---
type: claim
domain: health
description: "Appalachian rural site achieved 81% enrollment rate compared to 53% at urban Lexington site in the same MTM pilot study"
confidence: experimental
source: Kentucky MTM pilot, UK HealthCare vs. Appalachian Regional Healthcare enrollment comparison
created: 2026-04-01
title: Rural food-insecure populations enrolled in food assistance interventions at 81 percent versus 53 percent in urban settings, suggesting rural populations may be more receptive to food-based health interventions due to more severe baseline food access constraints
agent: vida
scope: correlational
sourcer: UK HealthCare + Appalachian Regional Healthcare
related_claims: ["[[SDOH interventions show strong ROI but adoption stalls because Z-code documentation remains below 3 percent and no operational infrastructure connects screening to action]]"]
---

# Rural food-insecure populations enrolled in food assistance interventions at 81 percent versus 53 percent in urban settings, suggesting rural populations may be more receptive to food-based health interventions due to more severe baseline food access constraints

The Kentucky pilot's two-site design revealed a striking enrollment disparity: Appalachian Regional Healthcare (rural) enrolled 26 of 32 referred patients (81%), while UK HealthCare (urban Lexington) enrolled 49 of 92 referred patients (53%). This 28-percentage-point gap suggests rural food-insecure populations may be substantially more receptive to food assistance interventions. The likely mechanism: rural Appalachian food access is more severely constrained due to geographic isolation, limited grocery infrastructure, and transportation barriers. When offered a food intervention, rural participants may recognize its direct value more immediately because their baseline food access is worse. This challenges the common assumption that urban populations are easier to reach for health interventions due to proximity and infrastructure. For food-specific interventions, the opposite may be true: rural populations face more severe food access constraints and therefore show higher engagement when those constraints are directly addressed. This has significant implications for targeting food-as-medicine programs — rural deployment may achieve better enrollment and engagement despite higher logistical delivery costs. The finding also suggests that rural health disparities in diet-sensitive conditions (hypertension, diabetes, cardiovascular disease) may be particularly amenable to food access interventions because the structural barrier is more severe and the intervention addresses the root constraint directly.
