Using the smart health management services and devices among China’s adults and the influencing factors: A mixed-methods study

As the emerging of structural imbalance characterized by surging demand and insufficient high-quality supply in China’s health management system, smart health management services become a novel measure to address this gap. Smart health management services refer to the health monitoring, assessment and intervention with support of information communication and artificial intelligence technologies. To systematically analyze the current status, needs, and influencing factors of the using of smart health management services and devices among China’s adults, thereby providing evidence support and suggestions for its development. A mixed-methods design was employed, combining quantitative and qualitative research methods. In the quantitative section, participants aged 18 years and above were selected by a stratified cluster random sampling method, their intentions and behaviors in utilizing smart health management services were analyzed by structural equation model (SEM). In the qualitative research section, 13 interviewees were selected for semi-structured, one-on-one interviews, the findings were analyzed by grounded theory coding. Quantitative and qualitative findings were integrated using an explanatory sequential mixed-methods framework. A total of 2786 adults participated the questionnaire survey with a response rate of 96.07 %. Of them, 13 participants agreed to attend the semi-structured, one-on-one interviews. The main findings are as follows: (1) 37.7 % of the adult participants used smart health management devices. The use rate presents decline with increasing age, and lower use among older adults. (2)The demand for smart health management systems shows a diversified trend, and significant differences between age groups. Overall, participants believe that certain basic functions of the smart health systems, such as health monitoring, are needed, and they hope that it can answer questions raised by users. Qualitative study further revealed that participants' needs for smart health systems are in line with Maslow's Hierarchy of Needs, which includes needs at various levels from "basic life safety and health security" to "active learning and self-actualization." Young participants prefer the support function for basic preventive activities and optimization of lifestyle; older participants then are more concerned about whether the system has practical functions for disease management. (3)The average using willingness was moderately high (62.68 ± 20.65). In the SEM, behavioral attitude emerged as the strongest predictor of willingness of use( β =0.568, P < 0.001), followed by subjective norms ( β = 0.103, P < 0.001) and media motivation ( β = 0.094, P < 0.001). Electronic health literacy exerted significant indirect effects on both willingness ( β = 0.045, P < 0.001) and behavior ( β =0.051, P < 0.001) via media motivation, while perceived behavioral control influenced them indirectly ( β = 0.014 and 0.016, both P < 0.001). Living in urban areas positively affected both willingness( β = 0.056, P < 0.001) and behavior ( β = 0.125, P < 0.001). Health insurance coverage significantly promoted willingness (β = 0.039, P < 0.001). (4)Qualitative findings revealed multiple barriers to using, including high costs, product quality concerns, discomfort during using, and security issues. Attitudes toward smart health management devices were polarized, positive or negative evaluations stemmed directly from experience, perceived benefits, and device intelligence level, whereas neutral users tended to discontinue use due to a lack of perceived value. In addition, personal beliefs and cultural values strongly influenced individuals’ acceptance. The study identified a distinct pattern of “high wish and low use” among adults regarding smart health management services. Both using behavior and demand pattern exhibited clear age-specific differences and were shaped by a number of factors. To bridge the gap between willingness to use and actual using behavior, future efforts should focus on age-appropriate design, precision implementation, and collaboration with primary care facilities, thereby enhancing adults’ capacity for actively managing their health.