The Journal Of Rural Health[JOURNAL]
Sun
200 papers
Challenges Associated With Rural-Urban Stratification for Generalizing Birth Outcomes: Insights From the ECHO Cohort.
Beene D, MacKenzie DA, Camargo CA … +12 more , Chehab RF, Elliott AJ, Gao G, Hirko KA, Karagas MR, Keim S, McCormack LA, Peterson AK, Sadeghi H, Towe-Goodman N, Kress AM, ECHO Cohort Consortium
J Rural Health · 2026 Mar · PMID 42117321 · Full text
PURPOSE: Efforts to generalize findings from the Environmental influences on Child Health Outcomes (ECHO) Cohort across rural and urban areas are challenged by limitations in both sample composition and the classificatio...
PURPOSE: Efforts to generalize findings from the Environmental influences on Child Health Outcomes (ECHO) Cohort across rural and urban areas are challenged by limitations in both sample composition and the classification schemes used to define place. We evaluated how rural-urban stratification affects the interpretation and generalizability of preterm birth (PTB) prevalence proportions in the ECHO Cohort compared to national benchmarks. METHODS: We used a population data science approach to compare bootstrap estimates of PTB prevalence in ECHO (2017-2019, 2020-2022) to county-level prevalence from the National Center for Health Statistics, stratified by rural-urban classification (RUCC, UIC, NCHS), race/ethnicity, education, and income. We applied post-stratification weights and conducted sensitivity analyses. FINDINGS: Overall PTB prevalence in ECHO was statistically similar to that in US live births. Estimates varied by rural-urban classification scheme but showed no consistent directional difference. Stratifying by race and education revealed variability in PTB differences and gaps in subgroup representation within the analytic sample. Post-stratification increased PTB estimates slightly and stabilized rural estimates. Two predominantly rural cohort sites strongly influenced rural means; excluding one reversed the direction of rural-urban difference while excluding the other increased it. Supplemental analyses showed regional variability in PTB prevalence and suggested that living above 130% of the federal poverty level may be protective. CONCLUSIONS: Rural-urban stratification alone, without accounting for the context of rural places, limits generalizability and may obscure differences between samples drawn from large cohort studies and the broader population. Context-aware stratification may improve validity and equity in population health research.
State-Level Medicaid Expansion and Hospital, Federally Qualified Health Center, and Rural Health Clinic Availability.
Paintsil E, Linde S
J Rural Health · 2026 Mar · PMID 42093306 · Full text
BACKGROUND: Medicaid expansion in early adopter states has been linked to reduced uncompensated care and improved financial stability of healthcare organizations; however, less is known about its longer-term effects, out...
BACKGROUND: Medicaid expansion in early adopter states has been linked to reduced uncompensated care and improved financial stability of healthcare organizations; however, less is known about its longer-term effects, outcomes among later adopters, and differences across rural and urban settings. OBJECTIVE: To examine the longer-term association between state Medicaid expansion and the availability of hospitals, federally qualified health centers (FQHCs), and rural health clinics (RHCs) in states expanding Medicaid in 2014, 2015, and 2016, and to assess differences across rural and urban counties. DESIGN: We applied difference-in-differences methods for staggered policy adoption. Covariates included county population, median age, median household income, and racial/ethnic composition. Outcomes were the county-level total number of hospitals, FQHC sites, and RHC sites, analyzed for all counties and rural/urban subsamples. SETTING: U.S. counties, during 2010-2019 period. PARTICIPANTS: Two thousand eight hundred and fourteen counties (1319 expansion; 1495 nonexpansion) across 44 states. RESULTS: Medicaid expansion was associated with slightly more hospitals (0.094; 95% CI -0.003 to 0.190; p <0.1) and FQHC sites (0.511; 95% CI 0.214-0.807; p <0.01), but no significant change in RHC sites (-0.032; 95% CI -0.310 to 0.247). Relative to 2013, these correspond to county-level increases of 4.9% for hospitals and 26.7% for FQHCs. Effects appeared in both rural and urban areas, with larger relative gains in rural counties. Event-study plots indicated that effect sizes increased over time. CONCLUSION: Counties exposed to Medicaid expansion experienced sustained growth in hospital and FQHC presence, but not in RHCs, possibly reflecting supply side constraints. Policymakers should recognize that stabilization effects may strengthen gradually following expansion.
A Pilot Implementation of a Peer-Delivered Service to Increase Behavioral Healthcare Engagement among Rural Veterans.
Possemato K, Barrie K, Johnson EM … +5 more , Marchbanks R, Gatewood M, Kane M, Shook CB, Stecker T
J Rural Health · 2026 Mar · PMID 42080307 · Publisher ↗
PURPOSE: Most rural Veterans with behavioral health concerns are not engaged in behavioral health care. Peer Support for Treatment Seeking (PS-TS) engages Veterans in care by leveraging Veteran peer specialists' unique s...
