skip to main content

This content will become publicly available on May 13, 2025

Title: Navigating Telehealth Challenges: Rural Perspectives on Technology Access and Trust
This study delves into the adoption and challenges of telehealth services in rural settings, examining racial and locational influences on usage. Employing qualitative methods, it draws on 30 detailed interviews with both healthcare providers and patients in two racially diverse, economically disadvantaged towns in Southern Illinois from fall 2021 to spring 2023. Our findings indicate that insufficient internet access and lack of necessary devices are significant factors in the reluctance of rural residents to embrace telehealth services. Additionally, this study reveals a major barrier: a deep-seated mistrust in the telehealth infrastructure's ability to safeguard private medical information. Notably, our results show that Black participants have heightened concerns regarding the health care industry's capacity to maintain the confidentiality of their medical data.  more » « less
Award ID(s):
Author(s) / Creator(s):
; ;
Ramsey, Doug
Publisher / Repository:
Rural Development Institute, Brandon University
Date Published:
Journal Name:
Journal of rural and community development
Page Range / eLocation ID:
Subject(s) / Keyword(s):
Medium: X
Sponsoring Org:
National Science Foundation
More Like this
  1. Background

    Rural and remote communities were especially vulnerable to the COVID-19 pandemic due to the availability and capacity of rural health services. Research has found that key issues surrounded (1) the lack of staff, (2) the need for coordinated health services, and (3) operational and facility issues. Similarly, research also confirms that irrespective of hospital capacity issues existing during crisis, compared to urban communities, rural communities typically face poorer access to health services. Telehealth programs have long held promise for addressing health disparities perpetuated by inadequate health care access. In response to the current COVID-19 pandemic, Adventist Health Saint Helena Hospital, a rural hospital in northern California, urgently worked to expand telehealth services. However, as Adventist Health Saint Helena Hospital is the longest-serving rural hospital in the state of California, administrators were also able to draw on experiences from the pandemic of 1918/1919. Understanding their historically rural and heavily Latino populations, their telehealth approach was coupled with cultural approaches for prioritizing socially responsive and equitable access to health services.


    This study aimed to present one rural community’s holistic sociotechnical response to COVID-19 in redesigning their health care delivery approach. Redesign efforts included the expansion of digital health services coupled with county-wide collaborations for nondigital mobile health centers, testing, and vaccination clinics to meet the needs of those with limited digital access and language barriers.


    We present data on telehealth services for maintaining critical care services and a framework on the feasibility of private-public partnerships to address COVID-19 challenges.


    In this paper, we provide a critical review of how a rural hospital adapted its health care approach to incorporate telehealth services and distance services to meet the needs of a diverse population.


    This paper contributes empirical data on how rural communities can use telehealth technologies and community partnerships for a holistic community approach to meet health needs during a natural disaster.

    Conflicts of Interest

    None declared.

