The Existing Health Disparities Between Rural and Non-Rural Populations

Dealing with type 2 diabetes (T2D) is challenging on its own, but individuals with T2D living in rural areas have an even bigger challenge on their hands. There are more individuals with type 2 diabetes in rural areas than in non-rural areas1, and research shows this is due to limited resources to help effectively manage their condition, including access to healthcare facilities and diabetes specialists, as well as lack of health insurance.2,3  

Jasmine Moore, the Manager of Medical Affairs and Research at Pack Health, a Quest Diagnostics Company, understands the current frustrations that individuals with type 2 diabetes may be experiencing while living in rural communities, starting with their access to healthcare.

“Access to care is a major problem among rural communities,” Moore discussed. “In addition to lack of readily available doctors and hospitals, many health institutions are not able to sustain health education and support programs that meet the wide and disparate needs of their communities.” 

Access to care and support resources widens the gap in diabetes-related health outcomes, such as controlled blood pressure and cholesterol, between individuals living in rural and non-rural areas over the past two decades.4 

With many factors beyond their control, individuals with T2D in rural areas still face many individualized issues that prevent them from effectively managing their care needs, from their work environment to lack of opportunities for physical activity.5  

Because of these circumstances, those within rural populations are in desperate need of interventions where individual care needs can be addressed from the convenience of their own home.6 Research points to digital health coaching as the most promising diabetes care support option to provide individuals with self-management skills.7,8   

 Moore commented further on how valuable digital health coaching can be as an intervention for rural populations as it has been for non-rural ones, “Digital health coaching helps individuals take the first step towards bettering their health,” she emphasized. “Health coaches meet members where they are and give them the tools to learn about and incorporate healthy behaviors at a pace and in a way that works for them.” 

The Pack Health Study

In a recent study, Pack Health researchers tested whether a digital health coaching (DHC) program could be effective for members with T2D living in rural areas within a six-month period. To understand the feasibility of digital health coaching as an intervention, the health behaviors and diabetes-related outcome measures of members within this population were compared to those of members living in non-rural areas. Participant data was collected at baseline, month 3, and month 6.  Outcome measures, such as health self-efficacy, diabetes distress, and HbA1c, were also assessed. 

Participants were provided access to a personalized health coaching program tailored for individuals with type 2 diabetes with a Health Advisor from Pack Health. The participants and their Health Advisors communicated weekly via email, text, or phone and discussed topics relevant to their condition, including goal setting and medication management.  

The Podium Presentation

Results from this study were recently presented as a podium presentation, “The Impact of a Digital Health Coaching Program on a Rural Population, during the 83rd American Diabetes Association (ADA) Scientific Sessions in San Diego, CA on June 23, 2023 

By month 6: 

  • Members decreased their diabetes distress by 22%.9 
  • Members improved their HbA1c by 13%.9  
  • 12% more members increased their health self-efficacy.9  
  • Members increased their weekly exercise minutes by 34%.9  

By month 6, members improved their HbA1c by 13%

Intervention results showed that the digital health coaching intervention was equally effective for individuals with T2D living in rural areas just as those living in non-rural areas. “This work highlights that digital health coaching provides an accessible path to patient support and can improve diabetes related clinical outcomes, even for those in resource-averse areas,” Moore, who presented the research at ADA, explained.  

With these promising results, we are hopeful that if individuals in rural areas are given additional support to manage their needs and ease barriers to care, they will improve their health outcomes as much as those in non-rural communities.  

Please visit here to learn more about our research at Pack Health.  

Copyright © 2023 Pack Health, A Quest Diagnostics Company. All rights reserved. 
  1. Kurani SS, Lampman MA, Funni SA, et al. Association Between Area-Level Socioeconomic Deprivation and Diabetes Care Quality in US Primary Care Practices. JAMA Netw Open. 2021;4(12):e2138438. doi:10.1001/jamanetworkopen.2021.38438 –  
  2. Why Diabetes is a Concern for Rural Communities. Rural Health Information Hub. Accessed June 20, 2023.  
  3. Massey CN, Appel SJ, Buchanan KL, Cherrington AL. Improving Diabetes Care in Rural Communities: An Overview of Current Initiatives and a Call for Renewed Efforts. Clin Diabetes 1 January 2010; 28 (1): 20–27.
  4. Mercado CI, McKeever Bullard K, Gregg EW, Ali MK, Saydah SH, Imperatore G. Differences in U.S. Rural-Urban Trends in Diabetes ABCS, 1999-2018. Diabetes Care. 2021;44(8):1766-1773. doi:10.2337/dc20-0097 –  
  5. Dugani SB, Mielke MM, Vella A. Burden and management of type 2 diabetes in rural United States. Diabetes Metab Res Rev. 2021;37(5):e3410. doi:10.1002/dmrr.3410 – link:  
  6. Rutledge SA, Masalovich S, Blacher RJ, Saunders MM. Diabetes Self-Management Education Programs in Nonmetropolitan Counties — United States, 2016. MMWR Surveill Summ 2017;66(No. SS-10):1–6. DOI:
  7. Li S, Yin Z, Lesser J, et al. Community Health Worker-Led mHealth-Enabled Diabetes Self-management Education and Support Intervention in Rural Latino Adults: Single-Arm Feasibility Trial. JMIR Diabetes. 2022;7(2):e37534. Published 2022 May 30. doi:10.2196/37534 
  8. Moschonis G, Siopis G, Jung J, et al. Effectiveness, reach, uptake, and feasibility of digital health interventions for adults with type 2 diabetes: a systematic review and meta-analysis of randomised controlled trials. Lancet Digit Health. 2023;5(3):e125-e143. doi:10.1016/S2589-7500(22)00233-3
  9. Pack Health internal data.