Megan Threats

BACKGROUND There are increasing interests in developing AI tools to identify and address individual-level social determinants of health in both health care and human service settings. These activities are part of social care integration, which at the individual level involves identifying individuals with social risks (awareness) and connecting them with relevant social care resources (assistance). Social care providers such as community health workers and social workers are deemed critical stakeholders in both settings. Chatbots have shown feasibility and acceptability for social risk screening in emergency departments and primary care centers. However, we do not know if a screening chatbot is worth developing for the safety net health care and human service settings, where there are visitors with greater social needs and less organizational resources. OBJECTIVE The study aims to investigate the perceived value proposition of an AI-based chatbot for social risk screening from the perspectives of social care providers in safety net health care and human service organizations. Providers’ perceived value propositions of other AI-based applications for social care integration were also examined. METHODS We conducted semi-structured interviews with 19 social care providers who have experience with awareness and/or assistance from 16 safety net health care and human service organizations in Michigan. Interview questions focused on their experiences and challenges regarding awareness and assistance when applicable. A simulated screening chatbot based on ChatGPT-4o was also used to solicit their feedback on the technology. The nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework was used to guide data analysis. Interview transcripts were first coded deductively, then inductively. RESULTS Social care providers perceived the screening chatbot as offering limited value. This is mainly because many participants engaged in assistance activities and they noted addressing social needs is a multi-step process requiring follow-up that screening chatbots do not provide. In addition, they valued cultivating trust as many patients/clients have high social needs and lack trust in the health care system, and felt chatbots present new challenges for maintaining essential trust and care quality with clients/patients. Instead of a screening chatbot, we identified that technologies to reduce documentation burden could improve providers’ efficiency and potentially increase time spent with patients/clients. This is because social risks and needs documentation generates administrative burden for providers. We also found that technologies to improve referral accuracy and engagement could improve providers’ effectiveness, as study participants have overall limited access to technologies that typically support referral-related activities. CONCLUSIONS Social care providers in the safety net preferred AI-based applications for addressing documentation burden and social needs assistance rather than for social risk screening. Future strategies to develop AI tools for social care integration should align with social care providers’ professional values and focus on equity-centered care.

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 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 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.

This study investigated the acceptability of using digital health, including telemedicine (e.g., video calls on a computer or smartphone), mHealth (a mobile app, text messaging, and social media messages), and artificial intelligence-enabled chatbots to communicate health information and facilitate access and uptake of sexual and reproductive healthcare among lesbian, bisexual, and queer (LBQ+) women of color (WOC) in the United States.

Black Twitter, now operating on X (formerly Twitter), is a crucial online platform that shapes cultural production, political activism, and educational exchange within the global Black community. This study broadens the scope to examine the global influence of Black Twitter, with a focus on the hashtag #diasporawars. This hashtag serves as a lens through which we can observe the tensions and interactions across the global Black community. Black Twitter’s significance extends beyond the United States, deeply embedded in the historical and cultural contexts of Blackness, which inform global conversations on identity. By employing both quantitative and qualitative research methods to analyze #diasporawars, this study aims to shed light on the complexities of global Blackness and how social media platforms contribute to shaping these identities and connections. Our findings reveal that #diasporawars reflects broader dynamics within the global Black community, highlighting how platforms like X both facilitate positive engagement and exacerbate conflicts. This research underscores the multifaceted nature of Black digital spaces, illustrating how they serve as arenas for collaboration and contention, influenced by diverse experiences and perspectives within the global Black diaspora.

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 : From November 2020 to March 2021, 350 LBQ+ WOC in the U.S. were recruited through social media and emails sent via listservs to complete a self-administered, web-based survey. The survey collected sociodemographic data and consisted of questions regarding 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 of using digital health modalities to facilitate access and uptake of SRH services and information. The data was analyzed using descriptive statistics and thematic analysis. RESULTS The findings (N=135) showed that LBQ+ WOC were most comfortable using video calls to communicate with a healthcare provider (79%) to receive support utilizing sexual and reproductive health services compared to a mobile app (65%) or SMS text messages (43%). Respondents showed high acceptance of the use of a chatbot (86.7%) to self-assess the risk for cervical and 88.9% to self-assess the risk of acquiring STIs. The results revealed high levels of agreement that a mobile app tailored to the information needs of LBQ+ WOC would increase comfort in seeking SRH services (89.6%). There was high acceptability for using a chatbot (84.4%) and SMS text messages (80%) to obtain SRH information during health crises. 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 interventions that utilize chatbots and mHealth would be advantageous for improving sexual and reproductive knowledge, access, and uptake of these critical services among LBQ+ WOC. Future work should consider the user-centered design preferences and SRH information needs of LBQ+ WOC and address technology access and adoption issues.

Using intersectionality as a critical theoretical framework and analytical tool, this study investigated the HIV/AIDS information practices of Black sexual minority men (SMM). Twenty‐two Black SMM were interviewed about their HIV/AIDS‐related information practices. The resulting data were analyzed inductively using methods influenced by constructivist grounded theory. I propose information resilience as a strengths‐based concept to describe protective and promotive information practices that focus on meeting individual or community‐centric goals despite intersectional stigma and discrimination. Anticipated and experienced intersectional stigma and discrimination were the key motivators for protective information practices among Black SMM. Promotive factors, including peer support and self‐efficacy, shaped promotive information practices to foster development and enhance well‐being. The findings have implications for the incorporation of intersectionality theory into information practices research, contribute to theoretical development in the field of library and information science, and have implications for the design of information and technology‐based HIV prevention and treatment interventions to address intersectional discrimination and its impact on Black sexual minority men.