    more » « less
  2. Due to long-standing barriers to healthcare access in rural areas, telehealth has been promoted as an effective means of delivering healthcare services. However, there is a general absence of quantitative data showing how geographic residence and race affect telehealth adoption. This study examines variations in telehealth adoption based on race and geographic residence in Southern Illinois using a mail survey. It finds that residents of urban Carbondale, compared to those in rural Cairo, have better access to broadband and are more likely to use telehealth. Respondents significantly differ from each other based on their geographic location of residence and race when it came to using telehealth to save money on travel and to save money on childcare. A significant barrier to telehealth adoption identified across all groups is privacy protection concern. The findings highlight the crucial role of broadband infrastructure in healthcare access and the need for trust in telehealth systems to ensure data privacy. 
    more » « less
  3. Despite providing convenience and reducing the travel burden of patients, Video-Conferencing (VC) clinical visits have not enjoyed wide uptake by patients and care providers. It is desired that the medical problems addressed by VC visits can match a face-to-face encounter in scope and quality. Subsequently, VC visits with nurse assistance are emerging; however, the scalable and financially sustainable of such services are unclear. Therefore, we explore the implementability of VC visits with nursing services using a game-theoretic model, and investigate the impact of different pricing schemes (discriminative pricing based on patient characteristics vs. non-discriminative) on patients’ care choices between VC and in-person visits. Our results shed light on the “artificial congestion” created by a profit-driven medical institution that hurts patient welfare, and subsequently identify the conditions where the interest of the social planner and the medical institution are aligned. Our results highlight that, compared to a uniform price of VC visits which seems fair, discriminative pricing can be more beneficial for patients and the medical institution alike. This heightens the importance of insurance coverage of telehealth-related services to promote the adoption of telehealth by patients and care providers, and ultimately, improving care access and patient outcomes. 
    more » « less
  4. In the United States, sensitive health information is protected under the Health Insurance Portability and Accountability Act (HIPAA). This act limits the disclosure of Protected Health Information (PHI) without the patient’s consent or knowledge. However, as medical care becomes web-integrated, many providers have chosen to use third-party web trackers for measurement and marketing purposes. This presents a security concern: third-party JavaScript requested by an online healthcare system can read the website’s contents, and ensuring PHI is not unintentionally or maliciously leaked becomes difficult. In this paper, we investigate health information breaches in online medical records, focusing on 459 online patient portals and 4 telehealth websites. We find 14% of patient portals include Google Analytics, which reveals (at a minimum) the fact that the user visited the health provider website, while 5 portals and 4 telehealth websites con- tained JavaScript-based services disclosing PHI, including medications and lab results, to third parties. The most significant PHI breaches were on behalf of Google and Facebook trackers. In the latter case, an estimated 4.5 million site visitors per month were potentially exposed to leaks of personal information (names, phone numbers) and medical information (test results, medications). We notified healthcare providers of the PHI breaches and found only 15.7% took action to correct leaks. Healthcare operators lacked the technical expertise to identify PHI breaches caused by third-party trackers. After notifying Epic, a healthcare portal vendor, of the PHI leaks, we received a prompt response and observed extensive mitigation across providers, suggesting vendor notification is an effective intervention against PHI disclosures. 
    more » « less
  5. null (Ed.)
    Worldwide, at the time this article was written, there are over 127 million cases of patients with a confirmed link to COVID-19 and about 2.78 million deaths reported. With limited access to vaccine or strong antiviral treatment for the novel coronavirus, actions in terms of prevention and containment of the virus transmission rely mostly on social distancing among susceptible and high-risk populations. Aside from the direct challenges posed by the novel coronavirus pandemic, there are serious and growing secondary consequences caused by the physical distancing and isolation guidelines, among vulnerable populations. Moreover, the healthcare system’s resources and capacity have been focused on addressing the COVID-19 pandemic, causing less urgent care, such as physical neurorehabilitation and assessment, to be paused, canceled, or delayed. Overall, this has left elderly adults, in particular those with neuromusculoskeletal (NMSK) conditions, without the required service support. However, in many cases, such as stroke, the available time window of recovery through rehabilitation is limited since neural plasticity decays quickly with time. Given that future waves of the outbreak are expected in the coming months worldwide, it is important to discuss the possibility of using available technologies to address this issue, as societies have a duty to protect the most vulnerable populations. In this perspective review article, we argue that intelligent robotics and wearable technologies can help with remote delivery of assessment, assistance, and rehabilitation services while physical distancing and isolation measures are in place to curtail the spread of the virus. By supporting patients and medical professionals during this pandemic, robots, and smart digital mechatronic systems can reduce the non-COVID-19 burden on healthcare systems. Digital health and cloud telehealth solutions that can complement remote delivery of assessment and physical rehabilitation services will be the subject of discussion in this article due to their potential in enabling more effective and safer NMSDK rehabilitation, assistance, and assessment service delivery. This article will hopefully lead to an interdisciplinary dialogue between the medical and engineering sectors, stake holders, and policy makers for a better delivery of care for those with NMSK conditions during a global health crisis including future pandemics. 
    more » « less