‘There’s a lot less time on small talk’: Rural patient perspectives on shifting to technology-enabled healthcare in Canada during COVID-19

The objective of this qualitative research study was to explore system, provider, and patient level factors from the perspective of rural-living citizens in Canada and how these factors influenced their telehealth experiences. Participants were recruited in follow-up to an online survey which asked for interest in participation in focus groups to talk about telehealth experiences. Twenty-two rural citizens participated in one of five focus groups. The qualitative data from the focus groups were thematically analyzed. The overarching theme that described rural participants’ experiences of telehealth during the pandemic was navigating the shifting care model. Two main themes were constructed from the data: shifts in the patient-provider relationship and mismatch between the telehealth requirements and provider and system support. Relational shifts involved a transactional or business-like relationship with their providers, that was reflected in changes in etiquette practices, personalization of care, and communication dynamics. Mismatch in telehealth system requirements and support was reflected in shifting personal and infrastructure technology requirements, blurred boundaries of health data access and privacy, and shifting appointment logistics. Continued use and expansion of technology-enabled healthcare must consider patient perspectives.