Adapting a Smartphone-Based Auricular Point Acupressure Self-Management Program for Rural Chronic Musculoskeletal Pain: Qualitative Study

Background: Chronic musculoskeletal pain is more prevalent in rural areas where access to pain interventions, including complementary approaches like Auricular Point Acupressure (APA), remains limited. APA is a non-invasive, needle-free approach, and its smartphone-based self-management delivery model has not been optimized for rural contexts. Objectives: To explore the perspectives of rural partners on adapting a smartphone-based Auricular Point Acupressure-Self-Management (APA-SM) program to better meet rural needs. Study objectives were to: (1) refine the APA-SM program for rural adults, (2) identify implementation barriers, (3) understand practice workflows and engagement, and (4) identify strategies to integrate the APA-SM program into rural pain care. Design: A qualitative study using semistructured focus group interviews. Methods: We conducted six semistructured focus group interviews with 24 participants who were purposively selected across South Carolina and Texas between October and December 2024. Data were analyzed thematically using an inductive approach following Braun and Clarke’s methodology. Ethical approval was obtained from a single Institutional Review Board. A limitation of the study was its regionally focused sample, which may hinder generalizability. Results: Four key themes emerged regarding partners’ perspectives on the APA-SM program: (1) building trust with rural communities, providing meaningful incentives, and having well-trained research staff; (2) communicating the value of APA and providing support through detailed information, motivational messaging, and guidance on integrating APA into daily routines; (3) ensuring accessibility and usability by providing educational materials in appropriate formats and addressing barriers related to technology gaps and communication needs; and (4) fostering partnerships with rural healthcare systems for effective implementation. Conclusion: These findings provide practical guidance for refining the APA-SM program to better fit the needs, barriers, and care contexts of rural communities.