Currently submitted to: Journal of Medical Internet Research
Date Submitted: Sep 9, 2026
Open Peer Review Period: Sep 10, 2026 - Nov 5, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Theoretical approaches in studying access to digital health services in rural contexts in high-income countries: a scoping review
ABSTRACT
Background:
Digital services are increasingly used in healthcare; however, access to these services may be hindered by several factors. People residing in rural areas may face additional challenges. Rural digital healthcare access is a complex and interdisciplinary topic; to what extent this complexity is captured and theorised in extant research remains unclear.
Objective:
We aimed to review the theoretical approaches used in previous studies on digital healthcare access in rural areas, specifically to identify the frameworks used and the application of intersectionality.
Methods:
We searched MEDLINE, Embase, CINAHL Plus, and Scopus for literature related to digital health access in rural areas in high-income countries. Search results were screened, extracted, and analysed with basic content analysis.
Results:
We included 101 studies in the analysis. Conceptual frameworks came from research fields of technology acceptance, healthcare access, and implementation research. The most used frameworks were the Technology Acceptance Model, the Unified Theory of Acceptance and Use of Technology, Andersen’s behavioural model, Levesque’s patient-centred framework, and the Consolidated Framework for Implementation Research. Forty-two studies focused on populations with some intersecting inequities, but none mentioned intersectionality specifically.
Conclusions:
All frameworks have their own limitations, especially when crossing disciplines in the specific rural context. We urge researchers to acknowledge these limitations and consider interdisciplinary frameworks. There is a need to theoretically approach the issue of inequity in this topic, and we recommend using equity-based frameworks for a comprehensive and intersectional understanding.
Citation
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Copyright
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