Acceptability and Use of Digital Health and Artificial Intelligence-Enabled Chatbots for Sexual and Reproductive Health Among Lesbian, Bisexual, and Queer Women of Color in the United States: Cross-Sectional Survey Study.

Background: Cisgender lesbian, bisexual, and queer (LBQ+) women of color experience barriers to accessing sexual and reproductive health (SRH) services in the United States. Barriers, including limited provider access and poor patient-provider communication, contribute to SRH service underutilization and poorer outcomes among these women than their heterosexual counterparts. Digital health modalities, including telemedicine, mobile health, and chatbots enabled by artificial intelligence (AI), offer potential to expand access to SRH information and services among these women. Objective: This study investigated the influencing factors, acceptability, and concerns regarding the use of digital health modalities (video calls, SMS text messaging, and mobile apps) and AI-enabled chatbots to support SRH information and service access among LBQ+ women of color in the United States. It also assessed their awareness and knowledge of human papillomavirus (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+ women of color (aged ≥18 years) residing in the United States. 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 exact tests, multivariable logistic regression, and thematic analysis. Results: Most respondents (233/285, 81.8%) were comfortable using video calls to communicate with health care providers for SRH support. Respondents with a bachelor's degree or higher (95% CI 0.00-0.24), with health insurance (95% CI 56.1-1025.7), and without a usual place of care (95% CI 0.07-0.43) were significantly (P<.001) more likely to agree with using video calls. Respondents with a bachelor's degree or higher (95% CI 0.23-0.74), aged <45 years (95% CI 0.07-0.25), and with health insurance (95% CI 3.23-12.45) were significantly (P<.001) more likely to agree with using mobile apps. Respondents aged ≥45 years (95% CI 0.14-0.53), without health insurance (95% CI 0.01-0.06), and with an income of <US $49,000 (95% CI 1.32-3.93) were significantly (P<.001) more likely to agree with the use of SMS text messaging. There was high acceptance of using chatbots for self-assessing sexually transmitted infection risk (229/285, 80.3%) but lower acceptance for self-assessing cervical cancer risk (136/285, 47.7%). 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+ women of color. Culturally tailored digital tools and interventions could improve awareness, knowledge, and attitudes toward SRH services. Addressing various digital literacy levels, data privacy concerns, and technology access and communication issues when developing digital health solutions may advance SRH equity among LBQ+ women of color.