{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T13:01:38Z","timestamp":1789995698920,"version":"4.0.1"},"reference-count":34,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T00:00:00Z","timestamp":1788307200000},"content-version":"vor","delay-in-days":93,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000102","name":"Health Resources and Services Administration","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000102","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Journal of Rural Health"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Technical assistance (TA) programs can support rural hospitals in addressing ongoing operational and financial challenges. However, there is limited evidence regarding the organizational motivations, facilitators, and barriers influencing rural hospitals\u2019 decisions to participate in these programs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study explored the motivations, facilitators, and barriers affecting rural hospitals\u2019 participation in TA initiatives.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Secondary qualitative data were obtained from applications submitted by rural hospitals to the Targeted Technical Assistance for Rural Hospitals Program between November 2023 and September 2025. Applications included organizational profiles and open\u2010ended responses describing motivations, anticipated barriers, and factors supporting successful participation. Data were analyzed thematically using a hybrid inductive\u2013deductive approach guided by Braun and Clarke's framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Hospitals were motivated to seek TA to improve organizational sustainability by addressing financial challenges, enhancing clinical and operational processes, and developing their workforce. Key enablers included stakeholder buy\u2010in, access to resources, perceived benefits of TA, strong mission orientation and community commitment, and prior TA or operational improvement experience. Commonly reported barriers involved capacity and staffing, operations, community engagement and perception, and coordination and logistics. To overcome these challenges, hospitals suggested strategies such as intentional planning and program prioritization, streamlining operational workflows to accommodate program participation, leveraging leadership support, and maintaining transparent communication with stakeholders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Rural hospitals\u2019 engagement in TA programs reflects both their resilience and desire to address systemic vulnerabilities. Tailoring support to the realities of rural healthcare is essential for enhancing hospital sustainability and maintaining access to care in underserved communities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jrh.70213","type":"journal-article","created":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T11:48:38Z","timestamp":1788349718000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Qualitative Exploration of the Drivers of Rural Hospital Participation in a Technical Assistance Program"],"prefix":"10.1111","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4848-4430","authenticated-orcid":false,"given":"Bettye A.","family":"Apenteng","sequence":"first","affiliation":[{"name":"Department of Health Policy and Community Health Jiann\u2010Ping Hsu College of Public Health Georgia Southern University  Statesboro Georgia USA"},{"name":"Center for Rural and Public Health Practice and Research Jiann\u2010Ping Hsu College of Public Health Georgia Southern University  Statesboro Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-1432-8333","authenticated-orcid":false,"given":"Carolyn","family":"Puobebe","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Community Health Jiann\u2010Ping Hsu College of Public Health Georgia Southern University  Statesboro Georgia USA"},{"name":"Center for Rural and Public Health Practice and Research Jiann\u2010Ping Hsu College of Public Health Georgia Southern University  Statesboro Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1888-5305","authenticated-orcid":false,"given":"Samuel T.","family":"Opoku","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Community Health Jiann\u2010Ping Hsu College of Public Health Georgia Southern University  Statesboro Georgia USA"},{"name":"Center for Rural and Public Health Practice and Research Jiann\u2010Ping Hsu College of Public Health Georgia Southern University  Statesboro Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela H.","family":"Peden","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Community Health Jiann\u2010Ping Hsu College of Public Health Georgia Southern University  Statesboro Georgia USA"},{"name":"Center for Rural and Public Health Practice and Research Jiann\u2010Ping Hsu College of Public Health Georgia Southern University  Statesboro Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0917-9567","authenticated-orcid":false,"given":"Linda","family":"Kimsey","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Community Health Jiann\u2010Ping Hsu College of Public Health Georgia Southern University  Statesboro Georgia USA"},{"name":"Center for Rural and Public Health Practice and Research Jiann\u2010Ping Hsu College of Public Health Georgia Southern University  Statesboro Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9303-5266","authenticated-orcid":false,"given":"Tilicia","family":"Mayo\u2010Gamble","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Community Health Jiann\u2010Ping Hsu College of Public Health Georgia Southern University  Statesboro Georgia USA"},{"name":"Center for Rural and Public Health Practice and Research Jiann\u2010Ping Hsu College of Public Health Georgia Southern University  Statesboro Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kwabena G.","family":"Boakye","sequence":"additional","affiliation":[{"name":"Center for Rural and Public Health Practice and Research Jiann\u2010Ping Hsu College of Public Health Georgia Southern University  Statesboro Georgia USA"},{"name":"Department of Information Systems and Analytics Parker\u00a0College of Business Georgia Southern University  