Barriers and Facilitators to Telehealth in Underserved Rural Communities: A Mixed-Methods Formative Evaluation

Telehealth can mitigate healthcare access barriers that contribute to persistent rural health inequities. However, a limited understanding of telehealth barriers and preferences hinders the implementation of effective programs in rural communities. We conducted a formative evaluation to identify barriers and facilitators to telehealth adoption in an underserved rural setting.

We used a mixed-methods design including surveys and in-depth semi-structured interviews with rural community stakeholders. The survey assessed telehealth utilisation, perceptions, technology access and barriers using Likert-type scales. Survey data were analysed descriptively, and interview data were examined thematically across the Unified Theory of Acceptance and Use of Technology (UTAUT) constructs.

Survey respondents (n = 59) were primarily female (73.2%), and White (73.2%), with a mean age of 61 years. Over half (51.8%) reported annual incomes below $20,000, and 18.6% lacked home internet access. While 59.3% had heard of telehealth, only 42.4% had used it. Among users, 61.9% reported satisfaction, and 71.4% agreed or strongly agreed that communication with providers was adequate. Key barriers included limited internet connectivity (72.8%), technology challenges (66.6%) and lack of knowledge about accessing telehealth (62.5%). Interview participants (n = 8) emphasised that trust and comfort with providers were central to acceptance and highlighted telehealth's convenience in reducing transportation barriers.

In this study population, telehealth was generally acceptable, with trust and comfort with the provider driving acceptance. Barriers were primarily related to connectivity, infrastructure and digital literacy. Consistent with larger studies, these findings support investments in broadband access, digital literacy, technical support and building patient confidence in virtual care.

Members of the public were involved in the design, recruitment and dissemination phases of this study. We partnered with local community organisations serving rural populations to inform recruitment strategies and to distribute surveys to community members with lived experience of healthcare access barriers. Community stakeholders also participated directly in the research through survey completion and in-depth interviews, providing critical insights into telehealth use, barriers and preferences. While the public was not involved in the initial study design or data analysis, their perspectives shaped the interpretation of findings, particularly regarding trust, technology use and access challenges. To support dissemination and ensure accessibility of results, we developed a one-page summary of findings that was shared with participating community partner sites for distribution back to the communities involved.