Nurse-Led Telehealth for Improving Access to Primary Healthcare in Geographically Isolated Communities: A Mixed-Methods Study in Arunachal Pradesh, India

Abstract

ABSTRACT Background: Geographic isolation can make routine primary healthcare difficult to reach when travel time, terrain, weather, transport interruptions, and limited local clinical capacity interact. Arunachal Pradesh has a dispersed population and difficult terrain, making service-delivery models that reduce unnecessary travel particularly relevant. India’s national telemedicine platform has expanded remote outpatient and provider-to-provider care, while evidence from nurse-led models suggests potential gains in access, continuity, and patient experience [1–4].

Objective: To examine whether a nurse-led telehealth model could improve access to primary healthcare in geographically isolated communities in Arunachal Pradesh and to explain, through qualitative inquiry, how patients and nurses experienced the intervention.

Methods: A convergent mixed-methods quasi-experimental study was designed across four rural primary-care catchments. Adults requiring non emergency primary-care follow-up were enrolled into an intervention group receiving 12 weeks of nurse-led telephone/video triage, health education, medication and appointment support, remote clinician coordination, and referral navigation, while a comparison group received usual facility-based care. Quantitative outcomes included travel-related burden, time to first professional contact, completed follow-up, missed appointments, and patient reported access. Semi-structured interviews with patients and nurses explored acceptability, trust, digital barriers, continuity, and perceived changes in care-seeking.

Results: In an illustrative dataset of 160 participants, the telehealth group showed greater reduction in travel burden and faster first professional contact than the comparison group. Completed follow-up increased from 62.5% to 84.0% in the intervention group compared with 64.0% to 70.5% in usual care. Qualitative analysis identified convenience, continuity with a known nurse, referral clarification, and reduced travel as major enabling themes, while network instability, shared phones, privacy concerns, and limited digital literacy remained important barriers. Numerical results are simulated for manuscript-development purposes and are not evidence of clinical effectiveness.

Conclusion: Nurse-led telehealth may be a feasible access strategy when it is integrated with local primary-care services, escalation pathways, and low bandwidth communication options. Mixed-methods evaluation is useful because utilization metrics alone cannot explain why telehealth is accepted, avoided, or interrupted in geographically isolated communities.

KEYWORDS: Telehealth; telenursing; primary healthcare; rural health; geographic access; Arunachal Pradesh; mixed methods; nurse-led care; Northeast India.