Enabling Rural Telehealth: Focus Group Study with Older Adults in Underserved Rural Communities (Preprint)
Authors: Hunter Inga , Lockhart Caroline , Rao Vasudha , Tootell Beth 
Published: December 2021

BACKGROUND

Telehealth is often suggested to improve access to healthcare and has had significant publicity internationally during the Covid-19 pandemic. However, there is limited research examining the telehealth needs of underserved populations such as rural communities.

OBJECTIVE

The aim of this study was to investigate enablers for telehealth use in rural underserved populations to improve access to healthcare for rural older adults.

METHODS

7 focus group discussions and 13 individual interviews were held across 4 diverse underserved rural communities. 98 adults, aged 55 years and over, participated. Participants were asked if they had used telehealth, how they saw their community’s health service needs evolving, how telehealth might help provide these services, and perceived barriers and enablers to telehealth for older adults in rural communities. Focus group transcripts were thematically analysed.

RESULTS

The term ‘telehealth’ was not initially understood by many participants and required explanation. The likelihood of using telehealth varied between those who had used telehealth and those who had not. Those who had used telehealth reported very positive experiences (time and cost savings) and would be more likely to use telehealth again.
Two main themes were identified through an equity lens. The first theme was “trust” with three sub-themes – trust in the telehealth technology, trust in the user (consumer and health provider) and trust in the health system. Having access to reliable and affordable internet connectivity and digital devices was a key enabler for telehealth use. Most rural areas had intermittent, unreliable internet connectivity. Having easy access to user support was another key enabler. Trust in the health system focused on waiting times, lack of/delayed communication and coordination, and cost.
The second theme was “choice” with three sub-themes – health service access, consultation type and telehealth deployment. Access to health services by telehealth needs to be culturally appropriate and enable access to currently limited or absent services such as mental health and specialist services. Accessing specialist care by telehealth was extremely popular but some participants would rather be seen in person. A major enabler for telehealth was deploying telehealth by a fixed community ‘hub’ or on a mobile bus, with support available, and especially when combined with non-health related services such as online banking.

CONCLUSIONS

Overall, participants were keen on the idea of telehealth. Several barriers and enablers were identified. The term ‘telehealth’ is not well understood. The unreliable and expensive connectivity options available to the rural communities has limited the telehealth experience to phone or patient portal use, for those who have connectivity. Having the opportunity to try telehealth, especially using video, would increase understanding and acceptance of telehealth. The study highlights that local rural communities need to be involved in the design of telehealth services within their community.