The impact of Chatbot-Assisted Self Assessment (CASA) on intentions for sexual health screening in people from minoritised ethnic groups at risk of sexually transmitted infections

Tom Nadarzynski; Nicky Knights; Deborah Husbands; Cynthia A. Graham; Carrie D. Llewellyn; Tom Buchanan; Ian Montgomery; Nuha Khlafa; Jana Tichackova; Riliwan Odeyemi; Samantha Johnson; Neomi Jesuthas; Syeda Tahia; Damien Ridge

doi:10.1071/SH24058

RESEARCH ARTICLE

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The impact of Chatbot-Assisted Self Assessment (CASA) on intentions for sexual health screening in people from minoritised ethnic groups at risk of sexually transmitted infections

Tom Nadarzynski

^A ^# ^* , Nicky Knights ^A ^# , Deborah Husbands ^A , Cynthia A. Graham ^B , Carrie D. Llewellyn ^C , Tom Buchanan ^A , Ian Montgomery ^D , Nuha Khlafa ^A , Jana Tichackova ^A , Riliwan Odeyemi ^A , Samantha Johnson ^A , Neomi Jesuthas ^A , Syeda Tahia

^A and Damien Ridge

^A

+ Author Affiliations

- Author Affiliations

^A School of Social Sciences, University of Westminster, London, UK.

^B Kinsey Institute, Indiana University, Bloomington, IN, USA.

^C Brighton and Sussex Medical School, University of Sussex, Brighton, UK.

^D Positive East, London, UK.

^* Correspondence to: T.Nadarzynski@westminster.ac.uk

^# These authors contributed equally to this paper

Handling Editor: Dan Wu

Sexual Health 21, SH24058 https://doi.org/10.1071/SH24058

Submitted: 18 March 2024 Accepted: 28 June 2024 Published: 25 July 2024

Abstract

Background

Sexually transmitted infections (STIs) present a significant global public health issue, with disparities in STI rates often observed across ethnic groups. The study investigates the impact of Chatbot-Assisted Self Assessment (CASA) on the intentions for sexual health screening within minoritised ethnic groups (MEGs) at risk of STIs as well as the subsequent use of a chatbot for booking STI screening.

Methods

A simulation within-subject design was utilised to evaluate the effect of CASA on intentions for STI/HIV screening, concern about STIs, and attitudes towards STI screening. Screening intentions served as the dependent variable, while demographic and behavioural factors related to STI/HIV risk were the independent variables. ANCOVA tests were conducted to measure the impact of CASA on these perceptions.

Results

Involving 548 participants (54% women, 66% black, average age = 30 years), the study found that CASA positively influenced screening intentions t(547) = −10.3, P < 0.001], concerns about STIs t(544) = −4.96, P < 0.001, and attitudes towards sexual health screening [t(543) = −4.36, P < 0.001. Positive attitudes towards CASA were observed (mean, 13.30; s.d., 6.73; range, −17 to 21). About 72% of users who booked STI screening appointments via chatbot were from MEGs.

Conclusion

CASA increased motivations for STI screening intentions among ethnically diverse communities. The intervention’s non-judgemental nature and the chatbot’s ability to emulate sexual history-taking were critical in fostering an environment conducive to behavioural intention change. The study’s high acceptability indicates the potential for broader application in digital health interventions. However, the limitation of not tracking actual post-intervention behaviour warrants further investigation into CASA’s real-world efficacy.

Keywords: AI, artificial intelligence, behaviour change, chatbot, natural language processing, risk assessment, self-assessment, sexual health, sexually transmitted disease, sexually transmitted infections, virtual assistant.

References

1 World Health Organization. Global health sector strategy on sexually transmitted infections 2016–2021. 2016. Available at https://www.paho.org/en/documents/global-health-sector-strategy-sexually-transmitted-infections-2016-2021-towards-ending#:~:text=The%20present%20global%20health%20sector,goals%2C%20targets%2C%20guiding%20principles%20and [Retrieved 1 November 2023]

2 Fu L, Sun Y, Han M, Wang B, Xiao F, Zhou Y, Gao Y, Fitzpatrick T, Yuan T, Li P, Zhan Y, Lu Y, Luo G, Duan J, Hong Z, Fairley CK, Zhang T, Zhao J, Zou H. Incidence trends of five common sexually transmitted infections excluding HIV from 1990 to 2019 at the global, regional, and national levels: results from the Global Burden of Disease Study 2019. Front Med 2022; 9: 851635.
| Crossref | Google Scholar |

3 Lieberman JA, Cannon CA, Bourassa LA. Laboratory perspective on racial disparities in sexually transmitted infections. J Appl Lab Med 2021; 6(1): 264-273.
| Crossref | Google Scholar |

4 Public Health England. Public Health England COVID-19: impact on STIs, HIV and viral hepatitis. 2020. Available at https://www.gov.uk/government/publications/covid-19-impact-on-stis-hiv-and-viral-hepatitis [Retrieved 1 November 2023]

