JMIR Publications

ABSTRACT

Background:

Veterans face stigma, privacy concerns, and access barriers to HIV screening. For studies that use at-home HIV self-testing (HIVST) kits distributed through vending machines (VMs), recruitment and educational materials must communicate study purpose and participation options clearly, minimize confusion and stigma, and provide actionable next steps for participants who test outside of clinical settings.

Objective:

To elicit Veteran Advocate feedback on recruitment flyers, education handouts, a web-based questionnaire, and a qualitative interview guide for a Veterans Health Administration study evaluating impacts of VM-dispensed HIVST kits to Veterans and to document how feedback informed revisions to these study materials.

Methods:

Using participatory action research, we recruited Veteran Advocates with lived/living expertise of HIV (August 2025). Veteran Advocates completed structured written reviews of study materials and returned written feedback forms; feedback was also discussed during a 1-hour virtual focus group in September 2025. We analyzed written feedback and the focus group transcript using a rapid, team-based consensus thematic approach. Two study team members independently reviewed each feedback source and documented key recommendations and candidate themes using analytic notes; the team then met to cluster feedback into themes and reach consensus on final themes and definitions. To ensure findings directly informed materials improvement, we created a revision matrix mapping each theme to the relevant study material(s), a summary of feedback, and the resulting changes made. This matrix served as an audit trail linking feedback to the “feedback and revisions” tables presented in the Results.

Results:

Four Veteran Advocates provided structured written feedback on study materials, and three participated in the 1-hour focus group. Across study materials, Veteran Advocates desired (1) clearer, plain-language descriptions of study purpose, eligibility, and participation pathways; (2) reduced potential for confusion between research recruitment, VM access, and HIVST kit promotion; (3) reduced text density and participant burden; and (4) more actionable “next steps,” including human support and linkage-to-care resources appropriate for at-home self-testing. Revisions included a streamlined recruitment flyer with simplified calls-to-action and clearer survey versus interview pathways; a more cohesive and condensed education packet oriented around self-testing steps, results interpretation, and support resources; questionnaire updates to reduce redundancy and improve usability; and an interview guide with improved flow, more participant-centered framing, and optional questions on emotional reactions and support needs.

Conclusions:

Veteran Advocate feedback was systematically translated into concrete revisions across multiple study materials prior to study launch. Transparently mapping stakeholder input to specific adaptations may strengthen acceptability and usability of Veteran-facing HIV screening and self-testing materials in VA and similar settings.