Trust-Centered Design and Feasibility Evaluation of an AI-Enabled Conversational Health Tool for Sexual and Reproductive Health Among Rural Young Adults: Protocol for a Mixed Methods Study.

Background: Young adults aged 18 to 25 years in rural communities face barriers to sexual and reproductive health (SRH) information, including clinician shortages, clinic closures, and privacy concerns in close-knit communities. Many rely on online sources of varying quality; one analysis found that 40% of birth control video content is inaccurate or misleading. AI-enabled conversational health tools (chatbots) may provide scalable SRH information, but implementation may be constrained by low institutional trust, privacy concerns, and rural users' underrepresentation in AI development. SARHAchat is an AI-enabled SRH conversational health tool developed through prior work. This protocol describes a study to co-design and evaluate SARHAchat with rural young adults, treating trust as a design input rather than a postdeployment outcome. Objective: This study aims to (1) identify multilevel determinants of trust and acceptability for AI-enabled conversational health tools among rural pregnancy-capable individuals aged 18 to 25 years in North and South Carolina; (2) co-design a SARHAchat prototype with rural stakeholders using human-centered design; and (3) evaluate its feasibility, acceptability, usability, trust, and implementation outcomes in a pilot. The goal is to develop methods that support responsible implementation of conversational AI health tools in rural and underserved communities. Methods: This protocol uses a 3-phase mixed methods design with exploratory sequential logic. In phase 1, we will conduct semistructured interviews (target n=24) with pregnancy-capable individuals aged 18 to 25 years living in Health Resources and Services Administration (HRSA)-designated rural counties in North and South Carolina to identify determinants of trust and acceptability and develop a conceptual framework. In phase 2, we will convene 5 to 8 stakeholders per session across 2 community feedback sessions to co-design and refine SARHAchat. In phase 3, we will conduct a nonrandomized mixed methods feasibility pilot with 75 pregnancy-capable individuals aged 18 to 25 years from rural counties, recruited through community-identified social media platforms. Results: This proposal was funded in February 2026. All 3 phases have been approved by the University of North Carolina at Chapel Hill Institutional Review Board (26-0669). A total of 14 participants have enrolled in phase 1. Phase 2 co-design activities are planned for August to October 2026, and phase 3 pilot recruitment is expected to begin in January 2027, with data collection concluding in October 2027. Findings are anticipated to be submitted for publication in April 2028. Conclusions: This protocol describes a feasibility study of a community-informed AI-enabled conversational SRH tool for rural young adults. By identifying trust-related design needs, refining a prototype through co-design, and generating preliminary feasibility, acceptability, usability, and implementation data, the study aims to establish trust-by-design methods that guide future effectiveness testing and may transfer to other sensitive health domains and underserved communities.