Achieving health equity through conversational AI: A roadmap for design and implementation of inclusive chatbots in healthcare.

BACKGROUND: The rapid evolution of conversational and generative artificial intelligence (AI) has led to the increased deployment of AI tools in healthcare settings. While these conversational AI tools promise efficiency and expanded access to healthcare services, there are growing concerns ethically, practically and in terms of inclusivity. This study aimed to identify activities which reduce bias in conversational AI and make their designs and implementation more equitable. METHODS: A qualitative research approach was employed to develop an analytical framework based on the content analysis of 17 guidelines about AI use in clinical settings. A stakeholder consultation was subsequently conducted with a total of 33 ethnically diverse community members, AI designers, industry experts and relevant health professionals to further develop a roadmap for equitable design and implementation of conversational AI in healthcare. Framework analysis was conducted on the interview data. RESULTS: A 10-stage roadmap was developed to outline activities relevant to equitable conversational AI design and implementation phases: 1) Conception and planning, 2) Diversity and collaboration, 3) Preliminary research, 4) Co-production, 5) Safety measures, 6) Preliminary testing, 7) Healthcare integration, 8) Service evaluation and auditing, 9) Maintenance, and 10) Termination. DISCUSSION: We have made specific recommendations to increase conversational AI's equity as part of healthcare services. These emphasise the importance of a collaborative approach and the involvement of patient groups in navigating the rapid evolution of conversational AI technologies. Further research must assess the impact of recommended activities on chatbots' fairness and their ability to reduce health inequalities.

"But can chatbots understand sex?" Attitudes towards artificial intelligence chatbots amongst sexual and reproductive health professionals: An exploratory mixed-methods study.

BACKGROUND: Artificial Intelligence (AI)-enabled chatbots can offer anonymous education about sexual and reproductive health (SRH). Understanding chatbot acceptability and feasibility allows the identification of barriers to the design and implementation. METHODS: In 2020, we conducted an online survey and qualitative interviews with SRH professionals recruited online to explore the views on AI, automation and chatbots. Qualitative data were analysed thematically. RESULTS: Amongst 150 respondents (48% specialist doctor/consultant), only 22% perceived chatbots as effective and 24% saw them as ineffective for SRH advice [Mean = 2.91, SD = 0.98, range: 1-5]. Overall, there were mixed attitudes towards SRH chatbots [Mean = 4.03, SD = 0.87, range: 1-7]. Chatbots were most acceptable for appointment booking, general sexual health advice and signposting, but not acceptable for safeguarding, virtual diagnosis, and emotional support. Three themes were identified: "Moving towards a 'digital' age'", "AI improving access and service efficacy", and "Hesitancy towards AI". CONCLUSIONS: Half of SRH professionals were hesitant about the use of chatbots in SRH services, attributed to concerns about patient safety, and lack of familiarity with this technology. Future studies should explore the role of AI chatbots as supplementary tools for SRH promotion. Chatbot designers need to address the concerns of health professionals to increase acceptability and engagement with AI-enabled services.

Reasons for incomplete STI vaccination among men who have sex with men in an English sexual health service.

BACKGROUND: In England, vaccination for human papillomavirus, hepatitis A, and hepatitis B is recommended for men who have sex with men (MSM). However, uptake is sub-optimal and some men do not complete all recommended vaccine doses. This service evaluation aimed to explore reasons for lack of uptake for each of these vaccines among MSM in one English sexual health service and to inform improvements in service delivery to increase full dose completion rates. METHODS: MSM, ≥18 years, who had previously attended NHS Solent Sexual Health for at least one vaccination, and who had not completed the full dosing regimen for at least one of these vaccines, were invited to participate in an anonymous, online survey between 14/12/2020-11/04/2021. RESULTS: Among 246 MSM (M = 42.1 years), the most common reason for non-vaccination was that participants thought it was unneeded and had not been recommended by a doctor or healthcare provider. None reported vaccine hesitancy. Likewise, the most common reasons for vaccination were doctor/healthcare provider recommendation (51.7-65.6%) and self-protection (60.9-68.1%). The most common reason for not having completed the full course of vaccination was being unaware that the next dose was due (30.0-37.8%). Many participants who had not completed vaccination indicated that a doctor/healthcare provider recommendation would be a motivating factor and that reminder messages and being able to book subsequent appointments in advance would facilitate vaccination. CONCLUSIONS: Sexual health clinicians should be encouraged to discuss STI vaccination with MSM and services should explore possibilities to improve ease and access to vaccine appointments to increase uptake and completion rates.

