ABSTRACT Background Telehealth can mitigate healthcare access barriers that contribute to persistent rural health inequities. However, a limited understanding of telehealth barriers and preferences hinders the implementation of effective programs in rural communities. We conducted a formative evaluation to identify barriers and facilitators to telehealth adoption in an underserved rural setting. Methods We used a mixed‐methods design including surveys and in‐depth semi‐structured interviews with rural community stakeholders. The survey assessed telehealth utilisation, perceptions, technology access and barriers using Likert‐type scales. Survey data were analysed descriptively, and interview data were examined thematically across the Unified Theory of Acceptance and Use of Technology (UTAUT) constructs. Findings Survey respondents ( n = 59) were primarily female (73.2%), and White (73.2%), with a mean age of 61 years. Over half (51.8%) reported annual incomes below $20,000, and 18.6% lacked home internet access. While 59.3% had heard of telehealth, only 42.4% had used it. Among users, 61.9% reported satisfaction, and 71.4% agreed or strongly agreed that communication with providers was adequate. Key barriers included limited internet connectivity (72.8%), technology challenges (66.6%) and lack of knowledge about accessing telehealth (62.5%). Interview participants ( n = 8) emphasised that trust and comfort with providers were central to acceptance and highlighted telehealth's convenience in reducing transportation barriers. Conclusion In this study population, telehealth was generally acceptable, with trust and comfort with the provider driving acceptance. Barriers were primarily related to connectivity, infrastructure and digital literacy. Consistent with larger studies, these findings support investments in broadband access, digital literacy, technical support and building patient confidence in virtual care. Patient or Public Contribution Members of the public were involved in the design, recruitment and dissemination phases of this study. We partnered with local community organisations serving rural populations to inform recruitment strategies and to distribute surveys to community members with lived experience of healthcare access barriers. Community stakeholders also participated directly in the research through survey completion and in‐depth interviews, providing critical insights into telehealth use, barriers and preferences. While the public was not involved in the initial study design or data analysis, their perspectives shaped the interpretation of findings, particularly regarding trust, technology use and access challenges. To support dissemination and ensure accessibility of results, we developed a one‐page summary of findings that was shared with participating community partner sites for distribution back to the communities involved.

INTRODUCTION:As telemedicine becomes an integral component of health care delivery, understanding factors that influence medical students' acceptance of this technology is essential. This study explores medical students' perceptions of telemedicine adoption using the Unified Theory of Acceptance and Use of Technology (UTAUT) framework. METHODS:A cross-sectional survey of 98 medical students assessed telemedicine perceptions across UTAUT constructs: performance expectancy (PE), effort expectancy (EE), facilitating conditions (FC), social influence (SI), and behavioral intention (BI). Open-ended responses were thematically analyzed using a deductive approach to contextualize quantitative findings. RESULTS:PE was the strongest predictor of BI to use telemedicine among medical students (B = 0.771, p < 0.001), whereas EE, SI, and FC were not significant predictors. Qualitative responses reinforced telemedicine's perceived value, particularly for improving access to care and shaping future health care delivery, while highlighting limited formal training and a desire for more structured learning opportunities. CONCLUSIONS:These findings support integrating structured telemedicine training, experiential learning, and mentorship into medical curricula to enhance readiness for delivering technology-enabled care.

Introduction: Telemedicine is widely used, yet nonverbal cues such as virtual backgrounds remain understudied despite their potential influence on patient perceptions of provider credibility. Methods: This study used a randomized experimental design to examine the impact of three telemedicine background conditions, clinical, home office, and plain white, on patient ratings of provider expertness, competence, and ethicality. Participants (N = 136) were recruited from a large Midwestern university and completed a postvideo survey. Results: Analysis of variance results showed significant effects of background type on all three credibility measures. Providers in the white background condition were consistently rated lower in expertness, competence, and ethicality compared with the clinical and home office backgrounds. Conclusions: Findings suggest virtual backgrounds convey meaningful professional cues. Clinical and home office settings enhanced perceptions of provider credibility, while plain backgrounds diminished them. Background choice in telemedicine influences patient trust, underscoring the need for visual professionalism guidelines in virtual care settings.

