Implementation strategies for evidence-based healthcare interventions in rural and remote settings: a scoping review

Globally, people living in rural and remote areas experience poorer healthcare access and outcomes than urban populations. Applying implementation strategies that support the translation of evidence-based healthcare interventions may help reduce these inequities; however, real-world implementation is complex, and it remains unclear how strategies are applied and tailored to rural and remote contexts. This scoping review synthesised evidence on implementation strategies for healthcare interventions in rural and remote settings of high-income countries. Five databases (Ovid MEDLINE, Embase, Cochrane CENTRAL, CINAHL, Web of Science) were searched for peer-reviewed studies published between 1/1/2000 and 25/10/2024. Extracted data were synthesised using a descriptive narrative approach. From 11,887 records, 78 papers (75 studies) met inclusion criteria. Implementation efforts were multifaceted, commonly drawing on strategies from three Expert Recommendations for Implementing Change clusters: train and educate stakeholders (n = 70, 93%), use evaluative and iterative strategies (n = 55, 73%), and develop stakeholder interrelationships (n = 48, 64%). Few studies (n = 21; 28%) reported rural-specific design features. Although implementation in rural and remote contexts has focused on provider-level strategies, there is a need to also address system-level determinants to implementation. Context-specific design, meaningful engagement with local communities and stakeholders, and clearer reporting are essential to optimise implementation and reduce rural-urban health disparities.