There’s a Massive Urban-Rural Divide in Digital Healthcare — and It’s Growing

On Jan. 27, the Federal Communications Commission published a report and order expanding access to digital healthcare tools in rural America. The report acknowledged that digital and telehealth options have grown increasingly critical to providing healthcare to consumers in sparsely populated communities with limited brick-and-mortar facilities. Moreover, the importance of adopting digitally enabled healthcare programs has increased considerably since the COVID-19 outbreak.

Digital tools could hypothetically help rural consumers without brick-and-mortar options access digital health and wellness services. But that is not necessarily what is happening. Urban consumers are three times more likely than rural consumers to use health- and wellness-related sites, apps and platforms. Moreover, urban consumers’ use of those tools has grown 8.9% year over year. Rural consumers’ use has gone relatively unchanged. The result is an expanding divide in the extent rural and urban consumers use digital healthcare tools, a trend showing no sign of slowing.

Rural consumers’ low use of digital health and wellness tools is part of a much broader trend. Across the board, consumers in rural areas show a much stronger tendency to perform every type of activity in person than their urban counterparts.

The “ConnectedEconomy™ Monthly Report: The Urban-Rural Health Divide Edition” details the drivers behind the growing gap in digital healthcare participation among rural and urban consumers. We surveyed a census-balanced panel of 2,498 United States consumers to learn how they use digital healthcare tools in their daily lives.

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This is what we learned.

Overall average engagement in online activities reached a new high in April, up 7.7% year over year.

While overall engagement with digital activities is up, engagement with digital healthcare activities rose more than average. Consumers went online to connect with healthcare providers and participated in health- and wellness-related activities 8.9% more than one year ago. Healthcare engagement saw nearly double the 4.9% growth in digital banking engagement. It fell behind just home and work activities in terms of increased engagement. In other words, consumers’ use of digital tools to engage in health- and wellness-related activities is growing faster than their use in nearly all other activities.

There are significant differences in healthcare digital engagement across generations. Baby boomers and seniors and Generation X engagement grew the most year over year. These generations increased their digital engagement in healthcare activities by at least 10%. Millennials increased this usage by 5.4% and Generation Z consumers increased engagement by 3.3%. These differences are not exclusive to digital healthcare engagement. Overall engagement by baby boomers and seniors grew 8.6%, compared to millennials’ increase of 6.6%.

There is a significant urban-rural divide in digital healthcare — and that gap is growing.

Urban consumers were nearly three times more likely than rural consumers to engage in any health-related activity in April 2023. Moreover, the share of urban consumers engaging in healthcare activities has increased by 8.9% year over year. The share of rural consumers doing the same is largely unchanged. Most of the growth seen in consumers’ use of digital health- and wellness-related tools comes from consumers in densely populated areas and urban centers.

Urban consumers participated in every type of healthcare-related activity we track more than their rural counterparts — especially online mental health and pharmacy activities.

One of the most significant differences between how urban and rural consumers use digital healthcare tools is their use of mental health apps, websites and platforms. Urban consumers are four times more likely to use mental health apps, websites or teletherapy sessions. Other top areas with a significant gap are using online health data apps and pharmacies.

Moreover, rural consumers’ participation in digital healthcare activities is down in seven of the nine digital healthcare activities we track. The two types of digital activities used more now than one year ago are streaming healthcare-related videos and using healthcare providers’ apps and sites. Even then, these increases are minimal. Just 6.3% more rural consumers report streaming healthcare videos, and 5.7% more report using providers’ apps and websites than one year prior.

Rural consumers’ low use of digital healthcare tools reflects a broader trend of engaging chiefly in person rather than online.

The stark differences in how rural and urban consumers use digital healthcare tools exemplify a much broader trend. Rural consumers tend to use digital tools much less than their urban counterparts in every area of their lives. Just 26% of rural consumers say they work remotely from a location other than a physical office or workplace. This share compares to 72% of urban consumers. Similarly, just 20% of rural consumers report ordering groceries online, compared to 63% of urban consumers.

This urban-rural divide tends to be smaller when it comes to non-digital activities. Sixty-nine percent of rural consumers say they work in a physical office space. Eighty-four percent of urban consumers say the same. This difference is still notable, but not nearly as much as in remote and hybrid working. This data suggests that many urban consumers work in a hybrid office setting.

This gap is even smaller for in-person grocery shopping. Eighty-seven percent of rural consumers say they shop for groceries in a physical store, and 91% of urban consumers do the same. This difference, once again, suggests that urban consumers use a mix of in-person and online channels to shop for their groceries. In contrast, rural consumers are far more likely to shop for groceries exclusively in person.

The urban-rural divide is more significant for physical healthcare-related activities than for many other in-person activities, but is still smaller for digital healthcare activities.

On average, rural consumers are 1.6 times as likely to perform any given activity in person as they are to perform that same activity online. Urban consumers, by contrast, are just 1.2 times as likely to perform any given activity in person as they do online.

Rural and urban consumers’ health- and wellness-related activity patterns match the average. Rural consumers are 1.6 times as likely to perform healthcare activities in person as they are to perform them online, while urban consumers are 1.2 times as likely to engage in them in person.

The most significant difference is in grocery shopping habits. Rural consumers are 3.4 times as likely to shop for groceries in person as they are to shop for groceries online, while urban consumers are just 1.6 times as likely to purchase groceries in person as they are to do so online.


The “ConnectedEconomy™ Monthly Report: The Urban-Rural Health Divide Edition” is based on a survey of a census-balanced panel of 2,498 U.S. consum­ers conducted between April 10 and April 11 as a follow-up to a continuing series of studies examining consumers’ shift to a more digital way of engaging in everyday activities. The sample was balanced to match the U.S. adult popula­tion in key variables: Respondents were 48 years old, on average, and 51% were female. Thirty-two percent of respondents held college degrees. We also collected data from consumers in different income brackets: 38% of respondents declared annual incomes of more than $100,000, 30% earned between $50,000 and $100,000 and 32% earned less than $50,000.

ConnectedEconomy™ Monthly Report: The Urban-Rural Health Divide Edition,” is the most recent installment of PYMNTS’ Connected Economy™ series. For more, read the previous edition, “ConnectedEconomy™ Monthly Report: The Love and Social Media Edition.”