The Impact of First UK-Wide Lockdown (March-June 2020) on Sexual Behaviors in Men and Gender Diverse People Who Have Sex with Men During the COVID-19 Pandemic: A Cross-Sectional Survey.

The global COVID-19 pandemic resulted in strict social distancing measures restricting close physical contact. Men (cis and trans) and other gender diverse people who have sex with men (MGDSM) are at higher risk of sexually transmitted infections (STIs) and may have experienced changes in sexual behavior during government restrictions on social and sexual contact. We aimed to examine self-reported sexual behavior of MGDSM during the first UK-wide lockdown to identify the characteristics of the individuals who might most require sexual health promotion and clinical support. In April-May 2020, we conducted an online survey of MGDSM, promoted on social media and Grindr. Our exploratory approach used descriptive analysis to identify self-reported changes in sexual behavior and performed regression analyses to identify correlates of casual sex during the lockdown. A total of 1429 respondents completed the survey: mean age 36 years, 84% White, 97% male or trans male, 98% assigned male sex at birth, 2% female or non-binary, 65% degree educated or higher. During the lockdown, 76% reported not having any casual sex partners. While the majority reported reduced casual sex, 3% reported an increase in casual sex with one person and 2% with three or more people (group sex). About 12% of the sample engaged in casual sex with only one person and 5% with four or more sexual partners during the lockdown. Reporting casual sex during lockdown was associated with: lower level of education OR = 2.37 [95% CI 1.40-4.01]; identifying as a member of an ethnic minority OR = 2.27[1.40-3.53]; daily usage of sexual networking apps OR = 2.24[1.54-3.25]; being less anxious about contracting SARS-CoV-2 through sex OR = 1.66[1.12-2.44]; using PrEP before lockdown OR = 1.75[1.20-2.56]; continuing to use PrEP OR = 2.79[1.76-4.57]; and testing for STIs during lockdown OR = 2.65[1.76-3.99]. A quarter of respondents remained sexually active with casual partners, indicating a need to provide STI screening services and health promotion targeted to groups most likely to have need over this period. Future research is required to better understand how to support sexual and gender minorities to manage sexual risk in the context of pandemic public health initiatives.

Reducing New Chlamydia Infection Among Young Men by Promoting Correct and Consistent Condom Use: Protocol for a Randomized Controlled Trial.

BACKGROUND: The health, social, and economic costs of sexually transmitted infections (STIs) represent a major public health concern. Young people are considered one of the groups most at risk for acquiring and transmitting STIs. Correct and consistent condom use has been shown to be the most effective method for reducing STIs; however, condoms are often not used properly. Evidence shows that brief behavior change interventions that focus on skills, communication, and motivation to acquire safe sex practices should be adopted into routine care to reduce STIs. Funding for sexual health services in England has declined dramatically, so novel ways of reducing clinic attendance are being sought. The home-based intervention strategy (HIS-UK) to promote condom use among young men has shown promise in feasibility and pilot studies by demonstrating high acceptability of the intervention in participant and health professional feedback, including aiding men to find condoms they like and feel more confident when using condoms. OBJECTIVE: The aim of this study is to determine the effectiveness and cost-effectiveness of HIS-UK when compared to usual condom distribution care among young men. METHODS: The 3 trial arms consisting of "e-HIS" (HIS-UK delivered digitally), "ProHIS" (HIS-UK delivered face-to-face), and control condition (usual National Health Service [NHS] care) will be compared against the following 3 primary outcomes: the extent to which correct and consistent condom use is increased; improvement of condom use experiences (pleasure as well as fit and feel); and decrease in chlamydia test positivity. Eligibility criteria include men aged 16-25 years at risk of STIs through reporting of condom use errors (ie, breakage or slippage) or condomless penile-vaginal or penile-anal intercourse with casual or new sexual partners during the previous 3 months. Prospective participants will be recruited through targeted advertisements and an opportunistic direct approach at selected sexual health and genitourinary medicine services and university-associated health centers and general practitioner practices. Community and educational establishments will be used to further advertise the study and signpost men to recruitment sites. Participants will be randomly allocated to 1 of 3 trial arms. A repeated measures design will assess the parallel arms with baseline and 12 monthly follow-up questionnaires after intervention and 3 chlamydia screening points (baseline, 6, and 12 months). RESULTS: Recruitment commenced in March 2020. Due to the COVID-19 pandemic, the study was halted and has since reopened for recruitment in Summer 2021. A 30-month recruitment period is planned. CONCLUSIONS: If effective and cost-effective, HIS-UK can be scaled up into routine NHS usual care to reduce both STI transmission in young people and pressure on NHS resources. This intervention may further encourage sexual health services to adopt digital technologies, allowing for them to become more widely available to young people while decreasing health inequalities and fear of stigmatization. TRIAL REGISTRATION: ISRCTN Registry ISRCTN11400820; https://www.isrctn.com/ISRCTN11400820.

