Observational studyThe Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association2026
More Than Activity: The Effect of Sustained Engagement in Digital Alcohol Support Interventions for Regional and Remote Communities.
Observational study in The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeThis study examines differences between major city and regional and remote participants in engagement in a digital alcohol support intervention (Daybreak), risky drinking, and psychological distress and tests the mediating role of psychological distress.
methodsThis was a longitudinal, observational cohort study of Daybreak participants between January 2019 and December 2024 (N = 12,824). Outcomes were risky drinking and psychological distress. Ordered logistic regression examined associations between the outcomes and program engagement, and multilevel generalized structural equation modeling tested mediation by psychological distress.
findingsAt 6 months, risky drinking scores declined by 42% in major city participants and 57% in regional and remote participants. High engagement in reacting to posts reduced risky drinking in both metro (OR = 0.47, 95% CI 0.27-0.80) and regional and remote areas (OR = 0.42, 95% CI 0.18-0.99). High engagement in post sharing was associated with lower odds of high risky drinking only in major city participants (OR = 0.56, 95% CI 0.33-0.98). In regional areas, participants who aimed to quit drinking at registration had lower risky drinking (OR = 0.72, 95% CI 0.53-0.99), while longer program inactivity increased odds of psychological distress (OR = 1.95, 95% CI 1.13-3.38). Psychological distress mediated 56% of the association between post reactions and risky drinking in major city participants and 33% in regional and remote participants.
conclusionsDistinct engagement pathways across regional and remote and major city settings suggest the need for more flexible digital program designs. Psychological distress, as a partial mediator, should be both a treatment target and a mechanism of change.
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