Validation of an mHealth adoption questionnaire for osteoporosis management in Iranian older adults at risk

BACKGROUND: With the increasing prevalence of osteoporosis among older adults and the growing need for effective self-management strategies, mobile health (mHealth) technologies may play an important role in supporting osteoporosis management. This study aimed to adapt and validate a culturally appropriate Persian questionnaire to assess mHealth adoption for osteoporosis management among Iranian adults aged ≥50 years, regardless of osteoporosis diagnosis status. METHODS: A questionnaire was adapted from established theoretical frameworks, including the Unified Theory of Acceptance and Use of Technology (UTAUT), the Health Belief Model (HBM), self-efficacy, digital literacy, and technology anxiety. The instrument underwent cross-cultural adaptation and psychometric evaluation in two phases: (1) content validation and cognitive testing, and (2) construct validation using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) with SmartPLS version 4. RESULTS: The final instrument consisted of 54 items after removing poorly performing indicators. The measurement model demonstrated satisfactory psychometric properties, with average variance extracted (AVE) values ranging from 0.608 to 0.833 and composite reliability (CR) values between 0.866 and 0.950. Discriminant validity was supported by heterotrait-monotrait ratio (HTMT) values below the recommended threshold. Performance expectancy, self-efficacy, digital literacy, and perceived severity emerged as key determinants of mHealth adoption among older adults. CONCLUSION: This study developed a culturally adapted Persian questionnaire with strong reliability and validity for assessing mHealth adoption in osteoporosis management among older adults. The instrument may help researchers, clinicians, and policymakers identify barriers to digital health engagement and design targeted interventions to improve mHealth adoption in ageing populations. The study designed and validated a culturally appropriate questionnaire to assess the acceptance of mHealth for osteoporosis management in Iranian adults over 50. Key predictors included performance expectancy, self-efficacy, and digital literacy. The findings support implementing tailored interventions to increase mHealth acceptance among older adults in resource-limited settings.