Navigating rural challenges and promoting posttraumatic growth via expressive writing: A qualitative study among rural breast cancer survivors.

Purpose: Breast cancer is the second most prevalent cancer among women in the United States. Rural breast cancer survivors (RBCS) face unique challenges because geographical isolation limits access to facilities, support groups, and mental health services. Expressive writing (EW), a therapeutic intervention navigates individuals through traumatic experiences, has demonstrated benefits for RBCS. However, first-person accounts of how RBCS experience EW remain limited. This study addresses this gap. Methods: Virtual semi-structured in-depth interviews were conducted with participants (N = 14) who previously completed a virtual EW randomized controlled trial. Interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis. Results: Interviewees' mean age was 54.71 years. Six themes emerged: rural-specific challenges (e.g., travel burden, infrastructure limit, gossip in small towns); emotion regulation and adaptive coping; personal strength through meaning-making; improved relationships; renewed purpose; and appreciation for life. These themes reflect participants' narratives of how EW fit into their cancer journeys. Conclusions: Participants reported varied but positive experiences with EW. The intervention appeared to address key psychosocial needs of RBCS, helping to mitigate rural-specific disparities in supportive care and fostering elements of posttraumatic growth. Centering survivors' own narratives adds a nuanced understanding of what it feels like to engage in EW and how the process supports adaptation in survivorship. EW may address unmet cognitive and emotional needs among RBCS, and may serve as an economical, accessible, and scalable survivorship support strategy. Future studies may triangulate the writings, self-accounts of experiences and intervention outcomes from EW interventions to contextualize the findings.