Some material in this chapter has been reproduced from Schumacher et al.53 This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: https://creativecommons.org/licenses/by/4.0/. The text includes minor additions and formatting changes to the original text.
Methods
Aim
The aim of the nested qualitative study was to explore participants’:
- Experience of trial procedures and materials.
- Views and experiences of the Wrapped intervention.
- Perceptions of whether the intervention changed their condom use beliefs or behaviours.
Design
Qualitative interviews.
Public and patient involvement
The Wrapped PPI group (as described in Chapter 2) worked with the research team to draft participant information and consent statements for this qualitative study to ensure they were clear and easy to understand. Two PPI members also piloted the interview schedule and changes were made accordingly.
Study population, setting and recruitment
In response to an item in fRCT M0 survey, 89 participants indicated interest in being interviewed about their views and experiences of the trial. Maximum variation sampling of this group was used to obtain a sample that represented: experience of intervention and control conditions, different levels of engagement with the trial, and varying demographic characteristics (age, gender, ethnicity, sexual identity, level of deprivation). To that end, recruitment proceeded iteratively, with individuals invited in turn to maximise inclusion across these categories. Those who wished to take part were sent a link via e-mail to an online participant information sheet, consent form and booking system. Interviews were conducted in three waves during the fRCT (M3, M6 and M12) to enable experiences across the timeline of the study to be captured.
To gain additional insight into perceptions of how intervention content may have changed condom use beliefs or behaviours, interviewees (referred to hereon in within this chapter as ‘primary participants’) were asked if a sexual partner(s) could also be invited for interview. Those providing verbal assent (n = 12) were sent an e-mail to forward on to a partner(s) if they wished. E-mail invitations contained a link to an online participant information sheet, consent form, and booking system. No pressure was put on any primary participant to forward this e-mail, and no direct contact made with partners until this step had been completed. Sexual partners who participated are referred to hereon in within this chapter as ‘secondary participants’.
Procedure
Thirty interviews with primary participants, and three interviews with secondary participants were conducted between August 2021 and September 2022 using a semistructured interview schedule designed to address the three main aims stated above. Interviews were conducted by telephone and were recorded and transcribed. Primary participant interviews lasted 7–50 minutes (mean 21 minutes), and secondary participant interviews between 2 and 13 minutes (mean 6 minutes).
Analysis
Two researchers (KK and LS) analysed transcripts using Framework analysis.54 Four interview transcripts were first independently coded by the two researchers and a preliminary analytical framework agreed. Further independent coding of four transcripts by the two researchers, using the initial analytical framework, and subsequent discussions about any codes that did not fit, resulted in an agreed final framework. The final agreed framework was then applied to all transcripts by KK using Nvivo software (indexing, QSR International; 2018). Microsoft Excel (Microsoft; 2023) was used to record illustrative quotes and a summary of the data related to each code of the framework (charting to framework matrix). The final framework consisted of five themes containing 21 sub-themes. Quotations have been selected to illustrate themes. In the presentation of the results, codes follow each quotation to indicate the participant’s number and whether each individual was a primary (PP) or secondary (SP) participant.
Results
Participant characteristics
The sample of primary participants consisted of 30 young people aged between 19 and 24 years. Most participants identified as female and of white ethnicity. Half (n = 15) of the participants were in the intervention group. Secondary participants (n = 3) all identified as white males and were between 18 and 28 years old. See Appendix 6, Table 49 for full demographic information.
Presentation of themes
Themes are aligned to each of the three research aims.
Aim 1: participant experience of trial procedures and materials
Theme 1: motivation for involvement in the research
Participants talked about motivational factors that impacted their decision to join the study and continue engaging throughout the 12-month trial period. Most participants were motivated by a combination of factors, but some solely by the monetary reward.
Subtheme 1.1: the role of financial incentive
The voucher incentive offered played a role in motivating most participants to take part in the study. This reward however was held with varying degrees of importance. For some participants, it was front and centre of their decision-making. Others viewed this as a bonus, or one of several motivating factors.
Probably just the Amazon vouchers, if I’m being completely honest. I probably wouldn’t have done it without. So, yeah, that was definitely an incentive.
It sweetens the deal, but I wouldn’t say it’s the sole reason I’m doing it.
Another role the vouchers played for some participants was keeping them engaged throughout the whole of the 12-month study period. Some participants felt that without this ongoing recognition, they may have stopped engaging. For others the vouchers were encouragement for timely completion of activities.
