Understanding Access to Primary Healthcare in Rural Communities: A Multilevel Model Approach

Imagine living 300 km from the nearest hospital. When a sudden health emergency arises, your only option is an expensive and time-consuming trip to the city—if weather conditions allow. This is the reality for many rural Albertans, where healthcare access is not a guarantee but a challenge. Can a multilevel approach bridge this gap?

Access to primary healthcare (PHC) is a crucial determinant of health outcomes, yet rural communities often face significant barriers in obtaining essential services. Geographic isolation, provider shortages, financial constraints, and systemic healthcare inefficiencies all contribute to these challenges (Gizaw et al., 2022). The Multilevel Model of Health provides a comprehensive framework for analyzing these barriers and developing targeted interventions to improve healthcare access.

This blog post applies the Multilevel Model of Health to Alberta’s rural healthcare system, examining barriers at multiple levels and comparing Alberta to other provinces to highlight key differences in healthcare accessibility.

Understanding the Multilevel Model of Health

This model acknowledges that healthcare access and outcomes are shaped by interactions across different levels (Beheshti et al., 2019):

• Individual Level – Personal health behaviors, socioeconomic status, health literacy, and transportation access.

• Community Level – Availability of local healthcare services, social determinants of health, and cultural attitudes toward medical care.

• Healthcare System Level – Accessibility of medical professionals, service delivery models, and integration of health technology.

• Policy Level – Government regulations, healthcare funding, and systemic interventions aimed at reducing disparities.

By applying this framework, researchers and policymakers can develop targeted strategies to reduce healthcare inequities in rural settings.

Barriers to Accessing Primary Healthcare in Rural Communities

According to Gizaw et al. (2022), rural populations experience various primary barriers to PHC access, which align with the multilevel framework:

• Individual-Level Barriers: Low health literacy, economic instability, and limited access to transportation prevent rural residents from seeking care.

• Community-Level Barriers: Many rural communities lack adequate healthcare infrastructure, including hospitals and primary care clinics.

• Healthcare System Barriers: Insufficient government funding, outdated medical technology, and workforce shortages contribute to disparities in healthcare delivery (Beheshti et al., 2019; Legere et al., 2024).

• Policy-Level Barriers: Limited investments in rural healthcare programs and inequitable public health funding exacerbate the issue, making it difficult for rural residents to receive timely medical attention (Government of Alberta, 2024; Legere et al., 2024).

How Alberta Compares to Ontario and New Brunswick (Syed & Dekleva, 2025)

Healthcare access varies across Canada, with some provinces facing more significant rural challenges than others. Utilizing Faiza and Candice’s comparison in their blog post, I examined how Alberta’s rural healthcare landscape compares to Ontario and New Brunswick. Like Ontario, Alberta has a mix of urban and rural regions, with major cities like Calgary and Edmonton providing access to specialized healthcare services, public transportation, and community programs. However, Alberta’s rural communities, particularly in the northern and remote areas, face similar challenges to New Brunswick, including physician shortages and limited healthcare infrastructure.

From a multilevel model perspective, Alberta and New Brunswick face similar healthcare system and policy-level barriers, such as physician retention issues and gaps in healthcare funding for rural areas. Meanwhile, Alberta benefits from policy-level advantages similar to Ontario, receiving federal funding for healthcare infrastructure and digital health initiatives. However, like New Brunswick, Alberta has struggled with implementing sustainable long-term solutions for rural healthcare accessibility. The Modernizing Alberta’s Primary Health Care System (MAPS) is an effort to improve both healthcare system and policy-level barriers through restructuring and funding initiatives. The table below highlights key differences in healthcare challenges across Alberta, Ontario, and New Brunswick, emphasizing disparities at the healthcare system and policy levels.

Physician Shortages (Higher is worse – Alberta and NB struggle more than Ontario) Telehealth Access (Higher is better - Ontario has the best access, while NB lags behind) Government Funding (Higher is better – Ontario receives the most funding, while NB has the least)

Strategies to Improve Rural Primary Healthcare Access

1. Community-Based Healthcare Programs

Community-driven healthcare initiatives are essential in expanding PHC services. Mobile clinics deliver outreach services to underserved populations, while school-based healthcare programs ensure primary care access for children and families (Gizaw et al., 2022). Additionally, student-led healthcare initiatives contribute to expanding service availability in rural communities.

In Alberta, initiatives such as the Strengthening Primary Care Program and Primary Health Care Grants support rural healthcare infrastructure (Government of Alberta, 2024).