Mental Well-Being and Sexual Intimacy among Men and Gender Diverse People Who Have Sex with Men during the First UK COVID-19 Lockdown: A Mixed-Methods Study.

This mixed-methods study aimed to explore mental well-being, circumstances and strategies around managing sexual intimacy and risk during the first UK COVID-19 lockdown (Spring 2020) among men and gender diverse people who have sex with men (MGDPSM), commencing while lockdown was in progress. n = 1429 MGDPSM completed the survey and 14 undertook an in-depth interview. Low mental well-being was reported by 49.6% of the survey participants. Low mental well-being was not predicted by relationship and living circumstance, sexual networking app use, or by casual sexual partners. Low mental well-being was associated with more frequent COVID-19 anxiety (OR = 5.08 CI: 3.74, 6.88 p < 0.001) and with younger age (18−24 years OR = 2.23 CI:1.41−3.53 p = 0.001, 25−34 years OR = 1.45 CI:1.04−2.02 p = 0.029, 35−44 years OR = 1.41 CI:1.00−1.99 p = 0.052). The interview participants understood their lockdown experiences as being relative to normalcy, and those experiencing more dramatic changes faced greater challenges. Living with partners was felt to protect well-being. Many participants reported intimacy interruption challenges. The findings indicate that mental well-being is predicted by age and COVID-19 impact, highlighting opportunities for targeting MGDPSM who are most vulnerable to poor mental health. Services that support MGDPSM during COVID-19 recovery efforts must provide non-judgemental and affirming support.

Health chatbots acceptability moderated by perceived stigma and severity: A cross-sectional survey.

BACKGROUND: Chatbots and virtual voice assistants are increasingly common in primary care without sufficient evidence for their feasibility and effectiveness. We aimed to assess how perceived stigma and severity of various health issues are associated with the acceptability for three sources of health information and consultation: an automated chatbot, a General Practitioner (GP), or a combination of both. METHODS: Between May and June 2019, we conducted an online study, advertised via Facebook, for UK citizens. It was a factorial simulation experiment with three within-subject factors (perceived health issue stigma, severity, and consultation source) and six between-subject covariates. Acceptability rating for each consultation source was the dependant variable. A single mixed-model ANOVA was performed. RESULTS: Amongst 237 participants (65% aged over 45 years old, 73% women), GP consultations were seen as most acceptable, followed by GP-chatbot service. Chatbots were seen least acceptable as a consultation source for severe health issues, while the acceptability was significantly higher for stigmatised health issues. No associations between participants' characteristics and acceptability were found. CONCLUSIONS: Although healthcare professionals are perceived as the most desired sources of health information, chatbots may be useful for sensitive health issues in which disclosure of personal information is challenging. However, chatbots are less acceptable for health issues of higher severity and should not be recommended for use within that context. Policymakers and digital service designers need to recognise the limitations of health chatbots. Future research should establish a set of health topics most suitable for chatbot-led interventions and primary healthcare services.

Barriers and facilitators to engagement with artificial intelligence (AI)-based chatbots for sexual and reproductive health advice: a qualitative analysis.

