JMIR Publications

ABSTRACT

Background:

Digital health technologies such as telehealth, remote patient monitoring, and smartphone applications have the potential to reduce access disparities faced by rural cardiovascular patients, but little is known about rural provider perspectives on adopting digital health in their practice.

Objective:

This study used diffusion of innovations theory as a guiding framework to interpret survey and interview findings on rural providers’ perspectives on the use of digital health to deliver rural cardiovascular care.

Methods:

We conducted surveys and semi-structured interviews with rural and rural-serving providers, including primary care advanced practice providers and physicians, as well as referring cardiologists from 6 different primary care clinics in Alaska, Idaho, and Washington state. We performed a directed content analysis of interview data informed by diffusion of innovations theory, and identified emergent subthemes related to each of the 5 factors that influence adoption: relative advantage, compatibility, complexity, trialability, and observability. We used descriptive analyses to summarize survey results.

Results:

Seventeen health care providers participated in this study. Most participants (88%) agreed they were open to using new technology in the management of CVD but were largely neutral about their patients’ (65%) and clinics’ (53%) openness to new technology. Participants described cycles of adopting and discontinuing the use of digital health in their practice. Participants described advantages to digital health including the reduced need for patient travel, the ability to leverage non-physician health care workers, and the availability of objective patient data from remote patient monitoring. Compatibilities included increased patient compliance and follow-up, and the ability to involve specialists in patient care. The trialability of digital health was described through experiences with remote patient monitoring and scaled-up use of telehealth during the COVID-19 pandemic, and participants observed the benefits of digital health in other disciplines and as patients. We also identified several incompatibilities and complexities that may hinder the adoption of digital health technologies in rural practice, most of which were highlighted at the clinic and patient levels. These incompatibilities and complexities included substandard equipment; inability to perform a physical exam; poor internet and cell phone service; concerns about patient age and technical abilities; concerns about proper fit and distribution of remote patient monitoring equipment; and questions about billing and data management for digital health technologies.

Conclusions:

Rural health care providers recognize the many advantages to using digital health in caring for their cardiovascular patients but find that digital health is often complex and incompatible with their needs and the needs of their patients. There is an apparent disconnect between the potential of digital health and how it works in practice. Future rural digital health interventions in cardiovascular care should take consideration to address specific complexities and incompatibilities in the rural context.