Very Low Uptake in Workplace Semen Analysis Research: Formative Web-Based Cross-Sectional Follow-Up Survey Distinguishing Employees With Self-Reported Unawareness From Aware Nonparticipants.

Background: Very low uptake in workplace semen analysis research is difficult to interpret, particularly in employer-adjacent settings, where nonparticipation may reflect limited recruitment reach, limited understanding of the occupational rationale, low perceived relevance, or procedure-related concerns. Objective: This post hoc formative study described self-reported awareness of a parent workplace semen analysis study as an indicator of effective recruitment reach, reported reasons for nonparticipation under the implemented survey condition, and design issues for exposure-defined workplace reproductive health research. Methods: In April-May 2025, we conducted an anonymous web-based cross-sectional follow-up survey among male employees in Japan who had been eligible for, but had not completed, a parent workplace semen analysis study. The parent study invited approximately 2000 male employees from 3 companies between November 2024 and January 2025; 6 completed the protocol. The follow-up survey invited approximately 900 male employees from 1 company. Part 1 assessed awareness, reasons for nonparticipation, interest in male reproductive health information, and general openness to future related research. Optional Part 2 assessed age, knowledge, concerns, expected reactions, and willingness under simplified conditions. Responses were summarized descriptively using Wilson 95% CIs; no hypothesis testing was performed. Results: We analyzed 108 submitted questionnaires; 83 respondents completed Part 2. Overall, 74/108 (68.5%; 95% CI 59.3-76.5) respondents reported no awareness of the parent study. Among unaware respondents, 68/74 (91.9%; 95% CI 83.4-96.2) selected "did not know the study existed." Among aware nonparticipants, the most frequent reasons were perceived irrelevance and resistance to collecting semen (each 9/34, 26.5%; 95% CI 14.6-43.1), embarrassment or reluctance (8/34, 23.5%; 95% CI 12.4-40), and hassle (7/34, 20.6%; 95% CI 10.3-36.8). In Part 2, anxiety about unfavorable results was reported by 52/83 (62.7%; 95% CI 51.9-72.3) respondents, concerns about collection location or privacy protection by 48/83 (57.8%; 95% CI 47.1-67.9), and self-reported resistance by 42/83 (50.6%; 95% CI 40.1-61.1). Under simplified conditions, 36/83 (43.4%; 95% CI 33.2-54.1) respondents indicated willingness to undergo semen analysis. Conclusions: Very low uptake in this employer-adjacent semen analysis study was not interpretable as a single phenomenon. This post hoc formative process evaluation identified limited awareness, suggesting limited effective recruitment reach under the implemented procedures, and characterized the reason profile among aware nonparticipants, including low perceived relevance and semen collection-related concerns. Rather than identifying primary causal determinants of nonparticipation, the findings support a bounded recruitment-methodological interpretation and highlight recruitment-cascade components for prospective measurement: objective exposure to recruitment materials, information access, understanding of the occupational rationale, voluntary postinformation declination, privacy concerns, logistical burden, and specimen-return completion. Informed acceptability after occupational reproductive-hazard education should be evaluated in future designs that include such education and comprehension assessment.