Preserving Valued Activities in Life for Adults With Rheumatoid Arthritis: Development and Pre-Testing Refinement of the PREVAIL Model of Care.

Substance misuse and related mental illness are the second largest contributor (23%) to the non‐fatal burden of disease in Australia, affecting 45% of all Australians at some point in their lives []. Related healthcare costs are considerable with $13.2 billion being spent on mental health and drug and alcohol treatment in 2022–23 []. The community burden is greater in rural Australia compared to cities. Harmful substance use and related deaths and illness are more prevalent in rural Australia and access to specialist care is limited, as drug and alcohol treatment services are mostly located in urban and inner regional areas []. Most substance use disorders remain untreated, with only 10.3% of people with substance dependence in high income countries receiving treatment []. In Australia, the time to first treatment has been estimated at 18 years []. To reduce the time to treatment and improve outcomes, development of innovative and improved methodologies for service delivery is required. Drug and alcohol problems are varied and often complex. Depending on the type of drug, method of administration, cost, legality, availability, patterns of use and toxicity, harms can be physical, social, psychological and financial. [, , ]. To address drug and alcohol problems, Australian state‐based systems or local health districts and state and commonwealth‐funded non‐government organisations provide a range of services, including specialist medical services, public hospital programs, community‐based counselling and outreach substance treatment services []. Drug and alcohol treatment clinicians are often uncertain about the most effective interventions that are feasible in real‐world settings. While clinical trials are the most trustworthy source of evidence‐based treatments, translating these interventions from highly controlled clinical settings to practice can be challenging, due to conflicts between maintaining the integrity of the intervention and its successful implementation []. This tension is often caused by the complex social, political and cultural contexts in which health interventions take place [, ]. Furthermore, it results in limited translation of research into practice []. Understanding the practice setting is crucial to facilitate successful translation of research into practice [, ]. These challenges are amplified in rural settings, where service delivery is shaped by geographic isolation, workforce shortages and limited access to specialist care. Rural clinicians often work in resource‐constrained environments that require broad scope of practice, limiting opportunities to implement structured or specialist interventions []. Barriers such as transport limitations, stigma and cultural safety concerns can further affect engagement with treatment. In addition, organisational constraints, workforce turnover and limited research infrastructure reduce capacity to adopt, evaluate and sustain new models of care or policy changes []. As a result, the translation of research into practice in rural contexts requires not only evidence of effectiveness but also adaptation to local conditions and service realities. Local customisation to support local practices and to reflect diverse populations or health service differences is critical to applying evidence‐based practices.