Communication practices in confidential sexual health chat support service on sex and sexuality among adolescents

This study examines communication practices in a Confidential Sexual Health Chat Support Service (CSHCSS) for adolescents in Israel. Based on 191 anonymized chat transcripts from a 2022 digital counseling initiative run by a sexual assault crisis center, the study analyzes how trained counselors addressed questions related to sex, sexuality, and relationships. Using qualitative content analysis, three overarching categories of communication were identified: (1) providing and receiving information, (2) trust-building and bonding, and (3) direct interventions, oriented to emotional or cognitive change. These categories encompassed ten specific conversational skills, including clarification, reflection, empathy, validation, reframing, and confrontation.The findings show that most interactions centered on providing information, particularly regarding contraception, sexual orientation, and relational boundaries. Empathic and validating responses were key to establishing trust within the written exchanges. Direct interventions, such as reframing or interpretative formulations, were less frequent but were phrased in ways that invited deeper reflection. The analysis highlights how counselors navigated competing discourses in sexuality education: a risk-focused, preventative model versus a critical, empowerment-oriented approach that emphasizes agency and self-awareness. By shedding light on the communicative strategies used in anonymous, chat-based support, the study contributes to the literature on digital sexual health interventions. It underscores the need to equip counselors with a balanced set of practices that integrate accurate information with emotional support, enhancing the effectiveness and responsiveness of online services for adolescents.