PURPOSE: Most rural Veterans with behavioral health concerns are not engaged in behavioral health care. Peer Support for Treatment Seeking (PS-TS) engages Veterans in care by leveraging Veteran peer specialists' unique skills to connect with other Veterans. PS-TS is a brief conversation about treatment-seeking beliefs that aims to connect Veterans to care. PS-TS was implemented in two rural Veterans Health Administration (VHA) regions in 2024. METHODS: Evidence-based implementation strategies were used to support uptake of PS-TS, including working with local stakeholders to identify site-specific implementation barriers, tailoring implementation materials for peer-delivery, tracking adaptations, and training peers to deliver PS-TS. We evaluated impact using the RE-AIM domains of reach, effectiveness, adoption, implementation, and maintenance. FINDINGS: Tailoring PS-TS and the implementation plan to fit the peers' scope of practice and the needs of rural Veterans enabled implementation, while peer discomfort with outreach calls and the complexity of delivering PS-TS were barriers. PS-TS content and training were adapted to provide peers with more support. Peers conducted 364 outreach calls and delivered PS-TS to 117 Veterans, of whom 43 (37%) initiated VHA behavioral health care and 17 (15%) sought community/other care. PS-TS fidelity was high overall, but quality of delivery was low moderate for more challenging components. PS-TS was not maintained after implementation support ended. CONCLUSIONS: Evidence-based implementation strategies enabled PS-TS to reach many rural Veterans with unmet behavioral health needs and increase care engagement. Future implementation efforts should prioritize increasing the quality of PS-TS delivery and enabling PS-TS maintenance over time.
Contraceptive Method Provision Patterns Among Rural and Urban Kentucky Medicaid Enrollees.
Miracle DK, Slavova S, Talbert J … +2 more , Moga DC, Freeman PR
J Rural Health · 2026 Mar · PMID 42080303 · Full text
PURPOSE: To characterize contraceptive provision among the Kentucky Medicaid population and assess for rural-urban disparities. METHODS: Kentucky Medicaid claims from the calendar year 2019 were used to identify females...
PURPOSE: To characterize contraceptive provision among the Kentucky Medicaid population and assess for rural-urban disparities. METHODS: Kentucky Medicaid claims from the calendar year 2019 were used to identify females at risk for unintended pregnancy (via a modified version of the criteria defined by the US Department of Health and Human Services Office of Population Affairs). Multinomial logistic regression was used to assess the impact of rural-urban residence on contraceptive outcomes, while adjusting for relevant covariates. Outcomes for the multinomial regression model were provision of a: (1) less effective method (i.e., condoms) or no contraceptive; (2) moderately effective method (oral, transdermal, injectable, or vaginal); (3) or long-acting reversible contraceptive (LARC) method. FINDINGS: A total of 239,160 enrollees at risk for unintended pregnancy were included for analyses. Adjusted odds of provision of a moderately effective method (vs. a less effective method or no method) were higher among both those residing in rural-adjacent to urban (aOR 1.17; 95% CI, 1.13-1.20) and rural-nonadjacent to urban (aOR 1.15; 95% CI, 1.12-1.18) locations compared to urban. Notably, adjusted odds of provision of an LARC method (vs. a less effective method or no method) were significantly lower among those residing in rural-nonadjacent to urban locations (aOR 0.81; 95% CI 0.77-0.85) compared to those in urban locations. CONCLUSIONS: Despite high moderately effective contraceptive provision among Kentucky Medicaid enrollees in rural-nonadjacent to urban counties, adjusted odds of LARC provision are significantly lower, signaling significant barriers to access among this population.
A Pilot Evaluation of a Telemedicine Pharmacist-Physician Management Model to Increase Access to Medication for Alcohol and Opioid Use Disorders for Rural Veterans.
Kennedy AJ, Frost MC, Malte CA … +11 more , Fletcher OV, Gray M, Kenny ME, Liu AW, Samawat S, Sinton TI, Tuegel C, Wyse JJ, Hagedorn HJ, Hawkins EJ, Chander G
J Rural Health · 2026 Mar · PMID 42080284 · Publisher ↗
BACKGROUND: Alcohol and opioid use disorders (AUD, OUD) cause significant morbidity and mortality among Veterans, yet only a minority receive evidence-based treatment. OBJECTIVE: Beginning in February 2022, we piloted a...
