Background. By 2030, adults aged 65 and older will approach near parity with younger populations, intensifying demand for scalable models of care. Although digital transformation has reshaped other industries, comparable impact in post-operative recovery has remained elusive, particularly among older adults. As innovation advances, it continues to outpace the capacity of patients and health systems to sustain meaningful engagement with digital tools. In the space between technological capability and human readiness, engagement becomes the defining hinge. Purpose. This study identified latent motivators, barriers, and contextual influences shaping older adults' engagement with a digital recovery platform during total joint replacement care. Methods. A convergent mixed-methods, cross-sectional design was used with pre-surgical and post-surgical surveys administered through Qualtrics (N = 209, with an analytical subset of N = 206). Quantitative analyses included descriptive statistics and chi-square tests examining associations between age cohort and Capability, Opportunity, Motivation–Behavior (COM-B) domains. Qualitative open-text responses were thematically synthesized and mapped to COM-B behavioral determinants, while adoption processes were interpreted through Diffusion of Innovations. Results. Within the pre-surgical group, chi-square analyses by age cohort demonstrated trend-level associations for reflective motivation and for physical and psychological capability, with moderate power. Within the post-surgical group, automatic motivation demonstrated a trend-level association and social opportunity demonstrated a statistically significant association, both with high power (0.79). Thematic synthesis yielded both favorable and challenging engagement narratives, with human connection emerging as a cross-cutting determinant—experienced as facilitative when the platform reinforced support and confidence, and as constraining when gaps in relational or practical support remained. When mapped to Diffusion of Innovations, engagement friction clustered most strongly in the persuasion and implementation stages, while knowledge, decision, and confirmation were comparatively less obstructive. Discussion. Engagement with digital recovery tools appears to be shaped by a combination of psychosocial predispositions and contextual opportunity. Findings suggest value in systematically assessing, or “triaging,” behavioral determinants prior to deployment so that onboarding and support can be matched to patients’ needs. Human connection functioned as a dual driver of engagement, indicating that digital platforms may be most effective when they extend, rather than replace, the support provided by orthopedic teams, caregivers, and broader support structures. Age associations observed among the pre-surgical cohort were not sustained post-surgically, suggesting that surgical recovery may serve as a contextual normalizer of engagement-relevant behavioral determinants. Interpreted through Diffusion of Innovations, persuasion and implementation represent the most consequential points of leverage for strengthening adoption and sustained use. For many participants, the platform was not simply a tool—it was experienced as either a bridge to support, or a mirror of what support was missing.
Viji Vellayan (Thu,) studied this question.