Health app adoption among older adults: A multi-phase domestication perspective

The digital divide remains a critical barrier to healthcare innovation among older adults in China. This study investigates the phases and factors underlying the adoption of health-related smartphone applications by Chinese older adults, including health monitoring apps, online hospital registration and wearable health devices. Drawing on domestication theory, a mixed-methods research design was employed, including 20 qualitative interviews and a quantitative fsQCA analysis with 264 participants. Findings show that adoption is not an individual decision about technology or personal health but a social process around well-being and social engagement, influenced by family, friends, local organisations and government. Health apps were adopted for social well-being as well as health benefits, highlighting the importance of perceived usefulness beyond medical functionality. The research contributes theoretically by integrating phase-based analysis into technology adoption studies, and methodologically by showcasing fsQCA's value in uncovering complex, non-linear adoption pathways. Practically, the study suggests targeted interventions integrating government support, community education, ageing-friendly app design and the need to recognize older adults' needs in promoting digital inclusion.