The Long-Term Evolution of User Perceptions of Healthcare AI Tools: Dual Trajectories of Cognitive Maturation and Attitudinal Recalibration

We report a four-year longitudinal mixed-methods study (2022–2025, N = 21) examining how perceptions of generative AI in personal healthcare evolved during a period of rapid technological change. During this period, participants not only gained experience with healthcare AI but also witnessed the broader public diffusion of generative AI. Our findings show a steady increase in AI literacy alongside a more dynamic attitudinal trajectory: participants moved from early caution to optimistic adoption and later to more selective and critical acceptance. We describe this pattern as a dual trajectory of cognitive maturation and attitudinal recalibration. These findings extend technology-acceptance perspectives by highlighting, within a Chinese digital health context, a dual trajectory in which increasing AI literacy coexists with more critical evaluation of healthcare AI. Finally, we derive design implications for transparency, trust calibration, and human–AI role boundaries in healthcare.