| Description: |
Background The opioid epidemic continues to disproportionately impact rural communities across the United States, where structural barriers, including geographic isolation, limited public health infrastructure, and heightened stigma, restrict access to harm reduction services. Public Health Vending Machines (PHVMs) that distribute naloxone and other wellness supplies (e.g., hygiene, wound care, socks, glasses) offer a promising, low-barrier, anonymous method for increasing access to life-saving interventions. However, the implementation of PHVMs in rural areas remains limited, and few studies have examined how these tools can be effectively and sustainably integrated into such contexts. Methods We employed a community-based participatory research (CBPR) approach, guided by the structural indicators of community-based participatory action research (SI-CBPAR). A qualitative needs assessment was conducted in six rural counties in North Carolina. Individuals with lived experience of substance use were trained as interviewers to recruit and conduct semi-structured interviews with peers. A total of 60 interviews were completed between June and December 2024. Participants discussed access to naloxone, stigma, preferred PHVM locations and distribution models, and desired harm reduction and wellness supplies. Transcripts were coded using a priori codes, with coding validation through inter-rater reliability and team-based consensus. Results Participants described a range of community-level challenges and assets related to naloxone accessibility, leading to the first overall theme, current community context of naloxone accessibility, with subthemes highlighting the sources of naloxone, its perceived importance, and structural and social barriers to access. Participants also provided input on the implementation of PHVMs (the second theme), expressing preferences for 24/7 access, private locations to reduce stigma, and expanded content to include additional harm-reduction supplies. These findings underscore the ... |