Digital Determinants of Sexual Health Equity Among Displaced Youth Living in Slum Settings in Uganda

Introduction: Digital technologies have increasingly become potentially useful tools in addressing health disparities and poor sexual health outcomes among displaced youth living in slum settings. However, the rapid digital transformation of sexual health services may contribute to increased inequality. To increase the reach and effectiveness of digital tools, digital health literacy is identified as a critical, yet understudied digital determinant of sexual health among displaced youth. Applying the social cognitive theory, we address these knowledge gaps: 1) explore the association between digital health literacy and awareness on how to access sexual health service, and 2) examine the association between digital health literacy and recent access to sexual health services.

Methods: A community-based cross-sectional survey was conducted among displaced youth living in the slums of Kampala between January to March 2018. Participants were recruited using peer network sampling, an effective non-probability strategy to recruit and include marginalized populations such as refugee youth in research. We assessed (1) awareness of sexual health services and (2) access to sexual health services in the past 3-months. Digital health literacy was measured using the 8-item eHealth Literacy Scale that assesses subjective digital health literacy. The eight items are rated on a five-point Likert scale (1–5 points), and total scores range from 8 to 40 points. We employ the multivariate probit technique which simultaneously estimates the probability of an individual’s awareness of and access to a set of sexual health services (i.e., sexual and reproductive health (SRH) information, training on condom use, external condom use, STI testing, and HIV testing).

Results: For awareness of sexual health services, we found that respondents with moderate and very high digital health literacy have 21% and 23% higher probability of being aware of HIV testing compared to those with low digital health literacy. Also, a person with very high digital health literacy has 19% higher probability of being aware of external condoms and 23% higher probability of being aware of training on condom use compared to someone with low digital health literacy. For sexual health service utilization, across the board, respondents with moderate and very high digital health literacy have 24% higher probability of accessing HIV testing compared to those with low digital health literacy. Also, a person with very high digital health literacy has 14% higher probability of having access to male condoms and 13% higher probability of having access to training on condom use compared to someone with low digital heat literacy. Respondents with high digital health literacy have 14% lower probability of being aware of SRH information compared to someone with low digital health literacy.

Conclusion: Digital sexual health interventions are likely to disproportionately benefit more advantaged people with greater digital health literacy, leaving behind people who have less digital health literacy. Findings have implications for social workers designing tailored and effective digital sexual health interventions that address their unique needs.