Views on Mobile Health Apps for Skin Cancer Screening in the General Population

An In-depth Qualitative Exploration of Perceived Barriers and Facilitators

T.E. Sangers; M. Wakkee; E.C. Kramer-Noels; T. Nijsten; M. Lugtenberg


The British Journal of Dermatology. 2021;185(5):961-969. 

In This Article

Abstract and Introduction


Background: Mobile health (mHealth) applications (apps) incorporating artificial intelligence for skin cancer screening are increasingly reimbursed by health insurers. However, an in-depth exploration of the general public's views towards these apps is lacking.

Objectives: To explore the perceived barriers and facilitators towards mHealth apps for skin cancer screening among the Dutch general population.

Methods: A qualitative study consisting of four focus groups with 27 participants was conducted. A two-stage purposive sampling method was used to include information-rich participants from the Dutch general population with varying experience of mHealth. A topic guide was used to structure the sessions. All focus group meetings were transcribed verbatim and analysed in thematic content analysis by two researchers using several coding phases, resulting in an overview of themes and subthemes, categorized as (sub-)barriers and (sub)facilitators.

Results: Main barriers to using mHealth apps included a perceived lack of value, perception of untrustworthiness, preference for a doctor, privacy concerns, a complex user interface, and high costs. The main factors facilitating the use of mHealth among the general population were a high perceived value, a transparent and trustworthy identity of app developers, endorsement by healthcare providers and government regulating bodies, and ease and low costs of use.

Conclusions: To increase successful adoption in skin cancer screening apps, developers should create a transparent identity and build trustworthy apps. Collaboration between app developers, general practitioners and dermatologists is advocated to improve mHealth integration with skin cancer care. Special attention should be given to the development of low-cost, privacy-friendly, easy-to-use apps.


Skin cancer is the most common form of cancer in countries with populations of predominantly European ancestry, and known for its increasing incidence rates.[1,2] The Netherlands ranks among the top European countries in terms of melanoma incidence.[3] In addition, the incidence of keratinocyte cancer (KC), most notably basal cell carcinoma and squamous cell carcinoma, is increasing steeply in the Netherlands, resulting in over 60 000 new KC cases being diagnosed in 2017.[4] Similarly to most other countries, Dutch healthcare providers rely on the patient's ability to detect skin cancer, as there is no population-based skin cancer screening implemented in the Netherlands. Given the rising incidence of skin cancer, new solutions are being explored to streamline skin cancer detection.

Artificial intelligence (AI) algorithms can interpret medical data without human intervention,[5,6] and have been found to achieve levels of accuracy comparable with those of dermatologists, and even exceed them, when classifying clinical images as benign or malignant skin lesions.[7,8] Recently, these algorithms have been implemented in consumer mobile health (mHealth) applications (apps), which allow users to instantly receive a risk assessment of a skin lesion by taking a smartphone camera photo.[9] mHealth apps may facilitate skin cancer detection, as people in the general population can screen a skin lesion anywhere, at any time. Moreover, an easy and swift diagnostic tool may result in skin cancers such as melanoma being detected at an earlier stage with better prognosis. Additionally, countries struggling with a rising incidence of skin cancer[1,10] and associated expenditures[11] may also benefit from integrating mHealth within their healthcare systems. mHealth apps can advise users to visit a doctor only in case of a suspicious skin lesion, reducing unnecessary consultations for benign skin lesions.

Given the hypothesized benefits, multiple health insurers in Europe, Australia and New Zealand have already introduced a form of reimbursement for mHealth apps[12–15] and have been included in the NHS Innovation Accelerator.[16] Moreover, the COVID-19 pandemic has been further emphasizing the importance of remote care and has accelerated virtual healthcare adoption.[17] Nevertheless, a systematic review underscored the need for proper validation of the accuracy of these algorithms before they should be integrated with healthcare systems.[18]

A critical challenge is the acceptance and actual use of these apps by the target group.[19] Our latest retrospective study revealed an uptake of only 1% among a cohort of two million insured adults in the Netherlands, indicating the presence of significant barriers towards the implementation of mHealth for skin cancer screening.[20] Although a recent study indicated a generally positive view by the general public towards the use of AI for skin cancer screening,[21] an in-depth qualitative exploration of their views towards mHealth applications for skin cancer screening is lacking. The aim of this study is to explore the views of the Dutch general population towards mHealth applications for skin cancer screening in terms of perceived barriers and facilitators.