Usability and Behavioral Intention in Quasimandatory National Digital Health Systems: The Mediating Role of E‐Satisfaction

The rapid expansion of national digital health infrastructures has transformed the way citizens interact with healthcare systems. However, the long‐term success of these platforms depends not only on technological implementation but also on users’ perceptions and continued engagement. This study investigates how the usability of a national mobile health application influences users’ behavioral intention through the mediating role of e‐satisfaction. Drawing on usability and technology acceptance literature, the study proposes a research model in which the perceived usability of a mobile health application positively affects users’ behavioral intention both directly and indirectly via e‐satisfaction. Empirical data were collected from users of the Turkish national digital health platform e‐Nabız through a structured survey. The proposed research model was tested using structural equation modeling techniques. The results indicate that mobile health application usability significantly enhances users’ e‐satisfaction, which in turn positively influences behavioral intention, including recommendation intention and continued preference intention. Interestingly, the analysis revealed that even negative usability perceptions were associated with increased e‐satisfaction, likely reflecting the quasimandatory nature of the platform, where functional necessity and perceived value can outweigh usability difficulties. The findings also demonstrate the mediating role of e‐satisfaction in the relationship between usability and behavioral intention. By focusing on a large‐scale national digital health platform, this study contributes to the growing literature on digital health adoption by highlighting the importance of usability‐driven user experience in quasimandatory digital health systems. The results provide practical insights for policymakers and digital health system designers seeking to improve citizen engagement and long‐term utilization of national digital health infrastructures.