BACKGROUND: Alcohol and opioid use disorders (AUD, OUD) cause significant morbidity and mortality among Veterans, yet only a minority receive evidence-based treatment. OBJECTIVE: Beginning in February 2022, we piloted a telemedicine pharmacist-physician management model (PPMM) in 6 Veterans Health Administration (VHA) primary care community-based outpatient clinics (CBOCs) across one VHA Health Care System to improve rural Veteran access to medications for opioid and alcohol use disorder (MOAD). METHODS: Veterans with AUD and/or OUD receiving primary care in participating CBOCs during the year following implementation were eligible for referral. Data obtained from study records and VHA electronic health records assessed patient sociodemographic and clinical characteristics and MOAD receipt among referred Veterans. RESULTS: There were 2274 Veterans diagnosed with AUD (n = 2062) and/or OUD (n = 307) receiving primary care from CBOCs during the study period. Of this population, 111 (4.9%) Veterans were referred and received PPMM services (AUD: n = 93; OUD: n = 9; AUD and OUD: n = 9), the mean age was 52 years, 92% were male, 68% White, and 39% lived in rural zip codes. Of the 102 Veterans referred to PPMM with AUD, 71% received medication. Of the 18 Veterans referred with OUD, 78% received medication. Most Veterans who were newly initiated on MOAD (N = 74) received medication within 72 h (N = 50, 68%). CONCLUSIONS: In this pilot implementation of same-day telemedicine PPMM, high rates of MOAD receipt were seen among referred Veterans. However, most Veterans with AUD/OUD seen in participating clinics were not referred. Further evaluation of barriers and/or facilitators to referral are needed to increase program uptake.
Enhancing Rural Health Professions Education: Experiences and Perspectives of Participants in the VA Rural Interprofessional Faculty Development Initiative.
Keithly S, Perry P, Sterling R … +6 more , Coogan S, Subramaniam S, Shirley SE, Maynard C, Kaminetzky CP, Wong ES
J Rural Health · 2026 Mar · PMID 42080247 · Publisher ↗
PURPOSE: Rural health professions education (HPE) is essential to mitigating workforce shortages in rural communities. The Department of Veterans Affairs (VA) Rural Interprofessional Faculty Development Initiative (RIFDI...
PURPOSE: Rural health professions education (HPE) is essential to mitigating workforce shortages in rural communities. The Department of Veterans Affairs (VA) Rural Interprofessional Faculty Development Initiative (RIFDI) is a multimodal, longitudinal faculty development program designed to enhance teaching and leadership skills of clinician-educators from multiple professions practicing in primarily rural settings. This qualitative evaluation assessed RIFDI's impact on rural HPE by evaluating participants' experiences and perspectives. METHODS: We conducted 27 semi-structured interviews with RIFDI participants. Interviews focused on their training experiences and perspectives on program implementation and effectiveness. Data were analyzed using a rapid analytic approach combining template and matrix analysis. FINDINGS: Three themes illuminated pathways by which RIFDI enhanced rural HPE. First, participants perceived that RIFDI offered practical support for clinician-educators in resource-limited settings, particularly among those involved in nascent HPE programs. Learning within a cross-site, interprofessional community of practice was viewed as especially useful in rural contexts. Second, experiential projects spurred a range of activities to improve rural educational environments, including faculty development offerings, HPE curriculum development, and new rotations. Third, participants described ways in which RIFDI advanced a culture of education in rural facilities, for example by "starting the conversation" about the importance of rural HPE and fueling motivation to support rural education and trainee recruitment. CONCLUSIONS: Findings demonstrate that a faculty development program can meaningfully strengthen rural HPE capacity in a national health care system. Investing in rural clinician-educators may help cultivate high-quality HPE environments, which existing literature links to improved health workforce recruitment and retention.
Rural-Urban and Racial-Ethnic Differences in Tele-Behavioral Health Access for Medicaid Beneficiaries.
Greenwood-Ericksen M, Quazi M, Slator C … +8 more , Wu X, Kincaid T, Dancis A, Zhu JM, Sabbatini A, Ziedonis D, Kamdar N, Bonham C
J Rural Health · 2026 Mar · PMID 42080245 · Publisher ↗
BACKGROUND: Tele-behavioral health (TBH) expanded significantly during the COVID-19 pandemic, but the extent to which this addressed or reinforced existing rural-urban disparities remains unclear, especially in states wi...
