JMIR Publications

ABSTRACT

Background:

Cisgender lesbian, bisexual, and queer (LBQ+) women of color (WOC) experience barriers to accessing sexual and reproductive health (SRH) services in the U.S. Barriers such as lack of health insurance, less access to healthcare providers, and discrimination in healthcare settings prevent LBQ+ WOC from utilizing sexual and reproductive healthcare. Compared to their heterosexual counterparts, they report higher rates of poor SRH outcomes. Digital health, including telemedicine, mHealth, and artificial intelligence-enabled chatbots, may help facilitate access and uptake of SRH information and services among LBQ+ WOC.

Objective:

This study investigated attitudes toward sexually transmitted infection (STI) and cervical cancer prevention methods and the acceptability and concerns of using digital health, including telemedicine (e.g., video calls on a mobile phone), mHealth (a mobile app, text messaging), and artificial intelligence-enabled chatbots to promote sexual and reproductive healthcare uptake and access to SRH information among LBQ+ WOC in the U.S.

Methods:

A cross-sectional, self-administered online survey was launched in November 2020 and closed in March 2021. Cisgender WOC (aged ≥18 years) who identified as lesbian, bisexual, queer, or women who have sex with women living in the U.S. were eligible to participate. The survey consisted of 88 questions, covering topics such as mobile phone and chatbot use, awareness and attitudes toward using HIV prevention medication, awareness and knowledge of HPV and cervical cancer prevention, and the acceptability and concerns associated with using digital health modalities to facilitate access to and uptake of SRH services and information. The data were analyzed using descriptive statistics, inferential statistics, and thematic analysis.

Results:

The findings (N=285) showed that LBQ+ WOC were most comfortable using video calls to communicate with a healthcare provider (81.8%) to receive support utilizing sexual and reproductive health services compared to a mobile app (61.8%) and SMS text messages (43.2%). Respondents showed high acceptance of the use of a chatbot (86.7%) to self-assess the risk of acquiring STIs (80.3%). Respondents with a bachelor’s degree or higher were more likely to be comfortable with the use of a video call or mobile app to communicate with a healthcare provider to receive support utilizing SRH services than those with less than a bachelor’s degree (P<.001). The primary concerns were data privacy and confidentiality, lack of affective communication, and technology connectivity and adoption issues. Finally, LBQ+ WOC reported low awareness and knowledge of HIV, HPV, and cervical cancer prevention.

Conclusions:

The results suggest that LBQ+ WOC hold favorable views of digital health, including chatbots, as a means of supporting sexual and reproductive healthcare uptake and engagement. Culturally tailored digital health equity interventions that utilize digital health be advantageous for improving sexual and reproductive knowledge, access, and uptake of SRH services among LBQ+ WOC. Future work should consider the design preferences and SRH information needs of LBQ+ WOC and address digital literacy and technology access.