Ladders to better health? Identifying the cognitive pathways and barriers to value attainment in wearable health device usage

Objective Wearable health devices (WHDs) are increasingly important in supporting personal health goals, yet their effectiveness is mediated by the user experience. This study employs means-end chain (MEC) analysis to map the cognitive pathways through which users transition from perceiving device attributes to attaining core health values. Methods We applied a soft-laddering technique to interview 63 adult WHD users. The interview data were analyzed using content analysis to identify key attributes, consequences, and values. A summary implication matrix was constructed to illustrate the linkages between these factors, culminating in the generation of a hierarchical value map. Results Results indicate that concrete WHD attributes (e.g., wearability, health tracking, haptic reminders) facilitate positive user consequences, such as a sense of companionship, risk awareness, and self-regulation. These pathways lead to the attainment of high-level health values including mental wellness, safety, self-optimization, and lifestyle improvement. Conversely, we identified significant “broken ladders” in which persistent design flaws (e.g., inaccurate/inconsistent data, black-box algorithms, mistimed prompts, unrealistic goals), lead to negative consequences such as decision paralysis, distress, and motivation crowding. These barriers actively hinder value attainment in WHD usage. Conclusions This study provides a comprehensive framework of the WHD user journey, highlighting that user value is not derived solely from the technology but also from psychological and cognitive mediators. Findings suggest that developers must move beyond usability to prioritize data transparency and literacy education, while implementers should monitor for compulsive usage patterns to reduce psychological burdens and support long-term digital health engagement.