National Centre for Remote and Rural Health and Care: Information Hub

Rural Health Service Decision Guide | CIHI

The Rural Health Service Decision Guide, developed by the Canadian Institute for Health Information (CIHI), introduces a structured 5-step process to support evidence-based decisions on sustainably delivering health services to rural populations. Although designed within the Canadian healthcare context, the guide offers a relevant framework for rural healthcare decision-making within wider contexts.

The process for assessing service needs and identifying delivery options aligns with Scotland’s goals of improving rural health equity and sustainability. The emphasis on balancing quality, patient and provider experience, and cost-effectiveness offers a robust decision-making model. Strategies for addressing travel burden, resource constraints, and stakeholder engagement can inspire locally tailored approaches. Overall, the core framework and methodology provide a valuable foundation for addressing rural health challenges.

JMIR Aging - Barriers to and Facilitators of Digital Health Technology Adoption Among Older Adults With Chronic Diseases: Updated Systematic Review

Hepburn, Williams, and McCann’s 2025 systematic review synthesises evidence on barriers to and facilitators of digital health technology (DHT) adoption among older adults (60+) with chronic conditions. Drawing on 29 peer-reviewed studies and 30 grey literature sources published between April 2022 and September 2024, the review applies the COM-B behaviour change model and the PROGRESS-Plus equity framework. Key barriers included low digital literacy and physical/cognitive challenges (capability), poor connectivity, high costs, and usability issues (opportunity), and mistrust, privacy concerns, and satisfaction with existing care (motivation). Facilitators included training and accessible design (capability), healthcare provider endorsement and hybrid care models (opportunity), and recognition of DHT benefits (motivation). Health professionals could act as either enablers or blockers depending on their confidence and involvement. Rural users faced infrastructural barriers but often reported high trust in and satisfaction with local care, which may reduce motivation to adopt DHTs. Gender was rarely analysed, but available evidence suggested lower uptake among older women. Co-design that involved older adults, clinicians, and community stakeholders improved adoption.

This review highlights crucial considerations for equitable DHT implementation in rural Scotland, where ageing populations and dispersed services intersect. It emphasises that infrastructure gaps, digital literacy needs, and the attitudes of healthcare providers are major determinants of uptake. The finding that high satisfaction with local care can paradoxically dampen rural uptake is particularly relevant in Scottish settings, where strong GP-patient relationships are common. The review also underscores the importance of reporting rurality and gender, and of embedding multistakeholder co-design and trusted local roles (such as link workers or community navigators) to tailor DHTs to rural contexts. This makes the paper a valuable resource for shaping inclusive digital health strategies in rural Scotland.