Development of an HPV Self-Collection Brochure for Unhoused Individuals Using Learner Verification and Revision

Individuals who are unhoused face disproportionately high rates of cervical cancer incidence and multiple barriers to screening, yet tailored educational materials to support human papillomavirus (HPV) self-collection in this population remain scarce. To address this gap, we conducted a sequential, two-phased qualitative study using Learner Verification and Revision methodology to iteratively develop and refine an instructional brochure on HPV self-collection designed for, and with, individuals who are unhoused. We first conducted focus groups with community health educators (n = 6) and street medicine team members (n = 12), followed by semi-structured interviews with individuals who were unhoused (n = 19) and had participated in an HPV self-collection pilot study. Data collection assessed comprehension, attraction, cultural-linguistic acceptability, and persuasion of the brochure, with trauma-informed care as an additional domain, and transcripts were analyzed using thematic analysis. Participants broadly found the brochure clear, visually appealing, and easy to follow, while identifying key areas for refinement, including greater brevity, more inclusive visuals, regional Spanish vocabulary adaptation, and language modifications to strengthen trustworthiness and empowerment. Street medicine team members emphasized that the brochure best complements verbal counseling rather than serving as a standalone resource. This community-engaged, iterative process yielded a tailored, trauma-informed educational tool which is publicly available and editable. As HPV self-collection expands across the United States, such materials will be valuable to support equitable access to cervical cancer screening.