A new study published in BMC Health Services Research offers one of the clearest pictures yet of what drives rural women of reproductive age to embrace or reject digital maternal care. Researchers Deborah Anjolajesu Elegbeleye and Motunrayo Florence Olanrewaju, both of the Department of Public Health at Babcock University in Ogun State, surveyed 336 women aged 15 to 49 who were attending nine rural primary health centres spread across three Local Government Areas in the Ibadan zone of Oyo State: Ido, Oluyole, and Ona Ara. Using multistage probability sampling, a technique that randomly selects clusters at successive levels to produce a representative sample, the team captured a snapshot of women who rely on exactly the kind of under-resourced facilities that telehealth is supposed to strengthen.

The instrument at the heart of the study was the Rural Telehealth Adoption Assessment Questionnaire, or R-TAAQ, a validated bilingual tool designed specifically for rural populations. Its architecture draws on three of the most influential frameworks in health behaviour and technology research: the Technology Acceptance Model, which emphasises perceived usefulness and ease of use; the Health Belief Model, which focuses on how people weigh susceptibility, severity, and benefit; and the Unified Theory of Acceptance and Use of Technology, which incorporates social influence and facilitating conditions. By grounding the questionnaire in these models, the researchers could measure not just whether women knew about telehealth, but whether they believed it would help them and whether they intended to use it.

The headline finding is genuinely encouraging. Nearly two-thirds of the women, 62.8 percent, demonstrated high knowledge of telehealth, scoring an average of 5.80 out of a possible 8 points on the knowledge scale. Even more striking, 82.4 percent held positive perceptions of its benefits, with a mean benefit score of 25.6 out of 30. And willingness to adopt was high across the board: 83.9 percent of respondents said they were willing to embrace telehealth for their maternal and reproductive health needs, averaging 11.1 out of 15 on the willingness scale. The response rate of 93.6 percent suggests these figures reflect genuine engagement rather than the skewed views of a small, self-selected minority.

But the statistical core of the study lies in what predicted that willingness, and here the results take an unexpected turn. Using chi-square tests, Pearson correlations, and binary logistic regression, the researchers tested whether knowledge, perceived benefits, facilitating conditions such as infrastructure and support, and a full range of socio-demographic characteristics shaped adoption intention. Perceived benefits emerged as the only variable significantly associated with willingness to adopt, with a chi-square statistic of 46.774 and a p-value below 0.001. Knowledge of telehealth, by contrast, showed no significant association at all, with a p-value of 0.428, and facilitating conditions produced a correlation coefficient of just 0.037, statistically indistinguishable from zero.

The logistic regression sharpened the picture further. Women who perceived strong benefits from telehealth were more than eleven times as likely to be willing to adopt it, with an adjusted odds ratio of 11.274 and a 95 percent confidence interval running from 5.427 to 23.422. The model explained a meaningful share of the outcome, with a Nagelkerke R-squared of 0.254, and correctly classified 84.5 percent of cases. In plain terms, believing that telehealth would genuinely improve one’s care was the dominant force behind the decision to embrace it. Neither age, education, income, nor any other demographic factor reached significance, with the single exception of parity: women with three or four children were dramatically less willing to adopt, with an adjusted odds ratio of 0.073 and a p-value of 0.027.

That parity finding deserves careful attention. Women who have already borne several children may feel they have managed pregnancy and childbirth successfully without digital tools, or they may face time constraints and caregiving burdens that make new technologies feel like one demand too many. Whatever the mechanism, the result signals that telehealth programmes cannot treat rural women as a uniform bloc. Mothers of larger families may need tailored outreach, different service designs, or different channels of communication altogether if they are not to be left behind by a digital transition that benefits their neighbours.