In the United States, racial/ethnic and sexual youth and young adults (YYA) of color are disproportionately affected by HIV. Subsequently, YYA experience HIV stigma and engage in increased risk behaviors and reduced HIV testing. HIV communication has been identified as a potential buffer to HIV stigma, resulting in health-seeking behaviors, such as HIV testing. In this study, we respond to a meaningful gap in the literature by examining different types of HIV communication and their impact on HIV stigma and HIV testing in a diverse sample of YYA. We analyzed secondary data from the Kaiser Family Foundation National Survey of Teens and Young Adults on HIV/AIDS. A 40-question, web-based survey was conducted with 1437 youth (ages 15–24). Recruitment included a dual sampling method from households with: (1) listed phone numbers, (2) unlisted phone numbers, (3) telephones, (4) no telephone, and (5) only cell phone access. The purpose of the survey was to establish participants’ HIV knowledge, communication, experiences, and testing behaviors. Findings suggested an association between intimate-partner HIV communication, increased HIV testing, and reduced HIV stigma. We also identified differentials in HIV testing and stigma based on gender, income, age, and sexual minority status, explained by HIV communication. Further research is needed that examines ways to use intimate-partner HIV communication to reduce stigma and increase HIV testing among YYA of different sociodemographic characteristics and sexual orientations.

Young Black gay and bisexual men who have sex with men experience stigma related to race, gender expression, sexuality and HIV status. Stigma impacts access to HIV care and prevention as well as interactions with healthcare providers. The amplification of stigma through popular media is under-researched in the health sciences. HealthMpowerment is a mobile phone optimised intervention to reduce sexual risk and support community-building for young Black gay and bisexual men (age 18–30). We analysed Forum conversations from 48 participants, 45.8% living with HIV. Of 322 stigma-relevant conversations, 18.9% referenced the media (e.g. television, news, social media) as a source of stigma. Forum conversations covered media representations of Black gay and bisexual men, media’s influence on identity, and the creation of stigma by association with media representations. Cultural messages embedded in the media may accentuate stereotypes that influence perceptions of Black gay and bisexual men and disregard intersectional identities. HealthMpowerment provided a space to challenge stigmatising representations. Participants used HealthMpowerment to garner social support and celebrate positive media representations. Interventions for young Black gay and bisexual men should consider the influential role of media and include spaces for participants to process and address stigma.

Background: HIV disproportionately affects young Black men who have sex with men (YBMSM) in the United States. eHealth holds potential for supporting linkage and engagement in HIV prevention and care and the delivery of HIV information to YBMSM. Objective: This study aims to investigate HIV information acquisition and use among YBMSM who use the internet. Methods: A web-based self-administered survey and semistructured interviews were conducted. The survey findings informed the development of the interview guide. Descriptive statistics were used to characterize the survey sample, and interview data were analyzed thematically using modified grounded theory methodologies. Results: Among the internet sample (N=83), the average age was 29.2 (SD 3.5) years, 41% (n=34) of participants self-reported living with HIV, 43% (n=36) were HIV-negative, and 15% (n=13) were unsure of their HIV status. Most participants (n=79, 95%) acquired HIV information through the internet while using a mobile phone. Web-based HIV information was intentionally sought from consumer health information websites (n=31, 37%), government health information websites (n=25, 30%), and social media (n=14, 17%). Most men incidentally acquired HIV information via advertisements on social media sites and geospatial dating apps (n=54, 65%), posts on social media sites from their web-based social ties (n=44, 53%), and advertisements while browsing the internet (n=40, 48%). Although the internet is the top source of HIV information, health care providers were the most preferred (n=42, 50%) and trusted (n=80, 96%) source of HIV information. HIV information was used to facilitate the use of HIV prevention and care services. The qualitative sample included YBMSM across a range of ages and at different points of engagement in HIV prevention and care. Qualitative findings included the importance of the internet as a primary source of HIV information. The internet was used because of its ease of accessibility, because of its ability to maintain anonymity while searching for sensitive information, and to mitigate intersecting stigmas in health care settings. Participants used HIV information to assess their risk for HIV and AIDS, support their skill building for HIV prevention, inform patient–doctor communication, and learn about HIV prevention and treatment options. Men expressed concerns about their diminishing access to online spaces for HIV information exchange among YBMSM because of censorship policies on social media sites and the stigmatizing framing and tone of mass media HIV-prevention advertisements encountered while using the internet. Conclusions: YBMSM in this sample had high utilization of eHealth for HIV information acquisition and use but diminished access to their preferred and most trusted source of HIV information: health care providers. Future eHealth-based HIV interventions culturally tailored for YBMSM should aim to reduce intersectional stigma at the point of care and support patient–provider communication. The findings demonstrate the need for community-informed, culturally tailored HIV messaging and online spaces for informational support exchange among YBMSM.