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Enhancing LGBTQ+ Inclusivity in an AI-Powered Sexual Health Chatbot: User-Centered Design Approach Through a Nonprofit and Academic Partnership

Liem, William Wibowo, Casline, Elizabeth, Lorenzo, Julianna, Gordon, Jacob D, Avila, Andrés Alvarado, Taylor, Attia, Levitz, Nicole, O'Keefe, Michael C, Shum, Karen, Macapagal, Kathryn·2026·Journal of Medical Internet Research
DOI 10.2196/78621PMC PMC12919746
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Abstract

Background: Despite the growing use of digital platforms for sexual health education, many tools fail to meet the needs of LGBTQ+ (lesbian, gay, bisexual, transgender, and queer) teenagers, who often lack access to inclusive, affirming resources. Artificial intelligence (AI)–enabled chatbots have emerged as promising tools to address these gaps, but concerns remain around bias, usability, and trustworthiness—particularly for queer and transgender teenagers. Participatory design approaches centered around marginalized teenagers are critical to ensuring these tools are relevant, trustworthy, and equitable; yet, few studies have systematically engaged LGBTQ+ teenagers in the co-design of AI-powered sexual health interventions. Objective: This paper examines LGBTQ+ teenagers’ perceptions of Roo, Planned Parenthood Federation of America’s (PPFA) AI-powered sexual education chatbot to identify opportunities and challenges in delivering LGBTQ+-inclusive, affirming sexual health information. Methods: Embedded within Sharing Health Education Resources, a hybrid effectiveness implementation trial of a digital HIV prevention intervention for LGBTQ+ teenagers, we collaborated with PPFA to create a customized instance of Roo for integration into this study. We engaged a Youth Advisory Council comprising 15 LGBTQ+ teenagers to independently explore and interact with Roo, then gathered feedback through a week-long asynchronous discussion on a private Discord (Discord Inc) server. The research team posed open-ended questions prompting participants to reflect on Roo’s inclusivity, usability, and content priorities. We used rapid qualitative analysis organized around our research questions. Results: Participants expressed both skepticism and curiosity about AI’s role in delivering sexual health information, offering critical insights on the chatbot’s language, trustworthiness, and relevance. Teenagers identified key limitations in Roo’s inclusivity, tone, and interface, particularly around transgender-specific content, conversational depth, and stigma reduction. These findings informed targeted content updates, interface refinements, and transparency improvements, implemented by PPFA to enhance Roo for broader use. Specific changes included expanding LGBTQ+ affirming content, revising language to eliminate gendered assumptions, incorporating concrete statistics and contextualized examples to reduce stigma, and adding clearer disclosures around Roo’s AI capabilities and limitations. Conclusions: Academic and nonprofit collaborations can leverage participatory methods to enhance digital health tools in real-world contexts. LGBTQ+ teenagers served not only as testers but as co-designers, shaping the chatbot’s evolution and surfacing broader lessons about trust, AI literacy, and health equity. This study demonstrates that marginalized teenagers possess the critical insights needed to meaningfully shape AI-enabled health interventions when provided with structured opportunities for engagement. This partnership offers a scalable model for integrating community voice into the development, evaluation, and implementation of inclusive, AI-enabled health technologies.

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  • The teenagers identified significant gaps in the chatbot's inclusivity, insufficient transgender-specific content, a tone they found clinical and distancing, and a lack of options for diverse relationship configurations, and their feedback was directly incorporated into the platform's development.

    “The teenagers identified significant gaps in the chatbot's inclusivity, insufficient transgender-specific content, a tone they found clinical and distancing, and a lack of options for diverse relationship configurations, and their feedback was directly incorporated into the platform's development.”

    From Artificial intelligence and immersive technologies for LGBTQ+ youth: a narrative review (2026) · cites this paper as Liem et al., 2026

  • LGBTQ+ teenagers are not simply passive recipients of technology but active and capable co-designers who can meaningfully shape the tools intended to serve them.

    “This study is significant not only for its findings but for its methodology: it demonstrates that LGBTQ+ teenagers are not simply passive recipients of technology but active and capable co-designers who can meaningfully shape the tools intended to serve them.”

    From Artificial intelligence and immersive technologies for LGBTQ+ youth: a narrative review (2026) · cites this paper as Liem et al., 2026

  • In co-design studies, LGBTQ+ young people identified gaps that developers had missed.

    “In co-design studies, LGBTQ+ young people identified gaps that developers had missed, although no study has yet compared co-designed tools with conventionally developed ones.”

    From Artificial intelligence and immersive technologies for LGBTQ+ youth: a narrative review (2026) · cites this paper as Liem et al., 2026

  • Several reviewed studies showed that young people, including LGBTQ+ youth, can be meaningfully involved in designing the tools intended to serve them.

    “Several studies reviewed here, including those by Liem et al. (2026), Marraccini et al. (2026), and Solyst et al. (2023), showed that young people, LGBTQ+ youth among them, can be meaningfully involved in designing the tools intended to serve them.”

    From Artificial intelligence and immersive technologies for LGBTQ+ youth: a narrative review (2026) · cites this paper as Liem et al. (2026)

  • AI chatbots are acceptable to LGBTQ+ young people and valued for their anonymity.

    “AI chatbots are acceptable to LGBTQ+ young people and valued for their anonymity, but current tools give generic responses and perform poorly outside North American and Western European contexts.”

    From Artificial intelligence and immersive technologies for LGBTQ+ youth: a narrative review (2026) · cites this paper as Liem et al., 2026

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Metadata

Authors
Liem, W. W., Casline, E., Lorenzo, J., Gordon, J. D., Avila, A. A., Taylor, A., Levitz, N., O'Keefe, M. C., Shum, K., & Macapagal, K.
ORCID
Venue
Journal of Medical Internet Research
Publisher
JMIR Publications Inc.
Published
2026-02-19
Volume
28
Pages
e78621-e78621
ISSN
1438-8871
DOI
10.2196/78621
PMC
PMC12919746
Cited by
8
References
4
Language
en

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