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

Materials and Methods

Study Design and Methodological Considerations

A qualitative design was considered the most suitable for exploring the views of participants. Focus groups were chosen, as group dynamics often stimulate participants to talk about things they would not have initially thought of themselves, leading to richer and more diverse information compared with individual interviews.[22,23] Moreover, a focus group design previously proved to be a suitable method for exploring the implementation of mHealth in healthcare fields other than dermatology.[24,25] The reporting of this study followed the Standards for Reporting Qualitative Research (SRQR).[26] The need for ethical approval was waived by the medical ethical committee of the Erasmus MC University Medical Center after review of the study design (MEC-2019-0409).

Selection of Participants

A two-stage purposive sampling method[23,27] was used for participant selection, aiming for a variable sample in terms of sex, age, and previous experience with mHealth.

For the first two focus groups the customer panel of a large Dutch health insurer (CZ, Tilburg, the Netherlands) was used to recruit participants. All CZ customer panel members received an invitation email to participate in a focus group including an information leaflet about the study. Potential participants could apply via a web form.

As the participants recruited through the CZ customer panel were aged 50 years and above, and had limited previous experience with mHealth, our focus for the additional focus groups shifted towards selecting younger participants who had more experience with mHealth apps.[27] Social media platforms (Facebook, LinkedIn) were used to invite additional participants. Data saturation was reached after no new concepts in terms of (sub-)barriers and (sub)facilitators were identified, which was the case after analysing four focus groups (Appendix S1; see Supporting Information).

Data Collection

The four focus groups were led by an experienced moderator of focus groups (M.L.) and cochaired by at least one medical doctor (E.C.K.-N., T.E.S.). A topic guide was used to structure the discussion based on the Technology Acceptance Model and existing literature concerning mHealth adoption (Appendix S2; see Supporting Information).[23,28,29] Relevant topics included general views towards skin cancer and apps, the role of health insurers and care providers, potential barriers, and factors facilitating the implementation of mHealth in practice. Before the focus group session's formal start, participants completed a questionnaire to collect demographic information, including mHealth experience, and provided written informed consent. The focus groups were audiotaped and transcribed verbatim in anonymized form. A €30 gift card was offered for participation.

Data Analysis

A thorough thematic content analysis using elements from Grounded Theory (i.e. open and axial coding, constant comparison technique) embedded in a constructivist methodology was performed.[30–32] The transcripts were analysed using the qualitative data analysis software NVivo version 12 Plus (QSR International Pty Ltd, Doncaster, Vic, Australia). Several phases of coding,[32] combined with the constant comparison technique, described in detail in Appendix S1, resulted in a final overview of themes and subthemes, which were categorized as (sub-)barriers and (sub)facilitators (Table 2). Descriptive analyses of demographic characteristics were performed on group level using SPSS Statistics version 15·0 (IBM SPSS Statistics, Armonk, NY, USA).