Virtual Care Prior to and During COVID-19: A Cross-Sectional Survey of Rural and Urban Adults (Preprint)

BACKGROUND The COVID-19 pandemic has driven a massive shift to virtual care to reduce person-to-person contact, though rural-urban differences are relatively unexplored. OBJECTIVE The two-fold purpose of the present study was to examine rural and urban virtual care access, use, and satisfaction during the pandemic and to identify any unmet needs. METHODS 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. RESULTS Overall, 501 (75% female; Age 19-86 years; 47% rural-living) Western Canadians completed the survey. Virtual care use was high among both rural (72%) and urban (71%) participants, with over half 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 to 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 Ps<.05) and eHealth literacy (all Ps<.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/healthcare providers, compared to urban participants (P<.001). When describing unmet needs, participants described: 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 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 post-pandemic. 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. CLINICALTRIAL Not Applicable