Rural- and nonrural-specific themes in personalized intervention messages for adults with at-risk alcohol use living in rural areas

There is a lack of personalized interventions designed specifically to meet the health care needs of rural populations. The goal of this qualitative work was to identify themes in intervention content developed by people residing in rural areas as part of a remotely delivered intervention for at risk alcohol use. This is formative, exploratory work from data obtained in a pilot clinical trial that employed episodic future thinking (EFT, visualizing future events) and volitional choice (VC, in-the-moment alternatives to drinking) interventions aimed at reducing alcohol use. Using participant-created messages, we double-coded messages into thematic categories (e.g., recreational activities, protective behavioral strategies) and subcategories (e.g., family/kinship, purchases). Subcategories were further classified as rural aligned or nonrural specific. Each message had additional participant ratings of condition-specific variables (e.g., importance, enjoyment). Participants in active intervention conditions (N = 57; i.e., EFT, VC, EFT/VC), created a total of 434 personalized messages. Of the 212 EFT messages, 17.0% were categorized as goal events, 81.1% as recreation events, and 1.9% as both. Of the 222 VC messages, 51.4% were categorized as alcohol protective behavioral strategies, 45.9% as alternative alcohol-free activities, and 2.7% as both. Nearly half (46.8%) of EFT messages were rural-aligned subcategories, whereas 17.1% of VC messages were rural-aligned. The messages displayed common themes, including both rural-aligned and nonrural-specific features. Consideration of cultural-centeredness in early intervention content may enhance its appeal and alignment with the populations served. (PsycInfo Database Record (c) 2026 APA, all rights reserved).