Preferences for Telehealth in Rural and Mental Healthcare Services: A Scoping Review

Rural and remote settings present unique challenges to the delivery of effective and timely mental health services. Telehealth services may help to bridge the gap between providers and rural consumers, but careful design is essential to ensure services meet consumer priorities and needs and to optimise uptake. Choice-based preference studies are uniquely suited to deliver this type of evidence to inform the design of appropriate telehealth services. This review aims to identify evidence from discrete choice experiments and best-worst scaling studies conducted internationally on attributes of telehealth services that are significant predictors of choice, with a focus on evidence relevant to tele-mental health services in rural and remote settings. Four online databases (Ovid MEDLINE, Web of Science, Embase and Scopus) were searched from inception until 13 November 2025 to identify discrete choice experiments and best–worst scaling studies eliciting preferences for attributes of tele-mental health services or telehealth care for other conditions among rural and remote consumers. We focused on studies published in English, and excluded studies that examine preferences for only in-person care, services that are not mental healthcare or focus only on urban consumers and for which full text versions are unavailable. Data were synthesised narratively based on an a priori identified conceptual framework of access to healthcare, and attributes were assessed for frequency and significance. Eighteen studies met the inclusion criteria, out of a total of 2,005 screened. We identified studies examining preferences for telehealth-delivered: (1) mental healthcare in urban only or pooled urban and rural populations; and (2) other healthcare in rural only or pooled rural and urban populations, but none focusing on tele-mental healthcare services in fully rural settings. A total of 114 attributes were identified and thematically classified into five dimensions of access to healthcare: approachability, acceptability, availability and accommodation, affordability and appropriateness. Consistently significant attributes included out-of-pocket costs, wait time, and those under the categories of modality, effectiveness and interaction features. Notably, while respondents prioritised in-person over telehealth-only appointments, they preferred a combination of in-person and telehealth over in-person only appointments. Telehealth also tends to be preferred by younger patients and those experiencing less severe health conditions. Encouraging the optimal use of telehealth delivered mental healthcare in rural settings is strongly dependent on making these services more affordable as well as available within reasonable timeframes. Moreover, while there is a strong case for effectively utilising telehealth services in rural settings, mixed service delivery models offering both in-person and telehealth options are likely to gain the most uptake among rural consumers and facilitate improved experiences and meet care needs.