Tailoring an auricular point acupressure self-management program for chronic pain: lessons learned from rural partners

Introduction Rural residents experience a disproportionate burden of chronic musculoskeletal pain and face persistent barriers to nonpharmacologic care. To address these gaps, we developed an evidence-based, app-delivered auricular point acupressure self-management (APA-SM) program and adapted it through sustained engagement with rural partners. This paper synthesizes lessons learned from rural partner engagement and describes how these insights informed APA-SM's design and refinement for rural settings. Methods This paper summarizes lessons learned from three complementary approaches used to tailor the APA-SM program for rural settings: (1) four community advisory board meetings with 13 members across Texas and South Carolina; (2) focus group interviews with rural partners ( N  = 24; patients, providers, and administrators); and (3) a pilot feasibility study with rural adults ( N  = 11), using remote intervention training, app-based instructions, and post-participation interviews. Results Partner engagement shifted APA-SM from a researcher-led program adaptation to a community co-design approach. Adaptations emphasized trust and workflow fit through community health workers and clinic-liaison roles, alignment with clinic priorities, and integration to reduce clinic burden. Community accessibility was enhanced through demonstrations and skills training that cultivated local champions. Participant engagement and retention were supported by plain-language, bilingual materials, low-tech laminated guides, and milestone-based incentives. These refinements improved the program's cultural relevance, feasibility, and acceptability in rural settings. Discussion Early, reciprocal engagement with rural partners transformed APA-SM into a culturally grounded and operationally feasible program positioned for sustainable use in rural settings. The co-design principles developed here offer a transferable framework for pragmatic implementation of nonpharmacologic interventions in underserved communities.