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Digital Health Equity Barriers to Smoking Cessation Support Among Rural Adults: A Qualitative Analysis
ABSTRACT
Background:
Rural residents who smoke tobacco face higher smoking prevalence and unique barriers to cessation support, including limited access to evidence-based treatments and digital health resources. The transition to digital smoking cessation interventions offers potential solutions but may exacerbate health disparities without a clear understanding of digital equity barriers in these populations.
Objective:
This formative evaluation study aimed to examine the barriers rural adults face in accessing digital smoking cessation interventions and to map these barriers to a digital health equity framework, to inform strategies for equitable program design.
Methods:
We conducted in-depth, semi-structured telephone interviews between January and April 2023 with 30 rural adults who smoke cigarettes. Participants, who resided in the Midwest (Minnesota, Wisconsin, Iowa) were recruited from a three-arm randomized pilot trial of digital smoking cessation interventions. Interview topics included rural living experiences, healthcare access, and efforts to quit smoking. Data were analyzed using inductive thematic analysis, then mapped to Richardson et al.’s Digital Health Equity framework to identify multilevel barriers and opportunities for intervention.
Results:
All 30 interview respondents were White, 67% were female, and the mean age was 51.9 years (SD 14.3). Three primary themes emerged: rural living conditions, healthcare access and navigation, and smoking cessation experiences. Major barriers to digital cessation support included unreliable internet connectivity, transportation and economic constraints, digital literacy challenges, lack of program personalization, social isolation, privacy concerns, and unaddressed mental health needs. Mapping to the digital health equity framework revealed nine modifiable barrier domains: digital infrastructure, economic inequities, transportation, digital literacy, adoption readiness, social isolation, privacy, integration of behavioral health, and navigation of government resources.
Conclusions:
Rural adults encounter multiple, intersecting barriers to digital smoking cessation interventions that span structural, psychosocial, and individual domains. Addressing these inequities will require comprehensive solutions, including broadband investment, integrated mental health support, hybrid (digital and in-person) program delivery, targeted digital literacy training, and policy changes to ensure affordable access to telehealth cessation services. Clinical Trial: Clinical Trials Registry (NCT05209451)
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© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.