Statesboro Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4594-6508","authenticated-orcid":false,"given":"Charles F.","family":"Owens","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Community Health Jiann\u2010Ping Hsu College of Public Health Georgia Southern University  Statesboro Georgia USA"},{"name":"Center for Rural and Public Health Practice and Research Jiann\u2010Ping Hsu College of Public Health Georgia Southern University  Statesboro Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3658-4728","authenticated-orcid":false,"given":"Andrew","family":"Hansen","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Community Health Jiann\u2010Ping Hsu College of Public Health Georgia Southern University  Statesboro Georgia USA"},{"name":"Center for Rural and Public Health Practice and Research Jiann\u2010Ping Hsu College of Public Health Georgia Southern University  Statesboro Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2353-2854","authenticated-orcid":false,"given":"William A.","family":"Mase","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Community Health Jiann\u2010Ping Hsu College of Public Health Georgia Southern University  Statesboro Georgia USA"},{"name":"Center for Rural and Public Health Practice and Research Jiann\u2010Ping Hsu College of Public Health Georgia Southern University  Statesboro Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Murdock","sequence":"additional","affiliation":[{"name":"Center for Rural and Public Health Practice and Research Jiann\u2010Ping Hsu College of Public Health Georgia Southern University  Statesboro Georgia USA"},{"name":"The Betty Foy Sanders Department of Art College of Arts and Humanities Georgia Southern University  Statesboro Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,2]]},"reference":[{"key":"e_1_2_10_2_1","volume-title":"Rural Hospitals","author":"Rural Health Information Hub","year":"2025"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1748-0361.2010.00312.x"},{"key":"e_1_2_10_4_1","volume-title":"The Chartis Center for Rural Health: The Rural Health Safety Net Under Pressure: Rural Hospital Vulnerability","author":"Topchik M.","year":"2020"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/jrh.12128"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/jrh.12671"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1353\/hpu.2024.a928626"},{"key":"e_1_2_10_8_1","volume-title":"Sheps Center for Health Service Research","author":"Cecil G.","year":"2025"},{"key":"e_1_2_10_9_1","volume-title":"The Impact of the Pandemic on Rural Hospitals","author":"Center for Healthcare Quality and Payment Reform","year":"2023"},{"key":"e_1_2_10_10_1","volume-title":"Rural Hospital Programs","author":"Health Resources and Services Administration","year":"2024"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1177\/01632787241237515"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2013.1016"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/jrh.12754"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/jrh.70024"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1080\/23303131.2015.1052124"},{"key":"e_1_2_10_16_1","volume-title":"Providing TA to Local Programs and Communities: Lessons From a Scan of Initiatives Offering TA to Human Services Programs","author":"Baumgartner S.","year":"2018"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1186\/s43058-022-00314-1"},{"key":"e_1_2_10_18_1","volume-title":"Partnering for Sustainable Local Healthcare","author":"Targeted Technical Assistance for Rural Hospitals Program","year":"2025"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1191\/1478088706qp063oa"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11414-014-9439-2"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1177\/15248399221080096"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1080\/23303131.2019.1696909"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen\u20102021\u2010057450"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1080\/21665095.2025.2517766"},{"key":"e_1_2_10_25_1","unstructured":"P.AhonenandC. C.Park Facilitators and Barriers to Utilization and Impact of Training and Technical Assistance(Training and Development in Human Services 2017)."},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0334616"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1177\/01632787241248769"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1108\/JHOM-03-2024-0077"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/jrh.12534"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.3122\/jabfm.2021.04.210011"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1177\/08912424211067193"},{"issue":"3","key":"e_1_2_10_32_1","first-page":"307","article-title":"Organizational and Administrative Factors Influencing the Adoption of Consortia Programs by Rural Hospitals","volume":"38","author":"Kralewski J. E.","year":"1993","journal-title":"Journal of Healthcare Management"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1745-5871.2009.00586.x"},{"key":"e_1_2_10_34_1","doi-asserted-by":"publisher","DOI":"10.1080\/20009666.2021.1929048"},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.1177\/19375867241250323"}],"container-title":["The Journal of Rural Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jrh.70213","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jrh.70213","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jrh.70213","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T12:07:17Z","timestamp":1789992437000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jrh.70213"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6]]},"references-count":34,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1111\/jrh.70213"],"URL":"https:\/\/doi.org\/10.1111\/jrh.70213","archive":["Portico"],"relation":{},"ISSN":["0890-765X","1748-0361"],"issn-type":[{"value":"0890-765X","type":"print"},{"value":"1748-0361","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6]]},"assertion":[{"value":"2025-12-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-13","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-02","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70213"}}