Mapping the missing: A scoping review identifying critically underrepresented LGBTQI + youth within online sexual, reproductive, and transgender healthcare research

Online sexual, reproductive, and transgender healthcare can overcome barriers to care among lesbian, gay, bisexual, trans, queer/questioning, intersex, and other (LGBTQI+) youth and address disproportionately poor sexual and reproductive health outcomes. However, LGBTQI + youth are heterogenous and online healthcare spans broad health topics and online platforms. To map recent research and identify gaps, we conducted a scoping review, following Joanna Briggs Institute methodology, using the Participants (LGBTQI + youth aged 10-35 years), Concept (online sexual, reproductive, and transgender healthcare), Context (high-income countries) eligibility framework. We searched nine databases for recent literature (2018-2024), two reviewers screened studies using Rayyan, and data were extracted to Excel and analysed descriptively (N = 132 included papers). Most papers (89/132) were from distinct studies; 43/132 were from 15 studies. There were quantitative (57/132), qualitative (41/132), and mixed methods studies (34/132). Most focused on sexual healthcare (95/132) including HIV/STI prevention (68/95) and HIV management (10/95); 30/132 on transgender healthcare; and only 3/132 on reproductive healthcare. Most targeted young men who have sex with men (79/132) or trans and gender-diverse youth (44/132). Only 4/132 targeted young sexual minority women. Almost all were from the US (119/132). Amid a global shift to delivering healthcare online, this timely review provides the first comprehensive map of critical blind spots, highlighting the urgency of research on reproductive health, sexual wellbeing, and sexual minority women. Addressing these gaps is essential for providing equitable healthcare and reducing health disparities. These findings can guide the delivery of online healthcare that meets the needs of all LGBTQI + youth.