Diabetes patients require consistent medication adherence to maintain optimal health outcomes, yet healthcare access disparities in Tripura present significant challenges, particularly for rural populations. This study examined how culturally-tailored public service advertisements (PSAs) with varying emotional appeals influence medication adherence behaviors among diabetes patients across Tripura’s diverse geographical contexts. Through structured questionnaire administered to 384 diabetes patients from all eight districts, we analyzed responses to different PSA formats that incorporated cultural elements and emotional messaging strategies. Our findings revealed distinct preferences between urban and rural populations: urban patients favored rationally-balanced emotional content, while rural patients demonstrated stronger responses to purely emotional appeals, with rural populations showing greater overall cultural sensitivity. Significantly, culturally-congruent PSAs enhanced reported medication adherence intentions by 37% in rural areas compared to 22% in urban settings. These results provide valuable empirical evidence for developing geographically-targeted healthcare communication strategies that strategically balance cultural relevance and emotional approaches based on the specific characteristics and preferences of urban versus rural patient populations.