Telehealth is a promising avenue to address the sexual and reproductive health (SRH) needs of adolescent and young adults (AYA). Though 15-24-year-olds account for 13% of the United States (U.S.) population, they represent nearly half of the 2.5 million sexually transmitted infections (STIs) annually.1 Untreated STIs can lead to pelvic inflammatory disease, infertility, adverse pregnancy outcomes, lifelong effects of herpes, syphilis, and HIV infections, and increased cancer risk.2., 3., 4. Untreated individuals can increase STI rates.5 New STIs account for nearly $16 billion in direct medical costs.1 Despite the risk posed by STIs, AYA often do not access SRH services, contributing to their disproportionate STI burden. Approximately 32% of U.S. high school students report ever having sex. However, only 7% report that they have ever had an HIV test, and 6% report that they have been tested for other STIs in the past year.6 Screening rates are especially low in asymptomatic adolescents.7 Similarly low rates of recommended STI testing has been seen among young adults.8 Social stigma around sexual health impacts an individual’s decision and ability to access SRH care.9 Adolescents and young adults (AYA) also face confidentiality barriers and are less likely to access primary care services compared to pediatric populations.9,10

SRH care gaps for AYA worsened during the Coronavirus-19 (COVID-19) pandemic.11,12 A study of over 1.7 million insured 15-29-year-olds found that chlamydia and gonorrhea testing rates decreased 19% during the pandemic relative to the pre-pandemic baseline. By the end of 2022, STI testing rates had not returned to pre-pandemic levels.13 Economically disadvantaged AYA seeking SRH care at safety net sites faced similar disruptions which persisted during later phases of the pandemic. For example, there were 30% fewer STI tests for 13 to 17-year-olds in 2020, and 20% fewer clinic visits for 13 to 24-year-olds in 2020 and 2021 compared to 2019.14,15 Given the persistence of lower-than-expected levels of sexual health clinic visits and STI testing even after the pandemic, it is important to explore potential approaches to enhance SRH care delivery for AYA. Telehealth is one such approach. Previous studies indicate that telehealth interventions can improve STI testing among AYA, yet these services remain underutilized.14,16 Hence, assessing the feasibility and acceptability of telehealth modalities is important.

An Australian survey of 16-24-year-olds, conducted over a decade ago, reported 63% of AYA were willing to have a phone consult for SRH concerns, but only 29% were willing to have a video consultation.17 Early pandemic studies also showed that while AYA mostly found telehealth acceptable for SRH care, they preferred in-person services. AYA in these studies had mixed views on whether telehealth improved or hindered quality of care and often cited privacy and confidentiality concerns.18,19 In our experience with 27,000 AYA accessing free SRH services in a publicly funded safety net clinic system in the US in 2020 and 2021, we found that 18% used telehealth. Demographic factors such as older age, Black race, Hispanic ethnicity, and higher income were associated with telehealth use and telehealth users were more likely to complete annual sexually transmitted infection testing.14 This previous study did not explore patient perspectives or telehealth access.

Studies exploring technology access and the perspectives of economically disadvantaged youth seeking SRH care at publicly funded community settings are lacking. Therefore, this study aimed to assess technological determinants of SRH care use by: (1) examining access to telehealth technology, barriers, attitudes, intentions, and facilitators of telehealth among AYA seeking SRH services at a free publicly funded safety net clinic system; and (2) identifying whether these constructs predict telehealth use among AYA seeking SRH services. We hypothesized that this population would report high rates of technological barriers to telehealth use, and individuals reporting these barriers or negative attitudes towards telehealth would be less likely to use this modality.