At HIV.gov, we know that many of our partners work in areas where reaching and engaging rural Americans is an essential part of their HIV communications. We asked the Federal Office of Rural Health Policy (FORHP, part of the Health Resources and Services Administration - HRSA) about this work:

The challenge in serving individuals with HIV/AIDS that live in rural areas is that, in general, rural Americans are less likely to be insured than their urban counterparts, they travel greater distances to receive regular care and are less likely to be tested for HIV due to limited access and the associated stigma. These circumstances also leave rural people with poorer access to prevention information, services and treatment. Digital media campaigns can have a significant impact on health attitudes and perceptions. For individuals living in rural areas, digital media offers connections and information that might otherwise be unavailable to them. - Nisha Patel, Associate Director/Senior Advisor, HRSA/Federal Office of Rural Health Policy (FORHP)

HRSA funds the Rural Health Information Hub Exit Disclaimer(RHIhub) to serve as a national clearinghouse. We reached out to Kristine Sande, RHIhub Program Director, for insights on how digital and social media can help with reaching rural residents.

HIV.gov: What are the unique communication challenges when reaching rural Americans?

Kristine: When talking about rural populations, you’ll often hear them referred to as “older, sicker, and poorer.” Each of those factors adds challenges to the audience, as does low population density. Compounding these challenges, it’s harder to reach rural Americans through newer media channels. Consider:

Broadband - Broadband is not ubiquitous in rural areas. The FCC’s 2018 Broadband Deployment Report states that 68.6% of rural Americans have access to fixed and mobile broadband that meets FCC speed benchmarks, compared to 97.9% of urban residents. Even when broadband is available in rural areas, there may be only a single provider and service may be more cost-prohibitive.

Internet Use – According to the Pew Research CenterExit Disclaimer, 22% of rural Americans don’t use the internet, compared to 8% of urban and 10% of suburban residents.

Social Media Use – The Pew Research Center also reportsExit Disclaimer that rural Americans are less likely to use eight of the most common social media platforms. For instance, 58% of rural adults use Facebook, compared to 75% of urban and 67% of suburban residents.

Of course, even though there is still a bit of a digital divide between rural and urban residents, it’s important to realize that the majority of rural residents do use the internet and social media platforms. We just can’t rely on reaching them all through those means. In terms of content that we develop for this audience, we must ensure it will work even with a slower connection.

HIV.gov: Why is it important for people working in HIV or other public health communications to understand the demographics of rural America?

Kristine: Just as demographic and other social factors affect our health, they also affect how we communicate and seek out information.

I previously mentioned that rural populations are older, sicker, and poorer. Rural areas as a whole tend to be less diverse, but the racial/ethnic composition varies from place to place. (See our RHIhub chartExit Disclaimer comparing the racial composition of populations in metro and nonmetro counties).

One caution I would have for folks trying to reach rural populations is that you can’t just look at the averages, because that masks the variation that exists among rural communities. If you’re looking to reach residents of a particular rural region or community, you need to look at the specific demographics of that area. There are many rural areas that have high numbers of minorities and immigrants, or where the average age is much lower than the national average.

Looking at indicators like poverty levels and industries in a region can also tell us about the population, such as how likely people might be to have access to the technology necessary to communicate and use social media. We’ve heard from rural HIV programs that often their clients do not have continuous access to a working cell phone, typically due to financial constraints.

HIV.gov: What role does social media and digital tools play in outreach communications today?

Kristine: Social media, websites, and apps have all become important tools to reach rural residents. We can reach and target people easily and ensure that our information is constantly available and always up-to-date, as opposed to trying to reach people via mass communications or paper outreach materials. The ability for people to engage with organizations in real-time is also very powerful.

In rural areas, traditional local media outlets like newspapers and radio tend to be highly trusted.  So, given the lower rates of internet availability and use in rural areas, those local media outlets can still be a good option, too.

HIV.gov: What future social media or digital tools might help improve communication and engagement with rural Americans?

Kristine: We continue to see a real push to improve broadband access in rural America. Regardless of what social media tools are available, I think that is critical to increase organizations’ ability to engage with rural Americans and for rural Americans to actively and effectively seek out information that can impact their health.

While I don’t have a crystal ball in terms of what the future holds for social media and other digital tools, I think organizations have to make sure that there is flexibility in their communications plans to allow for the use of new tools. With any new platform, you should make sure that it’s been adopted by a sufficient slice of rural Americans before you invest resources in using it.

HIV.gov: Thanks, Kristine, for sharing your perspective.

Are you new to using digital tools to communicate about HIV, or want to refine your use? Book an appointment for our (free) Virtual Office Hours technical assistance.