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

Abstract

Objective: 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.

Patients and methods: 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.

Results: 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.

Conclusions: 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.

Figure 1

Estimated time trends in monthly sexual and reproductive health (SRH) service use among youth aged 12-22 years by mode of contact (A), and specifically among digital visits (B), 2018-2022 aggregated per 10,000 individuals. Estimations using an ordinary least squares regression with restricted cubic splines with knots placed every year break (ie, 12-month distance).

Figure 2

Sex stratified annual utilization rate of in-person and digital visits at the population level across the entire study period. Sex was adjusted for age. Error bars represent 95% CIs.

Figure 3

Adjusted odds ratios and 95% CIs of sexual and reproductive health (SRH) service contacts at the population level for in-person and digital visits (A) and chat and video (B) consultations, across the entire study period 2018-2022. Estimates are adjusted for sex and age. Error bars represent 95% CI.

Figure 4

Adjusted differences in the percent of monthly overall sexual and reproductive health (SRH) service use at youth clinics across sociodemographic strata, before and after the COVID-19 pandemic, with estimates closer to zero signifying diminishing sociodemographic differences. Estimates are adjusted for sex and age, except when analyzed as the strata. 95% CIs are plotted but, because of the large sample size, they are not visible beyond the point estimate but available in the supplement.