Background The emergence of artificial intelligence (AI) provides opportunities for demand management of sexual and reproductive health services. Conversational agents/chatbots are increasingly common, although little is known about how this technology could aid services. This study aimed to identify barriers and facilitators for engagement with sexual health chatbots to advise service developers and related health professionals. Methods In January-June 2020, we conducted face-to-face, semi-structured and online interviews to explore views on sexual health chatbots. Participants were asked to interact with a chatbot, offering advice on sexually transmitted infections (STIs) and relevant services. Participants were UK-based and recruited via social media. Data were recorded, transcribed verbatim and analysed thematically. Results Forty participants (aged 18-50 years; 64% women, 77% heterosexual, 58% white) took part. Many thought chatbots could aid sex education, providing useful information about STIs and sign-posting to sexual health services in a convenient, anonymous and non-judgemental way. Some compared chatbots to health professionals or Internet search engines and perceived this technology as inferior, offering constrained content and interactivity, limiting disclosure of personal information, trust and perceived accuracy of chatbot responses. Conclusions Despite mixed attitudes towards chatbots, this technology was seen as useful for anonymous sex education but less suitable for matters requiring empathy. Chatbots may increase access to clinical services but their effectiveness and safety need to be established. Future research should identify which chatbots designs and functions lead to optimal engagement with this innovation.

Feasibility study of the Home-based Exercises for Responsible Sex (HERS) intervention to promote correct and consistent condom use among young women.

BACKGROUND: Male condoms are effective in preventing common sexually transmitted infections (STIs) and unintended pregnancy, if used correctly and consistently. However, condom use errors and problems are common and young people report negative experiences, such as reduced pleasure. The Kinsey Institute Home-Based Exercises for Responsible Sex (KIHERS) is a novel condom promotion intervention for young women, which aims to reduce condom errors and problems, increase self-efficacy and improve attitudes towards condoms, using a pleasure-focussed approach. The study objective was to test the operability, viability and acceptability of an adapted version of the KIHERS intervention with young women aged 16-25 years in the United Kingdom (UK) (Home-Based Exercises for Responsible Sex-UK (HERS-UK). METHODS: A repeated-measures single-arm design was used, with a baseline (T1) and two follow-up assessments (T2 and T3), conducted 4 weeks and 8 weeks post intervention over a 3-month period. Participants were provided a condom kit containing different condoms and lubricants and were asked to experiment with condoms alone using a dildo and/or with a sexual partner. Ten process evaluation interviews were conducted post intervention. RESULTS: Fifty-five young women received the intervention; 36 (65%) completed T2 and 33 (60%) completed T3. Condom use errors and problems decreased, self-efficacy increased and attitudes towards condoms improved significantly. The proportion of participants who reported using a condom for intercourse in the past 4 weeks increased from T1 (20; 47%) to T2 (27; 87%) and T3 (23; 77%) and using lubricant with a condom for intercourse increased from T1 (6; 30%) to T2 (13; 48%)) and T3 (16; 70%). However, motivation to use condoms did not change. Cronbach's alpha scores indicated good internal consistency of measures used. Qualitative data provided strong evidence for the acceptability of the intervention. CONCLUSIONS: HERS-UK was implemented as intended and the recruitment strategy was successful within a college/university setting. This feasibility study provided an early indication of the potential effectiveness and acceptability of the intervention, and the benefits of using a pleasure-focussed approach with young women. Measures used captured change in outcome variables and were deemed fit for purpose. Future research should explore cost-effectiveness of this intervention, in a large-scale controlled trial using a diverse sample and targeting young women most at risk of STIs.

Sexual healthcare professionals' views on the rapid provision of remote services at the beginning of COVID-19 pandemic: A mixed-methods study.

INTRODUCTION: The COVID-19 pandemic and social distancing measures forced sexual health services to engage with patients remotely. We aimed to understand perceived barriers and facilitators to the provision of digital sexual health services during the first months of the pandemic. METHODS: An online survey and qualitative interviews with UK sexual healthcare professionals recruited online and via snowball sampling were conducted in May-July 2020. RESULTS: Amongst 177 respondents (72% female, 86% White, mean age = 46, SD = 9), most utilised telephone and email as their main communication channels; however, their perceived effectiveness varied (94% and 66%, respectively). Most agreed that staff needed additional training (89%), the available technology was not adequate (66%) and health professionals were hesitant to provide online consultations (46%). They had positive attitudes towards digitalisation, improving service quality and cost-effectiveness but were concerned about exacerbating health inequalities. DISCUSSION: The study identifies a need for clear guidelines and training around the use of digital tools as well as a demand for investment in hardware and software required for the provision of remote services. Future research needs to explore the acceptability, safety and effectiveness of various digital tools to narrow health inequalities in sexual health service users.

