Commentary
It’s not one size fits all: a case for how equity-based knowledge translation can support rural and remote communities to optimize virtual health care
AUTHORS
#Emily E Giroux1 MSc, PhD Candidate * 
#Meaghan Hagerty2 MSc, PhD Student
Alanna Shwed3 MSc, PhD Candidate
Nicole Pal4 BSc
Ngoc Huynh5 RN, MN, Senior Lab Instructor III
Tannis Andersen6 RN, MN, GNC(c), Clinical Nurse Primary Specialist, & Adjunct Professor at the University of British Columbia Okanagan
Davina Banner7 RN, PhD, Associate Professor
#Contributed equally
AFFILIATIONS
1, 3 School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia Okanagan, 1238 Discovery Avenue, Kelowna, British Columbia V1V 1V9, Canada
2 School of Nursing, Faculty of Health and Social Development, University of British Columbia Okanagan, 1147 Research Road, Kelowna, British Columbia V1V 1V7, Canada
4 Faculty of Science, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, Netherlands; and School of Public Health and Social Policy, Faculty of Science, University of Victoria, 3800 Finnetry Road, Victoria, British Columbia V8P 5C2, Canada
5 School of Nursing, Faculty of Health and Human Sciences, University of Northern British Columbia, 3333 University Way, Prince George, British Columbia V2N 4Z9, Canada; and School of Nursing, Faculty of Applied Science, University of British Columbia Vancouver, 170-6371 Crescent Road, Vancouver, British Columbia V6T 1Z2, Canada
6 Interior Health, 505 Doyle Avenue, Kelowna, British Columbia V1Y 0C5, Canada
7 School of Nursing, Faculty of Health and Human Sciences, University of Northern British Columbia, 3333 University Way, Prince George, British Columbia V2N 4Z9, Canada
ACCEPTED: 1 March 2022
Now published, see the full article 
Early Abstract:
Context: People living in rural and remote British Columbia (BC) experience complex barriers to care, resulting in poorer health outcomes compared to their urban counterparts. Virtual healthcare (VH) can act as a tool to address some of the care barriers, including reducing travel time, cost, and disruptions to people’s lives. Conversely, VH can exacerbate inequities through unique difficulties in rural implementation, such as a lack of access to necessary infrastructure (i.e., internet), social supports, and technological capacity (i.e., devices and literacy).
Issue: The impacts of the COVID-19 pandemic induced a rapid shift to VH, providing new opportunities for healthcare while simultaneously highlighting and exacerbating inequities for people living in rural and remote settings. Equity-informed knowledge translation processes can help address these concerns. This commentary reports on an equity-informed knowledge translation process engaged by a diverse group of health researchers, community members, and practitioners in BC.
Lessons Learned: Informed by equity principles from the Canadian Coalition for Global Health Research, this knowledge exchange and translation process led to the co-creation of two practical tools: a set of VH appointment tip sheets and an open access report. Through stakeholder engagement and literature consultation, VH appointments were found to have many benefits for those in rural and remote communities, including expanding access to basic and specialized health services. However, some hesitation was noted when relying solely on these modes of care, as they can lack relationality, clarity, and time to process medical information. The tip sheets resulting from this process are an interactional level tool developed to address this concern and optimize VH appointments, for rural patients and care providers. They offer the respective stakeholder group insights on how to actively prepare for and participate in inclusive virtual care. On a systems level, there is a continually echoed need for equity-based processes to ensure that VH is striking the balance of meeting rural health needs without exacerbating inequities. Additionally, incorporating the voices of rural and remote community members is essential. To help address this gap, an open access report was compiled to serve as a small-scale example of integrating rural voices with existing literature to recommend systems level adjustments. Overall, VH holds promise as an effective tool for addressing inequities experienced by those living in rural areas. To maximize this potential, rural and remote stakeholders must be proactively engaged and listened to throughout the processes of considering, planning, and implementing shifts in the utilization of virtual healthcare options.