Building Community Capacity for Harm Reduction: An Adaptive Implementation Science Approach in Rural Appalachian Ohio

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• Harm reduction innovations emerged as sustainable solutions within resistant rural environments, supporting community capacity-building efforts.
• The study highlights that adaptive implementation strategies effectively address structural barriers in specific local contexts.
• Through community co-creation, foundational conditions were established to foster ongoing harm reduction efforts in rural Appalachian Ohio.
• These findings may enable further adaptation of harm reduction strategies across diverse rural settings, emphasizing local engagement.