ABSTRACT
Preventable mortality between rural and urban communities demonstrates disparities for nonmetropolitan areas, with chronic illness representing four of the five leading causes of death, including heart disease, stroke, respiratory disease, and cancer. Nurse-led mobile health units (MHUs) provide an efficient approach to improving access to screening and managing chronic care for vulnerable communities. Point-of-care (POC) testing provides a convenient approach for nurses to monitor various diagnoses in mobile settings for rural patients who often lack access to a car or public transportation. Additionally, this testing has been linked to improved patient awareness and adherence to chronic care diagnosis and management. This article describes a nurse-led MHU in a rural region that demonstrated significant improvements in the identification and management of chronic illness using POC testing while training advanced practice nursing students to provide clinical care. Literature is lacking in providing clinical experiences for nurses to lead MHUs within nurses’ college programs. Implementing a rural nurse educational program in conjunction with a nurse-led MHU offers the opportunity to train the next generation of advanced practice registered nurses to lead mobile health care with sensitivity to the cultural needs of vulnerable underserved communities, with the potential for improving health equity and access to chronic care management.
Keywords: Advanced practice registered nurses, chronic illness/conditions, health equity, mobile health unit, nursing education, patient access, point of care testing, rural communities
Background
Rural residents have higher rates of preventable mortality compared with their urban counterparts in the five leading causes of death, including heart disease, cancer, unintentional injuries, chronic respiratory disease, and stroke (Hogan et al., 2024; Cockroft et al., 2022; Townsend et al., 2023; Owen et al., 2021; Higgins et al., 2025; Brant et al., 2024; Gaffney et al., 2022; Bourdages et al., 2024; Burch, 2022; Garcia et al., 2024). Health risks for this vulnerable population include higher rates of poverty, tobacco use, advanced age, hypertension, comorbidities, obesity, reduced exercise, and limited access to insurance and health care, aggravated by a lack of transportation options (Garcia et al., 2024). Despite the implementation of the Affordable Care Act, vulnerable populations continue to struggle to access needed health care (Coaston et al., 2022). Mobile health units (MHUs) offer a unique solution for rural communities by bridging the gap between patients and preventive health care, thereby improving patient awareness and management of chronic illnesses (Bourdages et al., 2024; Brant et al., 2024; Burch, 2022; Gaffney et al., 2022; Higgins et al., 2025).
Although nursing education has traditionally focused on urban populations, a gap exists in the literature regarding preparation for culturally competent care in rural settings (Cockroft et al., 2022; Hogan et al., 2024). Advanced practice registered nurses (APRNs), including nurse practitioners, have demonstrated the ability to efficiently lead MHUs in low-income rural communities while building competencies for the nursing workforce (Cockcroft et al., 2020; Hogan et al., 2024; Rhoads et al., 2024). Mobile health units have benefited from the expansion of point-of-care (POC) testing in nurse-led rural units for screening and monitoring chronic illness, which has been associated with provider convenience, patient satisfaction, and improved patient adherence to chronic care management (Owen et al., 2021; Townsend et al., 2023).
This article describes one year of operation of a US Department of Health Resources & Services Administration (HRSA)–funded grant, which deployed an MHU by a college of nursing from a large state university to improve health care access and expand workforce training for graduate nurses in rural health care. The objective is to encourage other colleges of nursing to consider and publish efforts to educate graduate nursing students in culturally sensitive rural care, thereby leading MHUs in rural areas to improve access and health equity for vulnerable populations.
Methods
In 2022, a college of nursing at a large midwestern state university was awarded a $3.1 million, 4-year HRSA grant titled “Enhancing Nursing Education and Retention by Initiation of Care delivered by MHUs” (ENRICH; United States Department of Health and Human Services, 2021). A central objective of the ENRICH Project was to implement a nurse-led MHU to strengthen nurses’ diversity, education, and training, thereby improving health equity and promoting culturally competent care. In addition, the grant objectives included implementing a Rural Nursing Certificate Program (UIC, 2024). The targeted site was a rural region in central Illinois, characterized by poverty, high unemployment, high crime rates, and low high school graduation rates (Federal Programs, 2024).
The MHU was implemented in August 2024, following a 2-year development process that spanned an extended period, with the cooperation of university leaders, the Office of Faculty Practice and Partnerships, faculty APRNs, and the principal investigator (Figure 1). Although the original focus was on reproductive care for women, with the expansion of community partnerships, including several homeless shelters, the team identified a growing need to provide primary care, and screen and manage chronic illnesses for adult men and women. Repeat visits were encouraged, especially when a new chronic illness was identified. In response, the team introduced a variety of new POC tests to allow assessment of blood sugar, HbA1c, lipid levels, and the identification of strep, flu, and COVID-19 viruses.
Figure 1.
Mobile health unit.
Results
With the shift to chronic illness management in 2025, the demographic changed significantly with an older adult Black male, mixed race, and homeless patient population, and a dramatic pivot toward care for patients with hypertension, obesity, and tobacco abuse, as detailed in Table 1. The numbers and calculations in the table represented unique patients only. Repeat patients represented 15% of the total patient visits and were recorded in a separate file, and the numbers were not included in Table 1 to avoid redundancy. All patient records were completed manually and stored in a Health Insurance Portability and Accountability Act (HIPAA)–protected University Box account. Patient data were hand-tabulated and recorded in an Excel file stored in a University HIPAA-protected file.
Table 1.
