Wearable IoT health sensing beyond functional utility: Identity-expressive and hedonic determinants of user acceptance in intimate physiological monitoring devices — A sequential FA–ANP mixed-methods investigation with digital health policy implications

Background: IoT-enabled wearable physiological sensing devices are expanding rapidly into intimate sexual health monitoring contexts, encompassing IoT-enabled sexual wellness instrumentation, sexual health wearables, and related companion technologies, generating pressing digital health governance challenges alongside substantial market growth. Despite a sixfold sector expansion reaching USD 56.8 billion by 2022, the sensing design characteristics governing user acceptance of integrated multi-sensing unit (IMSU)-enabled devices remain empirically uncharacterized, leaving device developers, clinicians, and health informatics policymakers without an evidence base for design standards or biometric data governance frameworks. Objectives: This research identifies and prioritizes the sensing material characteristics determining anticipated user acceptance of IMSU-enabled intimate physiological health monitoring devices across three psychosocial acceptance pathways: Behavioral functional utility, Desire-based hedonic engagement, and Identity-expressive self-concept alignment. Methods: A sequential mixed-methods design integrated factor analysis (FA; n = 289 adult participants) with analytic network process (ANP) expert evaluation (n = 30 domain specialists), organized within a theoretical framework synthesizing the Technology Acceptance Model (TAM), Unified Theory of Acceptance and Use of Technology (UTAUT), and Human Determinism Theory of Behavior (HDTB). Results: Positive anticipated acceptance achieved the highest Standardized Comprehensive Evaluated Weight (SCEW = 0.3449), exceeding negative acceptance by 8.2%. Three sensing characteristics dominated positive acceptance: visual-aesthetic sensing integration (BLMA-STIP, 0.2447), anatomical personalization (APMA-SSC, 0.2376), and auditory-responsive physiological feedback (RPMMC-STIP, 0.2204). Identity dimension characteristics outperformed Behavioral characteristics by 31.5%. Cross-method convergence was confirmed (r = 0.68, p < .01). Conclusions: Acceptance of IMSU-enabled wearable health devices follows identity-expressive and hedonic pathways that substantially outweigh functional utility logic, extending TAM and UTAUT in domain-specific ways with direct implications for patient-centered device design, digital health communication strategy, and consent-based biometric data governance policy.