ArticleThe Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association2023
A qualitative analysis of rural syringe service program fidelity in Appalachian Kentucky: Staff and participant perspectives.
Article in The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
What it found
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Who cites it
8 citing papers in PubMed.
- "I'm not going to lay back and watch somebody die": a qualitative study of how people who use drugs' naloxone experiences are shaped by rural risk environment and overdose education/naloxone distribution intervention.Harm reduction journal · 2023Trial
- Emergency preparedness planning: lessons from COVID-19 and the opioid crisis in rural Ohio.medRxiv : the preprint server for health sciences · 2026Article
- History of Naloxone Possession Among Rural and Urban Individuals Participating in Prison-Based Treatment: An Observational Study.Substance use & addiction journal · 2026Observational
- Willingness to use a mobile syringe service program among people who inject drugs in rural Appalachia.Harm reduction journal · 2026Article
- "No judgment, no preaching": approaches to harm reduction service provision for people who use drugs in North Carolina.Harm reduction journal · 2026Article
- Preferences for harm reduction vending machine design among rural people who use drugs.Drug and alcohol dependence reports · 2025Article
- Racialized environments and syringe services program implementation: County-level factors.Drug and alcohol dependence · 2024Article
- Houselessness and syringe service program utilization among people who inject drugs in eight rural areas across the USA: a cross-sectional analysis.Harm reduction journal · 2023Article
Corrections and comments
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Authors and funding
11 authors.
Funding
Abstract
purposeAs drug-related epidemics have expanded from cities to rural areas, syringe service programs (SSPs) and other harm reduction programs have been slow to follow. The recent implementation of SSPs in rural areas demands attention to program fidelity based on core components of SSP success.
methodsSemistructured interviews conducted with clients and staff at 5 SSPs in 5 counties within 2 Central Appalachian health districts. Interviews covered fidelity of SSP implementation to 6 core components: (1) meet needs for harm reduction supplies; (2) education and counseling for sexual, injection, and overdose risks; (3) cooperation between SSPs and local law enforcement; (4) provide other health and social services; (5) ensure low threshold access to services; and (6) promote dignity, the impact of poor fidelity on vulnerability to drug-related harms, and the risk environment's influence on program fidelity. We applied thematic methods to analyze the data.
findingsRural SSPs were mostly faithful to the 6 core components. Deviations from core components can be attributed to certain characteristics of the local rural risk environment outlined in the risk environment model, including geographic remoteness, lack of resources and underdeveloped infrastructure, and stigma against people who inject drugs (PWID)
conclusionsAs drug-related epidemics continue to expand outside cities, scaling up SSPs to serve rural PWID is essential. Future research should explore whether the risk environment features identified also influence SSP fidelity in other rural areas and develop and test strategies to strengthen core components in these vulnerable areas.
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