Table 1 Issues that required modification from original intervention

Eligibility criterion: age and household membership

Rural communities have older populations; multigenerational co-residence common.

Open up to all eligible adults 18+--no upper age limits; open to all co-residing adults.

Recruitment

Lack of urban recruitment resources. (e.g., public transit)

Use social media, community settings. (church, centers)

Intervention component:

health coaches

Non-local coaches lack familiarity with available resources and local culture, undermining relevance and decreasing participant comfort. Insufficient and class divergent local health care providers.

Employ only lay, local coaches who know local norms, values, and community resources. Rigorously train local residents to promote capacity, expertise and sustainability.

Intervention component: coaching

Tight knit communities decrease enthusiasm for only individual-level activities.

Conduct quarterly group events.

Intervention component:

App

Concern about data costs; less tech experience.

Special health coach training on data use/cost; conduct in-person user training session.

Intervention component:

App messaging

Images lack resonance with local needs and population.

Reflect Appalachian context, with local images. Highlight success stories, fun activities.