A lot, to be honest. I could have seen myself only doing one [survey]. But I don’t think I would have continued doing it for a year, if it wasn’t for those.
To be honest, I would have done that anyway, but I think it kind of – I’d say if it wasn’t for them [vouchers], I might have not do them as quick, but that’s about it, really.
Subtheme 1.2: the role of non-financial incentives
In most cases, even when financial reward was cited as a driving factor in taking part, participants went on to talk about other motivating factors that played a role. A number of participants cited altruistic reasons for participation, including contributing to research or having a positive impact on sexual health services and support.
I just – I thought … I remember my initial thought was that I was really pleased that there was research going on in this area, and that there was a study that I could be a part of that could potentially help in any way, like sexual health for anyone else.
Other participants recognised that the study could directly benefit their own sexual health, through an increased focus on this over the period of the study.
I think a part of it, was getting repeat tests being sent, without having me to almost remember.
Other participants just thought the research looked interesting and appealed to them. These participants sometimes went on to say that they had a general interest in research.
I’m quite interested in sexual health, really, actually, and I just think it’s really interesting.
Theme 2: participant experience of research materials and procedures
Subtheme 2.1: process of joining the study straightforward and as expected
Participants recalled the process of joining the study as easy, quick and straightforward. They talked about how the process felt ‘normal’ and as expected for a research study. Some participants expressed that the level of detail provided at sign-up resulted in a reduced effort for them (e.g. not having to search for additional information), which had a positive impact on their experience. Other participants did not specifically remember the details of joining the study and then attributed this to the process presumably having been straightforward.
It was really easy. It was literally just filling out my information, and I think it had the terms and conditions, and reading through there, saying what they’re going to do with my information. And then I think it went pretty much straight to a survey. It was really easy.
And there was everything there that I needed, so I didn’t have to, like, think about it much.
It must’ve been pretty quick, or at least not too long, because I wouldn’t have bothered if it took up too much time.
Most of the participants talked broadly about the process of study sign-up, but of those that talked more specifically about the materials, such as the information sheet and consent form, positive feedback was given about the content being clear and easy to understand. Some felt the level of detail added an element of trust in the research.
I remember it being really straightforward and everything was clear and made sense.
The consent form, and I think that it detailed how my information would be used, and stuff like that. It was very detailed, which I was kind of like, if it was a scam, it’s not going to be that detailed.
When reflecting on their thoughts about the advertising of the study, some participants were unable to recall much detail. Of those who could, the advert was deemed appealing and detailed enough to pique their interest, with some participants particularly recalling the mention of an incentive and a call for people of their age. One participant felt that the advert could have been more prominent and included more detail what the study was about.
I just remember – yeah, I just remember it was about sexual health and learning more about sexual health within our age group.
I just think I just remembered seeing, oh, your test has been sent to you and, by the way, do you want to become part of this? And I just kind of like – it was quite … It wasn’t obvious. I think maybe mention a bit more about what it was, because I didn’t realise what it was about, really, until I clicked through.
Subtheme 2.2: experience of completing the online surveys
Most of the comments about the online surveys were positive, specifically in relation to the ease of completion. Most commented that the language used, and the instructional information provided, made everything clear and that this resulted in reduced participant burden. Some attributed the ease of completing the questions to a significant proportion being multiple choice, with a good variety of responses that represented all possible answers. One participant however indicated that the wording of some of the questions may have been too complex.
The language used was quite basic, which is useful. So you always know what the question was asking.
I remember there was quite a lot of questions, and there was a lot of options to answer. So you could literally answer how you feel, because there would have been a sentence that would have matched someone.
Not really. I think sometimes if you overthought the questions, like I did at first, and trying to figure out what they meant, was quite difficult.
The participants mostly described the surveys as the right length, reasonably quick to complete, laid out clearly, and easy to navigate. In some cases, participants described the experience of completing the surveys as interesting and enjoyable. It was mentioned a few times that the questions and surveys at different time points felt a little repetitive, but in most cases, these participants expressed an understanding and appreciation for the reason behind this.
It was fairly quick. It wasn’t too time-consuming, so I think it was a good amount, a good length of time.
No, not at all. Yeah, it was really easy to use, and I remember the interface being really good.
In some ways, it felt a little bit repetitive. But then I also noticed a change in my answers, as I participated in the study, which was quite interesting to see.
When commenting more specifically on the content of the surveys, there was a general feeling that the questions were quite personal, but no concern was expressed about answering them. In fact, in some cases, participants described understanding the importance of these questions.
