Rural Perspectives on Digital Health in Cardiovascular Care: Qualitative Study of Interviews With Rural and Rural-Serving Primary Care Providers and Cardiologists

Abstract

Background: Digital health technologies, such as telehealth, remote patient monitoring, and smartphone apps, have the potential to reduce access disparities faced by rural patients with cardiovascular disease, but little is known about rural health care providers' perspectives on adopting digital health in their practice.

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

Methods: We conducted semistructured interviews with rural and rural-serving health care providers, including primary care advanced practice providers and physicians, as well as referring cardiologists from 6 primary care clinics in Alaska, Idaho, and Washington. 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.

Results: Seventeen health care providers participated in this study. Participants described cycles of adopting and discontinuing the use of digital health in their practice. Participants identified advantages of digital health including reduced patient travel, the ability to leverage nonphysician health care workers, and the availability of objective patient data from remote patient monitoring. Compatibilities included increased patient adherence 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 disadvantages, 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 disadvantages, incompatibilities, and complexities included substandard equipment, inability to perform a physical examination, connectivity issues caused by 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 of using digital health in caring for patients with cardiovascular disease but find that digital health is often complex and incompatible with their needs and the needs of their patients. There may be a disconnect between the potential of digital health and how it works in practice, as evidenced by the cycles of adoption and discontinuance of digital health technologies described by rural health care providers. Future rural digital health interventions in cardiovascular care should take into consideration specific complexities and incompatibilities in the rural context.

Keywords: CVD; cardiovascular; digital health; heart disease; mHealth; remote patient monitoring; rural; telehealth.