# Youth Uptake of Digital Sexual and Reproductive Health Services Across Sociodemographic Groups (2018-2022): A Total Population Study from Stockholm, Sweden

## TL;DR

This study examines how adolescents and young adults in Stockholm used digital and in-person sexual and reproductive health services from 2018 to 2022, finding that digital services did not significantly reduce sociodemographic disparities in access.

## Contribution

The study provides new insights into the impact of digital SRH services on sociodemographic disparities in a real-world population setting.

## Key findings

- Women had significantly higher utilization rates of both in-person and digital SRH services compared to men.
- Digital services did not reduce socioeconomic disparities in SRH service uptake, with the lowest income group having notably lower usage.
- Chat-based digital services showed more equitable use across income groups compared to video consultations.

## Abstract

To examine uptake of in-person and digital sexual and reproductive health (SRH) services among adolescents and young adults, quantify uptake across time, and explore whether the introduction of digital services affected the sociodemographic composition of users.

This Swedish total population study included all Stockholm residents aged 12-22 years between January 1st 2018 and December 31st 2022. The primary outcome was in-person or digital visits (chat and video) of SRH services within a year, identified using regional health care registries. Sociodemographic predictors included sex, age, migrant background, parental education, and household income, analyzed with repeated-measures multivariable regressions.

Among the 454,405 individuals, 23.96% had at some point used SRH services (80.01% women) between 2018 and 2022. In-person visits remained the predominant mode of contact. Women had higher annual utilization rate of both in-person (women: 15.27%; 95% CI, 15.13-15.40; men: 1.75%; 95% CI, 1.72-1.78) and digital visits (women: 2.23%; 95% CI, 2.16-2.30; men: 0.12%; 95% CI, 0.11-0.13). Significantly lower uptake was also observed in the lowest income quintile (digital: adjusted odds ratio [aOR], 0.34; 95% CI, 0.31-0.36; in-person: aOR, 0.43; 95% CI, 0.42-0.45) compared with the highest quintile (reference group). Among digital visits, chat was more equitably used than video consultations across sociodemographic groups, including smaller differences between the highest and lowest income quintiles (chat: aOR, 0.59; 95% CI, 0.54-0.65; video: aOR, 0.25; 95% CI, 0.23-0.27). Only modest reductions in socioeconomic disparities were observed after the introduction of digital services.

Sociodemographic disparities in utilization were not alleviated by the introduction of digital visits; in-person users were also the primary digital users. Chat could be more equitable than video, but further research is needed.