Some of the questions, obviously they are a little bit personal, but I think that’s good, and it helps make you think about everything.
I feel like it started making me think a little bit, going, oh, it makes you think about yourself and what you could do yourself as well. It puts a light onto it, because I don’t think it’s talked about enough.
Also see the ‘re-evaluating sexual health’ subtheme within Report Supplementary Material 12 for related findings.
Subtheme 2.3: experience of chlamydia self-sampling kits
The arrival of the M3 and M12 chlamydia self-sampling kit in the post was mostly expected but in a few cases was not. This was usually due to participants not recalling receiving the automated SMS notification (note: our logs show that all SMS notifications were successfully sent). Regardless, when the package did arrive, it was considered discreet enough that no one else would know the contents of the package, which was important for participants’ privacy.
I remember, it just came through the door, and I’m bit like, what’s this? And I was like, oh, I remember!
When they come, they’re small and they’re discreet, so that’s fine.
The self-sampling kits felt familiar to participants, with the exception that they were testing for a single STI, which for some was at odds with the kits they had received previously from the same provider. The kits used were gender-neutral, thus containing materials required to take a urine sample or vaginal swab. Some participants liked this element of choice but others felt this was wasteful.
I feel like it was interesting to me, because obviously I normally order four-in-one kit. So having a test which just focuses on one thing alone, was a little bit strange, because it’s not usually what I get. But considering I have used the four-in-one kits before, it was nothing unusual, nothing out of place.
And then I remember that there were both the options to give a urine sample, or to do a vaginal swab. I think that you had the option – although there was also a side of me that was like, oh, I just … It was like, oh, it’s a bit wasteful.
Participants appreciated the handwritten note signed by one of the research team put within the test kit that indicated that the test kit was part of the research study.
I remember receiving – I really liked the personal touch of that little card that comes with it, and then you guys writing your name as well, that, for me, it was like a nice personal touch to it all. So it feels quite human, and it’s not just computer-generated kind of thing.
Also see ‘feeling valued’ within Report Supplementary Material 12 for related findings.
The process of completing the test was described as easy. This was attributed both to existing familiarity with self-sampling kits and to the instructional information provided. Returning the kits was also perceived as straight forward, and participants appreciated not having to self-report the results to the research team.
It’s all very smooth. The test kit coming out to me, it was in a black bag, a handwritten address label, so you couldn’t tell at all what was in it. Doing the test kits, very self-explanatory, very clear, and then simply returning it was really easy, and just putting it in a post box.
I think it was easy, in the sense that I didn’t have to submit my results to you guys, because you guys already had the results submitted, when I did the test.
Theme 3: research communications engaging and of appropriate frequency
Subtheme 3.1: frequency of communications
All participants were positive about the communications (e-mails, SMS text messages and phone calls) they received during the study. Most commented on the frequency being appropriate which allowed them to feel in the loop without being overwhelmed. Often communication was perceived as well-timed, acting as a valuable reminder to complete research activities.
I’d say that it was the right amount, and it was perfect. Anymore, I probably would have got a bit worried about, but any less I wouldn’t have been included, if that makes sense?
Yeah, it was great. I mean, there’s been a lot of times where I forgot to do something, or something slips my mind. I had an email, I had a text message reminding me, or even a phone call to see if I’m okay, if I’m still happy to go on with the research. Yeah, so there was a lot of communication between yourselves and I, so, yeah, I was really happy with it.
Subtheme 3.2: mode of delivery of communications
There were mixed views about preferred mode of delivery used to communicate with participants. Some participants’ personal preference was text message, with the reasoning being that this was more prominent (less likely to be missed). Others however preferred e-mails because they felt that these were more private or hidden, which was perceived as important given the topic of the study.
Probably the text message was the one that I seen first, because you’re always on your phone, aren’t you? And then emails, obviously, I check my emails as well because I’m a student now, so I study, but text messages were probably the things that I would catch straightaway.
I don’t mind on the email, because I feel like emails are quite hidden, like, nobody gets onto your emails, so I don’t mind it on the email. When we get test results by text, I don’t particularly like it.
Subtheme 3.3: content and style communications
Participants felt the content of the communications was concise and clear. Furthermore, it was perceived as sufficiently detailed to be informative while also discreet. This allowed for participants to easily engage with the communications. A few participants described the communications as professional and liked the inclusion of personalisation.
Short and concise. They gave you the information that you needed, yeah.
So you can feel the professionalism in it.
Yeah. Yeah, it’s just been like, all been really nice and personalised as well, which was quite nice.