2. Telehealth as a Game-Changer

Telehealth has emerged as a powerful tool for overcoming geographic barriers to healthcare, particularly in rural and northern communities (Legere et al., 2024; Jong et al., 2018). In remote regions, where medical travel expenses are significant, telehealth provides cost-effective alternatives to in-person care.

Telehealth benefits include:

• Remote consultations, reducing the need for long-distance travel.

• Timely access to specialists, improving treatment outcomes.

• Emergency triaging, reducing unnecessary medical evacuations.

eConsults further enhance rural healthcare by connecting primary care providers (PCPs) with specialists, reducing long wait times and unnecessary referrals (Liddy et al., 2018). In 2024, Alethea Medical, an Alberta-based eConsult platform, facilitated 21,841 eConsults, improving access to specialist care and reducing unnecessary referrals (Alethea Medical, 2025).

Alethea 2024 eConsult Statistics

Despite its advantages, barriers to telehealth adoption remain. Many healthcare providers hesitate to integrate virtual care into routine practice due to insufficient training and reimbursement issues (Legere et al., 2024). Additionally, unreliable broadband access in rural areas hinders its widespread implementation (Beheshti et al., 2019; Legere et al., 2024).

To fully leverage telehealth’s potential, targeted investments in digital infrastructure, provider training, and sustainable reimbursement models are essential.

3. Policy-Level Interventions: Funding and Incentives

A resilient and effective healthcare system requires a balanced approach, combining top-down policy initiatives with community-driven efforts.

To address rural healthcare challenges, the Alberta Government introduced Primary Health Care Grants to expand PHC access in rural areas (Government of Alberta, 2024). The Alberta Medical Association (AMA) Rural Medicine Section advocates for improved policies and funding for rural healthcare providers (Alberta Medical Association, 2024).

Educational institutions play a pivotal role in sustaining rural healthcare. The University of Calgary and University of Alberta offer Rural Medicine Programs to train and support healthcare professionals who choose to practice in rural Alberta (University of Alberta, 2023; University of Calgary, 2023). Additionally, the Rural Health Professions Action Plan (RhPAP) enhances workforce development and training programs for rural healthcare providers (RhPAP, 2023).

Conclusion

Improving PHC access in rural communities requires a multilevel approach, involving individuals, communities, healthcare systems, and policymakers. By integrating community-driven programs, expanding telehealth services, and implementing effective policy interventions, Alberta can bridge healthcare gaps and ensure all residents receive high-quality care.

From individuals advocating for their health to governments prioritizing rural healthcare funding, every level has a role to play. Ensuring equitable healthcare access across rural Canada demands collaboration, investment, and innovation. By working together, we can strengthen our healthcare system and provide rural communities with the care they need and deserve!

References

Alethea Medical. (2024). AI-powered clinical decision support. https://www.aletheamedical.com/

Alethea Medical. (2025). Alethea 2024 eConsult Statistics [Photograph].

Alberta Medical Association. (2024). Rural medicine advocacy. Retrieved from https://www.albertadoctors.org/about/governance/sections/rural-medicine/

Beheshti, L., Kalankesh, L. R., Doshmangir, L., & Farahbakhsh, M. (2019). Telehealth in primary health care: A scoping review of the literature. Journal of Telemedicine and Telecare, 19(1), 1-10.

Gizaw, Z., Astale, T., & Kassie, G. M. (2022). What improves access to primary healthcare services in rural communities? BMC Primary Care, 23(313). https://doi.org/10.1186/s12875-022-01919-0

Government of Alberta. (2024). Modernizing Alberta’s primary health care system. https://www.alberta.ca/modernizing-albertas-primary-health-care-system-maps

Jong, M., Mendez, I., & Jong, R. (2018). Enhancing access to care in northern rural communities via telehealth. International Journal of Circumpolar Health, 77(1), 1554174. https://doi.org/10.1080/22423982.2018.1554174

Legere T., Podolna, O. Ratcliffe, J., & Rice. F. (2024). From Concept to Care: Health Technology Talent in Alberta. Information and Communications Technology Council (ICTC)

Liddy, C., Moroz, I., Afkham, A., & Keely, E. (2018). Sustainability of a primary care-driven eConsult service. Annals of Family Medicine, 16(2), 120-126. https://doi.org/10.1370/afm.2177

Syed, F., Dekleva, C. (2025). Health in Context: A Multilevel Comparison of NB and ON. Retrieved from https://fsyed155.wixsite.com/

University of Calgary. (2023). Department of rural medicine. https://cumming.ucalgary.ca/departments/family-medicine/

University of Alberta. (2023). Rural stream residency program. https://www.ualberta.ca/en/family-medicine/postgraduate/