Rural community engagement and cultural considerations in the design and deployment of remote health monitoring systems: A scoping review

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.