To examine virtual health service (VHS) device usage patterns and identify factors associated with VHS engagement among Indigenous Australian adults with chronic conditions.

Cross-sectional survey.

An Aboriginal Community Controlled Health Organisation providing primary healthcare services across rural and remote Queensland, Australia.

74 consenting Indigenous Australian adults with at least one chronic condition who were registered VHS users.

Participants completed surveys assessing their use of four Bluetooth-enabled monitoring devices (pulse oximeter, blood glucose monitor, blood pressure monitor, weight scale) over a 2-week recall period. The primary outcome was VHS device usage status, categorised as active versus inactive users. Active users were defined as participants who reported any frequency of device use, while those reporting no use were classified as inactive users. All participants had access to Indigenous health coach support as part of the VHS model. Binary logistic regression was used to identify sociodemographic and geographical factors associated with VHS engagement.

Sixty-four per cent (n=47) were active users, with 73% of these using all four devices concurrently. Among active users, blood pressure monitors showed the highest utilisation (98%), followed by weight scales (91%), blood glucose monitors (89%) and pulse oximeters (86%). Three factors were significantly associated with VHS usage using binary logistic regression: residing in medium rural towns (adjusted OR 4.71, 95% CI 1.23 to 17.94, p=0.02), age 18–65 years (adjusted OR 3.59, 95% CI 1.05 to 12.22, p=0.04) and having multiple chronic conditions (adjusted OR 10.95, 95% CI 1.25 to 95.87, p=0.03) compared with those in more remote areas, aged ≥66 years and with single condition, respectively.

Indigenous-led VHS achieve substantial engagement through culturally grounded health coach support. However, addressing digital connectivity in remote areas, age-appropriate support for older adults and Indigenous workforce development is essential to ensure equitable access and sustained engagement

Digital technology in primary healthcare service delivery can enhance accessibility, service delivery and health outcomes in rural populations. The objective of this systematic review is to review and synthesise the scope and impact of digital health technology innovations within rural primary healthcare settings.

Systematic review.

Articles published on PubMed, PsycINFO, Cochrane Central, SCOPUS, Web of Science, EMBASE and CINAHL between January 2013 and October 2025 were searched using key search terms.

Patient, intervention, context, outcome model criteria guided article eligibility. Included articles were undertaken in rural populations, used digital health technology for treatment or management, explored the impact of digital health technology on rural primary healthcare and reported on healthcare outcomes. Included articles were in the English language and presented peer-reviewed primary research.

Extraction was performed using a bespoke standardised template by multiple reviewers. Quality assessment was undertaken using the Mixed Methods Appraisal Tool. Descriptive analysis and conventional inductive content analysis were applied to quantitative and qualitative data, respectively. The review is written in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols statement guidelines.

66 studies were included in the review. Most studies were conducted in the USA (n=26). Most studies focused on adult patient populations, with limited representation of Indigenous (In=3) and paediatric populations (n=2). Telemedicine/telehealth interventions using audio, video or both were the most common (n=36). Remote patient monitoring or point-of-care testing was integrated into 21 studies. Physical health conditions, particularly diabetes (n=17), cardiovascular diseases (n=11) and general primary healthcare concerns (n=13) were commonly reported. Others reported on areas including mental health, hypertension, obesity and pregnancy care.

Conventional inductive content analysis identified key themes: cost and time effectiveness, quality healthcare provision, consumer acceptance from both patients and practitioners, and healthcare service provider perspectives. Uptake barriers included staff workload and patient non-compliance, while facilitators encompassed process standardisation and practitioner acceptance and endorsement. Consumer acceptance was linked to satisfaction, willingness to engage and improved health outcomes and well-being.

Digital health interventions in rural primary healthcare offer significant potential to improve healthcare delivery, reduce costs and enhance patient access, satisfaction and health outcomes. However, careful consideration of factors such as feasibility, consumer and practitioner acceptance, and recognition of limitations is crucial for successful implementation. The review underscores the importance of flexible policies to support emerging digital healthcare solutions, including the integration of artificial intelligence. Overall, digital health interventions offer a promising avenue to improve healthcare outcomes in rural areas and should be prioritised for government funding and investment.

CRD42023477233.