The deeper lesson, however, is the one about benefits versus knowledge. For years, digital health advocates in low- and middle-income countries have assumed that the path to adoption runs through education: teach people what telehealth is, and uptake will follow. This study suggests that assumption is backwards, at least for this population. Women in these rural Ibadan communities already knew a great deal about telehealth, and that knowledge did not move the needle on their intentions. What moved the needle, overwhelmingly, was whether they believed the technology would deliver real, tangible improvements to their maternal care. The practical implication is that benefit-focused communication, messages that demonstrate concretely how a virtual consultation saves a dangerous journey or connects a pregnant woman to a skilled provider, will do far more work than awareness campaigns alone.

The authors are careful to note that willingness is not the same as sustained use. Intention is a necessary starting point, but structural barriers, unreliable electricity, patchy mobile networks, the cost of data, and the availability of devices, can still derail adoption after the initial enthusiasm. The study’s finding that facilitating conditions did not predict willingness does not mean infrastructure is irrelevant; it means that infrastructure alone will not create demand. The researchers conclude that telehealth promotion in rural primary health care settings should prioritise benefit-focused messaging while simultaneously addressing those structural obstacles to enable sustained engagement, a two-track strategy that treats perception and provision as equally essential.

For a country where rural women bear a disproportionate share of nearly one-third of the world’s maternal deaths, the stakes of getting this right could hardly be higher. What this study offers is a demand-side evidence base that has been missing from the conversation: rural Nigerian women are not waiting to be convinced that telehealth exists, and they are not blocked by ignorance or indifference. They are, by and large, ready. What they need is to be shown, convincingly and repeatedly, that the technology will make a real difference to their health and the health of their babies, and to be given the infrastructure that lets that promise hold. The digital bridge to safer motherhood, it turns out, is built first in the mind.

Subject of Research: Telehealth adoption readiness among rural women of reproductive age in Nigeria

Article Title: Knowledge, perceived benefits and willingness to adopt telehealth among women of reproductive age attending selected rural primary health care centres in Ibadan, Oyo State, Nigeria

Article References: Elegbeleye, D. A., & Olanrewaju, M. F. (2026). Knowledge, perceived benefits and willingness to adopt telehealth among women of reproductive age attending selected rural primary health care centres in Ibadan, Oyo State, Nigeria. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15815-1

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15815-1

Keywords: telehealth, maternal health, Nigeria, rural health, primary health care, technology acceptance, perceived benefits, women's health, health services research, digital health, reproductive health, Oyo State

The study was carried out by a team of researchers from Shahjalal University of Science and Technology in Sylhet, led by Amit Bhowmick, with contributions from Md Mohi Uddin Rajib, Md. Habibur Rahman and Shimul Roy. Using a mixed-methods research design, the team combined a quantitative survey of 384 respondents, selected through simple random sampling, with qualitative face-to-face interviews involving 16 service recipients and 10 service providers. This dual approach allowed the researchers to measure not only the statistical patterns of awareness and usage but also the lived experiences and frustrations of people working within and relying upon the Upazila Health Complexes, the secondary-level facilities that form the backbone of rural healthcare delivery in Bangladesh.

The headline numbers tell a story of paradox. On the one hand, connectivity is no longer the obstacle it once was: 81 percent of respondents reported having internet access at home, a figure that reflects the extraordinary expansion of mobile broadband across South Asia over the past decade. On the other hand, 68 percent of respondents had never used an e-health service of any kind. Awareness of what e-health services even exist scored lowest of all measured dimensions, with a mean score of just 2.53, while readiness to use such services, at 4.10, and perceived benefits, at 4.25, were both rated highly. Perceived barriers also scored high, at 4.21, suggesting that people recognize both the promise of digital health and the substantial obstacles standing in its way.

This combination of low awareness and high readiness is perhaps the most consequential finding of the entire study. It indicates that the problem is not a lack of demand or an unwillingness among rural Bangladeshis to embrace digital medicine. People are, in principle, ready and willing to consult doctors remotely, access electronic records, and call health hotlines. What they lack is basic knowledge that these services exist and practical pathways to use them. The gap, in other words, is not attitudinal but infrastructural and informational, a distinction with major implications for how policymakers should respond.