Background Telehealth approaches can address health care access barriers and improve care delivery in resource-limited settings around the globe. Yet, telehealth adoption in Africa has been limited, due in part to an insufficient understanding of effective strategies for implementation. Objective This study aimed to conduct a multi-level formative evaluation identifying barriers and facilitators for implementing telehealth among health service providers and patients in Central Uganda. Methods We collected surveys characterizing telehealth perceptions, barriers, and preferences from health care providers and patients seeking primary care in the Central Region of Uganda from January 2022 to July 2022. Survey development was informed by the technology acceptance model and evaluated predictors of technology acceptance (ie, perceived usefulness, ease of use, and attitudes). We used descriptive statistics to characterize telehealth perceptions and examined differences according to provider and patient characteristics using Student t tests. Results Nearly 79% (n=48) of 61 providers surveyed had used telehealth, and perceptions were generally favorable. While 93.4% (n=57) reported that telehealth adds value to clinical practice, less than half (n=30, 49.2%) felt telehealth was more efficient than in-person visits. Provider-reported barriers to telehealth included technology challenges for the patient (34/132, 26%), low patient engagement (25/132, 19%), and lack of implementation support (24/132, 18%). Telehealth use was lower among the 91 surveyed patients, with only 19.8% (n=18) having used telehealth. Although 89% (n=81) of patients reported saving time with telehealth approaches, 33.3% (n=30) of patients reported that telehealth made them feel uncomfortable, and 43.8% (n=39) reported concerns about confidentiality. Over 72% (n=66) of patients who had used telehealth previously reported satisfaction with the telehealth services they received. Several differences in perceptions of telehealth according to patient’s self-reported health status were observed. Conclusions Perceptions of telehealth were generally favorable, although higher among providers than patients. Barriers impeding telehealth use include technology challenges and the lack of infrastructure and implementation support. Findings from this study can inform the implementation of acceptable telehealth approaches to address disparities propagated by health care access barriers in Sub-Saharan Africa.

Telemedicine’s rapid integration into healthcare delivery has transformed how providers and patients interact. While much attention has been given to clinical efficacy and access, fewer studies have examined how telemedicine technology features shape the social dynamics of provider-patient communication. This chapter explores provider perspectives on how specific telemedicine affordances modality, interactivity, and navigability influence social presence and the delivery of social support. Drawing on qualitative interviews with providers across specialties, this work introduces a framework linking technological features to communication outcomes in virtual care. Findings highlight both benefits and barriers to empathy, engagement, and support, and suggest future directions for platform design, training, and research.

Cancer peer support groups are crucial in improving quality of life outcomes and extending cancer survival. Using the Health Belief Model (HBM) and Theory of Planned Behavior (TPB) as guiding frameworks, this study examined perceptions of telehealth-based cancer support groups among individuals treated for cancer at a rural oncology program. We distributed online surveys to 34 survivors or individuals undergoing cancer treatment who actively participated in virtual cancer support groups, achieving a 79.4% response rate (27 participants). The survey, blending quantitative and qualitative methodologies, assessed demographic characteristics, overall telehealth satisfaction, satisfaction with telehealth-based peer support, and perceived social support. Quantitative data were analyzed using descriptive statistics, while qualitative responses were examined through template analysis, focusing on the HBM and TPB constructs. Participants expressed general satisfaction with telehealth and indicated a willingness to use telehealth services again. Participants cited ease of use and broader access to cancer support groups with telehealth approaches. Barriers to telehealth included the lack of interpersonal connection, internet access, and technical difficulties. The findings underscore the nuanced perceptions of telehealth-based cancer support groups in a rural oncology setting. Despite acknowledging telehealth’s limitations, participants appreciated its role in facilitating access to support. The findings provide valuable insights for optimizing digital health interventions, emphasizing the need for a balanced approach that considers both the potential and the challenges of telehealth in cancer care. This study offers critical guidance in optimizing digital health interventions and ensuring accessible, effective support for cancer patients in rural areas.

