“I prefer a doctor on camera than none at all”: Participants’ Perspectives on the Implementation of Integrated Telehealth and Community Health Workers Services to Improve Access to Healthcare in Rural Communities

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ABSTRACT Background Rural and isolated communities, such as Culebra, Puerto Rico, face significant healthcare challenges due to geographic isolation, limited medical resources, and socioeconomic disadvantages. Chronic diseases, particularly diabetes and hypertension, are prevalent and contribute to poor health outcomes. Telehealth services (THS) and community health workers (CHWs) have been identified as effective interventions for improving healthcare access in underserved areas. This study aimed to explore the community perceptions and attitudes towards integrating THS with the support of CHWs to enhance chronic disease management in Culebra. Methods A Qualitative Research approach involved 20 patients from Culebra’s Federally Qualified Health Center (FQHC). Semi-structured interviews were conducted, guided by the Socio-Ecological Model (SEM), to assess community perspectives toward THS and CHWs at individual, interpersonal, community, and societal levels. Thematic analysis revealed three primary themes: social determinants of health, the role of CHWs, and the benefits and challenges of THS. Results Findings indicate that CHWs play a critical role in improving healthcare access by assisting with medical appointments, medication management, and providing emotional support. THS was recognized for its potential to reduce transportation barriers and improve continuity of care, though concerns regarding convenience, technology access, and data privacy persist. The integration of CHWs and THS was viewed positively as a solution to healthcare access challenges, with participants expressing trust in this model for managing chronic diseases. Discussion This study highlights the need for further development of THS infrastructure and CHW support to ensure equitable healthcare access in rural areas like Culebra. The combination of THS and CHWs shows promise for reducing healthcare disparities and improving outcomes for isolated populations. Future efforts should focus on systemic changes to address broader social determinants of health, fostering sustainable and effective healthcare delivery in underserved communities.

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