Perceptions and satisfaction with the use of digital medical services in urban older adults of China: a mixed-methods study (Preprint)

Background In an aging and information-driven society, older adults have distinct perceptions of and specific demands for digital medical services. It is essential for society to understand these needs and develop a more thoughtful approach to digital health care. Objective This study aims to evaluate the behavioral intention and satisfaction of older adults with digital medical services by identifying the perceived factors and the pathways through which these factors influence their behavior. Methods This study used a mixed methods approach, combining qualitative and quantitative analyses. A focus group interview was conducted with 30 randomly selected older adults, and the interviews were transcribed verbatim and coded using grounded theory. In addition, 876 valid questionnaires were collected to describe older adults’ perceptions of and satisfaction with digital medical care. Then, t tests and ANOVA were used to explore differences among various demographic groups, while hierarchical multiple regression was conducted to identify the factors most closely related to satisfaction. Structural equation modeling was used to identify multiple mediating effects. Results The qualitative study identified the core category of “medical service relief and transformation paths for older adults in the context of digital reform.” Quantitative analysis revealed that more than half of the older adults were satisfied with digital medical services, and behavioral intentions were higher among those with higher incomes and education levels. Structural equation modeling confirmed that external variables, such as digital skills training, positively influenced perceived ease of use (β=.594, P<.001), perceived usefulness (β=.544, P<.001), and promoted digital medical behavioral intentions (β=.256, P<.001), while also reducing perceived risk (β=–.295, P<.001). Additionally, perceived ease of use (β=.168, P<.001) and perceived usefulness (β=.508, P<.001) positively impacted behavioral intention, whereas perceived risk (β=–.05, P=.037) exerted a negative influence. Furthermore, behavioral intention (β=.641, P<.001) significantly and positively affected older adults’ satisfaction with digital medical care. The mediation test identified 4 significant paths: (1) external variables → perceived ease of use → behavioral intention (effect size of 13.9%); (2) external variables → perceived usefulness → behavioral intention (effect size of 38.4%); (3) external variables → perceived ease of use → perceived usefulness → behavioral intention (effect size of 10.1%); and (4) a direct effect (35.5%) from external variables to behavioral intention. Conclusions Based on the study’s findings, addressing the needs of older adults and enhancing perceived usefulness are the most effective ways to encourage the use of digital health care devices. Community support plays a crucial role in helping older adults integrate into digital health care, and adapting the design of services and products to suit their needs improves their perceptions of digital health care. This, in turn, promotes usage behavior and satisfaction, while the negative impact of perceived risk remains minimal.