Digital Health Interventions for Strengthening Rural Health Systems: Opportunities and Challenges

Abstract

Background: Rural health systems remain fragile due to limited workforce and infrastructure. Digital health interventions (DHIs) provide opportunities to address access, adherence, and monitoring challenges in underserved populations. Objective: This study evaluates DHIs’ effectiveness in strengthening rural health services, analyzing patient utilization, chronic disease management, maternal care, and preventive health outcomes in Khulna, Bangladesh, during an 18-month observation period. Methods: A cross-sectional study was conducted at the Department of Community Medicine and Public Health, Khulna City Medical College Hospital. Between January 2023 and June 2024, 152 patients were enrolled. Structured questionnaires, electronic logs, and clinical records were analyzed. Variables included consultation frequency, adherence, maternal follow-up, blood pressure, HbA1c, vaccination, and readmissions. Data underwent paired t-tests, chi-square tests, regression modeling, and ANOVA. Results: A total of 152 patients, 89 (58.6%) accessed teleconsultation, and 63 (41.4%) engaged with mobile reminders. Mean consultation visits increased (1.8 ± 0.6 vs 3.5 ± 1.1, p<0.001). Medication adherence rose from 54.3% to 78.9% (χ²=16.2, p=0.002). Maternal follow-up improved from 61.2% to 84.7% (p<0.001). Systolic blood pressure decreased from 146.5 ± 12.4 mmHg to 132.1 ± 10.6 (p<0.001, Cohen’s d=1.2). HbA1c in diabetic patients fell by 1.6% (8.9 ± 1.4 vs 7.3 ± 1.1, p=0.003). Vaccination completion increased from 72.5% to 92.8% (p<0.001). Hospital readmission within 30 days declined from 18.4% to 9.2% (p=0.004). Patient satisfaction rose significantly (3.1 ± 0.9 vs 4.4 ± 0.7, p=0.001). Conclusion: Digital health interventions significantly enhanced service utilization, chronic disease control, and preventive care in rural settings. Sustainable adoption demands infrastructure strengthening and equitable access policies to consolidate long-term systemic benefits.