Older Adults’ Continued Use of Smart Healthcare Applications: An Integrated HBM–UTAUT Model with Technology Anxiety

Background/Objectives: This study examines the continued use of smart healthcare applications among older adults by integrating the Health Belief Model (HBM) with the Unified Theory of Acceptance and Use of Technology (UTAUT). Perceived health threat and health management self-efficacy were considered health-related antecedents, while technology anxiety was examined as a moderator. Methods: Data were collected from 224 South Korean adults aged 60 years or older with prior experience using smart healthcare applications. Confirmatory factor analysis and structural equation modeling were used to assess the measurement and structural models. Indirect effects were tested using 5000 bootstrap resamples, and moderation was examined through hierarchical regression and simple slope analysis. Results: Perceived health threat was positively associated with performance expectancy but not with effort expectancy. Health management self-efficacy was positively associated with both performance and effort expectancy. Performance expectancy, effort expectancy, social influence, and facilitating conditions were all positively associated with behavioral intention, which showed the strongest relationship with actual use behavior. Technology anxiety significantly weakened the relationship between social influence and behavioral intention, whereas its moderating effects on performance expectancy and effort expectancy were not significant. Conclusions: The findings provide an integrated explanation of continued smart healthcare application use among older adults by linking health-related beliefs, UTAUT factors, and technology anxiety. Sustained use may be promoted by strengthening self-efficacy, improving usability, and reducing technology-related anxiety through accessible design and appropriate support.