centred teledermatological approaches to providing healthcare for patients with psoriasis receiving biological treatment.
A participatory design study was conducted in three phases: 1) the identification of needs, 2) design and development, and 3) test and evaluation. The study took a phenomenological-hermeneutic approach and was inspired by Ricoeur’s thoughts on narrative and interpretation.
Phase 1
To identify the needs of both patients and health care professionals, ethnographic field studies were conducted and consisted of 48 hours of participant observation of consultations, 15 semi-structured interviews with patients and two focus group interviews with HCPs. The findings revealed that the existing consultations were characterized by a biomedical approach and set routines, and that patients’ needs and their perspectives were not necessarily taken into consideration. Both patients and HCPs expressed a need to change current clinical practice.
Phase 2
Based on the findings from phase one, through a future workshop and four mock-up workshops, an mHealth app was designed by the patients, the health care professionals, an IT designer and the research group. In that way, the needs that had been identified through mutual learning were used as a starting point and guided the democratic and creative process. The mHealth app was designed to support patients at in-person visits and to replace in-person visits through the use of video consultations, aided by the feature “preparation before consultation”. A high-fidelity prototype was tested and adjusted before the next phase.
Phase 3
The mHealth app was tested in a real clinical setting for a period of three months. In total, 14 semi-structured interviews with patients were conducted and, subsequently two focus group interviews with health care professionals. The findings showed that all participants considered the mHealth solution to be easy to use. Patients especially highlighted the ability to attend video consultations and the opportunity to prepare ahead of consultations. Thus, reflexivity and being given a voice were experienced as important. On the contrary, health care professionals, were more reluctant and challenged, both in terms of their medical responsibilities and new workflows and routines that acquired different communicative approaches.
In conclusion, this study contributed with nuanced and specific knowledge about patients and HCPs during follow-up consultations. Furthermore, the study contributed with new knowledge about the lived experiences of patients with psoriasis receiving biological treatment. This knowledge served as the identified needs and was used to design an mHealth app, in close collaboration with all end-users and the research team. In addition, the study provided knowledge related to the everyday life experiences of patients with psoriasis receiving biological treatment. The test in clinical practice showed that the mHealth app could strengthen the relationship between patients and health care professionals and help patients to become more active in their care. Furthermore, the mHealth app facilitated patient-centred care and for patients to be supported in self-management.
Future research it is relevant to include patients with psoriasis who do not receive biologics. In addition, a further investigation of the findings of the current study could provide more insight into the scope of the findings and ultimately improve care and management for this group. Attention should be paid to the existing power structures in hospitals and to how to organize care and management through the use of technology, by involving patients and their experiences and perspectives.
Translated title of the contributionTeledermatologisk løsning til optimering af pleje- og behandlingsforløbet for patienter med psoriasis: et participartory design studie
Original languageEnglish
Awarding Institution
  • University of Southern Denmark
  • Agerskov, Hanne, Principal supervisor
  • Danbjørg, Dorthe Boe, Co-supervisor
  • Andersen, Flemming, Co-supervisor
  • Feldman, Steven, Co-supervisor
Publication statusPublished - 18. Nov 2021


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