Table 4 Additional recruitment efforts implemented as a result of qualitative study, grouped by theme or selected sub-theme, and suggestions of how these efforts could be applied into studies of other research topics

LACK OF KNOWLEDGE ABOUT HPV/ANAL CANCER

Lack of Knowledge of HPV/Anal Cancer

• ICF included information on anal HPV infection and anal cancer and groups at increased risk.

• Physician discussed anal cancer screening with participants.

• Flyers/posters/website/ads contained statements to address knowledge gap, for example “Did you know that all men who have sex with men (top or bottom) are at risk for anal cancer?”

• Created “HPV and Anal Cancer Education” presentation and presented it to community groups and health care provider groups in and around the San Francisco Bay Area.

• Include statements to address knowledge gaps specific to study topic on recruitment materials.

• If large knowledge gap is present in target population, education campaign should be considered.

RESEARCH FOCUSES ON ANAL CANCER

Physical Anal Discomfort

• Anal exam explained in detail at enrollment.

• Video created of principal physician describing the procedure in detail and showing all medical devices that will be used (speculum, swabs, colposcope).

• Video available on website and presented in educational presentation.

• Study procedures should be thoroughly explained in an accessible way as part of recruitment materials and not just as part of the enrollment process.

STIGMA-RELATED BARRIERS

Age Stigma

• Posters/flyers/website portrayed healthy men in older age groups.

• Eye catching “Peachy” campaign branded the AHHA Study with a peach emoji wearing a variety of underwear (Additional file 5). Posters/flyers/website/ads used new artwork. (The peach emoji is frequently used to symbolize a butt/bottom.)

• Researchers focusing on stigmatized populations, behaviors, or conditions should consider exploring these topics qualitatively before designing recruitment campaigns.

CONFIDENTIALITY CONCERNS

Confidentiality

• Confidentiality of study participants addressed as part of protections for human subjects procedures.

• Developed smaller pocket-sized flyer and tear-offs on flyers. QR codes were also placed on all study materials that link to the study website so that participants do not need to take a flyer to have study information.

• Provide a variety of methods of obtaining study information that are both accessible and sensitive to privacy concerns.

MOTIVATORS TO PARTICIPATION

Wanting Access to the Best Care

• Information on the UCSF ANCRE clinic’s experience and expertise included on clinic material.

• Included information on availability of anal cancer screening and treatment on posters/flyers/website/ads.

• Include important study institutions and collaborators on study recruitment materials.