Extending the technology acceptance model in digital therapeutics: integrating perceived wellbeing and patient cooperation in a patient-centered framework

Digital Therapeutics (DTx) represent interactive combinations of smart objects and software-based interventions increasingly integrated into healthcare pathways for a renewed patient-centric care approach. Unlike generic health apps, DTx may actively engage patients in their care journey, transforming technology into an interactive therapeutic companion that supports behaviour, adherence, and wellbeing. However, their effectiveness ultimately depends on patients’ acceptance, cooperation, and perceived wellbeing derived from the use of such technological tools, rather than being explained by traditional drivers of technology acceptance alone. This study proposes a renewed technology acceptance framework explaining patients’ acceptance of DTx by integrating institutional and technological factors as antecedents of perceived usefulness and ease of use, alongside the crucial roles of patients’ cooperation and perceived wellbeing. Using survey data from 158 respondents and applying PLS-SEM, the results reveal that technological factors, but not institutional conditions, significantly enhance perceived wellbeing. Wellbeing, in turn, positively influences perceived ease of use and perceived usefulness. These evaluations, in turn, foster patients’ cooperation, which emerges as the central behavioural mechanism translating perceived usefulness and perceived ease of use into intention to use. Thus, by demonstrating that perceived wellbeing acts as an experiential antecedent of acceptance evaluations, while patient cooperation functions as the behavioural path through which such evaluations become adoption intentions, this study advances a patient-centered reconceptualization of DTx acceptance.