Special Issue Editorial: Digital Interventions to Improve Rural Health Outcomes

Rural and regional areas of Australia are underserved by health services, which has been shown to result in poorer health outcomes [1]. Multiple policy initiatives have not significantly shifted the accessibility gap faced by rural communities in recent decades. Alternative, effective and creative solutions to improve rural pathways for care are therefore urgently needed to fill the gap, which may include growing the rural workforce, developing community-based models of care, and delivering services through evidence-based digital interventions. The focus of this special issue is on the latter use of digital interventions, which may be an important part of the solution to increase access to evidence-based care in rural Australia. While digital solutions alone cannot fill the gap and are not always a substitute for face-to-face services, they can provide efficient and effective delivery of evidence-based care in many areas of health. Digital interventions are delivered using, for example, internet or mobile technology and include therapeutic interventions, prevention and health promotion interventions, interventions to monitor or manage health conditions, informational and educational interventions related to health outcomes or service use, and social interventions, along with the use of big data or passive sensing to enhance the delivery of care for rural health consumers. Interventions may be self-guided or clinician-supported, and may also build on innovative features of technology such as artificial intelligence. Alongside an expansion in digital interventions, telehealth services represent a related aspect of digital health that has proliferated rapidly during the COVID-19 pandemic [2]. There are many challenges to the delivery of healthcare in rural areas, both for traditional face-to-face services and digital services. Tensions within the health system may limit innovation and implementation of technology-based services, based largely on the assumption that the efficiency of digital services may compromise quality care [3]. There also remain evidence gaps about the impacts and effectiveness of digital interventions on health outcomes specifically within rural areas. This special issue aimed to fill gaps in the evidence and implementation of digital interventions for rural and regional areas of Australia, considering a broad range of applications to diverse health conditions and settings across eight original research articles, one commentary and one narrative review. The special issue has a core focus on the implementation of digital health in rural Australia. A meta-review by Krahe et al. [4] summarises the key enablers and barriers to implementation, noting benefits such as improved accessibility and patient satisfaction. They emphasise the need for locally tailored interventions and consider implementation factors that encompass inner and outer settings, individual needs, intervention characteristics and careful implementation planning that accounts for existing systems and available resources. Critical to the equitable implementation of digital services in rural Australia is the inclusion of First Nations Australians in the design of delivery models. Nasir et al. [5] report on a co-design process with Indigenous Australians with chronic disease to develop virtual health services to facilitate the delivery of primary healthcare. Three articles in the special issue provide examples of implementation planning for a variety of digital tools. Le et al. [6] examine similarities and differences between clinician and consumer perspectives on the implementation of a digital mental health service, noting consistent enablers related to capability, opportunity, and motivation for using digital interventions with support from clinicians. Hambleton et al. [7] identify the ingredients of implementation that may be critical for the success of a rural digital service to treat anorexia nervosa. Talay et al. [8] identify benefits of access to a digital weight-loss service over traditional face-to-face services. The special issue also demonstrates the potential impacts of digital interventions for a wide range of health conditions. Dear et al. [9] draw on a large sample of people with chronic pain who engaged in a national digital service, to demonstrate patient satisfaction and clinical improvements in pain and mental health that were consistent across rural and urban settings. Similarly, Staples et al. [10] find evidence that an online mental health clinic delivers effective care for people in rural areas, while reaching disadvantaged populations that may not otherwise receive treatment. Digital services may also have a vital role to play in disaster-affected communities, with Curtin et al. [11] showing that allied telehealth services can deliver effective outcomes and high satisfaction among children affected by bushfires. Finally, Li et al. [12] demonstrate the utility of a novel digital screening program that uses artificial intelligence algorithms to detect diabetic retinopathy in remote Western Australia. The studies included in the special issue emphasise the potential for digital interventions to improve health outcomes in rural Australians across a range of health conditions, without compromising patient satisfaction. Many aspects of digital tools provide better access to care, and facilitate greater reach of existing services. Despite the benefits, digital technologies are not a panacea for the substantial gaps in rural health delivery [13]. Ensuring that digital interventions are thoughtfully integrated into existing care pathways, that they support clinician and consumer preferences for care, and that they are adequately resourced will be critical to maximising health gains, while acknowledging that broader system reforms are also required to support the health of rural communities. These authors eagerly anticipate the arrival of further digital technologies, which demonstrate tremendous promise for the health and well-being of rural communities. Philip J. Batterham: conceptualisation, writing – original draft; Louise M. Farrer: conceptualisation, writing – review and editing; Leanna Woods: conceptualisation, writing – review and editing; Mark E. Larsen: conceptualisation, writing – review and editing; Priya Martin: conceptualisation, writing – review and editing; Adam Hulme: conceptualisation, writing – original draft. The authors have nothing to report. Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.