5 Wayal S, Hughes G, Sonnenberg P, Mohammed H, Copas AJ, Gerressu M, Tanton C, Furegato M, Mercer CH. Ethnic variations in sexual behaviours and sexual health markers: findings from the third British National Survey of Sexual Attitudes and Lifestyles (Natsal-3). Lancet Public Health 2017; 2(10): e458-e472.
| Crossref | Google Scholar | PubMed |

6 FitzGerald C, Hurst S. Implicit bias in healthcare professionals: a systematic review. BMC Med Ethics 2017; 18(1): 1-18.
| Crossref | Google Scholar |

7 Hunt D-W, Dhairyawan R, Sowemimo A, Nadarzynski T, Nwaosu U, Briscoe-Palmer S, Heskin J, Lander F, Rashid T. Sexual health in the UK: the experience of racially minoritised communities and the need for stakeholder input. Sex Transm Infect 2023; 99(3): 211-212.
| Crossref | Google Scholar | PubMed |

8 Whelan I, Strachan S, Apea V, Orkin C, Paparini S. Barriers and facilitators to HIV pre-exposure prophylaxis for cisgender and transgender women in the UK. Lancet HIV 2023; 10: e472-e481.
| Crossref | Google Scholar |

9 Nwaosu U, Raymond-Williams R, Meyrick J. Are psychosocial interventions effective at increasing condom use among Black men? A systematic review. Int J STD AIDS 2021; 32(12): 1088-1105.
| Crossref | Google Scholar | PubMed |

10 Sumray K, Lloyd KC, Estcourt CS, Burns F, Gibbs J. Access to, usage and clinical outcomes of, online postal sexually transmitted infection services: a scoping review. Sex Transm Infect 2022; 98(7): 528-535.
| Crossref | Google Scholar | PubMed |

11 Brayboy LM, McCoy K, Thamotharan S, Zhu E, Gil G, Houck C. The use of technology in the sexual health education especially among minority adolescent girls in the United States. Curr Opin Obstet Gynecol 2018; 30(5): 305-309.
| Crossref | Google Scholar | PubMed |

12 Teadt S, Burns JC, Montgomery TM, Darbes L. African American adolescents and young adults, new media, and sexual health: scoping review. JMIR Mhealth Uhealth 2020; 8(10): e19459.
| Crossref | Google Scholar | PubMed |

13 Owusu MW, De Mesa MEF, Mohammed H, Gerressu M, Hughes G, Mercer CH. Race to address sexual health inequalities among people of Black Caribbean heritage: could co-production lead to more culturally appropriate guidance and practice? Sex Transm Infect 2023; 99: 293-295.
| Crossref | Google Scholar |

14 Balaji D, He L, Giani S, Bosse T, Wiers R, de Bruijn G-J. Effectiveness and acceptability of conversational agents for sexual health promotion: a systematic review and meta-analysis. Sex Health 2022; 19(5): 391-405.
| Crossref | Google Scholar | PubMed |

15 Young SD, Crowley JS, Vermund SH. Artificial intelligence and sexual health in the USA. Lancet Digit Health 2021; 3(8): e467-e468.
| Crossref | Google Scholar | PubMed |

16 Nadarzynski T, Lunt A, Knights N, Bayley J, Llewellyn C. “But can chatbots understand sex?” Attitudes towards artificial intelligence chatbots amongst sexual and reproductive health professionals: an exploratory mixed-methods study. Int J STD AIDS 2023; 19: 391-405.
| Crossref | Google Scholar |

17 Mills R, Mangone ER, Lesh N, Mohan D, Baraitser P. Chatbots to improve sexual and reproductive health: realist synthesis. J Med Internet Res 2023; 25: e46761.
| Crossref | Google Scholar | PubMed |

18 Nadarzynski T, Knights N, Husbands D, Graham CG, Llewellyn CD, Buchanan T, Montgomery I, Rodriguez AS, Ogueri C, Singh N, Oyebode O, et al. Chatbot-assisted self-assessment (CASA): designing a novel AI-enabled sexual health intervention for racially minoritised communities. BMJ STI 2023; 99(1): A60-A61.
| Google Scholar |

19 Milne-Ives M, de Cock C, Lim E, Shehadeh MH, de Pennington N, Mole G, Normando E, Meinert E. The effectiveness of artificial intelligence conversational agents in health care: systematic review. J Med Internet Res 2020; 22(10): e20346.
| Crossref | Google Scholar | PubMed |

20 Ho A, Hancock J, Miner AS. Psychological, relational, and emotional effects of self-disclosure after conversations with a chatbot. J Commun 2018; 68(4): 712-733.
| Crossref | Google Scholar | PubMed |

21 Aggarwal A, Tam CC, Wu D, Li X, Qiao S. Artificial intelligence–based chatbots for promoting health behavioral changes: systematic review. J Med Internet Res 2023; 25: e40789.
| Crossref | Google Scholar | PubMed |

22 van Wezel MM, Croes EA, Antheunis ML. “I’m here for you”: can social chatbots truly support their users? A literature review. In ‘Chatbot Research and Design: 4th International Workshop, CONVERSATIONS 2020, Virtual Event, November 23–24, 2020, Revised Selected Papers 4’. Springer International Publishing; 2021. pp. 96–113.