Demographic and History of Chronic Illness at 5 and 12 Months
August–December 2024 (N = 26)
January–August 2025 (N = 238)
% Change
Age mean
36
41
+14
Sex, n (%)
Male
5 (19%)
125 (47%)
+147
Female
21 (81%)
111 (53%)
−35
Not disclosed
0 (0.0%)
2 (1.0%)
+200
Race, n (%)
White
19 (73%)
137 (58%)
−21
Black
5 (19%)
68 (29%)
+53
Asian
0 (0.0%)
0 (0.0%)
0
American Indian
0 (0.0%)
3 (1%)
+300
Mixed
2 (8%)
8 (3%)
+63
Other
0 (0.0%)
9 (4%)
+400
Undisclosed
0 (0.0%)
13 (5%)
+500
Ethnicity, n (%)
Not Hispanic or Latino
100%
216 (94%)
−6
Hispanic or Latino
0 (0.0%)
13 (6%)
+600
History of hypertension, n (%)
No
24 (92%)
200 (84%)
−9
Yes
2 (8%)
38 (16%)
+100
High blood pressure identified, n (%)
No
24 (92%)
174 (73%)
−21
Yes
2 (8%)
65 (27%)
+238
History of diabetes, n (%)
No
22 (85%)
210 (88%)
+4
Yes
4 (15%)
28 (12%)
−20
Abnormal A1c screen, n (%)
Not offered until 2025
No
151 (63%)
Yes
87 (37%)
+87 identified
History of heart disease, n (%)
No
24 (92%)
210 (88%)
−4
Yes
2 (8%)
28 (12%)
+50
Obesity identified, body mass index ≥30, n (%)
No
14 (54%)
178 (75%)
+39
Yes
12 (46%)
60 (25%)
−46
Tobacco abuse identified, n (%)
No
9 (35%)
131 (55%)
+57
Yes
17 (65%)
107 (45%)
−31
History of hyperlipidemia, n (%)
No
25 (96%)
218 (93%)
−3
Yes
1 (4%)
20 (8%)
+100
Abnormal cholesterol screen identified, n (%)
Not offered until 2025
No
163 (68%)
Yes
75 (32%)
+75 identified
Using an expanded portfolio of POC test kits, the team was able to screen and positively identify 87 patients with elevated A1c levels and 75 patients with abnormal cholesterol levels, with most of these patients self-reporting no known medical history of diabetes or hyperlipidemia. For example, although only 12% (28) patients reported a history of diabetes, POC testing identified 37% (87) patients with elevated A1c levels, demonstrating a 211% increase in identified diabetes. This opportunity to increase patient awareness allowed our APRN-led team to provide counseling and improve the management of chronic illnesses. The team also focused on facilitating graduate student training by implementing an “ENRICH Scholars Program” to increase cultural sensitivity for the rural population and experience working on a nurse-led MHU. Following is the link to view the full scope of the ENRICH Project work ENRICH Project/University of Illinois Chicago (uic.edu).
However, the team faced several implementation issues. Staffing had to be addressed within less than 1 year of operation, as only one APRN was performing all clinical tasks and manually documenting patient visits, given the dramatic growth in community partnerships from 1 to 14 in 12 months. In response, the team developed a staggered calendar to visit different partners and festival dates, with the help of a full-time graduate nurse to assist with patient registrations using an electronic medical record system. This freed the primary APRN to precept ENRICH graduate nursing students.
Another issue was storing and maintaining the MHU 38-foot vehicle with adequate electrical support, as there were few options available in a rural community. Although the team temporarily used a personal garage in the region, this necessitated modifying the height of the garage door and addressing damage to the asphalt driveway, which cracked under the weight of the vehicle. The search for alternate storage continued.
Additionally, patients, especially in homeless settings, asked clinical staff for rides to the local pharmacy or laboratories for POC testing that required confirmatory laboratory testing. Few owned private vehicles or had funds for local transportation. In response, clinical staff ordered and offered local bus vouchers to ensure patients could obtain the required medications or undergo testing.
Finally, the team identified the overarching barriers to MHU acceptance in rural communities, as noted by Brant (2024), including improving visibility, earning trust, and meeting community needs to enhance access. By flexing the focus from reproductive health to chronic care screening and management, the team pivoted to meet the needs of the rural communities. The early response to social media was overwhelmingly positive, expanding the community’s footprint and increasing health care access in an underserved rural region.
Discussion
Developing a nurse-led mobile unit that responds to rural community needs while integrating a nurse training program requires a concerted effort between a college of nursing, the office of faculty, practice, and partnerships with APRN faculty. There is a gap in studies and publications on how nurse-led MHUs can support rural communities while training the next generation of APRNs to support vulnerable rural communities. Nursing colleges must invest in developing APRNs through rural nursing certification programs, providing clinical experiences, and establishing MHUs for vulnerable rural regions, as well as publishing their experiences.
The dramatic results the team achieved in 1 year, using APRN-administered POC tests to screen for chronic conditions, need to be considered when developing MHUs. This approach aims to increase patient awareness of their chronic condition, encourage them to manage their condition effectively to prevent complications, and reduce their risk of mortality. The ENRICH project demonstrated the successful collaboration between a nursing college in developing a nurse-led rural MHU, which was responsive to community needs while educating the future workforce of graduate nursing students toward improving access and health equality in an underserved rural region.
Contributor Information
Kelly D. Rosenberger, Email: kellyr@uic.edu.
Summer Roeschley-Park, Email: summerp@uic.edu.
Carolyn Dickens, Email: cdickens@uic.edu.
Authors’ Contributions
C. Sieck: Completed all narrative, drafts, figures, and tables. K.D. Rosenberger: Role: Contributions to narratives and drafts. S.R.-Park: Role: Clinical input to the draft as the primary MHU clinician. C. Dickens: Contributor.
Competing Interests
The authors report no conflicts of interest.
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