BACKGROUND: Tele-behavioral health (TBH) expanded significantly during the COVID-19 pandemic, but the extent to which this addressed or reinforced existing rural-urban disparities remains unclear, especially in states with diverse and underserved populations. This study investigates the role of rurality and broadband access in TBH utilization among adult Medicaid beneficiaries in New Mexico-a highly rural and racially diverse state. METHODS: We analyzed New Mexico Medicaid claims data from March 2019 to March 2021 for outpatient behavioral health visits. Using logistic regression models, we assessed differences in TBH use by rurality, race/ethnicity, and broadband connectivity across pre- and post-public health emergency (PHE) periods. Visits were categorized by modality (in-person, audio-only, video) and linked with county-level data on broadband access and provider availability. RESULTS: Our study included 2,934,451 behavioral health visits among 216,898 unique Medicaid members. Total patient visits for BH increased by 19.2% from 1,326,473 (72.7% urban, 27.3% rural) to 1,607,978 (72.3% urban, 27.7% rural) across the study period. Urban patients had greater odds of TBH use (specifically audio-only visits) compared to rural patients, even in rural counties with high broadband access. Modeling results demonstrated that urban patients had greater odds of a TBH visit as compared to rural patients, which was more pronounced in high versus low connectivity counties (OR 2.20; 95% CI 2.21, 2.27 vs. OR 1.53; 95% CI 1.51, 1.56). Native American patients had the greatest odds of TBH visits, which may reflect established telehealth infrastructure within the Indian Health Service. CONCLUSIONS: TBH expanded behavioral health access for Medicaid beneficiaries, but rural disparities persist and are not mitigated by broadband access alone. Rather, existing telehealth infrastructure appears to be related to improved rural TBH access. These findings underscore the need for policy efforts beyond broadband expansion to achieve equitable TBH access across diverse and rural populations.
Multi-Listing Among Rural Kidney Transplant Recipients: A National Cohort Study.
Weeda ER, Declan ABL, Greene PJ … +1 more , DuBay DA
J Rural Health · 2026 Mar · PMID 42059860 · Full text
PURPOSE: Rural patients who qualify for kidney transplantation are less likely to undergo transplant compared to urban patients. Multi-listing, or being added to the waiting list at more than two centers, has been shown...
PURPOSE: Rural patients who qualify for kidney transplantation are less likely to undergo transplant compared to urban patients. Multi-listing, or being added to the waiting list at more than two centers, has been shown to improve kidney transplantation rates, yet it remains a subject of debate and is understudied in rural populations. We sought to compare demographic, clinical, and donor characteristics among rural kidney transplant recipients who were on the waiting list at two or more centers (i.e., multi-listed) versus those who were on the waiting list at one center (i.e., single-listed) prior to transplant. METHODS: This retrospective, cohort study used the Scientific Registry of Transplant Recipients (SRTR) to identify adult, first-time, deceased-donor kidney transplant recipients between 2019 and 2023 who resided in rural areas, as defined by Rural-Urban Commuting Area (RUCA) Codes. Patients were divided into cohorts based on their listing status (single-listed vs. multi-listed) before transplant. FINDINGS: Of the 6246 rural kidney transplant recipients included, 829 (13.3%) were multi-listed. Compared to single-listed recipients, multi-listed recipients were more likely to be college-educated (54% vs. 44%, p < 0.001) and employed (26% vs. 23%, p = 0.02); they also had a shorter duration of dialysis before transplant (33 months [interquartile range, IQR = 18-50] vs. 35 months [15-62], p = 0.01). However, donors for multi-listed recipients had a higher median Kidney Donor Profile Index (50% [IQR = 25%-69%] vs. 44% [23%-66%], p = 0.006). CONCLUSIONS: These findings suggest that while multi-listed rural patients possess characteristics favorable to long-term graft success, they may receive organs from donors with less favorable profiles. Future work should focus on understanding and addressing any trade-offs involved in multi-listing strategies.
Characteristics of Firearm Injuries Among Rural- Versus Urban-Residing Veterans Who Presented to VA Healthcare, 2010-2019.
O'Neill AS, Maxim LA, Gilbert TA … +4 more , Lafferty M, Plunkett KA, Thompson AR, Carlson KF
J Rural Health · 2026 Mar · PMID 42052794 · Full text
PURPOSE: Military Veterans and rural residents are at greater risk of firearm injury than non-Veterans and urban residents. This retrospective cohort study used administrative data and electronic health record (EHR) revi...
