Digital health tools as conditional information scaffolds: Patient portals, wearables, communication, and trust in healthcare systems

This study uses the Extended Mind Thesis and Distributed Cognition as sensitizing frameworks for understanding digital health tools as conditional information scaffolds rather than as directly observable cognitive extensions. Analyzing nationally representative HINTS 2025 data (N = 7,278), we distinguish two confirmatory hypotheses from a set of exploratory research questions. Final-person-weighted least squares models show that patient portal use is negatively associated with patient-centered communication (PCC) and positively associated with institutional trust. Wearable use demonstrates no direct effects on either outcome. Moderation results indicate that digital literacy and health data sharing condition some associations, suggesting possible sociotechnical coordination around digital health information rather than evidence of continuous somatic extension or full cognitive extension.