Background Emerging adults (EAs; age 18-30 years) with type 1 diabetes (T1D) have more challenges with diabetes management and glycemic control than other age groups. Living in a rural community introduces additional unique diabetes care challenges due to limited access to specialty care and ancillary support services. Yet, few interventions have been developed to improve diabetes management in rural-dwelling EAs with T1D. Objective This study aimed to understand the diabetes management experiences of older adolescents and EAs (age 16-25 years) with T1D living in a rural area and to assess their perceptions of the acceptability of 4 fully automated mobile health (mHealth) interventions to support diabetes management. Methods EAs were identified by clinical staff through convenience sampling. In total, 8 EAs participated in 1 focus group and 1 EA completed an individual interview; all data were collected over Zoom. Facilitators explored EAs’ experiences living in a rural community with T1D and discussed EAs’ impressions of, feedback on, and recommendations for improving 4 mHealth interventions to meet the specific needs of EAs with T1D living in rural communities. Discussions were transcribed and analyzed using conventional content analysis. Results In total, 9 EAs (aged 18.8, SD 2.7 years; 5, 56% men; 8, 89% White) with a duration of diabetes of 8.6 (SD 4.3) years participated. They described experiences with diabetes stigma (attributing diabetes to poor lifestyle choices) and feelings of self-consciousness (hyperawareness) in their rural communities. They attributed these experiences to the small size of their communities (“everyone knows”) and community members’ lack of knowledge about diabetes (unable to differentiate between type 1 and type 2 diabetes). In contrast, EAs reported high levels of social support for diabetes and diabetes care from family, friends, and other community members, but low support for medical needs. The location of their diabetes care providers and the limited accessibility of diabetes-specific and general medical care services in their local community created a challenging medical care context. Overall, EAs found mHealth interventions appealing due to their digital delivery and highlighted features that increased accessibility (voiceovers and simple, jargon-free language), individualization (ability to tailor intervention content and delivery), and applicability to their own lives and other EAs with T1D (relatability of vignettes and other content). EAs suggestions for improving the interventions included more opportunities to tailor the interventions to their preferences (greater frequency and duration, ability to adapt content to emerging needs), increasing opportunities for peer support within the interventions (friend and significant other as identified support person, connecting with peers beyond their local community), and making the tone of intervention components more casual and engaging. Conclusions mHealth interventions aligned with EAs’ needs and preferences are a promising strategy to support EAs in communities where social support and resources might be limited. Trial Registration N/A, not a clinical trial

BACKGROUND Past research has demonstrated that adolescents with Type 1 diabetes (T1D) typically have a decline in health outcomes as they begin to assume more self-management activities. Mobile app interventions have been suggested as one possible way to improve this behavior. PURPOSE The primary aim of this study was to address declines in health outcomes by pilot testing the satisfaction, use and feasibility of an app-based family communication intervention aimed to assist in adolescent self-management of T1D. METHODS Thirty-three adolescent-parent pairs were enrolled in and completed the 12-week pilot study. Participants were randomized 2:1 to intervention (app use) or control group. Pre/post quantitative and qualitative data were collected, including HbA1c and surveys. Paired-sample t-tests and ANOVA statistics were conducted. RESULTS The parents and adolescents reported high satisfaction with the app, and that it was easy to use. Results showed HbA1c stability in the intervention group and significant worsening in the control group. There were also significant improvements in adherence to diabetes management and quality of life for the parents in the intervention group. The adolescents did not show any improvement in quality-of-life measures. CONCLUSION This study suggests that the app intervention is acceptable, shows promise for improving health outcomes for adolescents with T1D, and may improve family communication. The public health implications of this work are that app interventions have a potential role in positively influencing chronic disease outcomes. Additional research with a more extensive and diverse sample is needed to determine generalizability.

Informed consent, a cornerstone of research ethics, ensures participant protection and informed participation, particularly in online settings. Despite its significance, engagement with online consent forms remains low, underscoring the need for improved presentation strategies. This study investigates the impact of interactive elements and diverse presentation formats on the comprehension and engagement of online informed consent documents among a broad demographic beyond the commonly studied student populations. Employing a between-subjects experimental design, we explored six versions of online consent forms varying in interactivity, readability, and visual formatting to identify optimal strategies for enhancing participant comprehension and engagement. Our findings reveal that interactive formats significantly improve comprehension and perceived readability, highlighting the pivotal role of design in facilitating informed consent. The study also examines the influence of individual differences, such as self-efficacy and trust in science, on the effectiveness of consent forms, providing insights into the nuanced dynamics between participant characteristics and consent form engagement. These results advocate for integrating interactive elements and thoughtful design in consent forms to foster a more informed and engaged participant base. Implications for research ethics, best practices in consent form development, and future research directions are also discussed, emphasizing the need for ongoing innovation in the consent process to adapt to the evolving landscape of online research. This study contributes to the body of knowledge on research ethics by offering evidence-based recommendations for enhancing the informed consent process, ultimately promoting participant-centered research practices.