Participants understood and enjoyed the digital nature of the study but also appreciated the personal touches applied to communications. This made participants feel connected to the research team. Participants also spoke about how the research team felt approachable and how they liked that the same three researcher names were included in the communications. There were however some participants who were unsure about how they could contact the research team.
I know it sounds really silly as well, but I like how, at the end, like the emails or whatever communication it is, it’s signed off your names. It adds that little bit of a personal touch, it just adds that little bit more that you are being listened to, so you just don’t end up thinking, oh, I’m just part of the … I’m just a number in a study.
Really good. It’s easy to contact them.
I really liked the personal touch of that little card that comes with it, and then you guys writing your name as well, that, for me, it was like a nice personal touch to it all. So it feels quite human, and it’s not just computer-generated kind of thing. So I really like the personal touches that was through it, and it was like, oh, you kind of remember who we are.
Also see ‘feeling valued’ within Report Supplementary Material 12 for related findings.
Aim 2: participant views and experiences of the intervention
Theme 4: wrapped intervention website
Subtheme 4.1: reflections on accessing and using the Wrapped website
Eleven of the 15 participants in this qualitative study that were assigned to the intervention condition accessed the Wrapped website. These individuals reported finding the process of registration straightforward. Those who did not access the website reported time as a barrier to access. Some also didn’t remember receiving an invite (which was sent via e-mail) with the suggestion of sending the link via text message instead in the future.
So I honestly must have just not completely read through it. Yeah, if I had, I probably would have gone on to the website.
All the participants described the website as easy to navigate and found the process of ordering products smooth. Most participants liked the appearance of the website, stating that it was simple, smart and not medicalised in feel. Two participants, however, felt the design could have been more exciting.
I really liked it, and it was really simple to use. I liked how it wasn’t overloaded with information, and the information you wanted to find was quite simple. I liked the little icons and the style of it all, and that was really nice as well.
It’s quite neutral colours and quite friendly. It’s not like boring, this is medical. If you go on the NHS website kind of thing, it’s all like blue and medical and that kind of thing. Whereas it was a bit more friendly, and stuff.
Honestly it’s nothing special but it works. It’s simple and easy to navigate.
Subtheme 4.2: views of the intervention components
Condom sample pack
The sample pack was ordered by most of the participants who accessed the website (8 out of 11). Participants were pleased with the content, some expressing that the amount and variety of condoms included was more than they expected. The choice of condoms was also viewed as better than the usual free condoms offered elsewhere and thoughtful in the fact that they were all affordable and easily accessible for future purchase.
It was quite good, actually, and I was actually quite surprised. I was expecting a few, and not … About one or two or three maybe, but not the variety that actually comes with it.
I like how it was that was the range that was given, and it’s easily accessible, and it’s not super exclusive.
The tailoring element of the product (choosing colour of condom box and pattern of insert) was liked and appreciated by many, but ultimately wasn’t viewed as a deciding factor in ordering the pack. The information leaflet provided in the pack was viewed mostly as a refresher, one participant stated that they found it informative, but often participants felt this could benefit others more.
I think not necessarily learning things new, but it’s more refreshing old stuff.
PP15
Monthly condom-ordering service
The condom-ordering service was used by 9 of the 11 participants who accessed the website (all of whom were assigned this component), and in most cases more than once. The component was well liked, and one participant described it as feeling private and secure. The information provided about each condom was appreciated, and the variety of condoms and lubes available was again acknowledged and valued.
It was pretty good, I can’t fault it for a free service.
So it’s absolutely amazing the fact that there’s such a selection as well. And, yeah, tried both the lubes as well and it’s just great products there, so why would we not use them?
Well, it’s more private and secure [than in-person settings].
I guess some people are a bit, I don’t know, iffy about buying them themselves, I don’t know. So I just thought, oh, actually, it’s kind of like a private way of getting this stuff, I thought from that side of it, it was quite cool.
Condom carrier
The condom carrier had mixed reviews. Of those who were offered and ordered the carrier (8 out of 10), half were pleased with the product. They reported that the quality and style were good, and they appreciated its discreet nature, and multi-purpose function. Other participants, while thinking the idea was good, felt less positive about the quality and the usefulness of the product, and as a result didn’t use it.
So it was like discreet, and I could just have it around with me. And it’s also really useful, and I use it to store my cards in and everything like that, so it’s useful just to have it in there.
