Table 2.

Comparison of Themes Identified among Participants in a Small Rural Appalachian Town and a Mid-Atlantic City (2014-2016).

		Theme	Qualitative differences in perspectives of rural and urban participants	Representative Quotes
Both Methods	Confidentiality concerns	Importance of obtaining a certificate of confidentiality	Important for both study participation and for providing truthful responses among rural participants. Important for providing truthful responses, but not a pre-requisite for being willing to participate in a study among urban participants.	“[With a certificate of confidentiality] I'd be 101% more comfortable…That means everything to us as people walking through the door. That is very, very important for someone to know that they are not going to get locked up for going to a certain house and buying a pill” (40-year old rural female) “I think [having a certificate of confidentiality] puts the individual at ease and gives them more willingness to share information and be truthful” (52-year old urban male)
		Concerns associated with providing the locations for illegal activities (i.e., using and buying drugs)	Rural participants were more concerned about providing locations where drugs were purchased than where drugs were used. Of note, drugs were more often purchased in others homes in the rural setting. Urban participants were equally concerned with providing location information for buying and using drugs.	“I wouldn't really want to say where I get my stuff at” (42-year old rural male) “I would hate to have that location marked by someone…going to buy drugs would be my only concern” (45-year old rural female) Due to privacy concerns, a few indicated that they would answer the questions despite some discomfort; others refused and said, “I don't think I could do that” (41-year old rural female), “that's crossing the line” (29-year old rural female), or “there's no way” (33-year old rural female). “From personal experience, I'm not going to tell nobody where I buy no drugs at or use drugs at” (43-year old urban female)
		Importance of interviewer rapport	Mentioned by the majority of rural participants but only by a few urban participants. This difference likely reflects differences in prior experience as a research participant. While many urban participants had participated in research studies for many years, most rural participants had only participated in one prior study. “I've been doing studies for about 20 years.” (44-year old urban male).	“The first couple times…I thought that this place was setting people up--that they were going to have a big drug bust…after two or three times and nothing didn't happen, I gained trust in you…[Now] I [would] tell you [anything] because I know that it would be confidential 'cause I've told you all some stuff through the years that would probably put me in jail if the wrong people got a hold of it.” (52-year old rural male). “It's all about trust…you've gained trust in a lot of people here…it's all about how the person treats you and how you feel around them” (51-year old rural male). “If you feel comfortable with them, you will probably give them the information. But if you're not feeling that person, you probably wouldn't…at [urban study location], you feel like they have a genuine interest in you…that they do generally care…but other studies that I've been in, you don't feel it” (43-year old urban female).
	Privacy concerns	Willingness to provide the locations of others	The majority of rural participants but only a few urban participants mentioned concern about providing the locations of others' homes.	“That's their business. It's what they want to do… and that wouldn't be my place to put that out” (42-year old rural female) “I wouldn't give the addresses. I would give generalized locations” (39-year old urban male)
	Accuracy of location information provided	Likelihood of being honest about the location(s) where drugs were purchased	In both samples, a majority of participants indicated that they would either not answer this question or that they (and others) would not answer it honestly.	“They're definitely not going to want to tell you where they get [drugs]…they're going to lie to you anyway. You realize that 9 times out of 10 what they're telling you is really not the truth.” (52-year old rural male) “As far as where they purchase drugs…I don't think anybody would tell the truth about that” (43-year old urban female)
		Likelihood of being honest about the location(s) where drugs were used	More urban than rural participants were reluctant to provide this information in an interview.	“I don't think people are going to want to tell you where they're actually doing the drugs because they're afraid somebody would walk in and catch them.” (52-year old rural male) “I don't think I would be inclined to give an exact address, but a cross street would be easier for me to provide” (43-year old urban male)
	Confidentiality concerns	Concern that police might get access to the data	This was the primary concern in both settings. Rural participants were more concerned about disclosing the locations of others and the potential legal consequences for both themselves and others. Urban participants were primarily concerned with the legal consequences for themselves.	“The police is mainly who everybody'd be concerned about” (40-year old rural female) “You're just used to not telling people that… plus, you don't want to get anybody in trouble. If it's illegal they can get in trouble” (40-year old rural male). I'm not going to tell you where I use thinking somebody going to send the police there, and it's going to interrupt me while I'm using” (43-year old urban female) “[The police could] put a raid on where I live at” (62-year old urban male)
Web-based map only	Privacy and Confidentiality Concerns	Not wanting to pinpoint locations on a map due to fear that (1) they would be seen as a “rat” or (2) once entered into the internet, it could be accessed by others	Two rural participants and one urban participant expressed discomfort with “pin-pointing” locations on a map.	“I think if you go there on Google maps… somebody records that and can go back and find it…that would worry me. Don't ever make me point it out on a map” (40-year old rural male). “I just don't like the fact that you pinpoint a drug area” (52-year old urban male)
	Accuracy	Perceive the web-based map to be helpful in finding some locations	More urban participants preferred this method. Many noted that this tool unlike the first method, allowed them to use the map to find nearby cross-streets which were preferable to exact addresses. Of note, most urban participants (but none in rural Appalachia) had experience with this data collection method.	“I believe it would be a helpful tool because I know there's plenty of places that I have used before or have bought drugs before that I couldn't really tell you the name but I know what the place looks like and I know what's close by and stuff like that.” (32-year old rural male) “Sometimes. I don't know the exact address. I just know how to get there.” (54-year-old urban female)