Using protection motivation theory to explain the intention to initiate human papillomavirus vaccination among men who have sex with men in China.

BACKGROUND: Human papillomavirus (HPV) infection and related diseases are common among men who have sex with men (MSM). The most effective prevention is HPV vaccination. In China, however, men are not included in the HPV vaccination plan. We investigated the intention to initiate HPV vaccination and associated factors among MSM in China. Methods We surveyed 563 unvaccinated MSM aged 18 or older from six cities in China. Participants completed an electronic questionnaire about demographics, knowledge of and attitude towards HPV and HPV vaccine, intention to initiate HPV vaccination, willingness to recommend HPV vaccine to peers, feeling about government policy about HPV vaccination. We used the structural equation modeling (SEM) to analyze factors associated with HPV vaccine intention. Results The knowledge of HPV and HPV vaccine among participants was low. The mean score of knowledge about HPV and HPV vaccine was only 1.59 (range 0-11). The intention to initiate HPV vaccination within 6 months among participants was moderate (43.3% in total, 18.1% for 'very high' and 25.2% for 'above average').

Vaccine acceptability, uptake and completion amongst men who have sex with men: A systematic review, meta-analysis and theoretical framework.

BACKGROUND: Due to an increased risk of sexually transmitted infections (STIs), gay, bisexual and other men who have sex with men (MSM) have been recommended to receive vaccinations against human papillomavirus, meningitis C and hepatitis A/B. This review aimed to compare the rates of vaccine acceptability, uptake and completion, and to identify determinants of vaccine outcomes specific to MSM to inform a theoretical framework. METHODS: In January 2020 four databases were explored to identify vaccination behaviours and associated factors among MSM. A narrative systematic review and meta-analysis were performed. Data were synthesised for theoretical modelling. RESULTS: Seventy-eight studies, mostly from the USA, were included. The average vaccine acceptability was 63% (median = 72%, range: 30%-97%), vaccine uptake 45% (median = 42%, range: 5%-100%) and vaccine completion 47% (median = 45%, range: 12%-89%). Six categories of factors associated with vaccination acceptability, uptake and completion were conceptualised: Individual (e.g., demographic and psychosocial); Interpersonal (e.g., peer education); Healthcare provider (e.g., vaccine recommendation); Organisational and practice setting (e.g., routine collection of patient sexual orientation information that is integrated into a clinical decision support system); Community environment (e.g., targeted health promotion campaigns); and National, state and local policy environment (e.g., public health guidelines targeting MSM). CONCLUSION: Despite overall high levels of acceptability, uptake and completion rates were below targets predicted by cost-effectiveness modelling across all recommended vaccines. These parameters may need to be adjusted for more precise estimations of cost-effectiveness. Addressing the multiple levels of determinants, as outlined in our theoretical framework, will help guide interventions to increase vaccine completion among MSM.

Does online sexually transmitted infection screening compromise care? A service evaluation comparing the management of chlamydial infection diagnosed online and in clinic.

Patient demand on sexual health services in the United Kingdom is so high that many services have introduced online screening to accommodate more patients. There are concerns that these services may not be accessible to all. This service evaluation was undertaken to determine whether online screening is accessible by those patients most at need by comparing the demographics and number of asymptomatic chlamydial infections detected online and in clinic. No difference was found in the age nor level of deprivation, demonstrating that online services are an accessible way to screen for sexually transmitted infections without overburdening established services.

Acceptability of remote prescribing and postal delivery services for contraceptive pills and treatment of uncomplicated Chlamydia trachomatis.

