J Med Internet Res. 2025 Dec 12. doi: 10.2196/84393. Online ahead of print.
ABSTRACT
BACKGROUND: Cisgender lesbian, bisexual, and queer (LBQ+) women of color (WOC) experience barriers to accessing sexual and reproductive health (SRH) services in the United States (US). Barriers, including limited provider access and poor patient-provider communication, contribute to underutilization of SRH services and poorer outcomes compared to heterosexual counterparts. Digital health modalities, including telemedicine, mobile health, and artificial intelligence (AI)-enabled chatbots, offer potential to expand access to SRH information and services among LBQ+ WOC.
OBJECTIVE: This study investigated current use, influencing factors, acceptability, and concerns regarding digital health modalities (video calls, SMS text messaging, mobile apps) and AI-enabled chatbots to support SRH information and service access among LBQ+ WOC in the US. It also assessed awareness and knowledge of HPV and cervical cancer prevention, and attitudes toward HIV prevention medication.
METHODS: A self-administered online survey was conducted from November 2020 to March 2021 with 285 LBQ+ WOC (aged ≥18 years) residing in the US. The 88-item survey assessed digital health use, SRH knowledge and awareness, and acceptability of and concerns about digital health use for SRH information and services. Data were analyzed using descriptive statistics, Fisher’s exact tests, multivariable logistic regression, and thematic analysis.
RESULTS: Most respondents were comfortable using video calls (81.8%) to communicate with a healthcare provider for SRH support. Respondents with a bachelor’s degree or higher (95% CI 0.00-0.24, P < .001), with health insurance (95% CI 56.1-1025.7, P < .001), and without a usual place of care (95% CI 0.07-0.43, P < .001) were significantly more likely to agree with using video calls. Respondents with a bachelor’s degree or higher (95% CI 0.23-0.74, P < .001), aged <45 years (95% CI 0.07-0.25, P < .001), and with health insurance (95% CI 3.23-12.45, P < .001) were significantly more likely to agree with using a mobile app. Respondents ≥45 years (95% CI 0.14-0.53, P < .001), without health insurance (95% CI 0.01-0.06, P < .001), and with an income < $49,000 (95% CI 1.32-3.93, P < .001) were significantly more likely to agree with the use of SMS text messaging. High acceptance was reported for using chatbots to self-assess risk for sexually transmitted infections (80.3%), but lower acceptance for self-assessing cervical cancer risk (47.8%). Key concerns included data privacy and confidentiality, lack of affective communication, and technology connectivity and digital literacy issues. Respondents also demonstrated low knowledge of HPV and cervical cancer prevention.
CONCLUSIONS: Digital health was highly acceptable for supporting access to SRH information and services among LBQ+ WOC. Culturally tailored, digital tools and interventions could improve awareness, knowledge, and attitudes toward SRH services. Addressing varying levels of digital literacy, concerns about data privacy, technology access, and affective communication when developing digital health solutions may help to advance SRH equity among LBQ+ WOC.
PMID:41388972 | DOI:10.2196/84393
