Provider-Identified Barriers and Facilitators to Telehealth Adoption among Homeless-Experienced Veterans in Rural Areas

Document Type

Article

Publication Date

7-21-2025

Publication Title

Journal of Technology in Behavioral Science

Abstract

Telehealth, vital for improving healthcare access in rural areas, has become more widespread, especially after the COVID-19 pandemic, accelerated advancements in healthcare technology. Despite challenges, telehealth has successfully helped people in rural areas and those experiencing homelessness access healthcare. The Veterans Health Administration (VHA) has been a leader in using telehealth to reach vulnerable populations, including homeless-experienced veterans (HEVs). Ongoing examination of telehealth technologies is crucial to ensure effective healthcare access. This study focuses on understanding the challenges and benefits of telehealth use among providers who serve HEVs in rural areas, aiming to deepen our insight into their experiences and unique challenges in these locations. We conducted an inductive secondary thematic analysis of interview data originally collected by Cusack et al. (2022), who conducted 32 semi-structured interviews with Veterans Health Administration providers between May 2021 and February 2022. Ten providers were from Veteran Affairs Medical Centers and 22 providers from Community-Based Outpatient Clinics. The interviews included questions eliciting providers’ perspectives regarding veterans facing housing instability in rural areas; VHA services, policies, and culture; the community setting and available resources; network and communication; and suggestions for potential changes and enhancements. Using open coding and a descriptive phenomenological approach, we identified new themes to address our research. question. The analysis revealed three themes: (1) access to and support for telehealth services by rural HEVs and their providers, (2) advantages of using telehealth, and (3) obstacles to telehealth adoption. We found that more than half of the respondents accessed programs offering technological devices for HEVs. Respondents described the advantages of telehealth in rural areas, including virtual connections and increased flexibility for both providers and HEVs. Respondents acknowledged a learning curve for both themselves and older Veterans when using telehealth services, particularly in the context of challenges faced by rural Veterans, such as limited resources and low technology literacy. Finally, the primary challenges reported by respondents encompassed insufficient training and equipment for telehealth services, which affected their ability to connect effectively with veterans and deliver remote care in rural areas. Study findings suggest that healthcare providers in rural areas support telehealth services when assisting rural HEVs. However, barriers persist in the adoption of telehealth among both service providers and veterans. To address this issue, we suggest implementing telehealth training programs specifically designed to accommodate the unique characteristics and circumstances encountered by rural-based providers and HEVs. Such initiatives could enhance the utilization of telehealth technology by both providers and veterans, facilitating their access to essential healthcare services.

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