OBJECTIVES: The digitalisation of sexual and reproductive health (SRH) services offers valuable opportunities to deliver contraceptive pills and chlamydia treatment by post. We aimed to examine the acceptability of remote prescribing and 'medication-by-post' in SRH. STUDY DESIGN: An online survey assessing attitudes towards remote management was distributed in three UK SRH clinics and via an integrated sexually transmitted infection (STI) postal self-sampling service. Logistic regressions were performed to identify potential correlates. RESULTS: There were 1281 participants (74% female and 49% <25 years old). Some 8% of participants reported having received medication via post and 83% were willing to receive chlamydia treatment and contraceptive pills by post. Lower acceptability was observed among participants who were: >45 years old (OR 0.43 (95% CI 0.23-0.81)), screened for STIs less than once annually (OR 0.63 (0.42-0.93)), concerned about confidentiality (OR 0.21 (0.90-0.50)), concerned about absence during delivery (OR 0.09 (0.02-0.32)) or unwilling to provide blood pressure readings (OR 0.22 (0.04-0.97)). Higher acceptability was observed among participants who reported: previously receiving medication by post (OR 4.63 (1.44-14.8)), preference for home delivery over clinic collection (OR 24.1 (11.1-51.9)), preference for home STI testing (OR 10.3 (6.16-17.4)), ability to communicate with health advisors (OR 4.01 (1.03-15.6)) and willingness to: register their real name (OR 3.09 (1.43-10.6)), complete online health questionnaires (OR 3.09 (1.43-10.6)) and use generic contraceptive pills (OR 2.88 (1.21-6.83)). CONCLUSIONS: Postal treatment and entering information online to allow remote prescribing were acceptable methods for SRH services and should be considered alongside medication collection in pharmacies. These methods could be particularly useful for patients facing barriers in accessing SRH. The cost-effectiveness and implementation of these novel methods of service delivery should be further investigated.

Perceived barriers and facilitators to female condoms among UK based healthcare professionals.

OBJECTIVES: The female condom (FC) is an effective strategy against sexually transmitted infections (STIs) in susceptible women and men who have sex with men. FCs are the only female-initiated dual protection method that protects against both STIs and unintended pregnancy. As healthcare professionals (HCPs) are a key element in the promotion of contraceptive use, it is important to examine attitudes towards FCs among this group. Study participants: 15 male and female HCPs aged between 22 and 57 years recruited from sexual and reproductive health settings located in Brighton, London, and Glasgow. Sampling method: Purposive sampling with targeted advertisements (newsletters and bulletins). Study design: face-to-face and telephone interviews with sexual health HCPs. Main outcome measure: potential barriers and facilitators to FCs in the UK. Data were analysed thematically to identify common views and perspectives. RESULTS: FCs were thought to be unacceptable to most women due to stigma, design, negative visual appeal, insertion difficulties and lack of familiarity. The perceived unavailability and higher cost of FCs, in comparison to male condoms, are major barriers to their use. CONCLUSIONS: HCPs are reluctant to promote FCs, often due to the perceived social stigma surrounding FCs. Further education and promotion are needed to increase acceptability and correct usage. Future research needs to explore strategies to increase the acceptability of FCs among women, men who have sex with men and HCPs.

Acceptability of artificial intelligence (AI)-enabled chatbots, video consultations and live webchats as online platforms for sexual health advice.

OBJECTIVES: Sexual and reproductive health (SRH) services are undergoing a digital transformation. This study explored the acceptability of three digital services, (i) video consultations via Skype, (ii) live webchats with a health advisor and (iii) artificial intelligence (AI)-enabled chatbots, as potential platforms for SRH advice. METHODS: A pencil-and-paper 33-item survey was distributed in three clinics in Hampshire, UK for patients attending SRH services. Logistic regressions were performed to identify the correlates of acceptability. RESULTS: In total, 257 patients (57% women, 50% aged <25 years) completed the survey. As the first point of contact, 70% preferred face-to-face consultations, 17% telephone consultation, 10% webchats and 3% video consultations. Most would be willing to use video consultations (58%) and webchat facilities (73%) for ongoing care, but only 40% found AI chatbots acceptable. Younger age (<25 years) (OR 2.43, 95% CI 1.35 to 4.38), White ethnicity (OR 2.87, 95% CI 1.30 to 6.34), past sexually transmitted infection (STI) diagnosis (OR 2.05, 95% CI 1.07 to 3.95), self-reported STI symptoms (OR 0.58, 95% CI 0.34 to 0.97), smartphone ownership (OR 16.0, 95% CI 3.64 to 70.5) and the preference for a SRH smartphone application (OR 1.95, 95% CI 1.13 to 3.35) were associated with video consultations, webchats or chatbots acceptability. CONCLUSIONS: Although video consultations and webchat services appear acceptable, there is currently little support for SRH chatbots. The findings demonstrate a preference for human interaction in SRH services. Policymakers and intervention developers need to ensure that digital transformation is not only cost-effective but also acceptable to users, easily accessible and equitable to all populations using SRH services.

