Virtual Care Prior to and During COVID-19: Cross-sectional Survey of Rural and Urban Adults

Abstract

Background To reduce person-to-person contact, the COVID-19 pandemic has driven a massive shift to virtual care. Defined as the use of technology (synchronous or asynchronous) to support communication between health care providers and patients, rural-urban differences in virtual care are relatively unexplored. Objective The 2-fold purpose of this study was to examine rural and urban virtual care access, use, and satisfaction during the pandemic and to identify any unmet needs. Methods This study was a cross-sectional online survey exploring virtual care among rural and urban adults in summer 2021 using a combination of fixed and open-ended response options. Quantitative data were analyzed using both descriptive and inferential statistics, and qualitative data were analyzed using inductive thematic content analysis. Results Overall, 501 (373, 74.4% female; age range 19-86 years; 237, 47.3% rural-living) Western Canadians completed the survey. Virtual care use was high among both rural (171/237, 72.2%) and urban (188/264, 71.2%) participants, with over one-half (279/501, 55.7%) reporting having only started to use virtual care since the pandemic. The self-reported need for mental health programs and services increased during the pandemic, compared with prior for both rural and urban participants. Among virtual care users, interest in its continuation was high. Our analysis also shows that internet quality (all P<.05) and eHealth literacy (all P<.001) were positively associated with participants’ perceptions of virtual care usefulness, ease of use, and satisfaction, with no rural-urban differences. Rural participants were less likely to have used video in communicating with doctors or health care providers, compared with urban participants (P<.001). When describing unmet needs, participants described a (1) lack of access to care, (2) limited health promotion and prevention options, and (3) lack of mental health service options. Conclusions The increased demand for and use of virtual care may reflect increased availability and a lack of alternatives due to limited in-person services during the COVID-19 pandemic, so a balance between virtual care and in-person care is important to consider postpandemic. Further, ensuring availability of high-speed internet and education to support patients will be important for providing accessible and effective virtual care, especially for rural residents.

Video-Based Educational Interventions for Patients With Chronic Illnesses: Systematic Review

“…Outcomes resulting from repetition of the intervention were more frequently improved than those resulting from the intervention completed once (49% vs 40%, respectively; P=. 23).…”

“…In addition to the growing interest in technology-based interventions more broadly, there is increased pressure in the wake of the COVID-19 pandemic to develop and implement virtual care and education resources for patients because clinics halted in-person visits during the pandemic [23,24]. Stay-at-home orders and physical distancing led to virtual patient programming by primary care clinics, geriatricians, and pharmacists [25][26][27].…”

Black veteran use of video telehealth for mental health care.

“…As is the case across all races, veterans living in urban settings have surpassed veterans living in rural settings in adopting and using VTH due to the pandemic (Hogan et al, 2022;Rush et al, 2022). Rural populations have grown to be more racially diverse, as Black Americans make up the largest minority group in the rural, deep South (Johnson & Lichter, 2022).…”

Systemic effects of the COVID pandemic on rural black American men’s interpersonal relationships: A phenomenological examination

“…Findings from previous research indicate that Black Americans were among the most impacted racial/ethnic groups [21]. Evidence suggests that the pandemic uniquely impacted Black American men living in the rural South due to (a) being overrepresented in industries that require face-to-face interactions with the public, (b) living in multigenerational housing, and (c) having limited access to preventative and emergency health care [22][23][24].…”