JMIR Publications

ABSTRACT

Background:

Digital health interventions could enhance sexual health equity for marginalized and underserved populations, including displaced youth. However, there is limited understanding of displaced youth’s digital health literacy (DHL) and its association with knowledge of and access to sexual health products and services.

Objective:

Identify patterns of DHL among displaced youth and assess how these patterns are associated with awareness of and access to sexual health products and services, while accounting for gender to inform the future design of tailored digital sexual health equity interventions.

Methods:

We conducted a cross-sectional, tablet-assisted survey in Kampala, Uganda. We employed peer-driven sampling to recruit displaced youth aged 16-24 years living in five informal urban settlements (Kabalagala, Kasanga, Katwe, Nsambya, and Rubaga). We used latent profile analysis (LPA) to identify DHL patterns using the eHealth Literacy Scale. Gender-disaggregated multivariate probit models were constructed to estimate the relationship between DHL and awareness of, as well as access to sexual health products and services within the past 3-month (e.g., sexual and reproductive health [SRH] information, external condoms, condom use training, sexually transmitted infection (STI) testing and HIV testing).

Results:

Among participants (n = 445; mean age = 19.59 years, SD = 2.60; young women: n = 333; 74.7%), our LPA identified four DHL classes named: low (Class 1, n = 51, 11.5%), moderate (Class 2, n = 99, 22.2%), high (Class 3, n = 138, 31%), and very high (Class 4, n = 157, 35.3%). Our adjusted multivariate probit model indicated that, compared to Class 1 participants, Class 4 participants were more likely to know where to access condom use training, external condoms and HIV testing. We also noted gender-based differences: compared to men with low DHL, men with very high DHL were more likely to know where to access SRH information and condom use training, while women with very high DHL were more likely than those with low DHL to report knowing how to access condom use training, external condoms and HIV testing. Regarding access to sexual health products and services in the last 3 months, Class 4 respondents reported higher access to condom use training, external condoms, and HIV testing compared to Class 1 respondents. Gender differences showed that among men, compared to those with low DHL, those with very high DHL were more likely to access condom use training. In contrast, among women, those with very high DHL were less likely to access SRH information.

Conclusions:

Our findings reveal a generally high level of DHL but suboptimal awareness of and access to SRH services among urban displaced youth in Kampala. Marginalized and underserved individuals with limited access and skills to utilize digital sexual health technologies face the risk of digital marginalization, which may exacerbate sexual health inequities. Improving sexual and reproductive health and rights among urban displaced populations will require gender-responsive and culturally grounded digital sexual health interventions to increase their awareness of and access to sexual health products and services. Thus, these findings signal the urgent need for new insights into leveraging emerging technologies in the future design of tailored HIV prevention interventions.