The challenges of healthcare in rural areas are well-known: delivering high-quality services to small numbers of people, scattered across wide areas, is inherently difficult. As broadband and other digital technology improve, telehealth — using the internet to manage or deliver care — is increasingly touted as a solution.

But despite the hopes invested in using online services to improve rural healthcare, little is known about what makes people more likely to engage with telehealth. A new study from the US Department of Agriculture’s Economic Research Service aims to fill that gap.

Its author found that higher incomes and more advanced education made a major difference to rural residents’ likelihood of using telehealth services. That means there could be some way to go before digital technology can help significantly improve the accessibility of rural healthcare.

Telehealth need not be complicated

The new study is based on a survey of more than 50,000 households asking about their telecommunications practices, administered in 2015. Peter Stenberg, the report’s author, focused on those aged over 15 and living in rural areas.

Three core telehealth activities were examined: online health research (looking up information on the internet), maintenance (using the web for activities like booking appointments), and monitoring.

Online health monitoring involves more advanced technologies, which send data to medical professionals about patients — for example, implants that check for heart problems and devices that detect when an elderly or vulnerable person has fallen down.

As these different categories suggest, it doesn’t necessarily require technical know-how or advanced technology to engage with telehealth services.

But overall rates of uptake are still quite low: only 1.3% of rural residents had used remote health monitoring services. Just 16.6% had done even simple online research about their health needs.

Usage is concentrated among the richer and better-educated

There was significant variation, the report found, in levels of use among different rural demographics.

Most important was education: every additional level of qualification marked an increase in the likelihood of telehealth use. Those with college degrees, for example, engaged with telehealth services more than twice as often as the overall rural population.

Higher incomes were also a major driver of higher use of health maintenance and monitoring services, though not research.

By contrast, more obvious factors like owning a computer or having a broadband internet connection were not so significant. Some 13% of rural residents who didn’t own a PC still carried out online health research, not far below the overall rate.

There was a bigger gap for the more advanced kinds of telehealth practices: computer owners were about twice as likely to engage in health maintenance activities online than non-owners.

And, the report notes, access to technology is likely to become more important in future. “Health providers … continue to improve their offerings,” Stenberg wrote, “so needs for high-quality household broadband service will likely increase if patients are to avail themselves of these new services”.

For the time being, though, the data suggests that telehealth will need more than improved technology to become pivotal to rural healthcare. — Fergus Peace

(Picture credit: Pxhere)