23 Wilding S, Conner M, Sandberg T, Prestwich A, Lawton R, Wood C, Miles E, Godin G, Sheeran P. The question-behaviour effect: a theoretical and methodological review and meta-analysis. Eur Rev Soc Psychol 2016; 27(1): 196-230.
| Crossref | Google Scholar |

24 Rodrigues AM, O’Brien N, French DP, Glidewell L, Sniehotta FF. The question–behavior effect: genuine effect or spurious phenomenon? A systematic review of randomized controlled trials with meta-analyses. Health Psychol 2015; 34(1): 61.
| Crossref | Google Scholar | PubMed |

25 Nadarzynski T, Puentes V, Pawlak I, Mendes T, Montgomery I, Bayley J, Ridge D, Newman C. Barriers and facilitators to engagement with artificial intelligence (AI)-based chatbots for sexual and reproductive health advice: a qualitative analysis. Sex Health 2021; 18(5): 385-393.
| Crossref | Google Scholar | PubMed |

26 Abelson J, Wagner F, DeJean D, Boesveld S, Gauvin F-P, Bean S, Axler R, Petersen S, Baidoobonso S, Pron G, Giacomini M, Lavis J. Public and patient involvement in health technology assessment: a framework for action. Int J Technol Assess Health Care 2016; 32(4): 256-264.
| Crossref | Google Scholar | PubMed |

27 Sallam M. ChatGPT utility in healthcare education, research, and practice: systematic review on the promising perspectives and valid concerns. Healthcare 2023; 11(6): 887 10.3390/healthcare11060887.
| Google Scholar |

28 Branley-Bell D, Brown R, Coventry L, Sillence E. Chatbots for embarrassing and stigmatizing conditions: could chatbots encourage users to seek medical advice? Front Commun 2023; 8: 1275127.
| Crossref | Google Scholar |

29 Yam EA, Namukonda E, McClair T, Souidi S, Chelwa N, Muntalima N, Mbizvo M, Bellows B. Developing and testing a chatbot to integrate HIV education into family planning clinic waiting areas in Lusaka, Zambia. Glob Health Sci Pract 2022; 10(5): e2100721.
| Crossref | Google Scholar |

30 O’Byrne P, Musten A, Orser L, Buckingham S. Automated STI/HIV risk assessments: testing an online clinical algorithm in Ottawa, Canada. Int J STD AIDS 2021; 32(14): 1365-1373.
| Crossref | Google Scholar | PubMed |

31 Chapman KS, Gadkowski LB, Janelle J, Koehler-Sides G, Nelson JA. Automated sexual history and self-collection of extragenital chlamydia and gonorrhea improve detection of bacterial sexually transmitted infections in people with HIV. AIDS Patient Care STDS 2022; 36(S2): 104-110.
| Crossref | Google Scholar | PubMed |

32 Brickman J, Willoughby JF. ‘You shouldn’t be making people feel bad about having sex’: exploring young adults’ perceptions of a sex-positive sexual health text message intervention. Sex Educ 2017; 17(6): 621-634.
| Crossref | Google Scholar |

33 Gasmelsid N, Moran BCB, Nadarzynski T, Patel R, Foley E. Does online sexually transmitted infection screening compromise care? A service evaluation comparing the management of chlamydial infection diagnosed online and in clinic. Int J STD AIDS 2021; 32(6): 528-532.
| Crossref | Google Scholar | PubMed |

34 Zhang L, Ni Z, Liu Y, Chen H. The effectiveness of e-health on reducing stigma, improving social support and quality of life among people living with HIV: a systematic review and meta-analysis of randomized controlled trials. Int J Nurs Stud 2023; 148: 104606.
| Crossref | Google Scholar |

35 Luk TT, Lui JHT, Wang MP. Efficacy, usability, and acceptability of a chatbot for promoting COVID-19 vaccination in unvaccinated or booster-hesitant young adults: pre-post pilot study. J Med Internet Res 2022; 24(10): e39063.
| Crossref | Google Scholar | PubMed |

36 Zhai C, Wibowo S. A systematic review on cross-culture, humor and empathy dimensions in conversational chatbots: the case of second language acquisition. Heliyon 2022; 8: e12056.
| Crossref | Google Scholar |

37 UK Health Security Agency. A look at the sexual health of young Londoners. 2016. Available at https://ukhsa.blog.gov.uk/2016/09/22/a-look-at-the-sexual-health-of-young-londoners/ [accessed 1 November 2023]

38 Reddy H, Joshi S, Joshi A, Wagh V. A critical review of global digital divide and the role of technology in healthcare. Cureus 2022; 14(9): e29739.
| Crossref | Google Scholar |