Appropriate and Acceptable? A Mixed Methods Study of a “Smart” Harm Reduction Vending Machine in Pennsylvania

Nonmedical opioid use and opioid-related overdose remain among the most pressing public health and criminal justice crises in the United States. While access to evidence-based harm reduction interventions, such as take-home naloxone and drug testing strips, has increased over the past decade, gaps in access persist, particularly outside urban areas. Harm reduction vending machines represent an emerging model for addressing the overdose epidemic in underserviced communities; however, relatively little is known about their usage for this application in the United States. Furthermore, interactive “smart” vending machines (SVM) can also help connect individuals to care, collect data on usage, and administer surveys to further evaluate needs. Combining SVM-collected quantitative data with interviews and focus groups among clients of a new SVM in Pennsylvania, this convergent mixed methods study describes the perceived fit of the SVM model for its location (appropriateness), while characterizing the clients’ experience (acceptability) and the degree to which clients engaged with the SVM as intended (fidelity). Among 26 qualitative participants, nearly all identified the SVM as filling a crucial gap for accessible health, hygiene, and harm reduction items needed by community members. Despite recurring shortages of popular items, the SVM model was praised for its convenience and discretion. Some clients were unaware of the SVM's interactive features and, therefore, did not use them as intended, highlighting opportunities to enhance the client experience and fidelity with the SVM. Advertising SVM services and engaging with the community may help increase uptake of SVM's innovative features.