During the COVID-19 pandemic, telemedicine and telehealth saw a groundswell of growth, only to be shackled in the aftermath of the Public Health Emergency. A Think Tank, funded by Agency for Healthcare Research and Quality, was held at Michigan State University in August 2024. This paper serves as an introduction to a series of articles focusing on the evolution and future of telehealth in a postpandemic world. It highlights key themes including patient equity, technology, clinical opportunities, research, and education, using Michigan as a model for national adaptation. The paper aims to ignite further discussion and innovation within the telehealth community.

The promise of remote patient monitoring (RPM) lies in its ability to revolutionize health care delivery by enabling continuous, real-time tracking of patient health outside traditional clinical settings. The COVID-19 pandemic accelerated the adoption of RPM, particularly in underserved and rural populations, highlighting both its potential and the persistent barriers that limit its widespread use. This paper explores the critical role of technological advancements-such as wearables, artificial intelligence (AI), and broadband expansion-in sustaining and optimizing RPM in the postpandemic era. We examine Michigan as a microcosm of national health care challenges, focusing on its diverse population and geographic barriers, and propose condition-specific RPM protocols to address these inequities. Key facilitators and barriers to RPM implementation are discussed, with a focus on AI integration, community engagement, and digital infrastructure. We also explore the role of policy reform and public-private partnerships in supporting RPM's scalability and long-term sustainability. Our findings suggest that while RPM offers a powerful tool for improving health care access and outcomes, especially for chronic conditions and rural maternal health, sustained investment in technology and infrastructure is critical. By addressing these challenges, RPM can become a cornerstone of modern health care, reducing disparities and improving care delivery for underserved populations.

The widespread use of smartphones in the United States has led to a surge in mHealth apps designed to support people with various health issues. Yet the effectiveness and long-term impacts of these apps still need to be determined. This article presents a case study of the development of MyT1DHero, an mHealth app for people with type 1 diabetes, to identify best practices for app development. We propose four essential best practices based on the insights gained from this case study: incorporating theoretical frameworks, prioritizing user feedback, engaging key stakeholders, and establishing a robust data-collection foundation. These findings have practical implications for researchers and developers seeking to create effective mHealth interventions. Furthermore, we suggest future research directions to advance the development and implementation of innovative health technologies.

BACKGROUND:Type 1 diabetes (T1D) is a chronic condition that typically affects young age group people and is estimated to afflict approximately 154,000 people younger than 20 years in the United States. Since T1D typically impacts children, parents must play an active role in helping their child manage the condition. This creates a substantial burden and responsibility for the parents.OBJECTIVE:This pilot study sought to find ways to help parents with children with T1D in coping with stresses related to managing and monitoring their child's disease by providing informational support, either about parenting a child with T1D or general parenting messages through different channels.METHODS:Parents (N=120) of children with T1D were recruited through an email listserv through local T1D Facebook groups. A total of 102 participants were included in the analysis. We conducted a 2×2 experimental study over an 8-week period to test 2 types of messages (diabetes specific vs general parenting) and the medium in which the messages were delivered (Facebook vs SMS text message). Diabetes behavior, informational support, emotional support, and quality of life were the main outcomes of interest.RESULTS:The results suggested that the participants in the diabetes message groups showed improvement in diabetes behaviors (F1,99=3.69; P=.05) and were more satisfied with the intervention (F3,98=4.59; P=.005). There were no differences between message and medium groups on informational support, emotional support, or quality of life.CONCLUSIONS:The results of this study demonstrate that the medium-Facebook or SMS text messaging-does not matter for parents' perceptions of social support or quality of life. The diabetes message group reported higher levels of disease management. Finally, the groups with the diabetes support messages were more satisfied than those who received general parenting messages. The findings provide starting guidance for the development of social support interventions for this population.

