Peng Mary L, Wickersham Jeffrey A, Altice Frederick L, Shrestha Roman, Azwa Iskandar, Zhou Xin, Halim Mohd Akbar Ab, Ikhtiaruddin Wan Mohd, Tee Vincent, Kamarulzaman Adeeba, Ni Zhao
Social and Behavioral Sciences Department, Yale School of Public Health, New Haven, CT, United States.
Section of Infectious Disease, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States.
JMIR Form Res. 2022 Oct 6;6(10):e42055. doi: 10.2196/42055.
Mobile technologies are being increasingly developed to support the practice of medicine, nursing, and public health, including HIV testing and prevention. Chatbots using artificial intelligence (AI) are novel mobile health strategies that can promote HIV testing and prevention among men who have sex with men (MSM) in Malaysia, a hard-to-reach population at elevated risk of HIV, yet little is known about the features that are important to this key population.
The aim of this study was to identify the barriers to and facilitators of Malaysian MSM's acceptance of an AI chatbot designed to assist in HIV testing and prevention in relation to its perceived benefits, limitations, and preferred features among potential users.
We conducted 5 structured web-based focus group interviews with 31 MSM in Malaysia between July 2021 and September 2021. The interviews were first recorded, transcribed, coded, and thematically analyzed using NVivo (version 9; QSR International). Subsequently, the unified theory of acceptance and use of technology was used to guide data analysis to map emerging themes related to the barriers to and facilitators of chatbot acceptance onto its 4 domains: performance expectancy, effort expectancy, facilitating conditions, and social influence.
Multiple barriers and facilitators influencing MSM's acceptance of an AI chatbot were identified for each domain. Performance expectancy (ie, the perceived usefulness of the AI chatbot) was influenced by MSM's concerns about the AI chatbot's ability to deliver accurate information, its effectiveness in information dissemination and problem-solving, and its ability to provide emotional support and raise health awareness. Convenience, cost, and technical errors influenced the AI chatbot's effort expectancy (ie, the perceived ease of use). Efficient linkage to health care professionals and HIV self-testing was reported as a facilitating condition of MSM's receptiveness to using an AI chatbot to access HIV testing. Participants stated that social influence (ie, sociopolitical climate) factors influencing the acceptance of mobile technology that addressed HIV in Malaysia included privacy concerns, pervasive stigma against homosexuality, and the criminalization of same-sex sexual behaviors. Key design strategies that could enhance MSM's acceptance of an HIV prevention AI chatbot included an anonymous user setting; embedding the chatbot in MSM-friendly web-based platforms; and providing user-guiding questions and options related to HIV testing, prevention, and treatment.
This study provides important insights into key features and potential implementation strategies central to designing an AI chatbot as a culturally sensitive digital health tool to prevent stigmatized health conditions in vulnerable and systematically marginalized populations. Such features not only are crucial to designing effective user-centered and culturally situated mobile health interventions for MSM in Malaysia but also illuminate the importance of incorporating social stigma considerations into health technology implementation strategies.
移动技术正日益发展，以支持医学、护理和公共卫生实践，包括艾滋病毒检测和预防。使用人工智能（AI）的聊天机器人是新型移动健康策略，可促进马来西亚男男性行为者（MSM）中的艾滋病毒检测和预防，这是一个难以接触到且艾滋病毒感染风险较高的人群，但对于这一关键人群而言，重要的特征却鲜为人知。
本研究的目的是确定马来西亚男男性行为者接受旨在协助艾滋病毒检测和预防的人工智能聊天机器人的障碍和促进因素，这些因素与潜在用户对其感知的益处、局限性和偏好特征有关。
2021年7月至2021年9月期间，我们对马来西亚的31名男男性行为者进行了5次基于网络的结构化焦点小组访谈。访谈首先进行录音、转录、编码，然后使用NVivo（第9版；QSR国际公司）进行主题分析。随后，采用技术接受与使用统一理论来指导数据分析，将与聊天机器人接受的障碍和促进因素相关的新出现主题映射到其四个领域：绩效期望、努力期望、促进条件和社会影响。
为每个领域确定了影响男男性行为者接受人工智能聊天机器人的多个障碍和促进因素。绩效期望（即人工智能聊天机器人的感知有用性）受到男男性行为者对人工智能聊天机器人提供准确信息的能力、其在信息传播和解决问题方面的有效性以及提供情感支持和提高健康意识能力的担忧的影响。便利性、成本和技术错误影响了人工智能聊天机器人的努力期望（即感知易用性）。与医疗保健专业人员的有效联系和艾滋病毒自我检测被报告为男男性行为者接受使用人工智能聊天机器人进行艾滋病毒检测的促进条件。参与者表示，影响马来西亚接受解决艾滋病毒问题的移动技术的社会影响（即社会政治气候）因素包括隐私担忧、对同性恋的普遍污名化以及同性性行为的刑事定罪。可提高男男性行为者对艾滋病毒预防人工智能聊天机器人接受度的关键设计策略包括匿名用户设置；将聊天机器人嵌入对男男性行为者友好的基于网络的平台；以及提供与艾滋病毒检测、预防和治疗相关的用户引导问题和选项。
本研究为设计人工智能聊天机器人作为一种文化敏感的数字健康工具以预防弱势群体和系统性边缘化人群中受污名化的健康状况的关键特征和潜在实施策略提供了重要见解。这些特征不仅对于为马来西亚的男男性行为者设计有效的以用户为中心且符合文化背景的移动健康干预措施至关重要，而且还阐明了将社会污名考虑纳入健康技术实施策略的重要性。