I wasn’t a massive fan, to be honest. I just put it straight in the drawer and haven’t used it. I know it’s supposed to be inconspicuous, but it’s a bit boring. I thought it would draw more attention to itself, and it was just not the most attractive thing to look at.
Video components
Of the 10 participants who accessed the intervention and had been assigned the video components, half told us that they didn’t engage with them. Some stated they were unaware of the videos and others chose not to watch them because of preconceptions that they would be ‘cheesy’ or irrelevant, mainly due to the name or description of the content.
Other than potentially bad acting and second-hand embarrassment not really – but I imagine they would be useful for someone less informed about sex.
Of the participants interviewed who did watch the ‘condom demonstration’ and ‘discussing condoms’ videos, one felt they were too long, but two participants felt the length was fine. They all liked the idea of video content and preferred this to purely written content. They also found the content to be well written, enjoyable and relatable.
It was very well thought out and scripted, and you could tell that everyone was trying to be as honest as they could … about everything. And it was almost similar to a conversation I would have with my friends.
Two of the participants did however comment that they felt the content was aimed at a younger, less experienced audience.
Potentially, I think it’s slightly aimed at younger people, but, yeah, I thought it was really interesting. And, yeah, I would quite like my sister, for example, who is a few years younger than me, to have seen that, growing up.
Only one participant remembered watching the ‘real-life’ videos. They recalled finding these interesting, educational and relatable.
But it was definitely something I looked through, because I was like, oh, this is really interesting. And it’s not – it was real people, and it’s not porn and it’s more for actual educational purposes, and I quite liked that. It wasn’t awkward, like watching the videos you watched in school, where you cringe a bit, because your teacher is there, and it just … Yeah, I felt comfortable to watch them.
Yeah, I definitely think I could, because it was like, well, they’re just normal people. They’re not people you think that are in porn, and they’re like naked, unrealistic and stuff. And the fact that it’s just kind of this could be an actual real-life situation, instead of the weird fantasies that I don’t really understand.
The remaining participants either reported that they had not watched the ‘real-life’ videos or could not remember if they had.
Aim 3: participant perceptions of whether the intervention changed their condom use, beliefs or behaviours
Theme 5: addressing condom beliefs, removing barriers and facilitating condom use
Participants who had received the Wrapped intervention largely said that it had positively altered their condom related beliefs and/or behaviour.
Subtheme 5.1: condom beliefs
Some participants already had positive views about condoms, and as such their views remained the same. One common theme was the increase of knowledge and awareness of condom variety attributed to the sample pack provided, and a move away from the belief that all condoms are the same. Furthermore, some participants said that their preconceived notion that condoms provided for free are poor quality had been shifted.
Yes, it was one of those, I just thought it’s a condom. How can there be like 25 more different varieties of them? But there is!
So, no, I’ve never been a fan [of condoms], but, obviously, you know the thin feel and stuff like that, it’s, I don’t know, made me more aware that it’s not just one glove-like fit. There’s so many different ones.
I don’t know why, but I’ve just, in the past, always just assumed that condoms that you get for free aren’t good quality, that unless you pay for the quality of condoms.
For many, the sample pack provided a unique opportunity to explore the variety of condoms without the associated barrier of cost. This allowed them to find a condom that suited them. These positive views were also reported to have had an impact on condom use.
I think it has, and it’s opened my eyes to go, there’s lots of different condoms out there, and maybe they might have helped me feel different, or them feel different. And it just – it kind of made me feel like it’s okay to explore. It’s a good, safe practicing thing that shouldn’t make the experience any worse, or make it in a bad way. So it’s just finding the right one that will be useful.
It was very good, and it had a nice variety, and it allowed you to figure out which ones would be more beneficial to you.
Yeah, definitely, knowing that there’s more different sizes and shapes. I think men are liars now. Yeah, definitely! It definitely has changed my outlook on using condoms, so it’s something that I’m always going to want to use now. It makes me want to use them, if anything, because I’ve never really been the type of person to use condoms, but now I’m definitely going to give them a try.
But for a couple of participants, the intervention wasn’t enough for them to change their views about condoms.
I: And did they change your views on condoms?
R: No, not really.
Subtheme 5.2: condom availability
The sample pack, and the subsequent opportunity to order condoms via the monthly ordering service, facilitated condom use by providing an online service that was viewed as private and removed the barrier of embarrassment associated with getting condoms in-person. This meant they had condoms readily available.
Well, before when I’ve – I used to have a c:card, and you would have to go into the pharmacy, and I used to find that quite awkward. Yeah, so having them delivered to your door is a lot easier.
