Empowering Influencers to Support Harm Reduction: A Mixed-Methods Process Evaluation of Appalachian Influence.

Harm reduction is a public health approach focused on minimizing the negative consequences of drug use, with syringe services programs (SSPs) playing a key role by offering sterile syringes, naloxone distribution, and connections to broader social services. Despite their effectiveness, SSPs often face stigma and misconceptions, making it crucial to address these barriers to promote supportive policies and community acceptance. This study explores the role of social media influencers in promoting harm reduction and SSPs within the Appalachian regions of West Virginia, Tennessee, and Kentucky through the Appalachian Influence intervention. The intervention engaged 67 local influencers to disseminate evidence-based messages about harm reduction. A mixed-methods approach was used to understand influencer perceptions of their own engagement in Appalachian Influence, including interviews, surveys, and sentiment analysis of comments on influencers' social media posts. Findings reveal that influencers valued the educational resources provided, which increased their confidence and ability to communicate complex harm reduction topics. The flexibility to personalize content was also appreciated, resulting in high levels of engagement and positive audience reception. Sentiment analysis of 589 comments from 65 posts showed that 82.9% were positive, indicating general support for the messages. The study highlights the potential to use influencers to promote public health messages. Implications for practice include the importance of providing influencers with ongoing support and educational materials, fostering a collaborative environment, and monitoring public sentiment to address misconceptions. Future research should explore the long-term impacts of influencer engagement in health communication programs.