ORCID ID
Graduation Date
Spring 5-9-2026
Document Type
Dissertation
Degree Name
Doctor of Philosophy (PhD)
Programs
Biomedical Informatics
First Advisor
Martina Clarke
Second Advisor
Ellen Kerns
Third Advisor
Keyonna King
Fourth Advisor
Russell McCulloh
Abstract
Rural populations in the United States continue to experience persistent disparities in healthcare access, preventive care utilization, and health outcomes. Rurality is commonly operationalized using geographic classification systems such as Rural–Urban Commuting Area (RUCA) codes; however, these measures may not fully capture how individuals perceive, experience, and navigate rural life. This dissertation examines rurality as a multidimensional construct by integrating geographic classification, self-reported rural identity, and lived experience, and applies these insights into a digital tool study.
Using a mixed-methods approach, this work includes three complementary studies. The first study quantitatively assessed agreement between RUCA classification and self-reported rural identity among caregivers of children in Nebraska using survey data collected through electronic health record patient portal messages. Reliability and dimensionality of a rural identity scale were evaluated, and agreement between measures was examined. The second study qualitatively explored how caregivers who self-identify as rural conceptualize rurality and how this identity shapes perceptions of access, their community, and rural living through interviews and focus groups. The third study gathered these insights to the evaluation of a user-centered mobile health (mHealth) application for vaccine communication, comparing its usability to an existing web-based resource.
Findings demonstrated moderate agreement between RUCA and self-reported rurality, with stronger alignment found in community-focused dimensions of rural identity. Qualitative results highlighted rurality as both place-based and identity-based. Evaluation of the mHealth application suggested that tailored, user-centered digital tools may better meet the informational needs of caregivers than existing resources.
Collectively, this dissertation contributes conceptually by reframing rurality as a social and cultural construct in addition to a geographic classification, and methodologically by demonstrating the value of incorporating self-reported rural identity into research design. These findings underscore the importance of multidimensional definitions of rurality to enhance the validity, relevance, and equity of rural health research and intervention development targeted for rural individuals.
Rights
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Recommended Citation
Reisher, Elizabeth, "Reconceptualizing Rurality in Health Research: Implications for Intervention Design" (2026). Theses & Dissertations. 1049.
https://digitalcommons.unmc.edu/etd/1049