PURPOSE: Military Veterans and rural residents are at greater risk of firearm injury than non-Veterans and urban residents. This retrospective cohort study used administrative data and electronic health record (EHR) reviews to compare the characteristics of firearm injuries between rural and urban Veterans who presented to the Department of Veterans Affairs (VA) healthcare system. METHODS: A national, stratified random sample of 600 Veterans (300 rural, 300 urban) with firearm injury-related healthcare visits was identified using VA administrative data. Eligible injuries were caused by a firearm and occurred after military separation and between 2010 and 2019. Details about Veterans and firearm injuries were ascertained from administrative data and through EHR reviews. Analyses compared characteristics of firearm injuries by Veterans' rurality. FINDINGS: N = 340 firearm injuries were eligible (178 rural, 162 urban). Most were nonfatal (94.7%). Injury intent differed by rurality, where unintentional injuries comprised a higher proportion of firearm injuries for rural Veterans (55.0% rural, 34.6% urban) and assault-related injuries comprised a higher proportion for urban Veterans (16.3% rural, 37.0% urban). Initial treatment was mostly delivered at facilities outside the VA (82.8%), while follow-up care was mostly at VA facilities (75.8%). Firearm safety counseling was rarely documented (8.3%). CONCLUSIONS: This study describes firearm injuries to inform healthcare-based prevention efforts for rural and urban VA facilities. Differences by rurality in Veterans' injuries suggested that intent-focused tailoring of prevention efforts is critical. Findings highlight opportunities for VA providers to deliver firearm safety counseling. Future research should examine the potential effectiveness of prevention tailored by rurality.
The Association Between Telehealth Use and Health Care Costs Among Rural Medicare Fee for Service Beneficiaries During the COVID-19 Pandemic.
Jonk Y, O'Connor H, Thayer D
J Rural Health · 2026 Mar · PMID 42017577 · Publisher ↗
PURPOSE: To address rural-urban differences in health services use and costs among Medicare fee-for-service (FFS) beneficiaries by telehealth use before and during the COVID-19 pandemic. METHODS: The study population con...
PURPOSE: To address rural-urban differences in health services use and costs among Medicare fee-for-service (FFS) beneficiaries by telehealth use before and during the COVID-19 pandemic. METHODS: The study population consisted of a nationally representative 5% sample of Medicare FFS beneficiaries aged 65 years and older during 2019-2020. Rural-Urban Continuum Codes identified rural-urban residential locations. Propensity scores were used to correct for selection bias and identify matching cohorts of telehealth and non-telehealth users. Differences in health services use and costs by telehealth use were addressed using difference in differences logistic and generalized linear models. FINDINGS: Telehealth use curbed the decline in in-person outpatient visits for rural and urban beneficiaries early in the pandemic. During 2020, both rural and urban telehealth users had significantly lower probabilities of being hospitalized compared to 2019 (marginal effects [ME]: rural -0.22, urban -0.18), and were less likely to visit the emergency department (ED) (ME: rural -0.23, urban -0.20). Yet, telehealth users were more likely to be hospitalized than non-telehealth users during 2020 (ME: rural 0.018, urban 0.011) and more likely to visit the ED (ME: rural 0.032, urban 0.024). While total costs were significantly higher for telehealth users (rural $8484, urban $7272) than non-telehealth users (rural $6749, urban $5201) during 2020, total costs were reduced by a greater amount ($9200) for rural telehealth users than urban ($8000) and rural non-telehealth ($6900) counterparts. CONCLUSIONS: While telehealth users realized higher total costs of care in 2019-2020, rural telehealth users realized greater declines in total costs than rural non-telehealth users and urban beneficiaries.
The National Physician Shortfall: Congress Steps Into the Breach.
Adashi EY, Cohen IG
J Rural Health · 2026 Mar · PMID 41987565 · Publisher ↗
As recently as November 2024, the National Center for Health Workforce Analysis (NCHWA) of the Health Resources and Services Administration (HRSA) made note of the latest census data of U.S. physicians [1]. It was the co...
As recently as November 2024, the National Center for Health Workforce Analysis (NCHWA) of the Health Resources and Services Administration (HRSA) made note of the latest census data of U.S. physicians [1]. It was the conclusion of the NCHWA that the U.S. is presently home to a total of 933,788 "professionally active" physicians of whom 800,355 are "reported as patient care practicing physicians [1]." The NCHWA went on to project a "shortage of 187,130 full-time equivalent (FTE) physicians in 2037" as well as the possibility that "nonmetro areas will experience greater shortages of physicians than metro areas [1]." The NCHWA further estimates that "75 million people live in a primary care Health Professional Shortage Area (HPSA)" and that "a total of 122 million people live in a mental health HPSA [1]." Note was also made of the reality that "the maldistribution of the health care workforce results in severe shortages in rural communities [1]." Seeking to address the extant challenges, a bipartisan group of members of the Senate Committee on Finance stepped into the breach [2]. Led by Sen. Ron L. Wyden (D-OR), it was the intent of the Senators to introduce legislation that will assist teaching hospitals in the training of more physicians by reforming Medicare's Graduate Medical Education (GME) rules [2]. In this Commentary, we review the evolution of the aforementioned draft legislation as well as assess the likelihood of the materialization thereof.
Rural and Urban Disparities in Healthcare Utilization and Cost at the End-of-Life in Quebec: A Retrospective Study.