Acceptability of artificial intelligence (AI)-led chatbot services in healthcare: A mixed-methods study.

BACKGROUND: Artificial intelligence (AI) is increasingly being used in healthcare. Here, AI-based chatbot systems can act as automated conversational agents, capable of promoting health, providing education, and potentially prompting behaviour change. Exploring the motivation to use health chatbots is required to predict uptake; however, few studies to date have explored their acceptability. This research aimed to explore participants' willingness to engage with AI-led health chatbots. METHODS: The study incorporated semi-structured interviews (N-29) which informed the development of an online survey (N-216) advertised via social media. Interviews were recorded, transcribed verbatim and analysed thematically. A survey of 24 items explored demographic and attitudinal variables, including acceptability and perceived utility. The quantitative data were analysed using binary regressions with a single categorical predictor. RESULTS: Three broad themes: 'Understanding of chatbots', 'AI hesitancy' and 'Motivations for health chatbots' were identified, outlining concerns about accuracy, cyber-security, and the inability of AI-led services to empathise. The survey showed moderate acceptability (67%), correlated negatively with perceived poorer IT skills OR = 0.32 [CI95%:0.13-0.78] and dislike for talking to computers OR = 0.77 [CI95%:0.60-0.99] as well as positively correlated with perceived utility OR = 5.10 [CI95%:3.08-8.43], positive attitude OR = 2.71 [CI95%:1.77-4.16] and perceived trustworthiness OR = 1.92 [CI95%:1.13-3.25]. CONCLUSION: Most internet users would be receptive to using health chatbots, although hesitancy regarding this technology is likely to compromise engagement. Intervention designers focusing on AI-led health chatbots need to employ user-centred and theory-based approaches addressing patients' concerns and optimising user experience in order to achieve the best uptake and utilisation. Patients' perspectives, motivation and capabilities need to be taken into account when developing and assessing the effectiveness of health chatbots.

Attitudes of Pregnant Women and Healthcare Professionals Toward Clinical Trials and Routine Implementation of Antenatal Vaccination Against Respiratory Syncytial Virus: A Multicenter Questionnaire Study.

INTRODUCTION: Respiratory syncytial virus (RSV) is a common cause of infant hospitalization and mortality. With multiple vaccines in development, we aimed to determine: (1) the awareness of RSV among pregnant women and healthcare professionals (HCPs), and (2) attitudes toward clinical trials and routine implementation of antenatal RSV vaccination. METHODS: Separate questionnaires for pregnant women and HCPs were distributed within 4 hospitals in South England (July 2017-January 2018). RESULTS: Responses from 314 pregnant women and 204 HCPs (18% obstetricians, 75% midwives, 7% unknown) were analyzed. Most pregnant women (88%) and midwives (66%) had no/very little awareness of RSV, unlike obstetricians (14%). Among pregnant women, 29% and 75% would likely accept RSV vaccination as part of a trial, or if routinely recommended, respectively. Younger women (16-24 years), those of 21-30 weeks' gestation, and with experience of RSV were significantly more likely to participate in trials [odds ratio (OR): 1.42 (1.72-9.86); OR: 2.29 (1.22-4.31); OR: 9.07 (1.62-50.86), respectively]. White-British women and those of 21-30 weeks' gestation were more likely to accept routinely recommended vaccination [OR: 2.16 (1.07-4.13); OR: 2.10 (1.07-4.13)]. Obstetricians were more likely than midwives to support clinical trials [92% vs. 68%, OR: 2.50 (1.01-6.16)] and routine RSV vaccination [89% vs. 79%, OR: 4.08 (1.53-9.81)], as were those with prior knowledge of RSV, and who deemed it serious. CONCLUSIONS: RSV awareness is low among pregnant women and midwives. Education will be required to support successful implementation of routine antenatal vaccination. Research is needed to understand reasons for vaccine hesitancy among pregnant women and HCPs, particularly midwives.