The qualitative interviews painted a bleaker picture of conditions inside the health complexes themselves. Participants consistently reported that Upazila Health Complexes are inadequately equipped to meet the healthcare needs of the rural populations they serve. Although initiatives such as online record-keeping and e-health hotlines do exist on paper, their actual utilization remains limited. Respondents described shortages of information and communication technology equipment, an absence of skilled personnel to operate and maintain digital systems, insufficient training for existing staff, and poor physical infrastructure, including unreliable electricity and connectivity at the facility level. These are not exotic technical problems; they are the mundane, grinding deficits that determine whether a national digital health strategy functions or fails.

Weak integration with the existing health system emerged as another critical barrier. E-health services in Bangladesh have often been introduced as standalone projects, bolted onto health facilities without being woven into referral pathways, patient records, or routine clinical workflows. The study found that this fragmentation undermines both effectiveness and sustainability, because a telemedicine consultation that cannot feed its results into a patient’s medical record, or a hotline that cannot escalate a case to a physical clinic, delivers only a fraction of its potential value. The researchers emphasize that digital tools amplify the performance of a health system rather than substituting for it, so gaps in the underlying system are magnified rather than erased by digitization.

From a technical and methodological standpoint, the study is careful about the limits of its own conclusions. The authors frame their results as preliminary, context-specific observations intended to inform hypothesis generation for future intervention research, rather than as definitive evidence of causal effects. They explicitly recommend that policy recommendations emerging from the findings should be tested through experimental designs before implementation. This caution is warranted in a research area where enthusiasm frequently outpaces evidence, and where well-intentioned digital health programs in low- and middle-income countries have repeatedly failed to survive beyond their pilot phases. The study’s mixed-methods design, however, gives it particular strength: the survey quantifies the scale of the awareness and usage gap, while the interviews explain the mechanisms behind it, from broken equipment to undertrained staff to patients who simply do not know the services exist.

The implications for Bangladesh’s health policy are significant. The country has invested in digital health ambitions for years, and the government has positioned information technology as a pillar of national development. Yet this study suggests that investments concentrated on smartphones and connectivity in people’s hands have not been matched by investments in the facilities where formal e-health services are supposed to be delivered. Addressing the mismatch will require, at minimum, procurement of reliable ICT equipment at Upazila Health Complexes, sustained training programs that build digital skills among health workers, infrastructure upgrades to guarantee power and connectivity, and public awareness campaigns that translate high readiness into actual utilization. Above all, the researchers argue, Bangladesh needs a clear and coherent policy framework that defines how e-health integrates with the broader health system, rather than a patchwork of disconnected initiatives.

For the international global-health community, the findings offer a sobering case study with relevance far beyond Bangladesh. Rural health systems across South Asia, Sub-Saharan Africa and beyond face strikingly similar configurations: rising consumer connectivity, under-resourced public facilities, enthusiastic national digital strategies, and weak last-mile implementation. The Bangladesh study suggests that the binding constraint on e-health effectiveness in such settings is rarely the technology itself. It is the institutional capacity, human resources and system integration that determine whether digital tools reach the patients who need them. Until those foundations are strengthened, the researchers conclude, e-health initiatives will continue to demonstrate significant potential on paper while delivering limited impact in the communities they are designed to serve. The next step, they argue, is rigorous experimental research to identify which interventions, deployed under which conditions, can finally close the gap between digital health’s promise and its performance in rural Bangladesh.

Subject of Research: Effectiveness of e-health services at the Upazila Health Complex level in rural Bangladesh

Article Title: Effectiveness of E health services at Upazila health complex level in Bangladesh

Article References: Bhowmick, A., Rajib, M. M. U., Rahman, M. H., & Roy, S. (2026). Effectiveness of E health services at Upazila health complex level in Bangladesh. Discover Social Science and Health. https://doi.org/10.1007/s44155-026-00461-z

Image Credits: AI Generated

DOI: 10.1007/s44155-026-00461-z

Keywords: e-health, Bangladesh, Upazila health complex, digital health, rural healthcare, health information technology, awareness, readiness, perceived benefits, barriers, telemedicine, health policy