Designing AI-powered healthcare assistants to effectively reach vulnerable populations with health care services: A discrete choice experiment among South African university students

South African young adults are at increased risk for HIV acquisition and other non-communicable diseases and face significant barriers to accessing healthcare services. The rapid development of artificial intelligence (AI), in particular AI-powered healthcare assistants (AIPHA), presents a unique opportunity to increase access to health information and linkage to healthcare services and providers. While successful implementation and uptake of such tools require understanding user preferences, limited understanding of these preferences exist. We sought to understand what preferences are important to university students in South Africa when engaging with a hypothetical AIPHA to access health information using a discrete choice experiment. We conducted an unlabeled, forced choice discrete choice experiment among adult South African university students through Prolific Academic, an online research platform, in 2024. Each choice option described a hypothetical AIPHA using eight attribute characteristics (cost, confidentiality, security, healthcare topics, language, persona, access, services). Participants were presented with ten choice sets each comprised of two choice options and asked to choose between the two. A conditional logit model was used to evaluate preferences. 300 participants were recruited and enrolled. Most participants were Black, born in South Africa, heterosexual, working for a wage, and a mean age of 26.5 years (SD: 6.0). Results from the discrete choice experiment identified that language, security, and receiving personally tailored advice were the most important attributes for AIPHA. Participants strongly preferred the ability to communicate with the AIPHA in any South African language of their choosing instead of only English and to receive information about health topics specific to their context including information on clinics geographically near them. Results were consistent when stratified by sex and socioeconomic status. Participants had strong preferences for security and language which is in line with previous studies where successful uptake and implementation of such health interventions clearly addressed these concerns. These results build the evidence base for how we might engage young adults in healthcare through technology effectively.