How culture and environment reshape the adoption and effectiveness of wearable diet monitoring in university students: an extended KANO–TAM–SEM model study using Taiwan as an example

Background: A healthy lifestyle contributes to optimal nutrition and physical well-being. However, the cognitive and feedback regulation of hunger at psychophysiological levels-as a core mechanism for food intake control and self-regulation-remains understudied. University students commonly exhibit a gap between nutritional knowledge and practice. In Taiwan, the prevalence of lifestyle-related chronic diseases coexists with universal health insurance coverage, highlighting the urgent need for culturally adapted, user-centered technological interventions to enhance daily self-management capabilities. Objective: Guided by the KANO model, this study integrates Culture, Environment, Habit, Self-Perception, and User Evaluation (CEHSV) into a unified KANO-TAM-SEM framework, extending the Technology Acceptance Model (TAM) to explain adoption behaviors and downstream outcomes of dietary tracking wearables. Methods: The present study employed a single-arm, prospective field intervention with pre-post assessments (within-subject longitudinal design). During a 12-week field intervention, N = 200 university students (mean age 20.4 ± 1.8 years; 62% female) used a human-centered application designed based on the Kano model (Basic Functions: Accuracy/Reliability/Simplicity; Efficacy features: goal setting and feedback; Attractiveness features: gamification and social sharing). Evaluation metrics included: fruit and vegetable intake portions, dietary self-regulation scores, daily step counts, and WHOQOL-BREF quality-of-life scales. Structural equation modeling (SEM) validated the theoretical framework; multi-group SEM separately examined dormitory vs. home living environments and self-efficacy subgroups. Results: < 0.01). The extended model explained 36% of usage frequency, 45% of dietary self-regulation improvement, and 54% of quality-of-life enhancement, significantly surpassing baseline effects observed with TAM alone (approximately 7% usage rate; ~39% dietary change). This model structure was validated across dormitory/home environments and across low- and high-self-efficacy groups. Conclusion: Integrating CEHSV contextual factors into TAM establishes a culturally intelligent and user-centered framework for preventive dietary wearables. This framework bridges the knowledge-practice gap, thereby enhancing health and well-being.