Bosson-Rieutort D, Duc J, Boulianne JF … +2 more , Barbat-Artigas S, Strumpf EC
J Rural Health · 2026 Mar · PMID 41983594 · Full text
BACKGROUND: The end-of-life (EoL) is a critical period as individuals can face multiple health problems, increasing healthcare utilization and cost. Knowing that regional healthcare availability may contribute to some va...
BACKGROUND: The end-of-life (EoL) is a critical period as individuals can face multiple health problems, increasing healthcare utilization and cost. Knowing that regional healthcare availability may contribute to some variations, we aimed to describe rural and urban disparities in healthcare utilization and costs during the last year of life among Quebec residents aged 66 years or older. METHODS: We used a retrospective cohort of individuals who died between April 1, 2014 and March 31, 2018. Data included medical visits, emergency visits, hospitalizations, community care, and long-term care (LTC). Costs were extracted from administrative databases or financial reports and used to estimate total, health-related and social individual costs. Regions of residence were categorized as urban, mid-urban, mid-rural and rural. Generalized linear models were employed to examine variations in service utilization and cost. RESULTS: The cohort comprised 21,117 individuals. Service utilization was generally higher for most health-related than social services. Regional differences in utilization were limited in primary care but variations were observed for LTC and community care. Conversely, average social costs, mostly driven by LTC, nearly doubled health-related costs. Additionally, costs differences between regions were mostly driven by increased utilization rather than higher fees. CONCLUSION: Some urban regions showed higher levels of service use and associated costs. However, this was not uniformly observed across all urban regions, nor were rural regions consistently associated with lower utilization or costs. Factors beyond urbanization level, such as individual healthcare needs, population characteristics or healthcare offer, are critical to understanding EoL service use and costs.
"Hit or Miss": Rural Veterans' Experiences Receiving Community Mental Health Care.
Chen PV, Walsh J, Smith AH … +5 more , Eck CS, Caloudas AB, Plasencia M, Kanzler KE, Grubbs KM
J Rural Health · 2026 Mar · PMID 41964331 · Publisher ↗
PURPOSE: Veteran use of Veteran Health Administration (VHA)-purchased community care (CC) for mental health has accelerated at a faster pace compared to both primary care and emergency services. Few studies have conducte...
PURPOSE: Veteran use of Veteran Health Administration (VHA)-purchased community care (CC) for mental health has accelerated at a faster pace compared to both primary care and emergency services. Few studies have conducted an in-depth exploration of rural Veteran experience using community mental health. This paper focuses on the voices of rural Veterans, with the aim of exploring advantages and disadvantages for Veterans receiving mental health services through CC. METHODS: We conducted interviews with rural Veterans, using purposive sampling to identify Veterans through the Integrated Veteran Care Consolidated Data Sets who were enrolled in VHA medical centers in the southcentral United States, had received CC for mental health, and were living in a rural area. Interviews asked Veterans about their experience with receiving community mental health care. We used thematic analysis to organize quotes and present salient themes from interviews. FINDINGS: We interviewed 30 Veterans. We highlight four findings: (1) Most Veterans were pleased with the mental health care they received through the community. (2) Some Veterans reported instances of unprofessionalism and recognized a lack of military expertise among community providers. (3) Rural Veterans continue to face access barriers and noted limited availability of community mental health providers. (4) Difficulty with navigating multiple health systems impacted some rural Veterans' continuity of care. CONCLUSIONS: While CC has improved access to mental health care for Veterans, there are concerns related to the quality of care and continuity gaps for rural Veterans.
Rural health care workforce retention measures: A rapid scoping review.
Mengeling MA, Sears R, Buchanan CH … +9 more , Howren MB, Samuelson RJ, Miller K, McConnell C, Wilson JR, Archambault E, Anderson BL, Axon RN, CPIC – VA QUERI Center
J Rural Health · 2026 Mar · PMID 41964317 · Publisher ↗
PURPOSE: Rural Veterans face persistent barriers to care, often exacerbated by health care workforce shortages. Although recruitment initiatives are important, retaining providers in rural areas is equally critical to su...
