# Community Perceptions of Integrating Community Health Workers and Telehealth Services for Chronic Disease Management in a Rural Island Community: A Qualitative Study

## TL;DR

This study explores how a rural island community perceives combining community health workers and telehealth to manage chronic diseases like diabetes and hypertension.

## Contribution

The study introduces an integrated model of community health workers and telehealth as a practical application of community-oriented primary care in isolated island settings.

## Key findings

- Community health workers are trusted and valued for their role in improving healthcare access through support and guidance.
- Telehealth services are seen as beneficial for reducing transportation barriers but face challenges like technology access and data privacy concerns.
- The integration of community health workers and telehealth is viewed as a promising solution for chronic disease management in isolated areas.

## Abstract

Rural and isolated communities, such as Culebra, Puerto Rico, face significant health care challenges due to geographic isolation, limited medical resources, and socioeconomic disadvantages. Chronic diseases, particularly diabetes and hypertension, are highly prevalent and contribute to poor health outcomes. Telehealth services (THS) and community health workers (CHWs) have been identified as effective interventions for improving health care access in underserved areas. This study is grounded in the principles of community-oriented primary care, which emphasizes the integration of primary care and public health for a defined community, and positions the combination of CHWs and THS as a practical application of this model in an isolated island setting.

This study aimed to explore community perceptions and attitudes toward integrating THS with the support of CHWs to improve chronic disease management in Culebra, Puerto Rico.

A qualitative study using semistructured individual interviews was conducted with 20 patients from Culebra’s Federally Qualified Health Center. Interviews were guided by the socioecological model to assess community perspectives at the individual, interpersonal, community, and societal levels. Thematic analysis was conducted using Dedoose by the principal investigator and a research assistant, with coding discrepancies resolved through negotiated agreement. Translation and back-translation of themes followed the Brislin method. The study adhered to the COREQ (Consolidated Criteria for Reporting Qualitative Research) guidelines.

Thematic analysis revealed three primary themes: (1) the pervasive impact of social determinants of health on daily life and health care access, (2) the valued and trusted role of CHWs in the community, and (3) the dual potential and challenges of THS. CHWs were recognized as critical for improving health care access through appointment assistance, medication management, and emotional support. THS was viewed positively for its potential to reduce transportation barriers and improve continuity of care, although concerns regarding technology access, convenience, and data privacy were also raised. The integration of CHWs and THS was broadly viewed as a promising and trustworthy solution to chronic disease management challenges.

This study highlights the potential of an integrated CHW-assisted THS model as a practical application of community-oriented primary care principles in isolated island communities. The combination of CHWs and THS shows promise for reducing health care disparities and improving chronic disease management. Future research should focus on implementing and evaluating this model through participatory approaches, assessing clinical outcomes and cost-effectiveness, while policy efforts should prioritize THS infrastructure investment and standardized CHW training curriculum.