M. Sc. Juliane Freyboth

Innovative Approaches to General Medical Care in Rural Areas of Germany – An Analysis of Factors Influencing Acceptance and Motivation

Securing general medical care presents increasing challenges in sparsely populated and shrinking areas. An aging rural population and ongoing migration to cities lead to new demand structures in this sector. Additionally, many practicing general practitioners (GPs) are of advanced age, and younger doctors increasingly find settling in rural areas unattractive. As a result, a large proportion of vacant medical positions in rural regions are difficult to fill, causing an allocation problem in healthcare provision that disadvantages these areas. This decline in the number of healthcare facilities per capita and per area results in long travel distances for patients seeking primary care.

To address these challenges and ensure continued access to general medical care in peripheral rural areas, more innovative healthcare concepts are being developed and tested. A key factor for the success of these innovative approaches is the acceptance by the local population. However, the factors influencing acceptance in rural areas from the perspective of the population have been little studied in the literature so far. Furthermore, in planning and implementing innovative healthcare concepts, the acceptance of users has rarely been considered. There is also a lack of focus on rural areas specifically. Another research gap is the comparative analysis of acceptance of different innovative healthcare concepts in general practice.

Objective of the Research Project

This doctoral project aims to fill this research gap by examining the acceptance of innovative healthcare concepts in general practice from the perspective of potential patients in rural areas. The theoretical framework used to operationalize acceptance is the Unified Theory of Acceptance and Use of Technology (UTAUT), adapted for the selected healthcare concepts. The research questions address both substantive issues and the methodological applicability of the theory.

The overarching questions to be answered in this acceptance analysis from the perspective of patients in rural Germany are:

• Which innovation-specific, socio-economic, and spatial factors influence the acceptance of innovative healthcare concepts in general practice?
• Can preferences for specific innovative healthcare concepts be identified, and what implications do these have for the future design and implementation of such concepts?
• Is the UTAUT framework suitable for comparative acceptance analysis of different innovative healthcare approaches in general practice?

Innovative Approaches to General Medical Care

There are many different approaches to improving primary healthcare in rural areas. Due to the scope, this research project focuses on three specific solutions:

1. Video Consultation

• Treatment by experienced doctors online via video consultations
• Contact with doctors from anywhere (at home, on the go, on vacation)
• Appointments available at short notice
• Advice, sick leave certificates, and prescriptions can be issued; physical examinations via video are only limited

2. Community Nurses

• Treatment by medical assistants who have completed additional training as community nurses
• Home visits within the patient's home
• Appointments for home visits are scheduled through the general practitioner’s practice
• Complaints and vital parameters (e.g., blood pressure, heart rate) are recorded by the community nurse and transmitted to the general practice
• If needed, a doctor can be digitally connected via video call during the home visit for further consultation, sick leave, or prescription issuance

3. Medibus

• Treatment by doctors in direct patient contact
• In a bus that has been converted into a fully equipped medical practice
• The bus comes to your village
• The Medibus visits various villages according to a fixed schedule and is available in your village for several hours on multiple days each week
• No prior appointment is necessary
• All services offered in a traditional general practice are available (e.g., blood pressure measurement, EKG, ultrasound, etc.)

Methodology
Answering the research questions is carried out within a sequential mixed methods approach. The research design is illustrated in Figure 1.
First, a systematic literature review is conducted to derive initial acceptance factors of the selected innovative care concepts from the literature. To obtain comprehensive information about the selected concepts, they are then explored in a preliminary study. This involves analyzing case studies regarding their substantive and conceptual features as well as their acceptance among user groups.

The comparative acceptance analysis of the selected innovative care concepts takes place during the main study through a quantitative survey of the general population. Finally, the research results are validated through qualitative expert interviews.

The doctoral project is carried out within the framework of the ESF Plus – Doctoral Scholarship.