PURPOSE: Rural Veterans face persistent barriers to care, often exacerbated by health care workforce shortages. Although recruitment initiatives are important, retaining providers in rural areas is equally critical to sustaining access and continuity of care. This rapid scoping review examined how "rural workforce retention" is defined and measured in the peer-reviewed literature and synthesized recommended reporting elements to improve clarity and comparability. METHODS: Six bibliographic databases were searched (2014-2025) for English-language studies of rural health care in the United States, Canada, the United Kingdom, and Australia using terms related to rural workforce retention. Data were extracted on definitions of retention, time frames, and measurement approaches. FINDINGS: Of 2392 abstracts screened, 268 met inclusion criteria. Among these, 172 (64%) lacked a retention definition. Of the remaining 96, nearly half (45%) measured retention using providers' intentions to stay or leave; others relied on turnover or continued rural practice. More than half (61%) specified a retention timeframe, most often retrospectively (41/59; 69%). Substantial heterogeneity across definitions, time horizons, and data sources led to the development of a reporting checklist outlining key conceptual, temporal, and methodological elements for retention research. CONCLUSIONS: Inconsistent and incompletely reported measures of rural workforce retention limit evaluation and scalability of effective strategies. Research should explicitly define retention, specify a measurable time frame, and clearly report key conceptual and methodological elements to enable comparison across settings. For the Veterans Health Administration (VHA) and other rural systems, clear retention metrics are essential to ensure workforce stability and sustain access to high-quality care for rural Veterans.
Adult tobacco product use patterns across the urban-rural continuum: The longitudinal Population Assessment of Tobacco and Health (PATH) study, 2016-2023.
Zhang J, Rose SW, Hahn EJ … +10 more , Roberts ME, Fennell BS, Ozga JE, Himelhoch S, Feizy S, Christian WJ, Wiggins AT, Abadi M, Mattingly DT, Rayens MK
J Rural Health · 2026 Mar · PMID 41964313 · Full text
PURPOSE: To determine the association between adult tobacco/nicotine product use over time and residence location (urban, suburban, town, rural), controlling for demographics. METHODS: Data from Waves 4-7 (2016-2023) of...
PURPOSE: To determine the association between adult tobacco/nicotine product use over time and residence location (urban, suburban, town, rural), controlling for demographics. METHODS: Data from Waves 4-7 (2016-2023) of the Population Assessment of Tobacco and Health (PATH) study (N = 18,590 adults) were analyzed using survey-weighted logistic regression to evaluate location and time differences in likelihoods of current, daily, and established use of combustible tobacco, electronic nicotine delivery systems (ENDS), smokeless products, and poly use (≥2 products). FINDINGS: Compared to those residing in urban locations, suburban residents were less likely to report current (adjusted odds ratio (aOR) = 0.88), daily (aOR = 0.73), and established combustible products use (aOR = 0.77); town residents were more likely to use these products currently (aOR = 1.20) and daily (aOR = 1.42), and rural residents were more likely to use daily (aOR = 1.25) and report established use (aOR = 1.33). Rural residents had a lower likelihood of current ENDS use (aOR = 0.90), compared with those in urban locations. Compared with urban residents, current smokeless products use was more likely among rural residents (aOR = 1.63) and less likely among those in suburban locations (aOR = 0.74). Participants living in suburban (vs. urban) locations were less likely to use ≥2 products currently (aOR = 0.89) or daily (aOR = 0.79), while rural residents were more likely to engage in daily poly use (aOR = 1.39). Time was a significant factor in all models, with fluctuating patterns across waves. CONCLUSIONS: These findings highlight nuanced geographic differences in tobacco/nicotine product use patterns beyond simple urban-rural comparisons, informing efforts to eliminate tobacco/nicotine use disparities.
Artificial intelligence in rural health care: A framework for responsible adoption, readiness, and access.
Huang Q, Williams S, Helle S
J Rural Health · 2026 Mar · PMID 41947609 · Publisher ↗
Abstract loading — click title to view on PubMed.
Transforming Rural Health: States Should Invest Federal Funds to Enhance Primary Care.
Huynh J, Mackwood M, Colla C
J Rural Health · 2026 Mar · PMID 41947598 · Full text
Abstract loading — click title to view on PubMed.
Rural community engagement and cultural considerations in the design and deployment of remote health monitoring systems: A scoping review.
Reed K, Petermann VM, Nicholas RD … +2 more , Truong TTV, LeBaron V
J Rural Health · 2026 Mar · PMID 41947591 · Full text
PURPOSE: Remote health monitoring systems (RHMS) use technology (e.g., wearables, smartphones) to track health-related information outside of traditional health care settings and hold great promise to enhance access to c...
