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

Kathy L Rush; Cherisse L Seaton; Kendra Corman; Nicole Hawe; Eric Ping Hung Li; Sarah J Dow-Fleisner; Mohammad Khalad Hasan; Nelly D Oelke; Leanne M Currie; Barbara Pesut

doi:10.2196/37059

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

JMIR Form Res. 2022 Aug 22;6(8):e37059. doi: 10.2196/37059.

Authors

Affiliations

¹ School of Nursing, University of British Columbia, Kelowna, BC, Canada.
² Faculty of Management, University of British Columbia, Kelowna, BC, Canada.
³ School of Social Work, University of British Columbia, Kelowna, BC, Canada.
⁴ Department of Computer Science, University of British Columbia, Kelowna, BC, Canada.
⁵ Rural Coordination Centre of British Columbia, Vancouver, BC, Canada.
⁶ Department of Community Health Sciences, Cummings School of Medicine, University of Calgary, Calgary, AB, Canada.
⁷ School of Nursing, University of British Columbia, Vancouver, BC, Canada.

PMID: 35849794
PMCID: PMC9400845
DOI: 10.2196/37059

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.

Keywords: COVID-19; digital literacy; rural; unmet needs; urban; virtual care.

©Kathy L Rush, Cherisse L Seaton, Kendra Corman, Nicole Hawe, Eric Ping Hung Li, Sarah J Dow-Fleisner, Mohammad Khalad Hasan, Nelly D Oelke, Leanne M Currie, Barbara Pesut. Originally published in JMIR Formative Research (https://formative.jmir.org), 22.08.2022.