Some factors encountered in adaptation of Teledermatology in rural areas

Abstract

Background: Mongolia’s geographical characteristics limit access to specialist healthcare for residents of remote soums, resulting in out-of-pocket expenditure, substantial travel time, and reliance on accompanying family members. To address these barriers, the store-and-forward “Derma” application was introduced progressively across 334 soums between 2017 and 2020. Nevertheless, challenges persist in sustaining its operation and embedding it in routine clinical practice. Aim: To explore soum doctors’ experiences with the “Derma” application and identify factors influencing the sustainability of teledermatology services. Materials and Methods: Focus group interviews were conducted in seven aimags between December 2019 and June 2020. A pilot interview with eight doctors in Sukhbaatar aimag informed the development of a semi-structured interview guide. Written interview records underwent directed content analysis guided by Donabedian’s structure–process–outcome framework. Response frequencies were interpreted at group and participant levels, accounting for variation in the number answering each question. The analysis examined service interruptions and organisational requirements for sustainability, incorporating recurrent themes, emerging concerns, and critical perspectives on technology use. Ethical approval and written informed consent were obtained. Results: Overall, 98.1% (52/53) of participants reported difÏculty diagnosing and treating skin diseases locally. Among respondents to the relevant questions, 85.4% (41/48) considered the application helpful, 95.8% (46/48) perceived little difference in quality between remote and in-person care, and 89.6% (43/48) reported learning benefits. Most participants reported no increase in workload (94.3%; 50/53). Mean case submission time was 9.67±4.42 minutes; the reported specialist response time was 2.5 days (range: 1–14). Barriers included mobile network limitations in five aimags, difÏculties obtaining recommended medicines in six, and personal expenditure of 8,000 MNT per month on mobile data among doctors in three aimags. A small number of accounts highlighted the need for standardised response times, access for all doctors, technical maintenance, dedicated data funding, medicine availability, and secure communication channels. Conclusion: Soum doctors perceived teledermatology as supporting specialist consultation, continuing professional learning, and healthcare access. Its sustained adoption was constrained by workforce instability and inadequate infrastructural, financial, and organisational support.