Just because it’s that kind of embarrassment and going, oh, no, which one do I get?
Subtheme 5.3: carrying condoms
The condom carrier was not ordered by everyone who was allocated it (eight out of ten). Of those that did order, a few (all female) made comments about the intervention having empowered them to carry condoms and providing them with a way of doing this discreetly.
I just thought it was a really good idea to have them on you easily. Most of the time, it’s not really subtle to have condoms on you, is it? Everyone knows what the package looks like, so if you have it in a little purse-looking thing, I was like that’s a really good idea to be able to carry around normally, and not be worried that someone’s going to see it.
And it’s also very silly, but it’s just like, as a woman, just carrying around and I was like, oh, yeah, nice. I’ve got a little thingamy bag now, so I can carry it around.
Subtheme 5.4: discussing condoms with sexual partners
All participants who accessed the intervention and were assigned the discussing condoms content reported a positive impact on their confidence around this behaviour. Some expressed that they were already confident but that the intervention reinforced their position in condom discussions and further supported them to continue saying no to condomless sex. In one case, this was identified as specifically relevant when experiencing resistance from a partner to use condoms.
They [partners] always try to, like not use it, but then I just threaten them with like, well, I’m not going to do it then. [I feel] more confident to like to persuade the person to [use condoms now].
Other participants explicitly reported that they felt more confident initiating or holding discussion about condom use than they did before. One participant specifically stated that they felt the videos had provided phrases to use that would facilitate future condom use and another commented that the intervention had led them to reframe condom use as something that they would be less ‘discussing’, more ‘insisting’ on in the future.
I’m more comfortable talking about it, probably.
Yeah, I’m more confident in discussing it now. Well, it’s like not really discussing it, and I’m like, right, but it’s allowed me to think, right, I’m going to, because that’s what I want to do. But also I’m not afraid to actually bring it up, and discuss what I want to.
Maybe a little bit, and I think there were some good lines in there that were, like, oh, actually, they’d be good lines to steal, to use in the future.
I definitely feel like it made me feel more okay to go, this is what I want.
Subtheme 5.5: condom-use behaviour
When participants assigned the Wrapped intervention were explicitly asked whether it had had an impact on their condom use, while some said that they already use condoms, others said they now use them (when they did not previously) or used them more often. A minority reported that they continued to not use them.
I definitely use them a lot more frequently than I ever had in the past, and they’ve made me a lot more aware to have them on hand.
Yeah, I’ve definitely tried to use them more often.
I would say I’m 95 per cent sure those [condoms] that have been used have been part of the study.
Additional findings
Findings that did not directly answer any one of the three aims outlined above but were thought to provide valuable insight into other related issues concerning participation and sexual health, are included in Report Supplementary Material 12. Themes include feelings about the research and the research team; the control website being informative but not persuasive; and wider impact of the research study.
Qualitative comments from month 12 survey
At the end of the M12 survey, participants were invited to provide written comments (‘good or bad’) about participating in the study or about the surveys. These qualitative data add further process evaluation data to the qualitative interviews. A total of 45 participants (23.4%) responded to this item. Almost half of responses included reference to participation as enjoyable. Typical comments included ‘It’s a really interesting study and I’m happy to be part of it!’ and ‘I’ve enjoyed taking part in this project’. Participants also expressed keenness to hear the results and to learn of any future opportunities to take part in research. Responses conveyed finding the research team supportive and friendly and the ease of taking part, for example ‘Really great help and support if needed. Easily understood all parts of it’ and ‘The study was run by a super supportive team who were always quick to help with any issues. Thanks guys!’. Several participants detailed that they had experienced a change in their condom-use beliefs and behaviours because of participation, including an increase in knowledge, confidence and use, such as ‘Made me much more comfortable wearing condoms’ and ‘Positive impact. Made me more aware of condom usage & found a condom both my partner and I enjoy’. Comments also reinforced recruitment and retention strategy decisions, such as ‘Great communication in regards to sending emails, calls, and voicemails. Enough time was given to complete particular tasks and reminders were sent after a reasonable period of time. The reminders were not overbearing or continually sent’. None of the comments received were negative but a few participants offered constructive suggestions for improvements to the study, such as the addition of a back button on the surveys, adding additional survey items (to measure contraceptive use) or clarifying existing items, and wanting to be able to allow friends to take part in the research so they could benefit from it as well. One participant reported, ‘Taking part in the research while in a relationship made me feel uncomfortable but my partner was understanding’.