ArticleJMIR mHealth and uHealth2026
Mobile Health App Acceptance in Japan's Aging Society: Multigroup Structural Equation Modeling Based on the Extended Unified Theory of Acceptance and Use of Technology and eHealth Literacy Frameworks.
Article in JMIR mHealth and uHealth, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundMobile health (mHealth) technologies are increasingly promoted as tools for chronic disease management and healthy aging, yet adoption remains persistently uneven across demographic groups. Japan, where 29.1% of the population is 65 years or older-the highest proportion globally-exemplifies the challenges of mHealth promotion in super-aging societies. Despite high smartphone penetration (90.1%) and active national digital transformation initiatives, only 21.6% of Japanese adults report regular mHealth app use, with marked disparities by age and sex.
objectiveThis study examined determinants of mHealth acceptance by extending the unified theory of acceptance and use of technology to incorporate eHealth literacy, self-efficacy, perceived risk, distrust, and health-related factors (health status and health interest). Age- and sex-specific differences in acceptance mechanisms were also investigated using multigroup structural equation modeling (SEM).
methodsWe conducted a cross-sectional online survey in November 2023 with 960 Japanese adults sampled across 7 age strata (aged 18-27 years to aged ≥78 years). SEM tested hypothesized relationships among 9 constructs. Health status and health interest were included as observed covariates. Multigroup SEM with configural, metric, and structural invariance testing examined age- and sex-specific differences, and binary logistic regression identified predictors of current mHealth app use.
resultsThe structural model demonstrated good fit (χ
conclusionsmHealth acceptance in Japan's aging society is characterized by stable proximal determinants of behavioral intention alongside heterogeneous upstream belief formation processes that vary systematically by age and sex. Health interest, rather than health status, emerged as the key contextual driver of perceived usefulness. At the theoretical level, this study clarifies how eHealth literacy, self-efficacy, and distrust function as age- and sex-contingent antecedents within an extended unified theory of acceptance and use of technology framework. At the practical level, these findings highlight the need for trust-centered, demographically tailored, and literacy-sensitive strategies to promote equitable mHealth adoption in rapidly aging societies.
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