Aim: This work aims to uncover differences between users and non-users of telemedicine and provider perspectives about what types of medical visits work well in telemedicine and what procedures must take place during in-person medical visits, and potential factors that may influence the future use of telemedicine.Background: The COVID-19 pandemic triggered many changes for individuals worldwide; one example is an increased reliance on telemedicine to receive health care. Little is known about the provider perspective of telemedicine use beyond their thoughts on reimbursement, liability, technical challenges, and licensure/credentialing.Methods: A cross-sectional survey study was conducted with 59 medical providers to determine perceptions of the best-suited services for telemedicine and the differences between users and non-users of telemedicine.Results: Results suggest that providers perceive only a few services that are best suited for telemedicine. Communication concerns were the only significant difference between users and non-users in that non-users are most concerned about their ability to communicate with their patients via telemedicine effectively. In addition, positive telemedicine experiences play a key role in the continuing use of telemedicine.Conclusion: This study contributes to our understanding of how medical providers feel about using telemedicine and its sustainability, which is crucial as we are coming out of the pandemic but still acknowledging the greater use of technologies for health care.

The medical environment is on the verge of a dramatic transformation as artificial intelligence (AI) evolves. With the inevitable shift toward AI in health care delivery, there are concerns around its implementation, including ethics, privacy, data representation, and the potential for eliminating physicians. However, AI cannot replicate a physician's knowledge and understanding of the patient as a person and the conditions in which he or she lives. Therefore, provider-patient communication will be paramount in providing safe and effective health care. This piece describes the importance of patient-centered communication and the unintentional move away from this in recent times. We argue that patient-provider communication is vital in the age of AI as it will integrate into the way medicine is practiced, thus leading to more time with the patient to build rapport, trust, and empathy. This will ultimately lead to optimal health-related outcomes.

Objective: Millions of people use mobile phone or computer-based applications-apps-to maintain their mental health and connect with treatment providers through text- and video-based chat functions. The present study sought to understand young adults' motivations for adopting this technology using the unified theory of acceptance and use of technology (UTAUT), how they use mental health apps, and the gratifications they receive from using mental health apps. Participants: One hundred-eighteen mental health app users responded to an online survey. Methods: A survey was conducted with students at a Midwestern university. The survey included questions regarding current mental health services, mental health apps used, UTAUT and gratifications survey items. Results: A regression analysis suggested users' performance expectancies, effort expectancies, and facilitating conditions predicted the adoption of mental health apps. Young adults most often use mental health apps for stress relief. While they preferred in-person treatment, users described mental health apps as efficient and helpful. Conclusion: Overall, the results reinforce the sense of optimism for the future of mental health apps, suggesting the potential for apps to supplement-but not necessarily replace-in-person care.

Parents of children with type 1 diabetes are often the main caregiver for their child. Generally, type 1 diabetes is diagnosed in childhood and the parents must take on a complex and stressful management regime for their child. Many parents report feeling overwhelmed by all of the information that accompanies a diagnosis of type 1 diabetes, leading to feelings of stress and isolation, which can lead to worse health outcomes for the parents. This study sought to find ways to help parents with children with type 1 diabetes in coping with stresses related to managing and monitoring their child’s disease. Parents (n=120) of children with type 1 diabetes were recruited through an email listserv through local type 1 diabetes Facebook groups. We conducted a 2x2 experimental study over an 8-week period to test the messages (diabetes specific vs. general parenting) and the medium they were delivered (Facebook vs. text message). The diabetes message groups improved in diabetes behaviors [F(1, 99)=3.69, p=0.05] and were more satisfied with the intervention [F(3, 98)=4.59, p=0.005). There were no other differences in message or medium groups. Results suggest that diabetes-specific messages are likely to be more effective in improving diabetes management skills. These findings provide guidance for more effective development of social support interventions for similar populations.

Abstract The rise of social media has been meteoric over the past two decades, connecting people from across the world to share information regardless of geography and time. This entry provides a general breadth of understanding of how social media has been utilized in health communication. It begins with a brief examination of the differences between online health communities, which have traditionally been spaces for health discussions online, and health communities on social media platforms. Next, it briefly discusses each of the major social media platforms, including a short description, and presents examples of how these have been used in the health communication context. The entry then reviews the different theories that have been used in the social media/health communication space. It further considers “rules of thumb” when thinking about using social media for health communication promotion or campaign and trends. Finally, the entry concludes by examining health‐related misinformation and disinformation on social media platforms, and ends with a brief discussion regarding the future of social media and health communication.