Co-Design with Rural Adolescents to Inform a School-Based Physical Activity and Social Media Literacy Intervention: A Qualitative Study

Cardiovascular disease remains the leading cause of death in the United States, with rural communities experiencing elevated risk. Youth in rural settings are particularly vulnerable, reporting worse health outcomes than their urban peers. The growing influence of social media has added complexity to adolescent health behaviors, particularly among youth experiencing challenges with physical and mental well-being. This qualitative study presents findings from a co-design initiative conducted with rural middle school students to examine adolescents’ views on body image, social media use, and engagement in physical activity, and to inform the development of the Hoosier Sport Re-Social intervention. Fourteen middle school students (grades 7–8) from a rural community participated in a structured co-design process spanning five sessions over nine weeks. A deductive thematic analysis was employed using Basic Psychological Needs Theory (BPNT) and Social Comparison Theory (SOCO) as guiding frameworks.