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\begin{document}

\title{``A great way to start the conversation'': Evidence for the Use of an
Adolescent Mental Health Chatbot Navigator for Youth at Risk of HIV and
other STIs}



\author[1]{Gabriella Sanabria}%
\author[1]{Karah Y. Greene}%
\author[1]{Jennifer T. Tran}%
\author[1]{Shelton Gilyard}%
\author[1]{Lauren DiGiovanni}%
\author[1]{Patricia J. Emmanuel}%
\author[1]{Lisa J. Sanders}%
\author[1]{Kristin Kosyluk}%
\author[2]{Jerome Galea}%
\affil[1]{Affiliation not available}%
\affil[2]{University of South Florida School of Social Work}%


\vspace{-1em}



  
  \date{June 15, 2024}


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\selectlanguage{english}
\begin{abstract}
Chatbot use is increasing for mobile health interventions on sensitive
and stigmatized topics like mental health because of their anonymity and
privacy. This anonymity provides acceptability to sexual and gendered
minority youth (ages 16-24) at increased risk of HIV and other STIs with
poor mental health due to higher levels of stigma, discrimination, and
social isolation. This study evaluates the usability of Tabatha-YYC, a
pilot chatbot navigator created to link these youth to mental health
resources. Tabatha-YYC was developed using a Youth Advisory Board (n=7),
and the final design underwent user testing (n=20) through a think-aloud
protocol, semi-structured interview, and a brief survey post-exposure
which included the Health Information Technology Usability Evaluation
Scale. The chatbot was found to be an acceptable mental health navigator
by participants. This study provides important design methodology
considerations and key insights into chatbot design preferences of youth
at risk of STIs seeking mental health resources.%
\end{abstract}%



\sloppy


Table I. Participant Characteristics (n=20)\selectlanguage{english}
\begin{longtable}[]{@{}lll@{}}
\toprule
\begin{minipage}[b]{0.30\columnwidth}\raggedright\strut
\textbf{Characteristics}\strut
\end{minipage} & \begin{minipage}[b]{0.30\columnwidth}\raggedright\strut
\textbf{n}\strut
\end{minipage} & \begin{minipage}[b]{0.30\columnwidth}\raggedright\strut
\textbf{(\%)}\strut
\end{minipage}\tabularnewline
\midrule
\endhead
\begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
\textbf{Biological Sex Assigned at Birth}\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
Male\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
8\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
(40)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
Female\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
12\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
(60)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
\textbf{Age Groups}\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
14-17 yrs\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
1\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
(5)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
18-26 yrs\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
19\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
(95)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
\textbf{Sexual Orientation}\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
Gay or lesbian\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
4\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
(20)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
Straight\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
12\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
(60)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
Bi-sexual\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
4\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
(20)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
Other\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
(0)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
\textbf{Race}\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
African American/Black\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
10\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
(50)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
White\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
6\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
(30)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
Asian\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
1\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
(5)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
Multi-racial\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
1\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
(5)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
Other\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
2\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
(10)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
\textbf{Ethnicity}\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
Hispanic\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
4\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
(20)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
Non-Hispanic\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
16\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
(80)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
\textbf{Education}\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
High school graduate\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
5\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
(25)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
Some college, no degree\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
8\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
(40)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
Associates degree\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
2\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
(10)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
Bachelor's degree\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
4\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
(20)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.32\columnwidth}\raggedright\strut
Currently enrolled in high school or GED program\strut
\end{minipage} & \begin{minipage}[t]{0.32\columnwidth}\raggedright\strut
1\strut
\end{minipage} & \begin{minipage}[t]{0.32\columnwidth}\raggedright\strut
(5)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
\textbf{Currently Receiving Mental Health Treatment}\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
Yes\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
5\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
(25)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
No\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
15\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
(75)\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

Table II. Health-ITUES Scores (n=20)*\selectlanguage{english}
\begin{longtable}[]{@{}lll@{}}
\toprule
\textbf{Scale} & \textbf{Mean} & \textbf{(SD)}\tabularnewline
\midrule
\endhead
Impact & 4.3 & 0.8\tabularnewline
Perceived usefulness & 4.4 & 0.8\tabularnewline
Perceived ease of use & 4.5 & 0.7\tabularnewline
User control & 3.6 & 1.3\tabularnewline
Overall health-ITUES score & 4.3 & 0.9\tabularnewline
\bottomrule
\end{longtable}

\textbf{*} rating completed off a five-point Likert scale, with five
being the highest or best score

\textbf{Hosted file}

\verb`Figures_Tabatha_18oct2022.docx`  available at \url{https://authorea.com/users/719156/articles/704202--a-great-way-to-start-the-conversation-evidence-for-the-use-of-an-adolescent-mental-health-chatbot-navigator-for-youth-at-risk-of-hiv-and-other-stis}

\textbf{Hosted file}

\verb`Usability Paper_Tabatha-10.22.22-Unblinded.docx`  available at \url{https://authorea.com/users/719156/articles/704202--a-great-way-to-start-the-conversation-evidence-for-the-use-of-an-adolescent-mental-health-chatbot-navigator-for-youth-at-risk-of-hiv-and-other-stis}

\selectlanguage{english}
\FloatBarrier
\end{document}