PURPOSE: Remote health monitoring systems (RHMS) use technology (e.g., wearables, smartphones) to track health-related information outside of traditional health care settings and hold great promise to enhance access to care for rural residents. To be most effective, RHMS must meet the unique needs and preferences of rural residents. Therefore, the aim of this scoping review is to explore if, and how, RHMS in the United States (US) are designed and deployed with consideration for the cultural and contextual needs of rural residents. METHODS: PubMed, CINAHL, and Web of Science were searched using a combination of keyword and MeSH terms related to rural and remote health technology. Included articles were original research studies published between 2014 and 2024 that focused on the design and/or deployment of RHMS for adults in the US and included rural participants. FINDINGS: An initial 9175 studies were identified and screened, with 61 unique studies selected for analysis. Of these studies, 50.8% (n = 31) provided a clear, operational definition of "rural." Stakeholder engagement in the design/deployment of RHMS was described in 63.9% (n = 39) of studies; however, few studies engaged caregivers (9.8%, n = 6). Approximately 44.3% (n = 27) of studies explicitly modified RHMS for low broadband access. CONCLUSIONS: Three key themes emerged: limited stakeholder engagement, ongoing infrastructure barriers, and significant variability in how the cultural and contextual considerations of rural residents were incorporated into RHMS design and deployment. As RHMS are increasingly integrated into health care, it is critical to advance approaches that meaningfully support the health and well-being of rural residents.
Impact of Rural Hospital Closures on Survival Among Medicare Beneficiaries Diagnosed With Colorectal, Lung, Breast, and Prostate Cancer.
Liu Z, Gao D, Martin T … +3 more , Winegar R, Giordano SH, Kuo YF
J Rural Health · 2026 Mar · PMID 41947577 · Full text
PURPOSE: To examine the impact of rural hospital closures on mortality among patients with colorectal, lung, breast, and prostate cancer. METHODS: This retrospective observational cohort study uses SEER-Medicare linkage...
PURPOSE: To examine the impact of rural hospital closures on mortality among patients with colorectal, lung, breast, and prostate cancer. METHODS: This retrospective observational cohort study uses SEER-Medicare linkage data from 2000-2020 to evaluate all-cause and cancer-specific mortality among Medicare beneficiaries diagnosed with colorectal, lung, breast, or prostate cancer. The closure group included patients living in counties that experienced rural hospital closures; the control group consisted of patients from propensity score-matched rural counties with sustained hospital access. The primary outcomes were all-cause and cancer-specific mortality among patients with colorectal, lung, breast, and prostate cancer. Analyses compared outcomes before and after rural hospital closures and between rural counties with and without closures. FINDINGS: A total of 33,716 cancer patients were included. Cox proportional hazards analyses revealed significantly higher all-cause mortality among colorectal cancer patients living in counties that experienced rural hospital closures (HR = 1.139, 95% CI: 1.030-1.259), but no significant difference was observed among those living in control counties, after adjusting for covariates. For lung cancer patients, significantly lower cancer-specific mortality was observed in control counties during the post-closure period (HR = 0.906, 95% CI: 0.834-0.983), with no significant difference in the closure group. No significant effects were found for breast or prostate cancer patients. CONCLUSIONS: Rural hospital closures are associated with worse survival outcomes for colorectal and lung cancer patients but not for breast or prostate cancer patients. Targeted policy interventions are needed to mitigate the adverse effects of hospital closures on cancer care in rural communities.
The association between residential relocation and mortality among Veterans with experience of housing instability in rural areas.
Montgomery AE, deRussy A, Richman J … +2 more , Wachtel LH, Blosnich J
J Rural Health · 2026 Mar · PMID 41947571 · Publisher ↗
PURPOSE: Housing instability deleteriously affects health outcomes (i.e., lack of access to care, premature mortality). Veterans experiencing housing instability in rural areas-which often lack housing options, transport...
PURPOSE: Housing instability deleteriously affects health outcomes (i.e., lack of access to care, premature mortality). Veterans experiencing housing instability in rural areas-which often lack housing options, transportation, and services-have greater odds of residential relocation compared to urban Veterans, and they most frequently relocate to urban areas. Urban relocation is associated with changes in health outcomes, including increased services use, but studies have not examined the association between residential relocation and mortality. METHODS: This study used Veterans Affairs electronic health record data for 28,058 Veterans who experienced housing instability at a rural residence and then, within 2 years, changed their residential location by ≥40 mi or from a rural-to-urban location. We assessed the risk of mortality during the 6 months following residential relocation, controlling for sociodemographics, baseline comorbid health conditions, and time-varying services use. FINDINGS: One-third of the rural Veterans experiencing housing instability had a rural-to-rural relocation (n = 7227), whereas the remaining had a rural-to-urban relocation (n = 17,375). Veterans with a rural-to-rural relocation were older and had more comorbid medical conditions compared to Veterans with rural-to-urban relocation; however, Veterans with a rural-to-urban relocation had 28% greater odds of mortality during the 6 months following residential relocation than Veterans with rural-to-rural relocation. CONCLUSIONS: Rural-to-rural relocation was associated with reduced odds of mortality, even when controlling for services utilization, age, and baseline comorbidities. Future research should explore if and how remaining in rural environments is protective and identify ways to support care coordination following residential relocations among Veterans with experience of housing instability.
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