Research On User Engagement With Smart Wearable Health Technologies (SWHTs) And Impacts On Health Behavior

Smart wearable health technologies(SWHTs)have brought novel health information to general consumers and changed the way how they access health information unprecedently.With the prevalence of sub-health status,high incidence and low recovery rate of chronic diseases,and improvement of health consciousness in public,the SWHTs market has expanded year by year and many stakeholders such as technology companies,consumers,and public health policymakers have paid attention to them.However,there exist problems of user discontinuance and negative experiences in SWHTs practice.To be specific,market surveys suggest that about 30% percent of users abandon their SWHTs devices in half a year,and the number is 50% in one year.For some users,SWHTs cannot "protect health" or "support health" as claimed by the technology providers.Instead,it brings a series of negative psychological experiences such as invasiveness,confusion,and frustration to users,which ultimately lead to a reduction in the frequency of use and even abandonment of SWHTs.Therefore,how to improve the user experience and realize user retention is the key to the further development of SWHTs.The problems with the use and experience of SWHTs have attracted the research interests of IS scholars.Existing literature has constructed theoretical models based on general theories,including the technology acceptance model,expectation confirmation theory,and motivation theory.However,those models only provide low explanatory power for continuous use intention,use frequency,and function use.Some scholars summarized the complex psychological experience of users interacting with SWHTs based on the user interview data,but the research conclusions obtained through qualitative analysis are scattered and lack theorization.Therefore,there is a need to strengthen the understanding of SWHTs users’ psychological experiences and behavior.User engagement is a novel theoretical concept in IS area.It focuses on users’ psychological state and behavioral performance during their interactions with information technologies,which provides theoretical guidance for maximizing the effects of information technologies,thus offers a referential theoretical perspective for investigating the use and experience of SWHTs.The concept connotation of user engagement is contextual.While,so far,no studies have investigated user engagement in SWHTs settings.Therefore,this paper introduces the user engagement theory into the SWHTs settings to systematically explore the construct dimension,measurement scale,formation process,and impact on the health behavior of SWHTs user engagement.This paper mainly carries out the following four aspects of work.Firstly,based on engagement-related concepts in current literature,this paper proposes the definition of user engagement with SWHTs.Through in-depth interviews and following grounded theory methodology,this study extracts the constituent elements and the dimensional structure of user engagement with SWHTs.Accordingly,the construct of user engagement with SWHTs is divided into five dimensions,including sensory engagement,cognitive engagement,emotional engagement,behavioral engagement,and social engagement,and their conceptual connotation are explained.Secondly,following the standardized development steps of scales,this paper designs measurement items based on interview data and literature.Using expert screening and user evaluation mechanisms,the initial measurement scale of user engagement with SWHTs with ensured content validity is proposed.The initial scale is further purified through the examination of reliability and exploratory factor analysis using data collected by preliminary survey.The purified survey is tested through confirmatory factor analysis and nomological analysis based on data collected from the formal survey.The data analysis results of the preliminary and formal survey suggest that the user engagement with SWHTs scale proposed by this paper has good reliability and validity.Thirdly,based on the coping model of user adaptation,this paper proposes the SWHTs user engagement formation process model,and theoretical hypotheses are put forward.Empirical data were collected through questionnaires and Smart PLS 3.3.9 was used for data analysis and model test.The results suggest that self-regulation affordances have a positive impact on problem-focused and emotion-focused adaptation,respectively,while cognitive dissonance only has a positive impact on problem-focused adaptation.Perceived control negatively moderates the relationship between self-regulation affordances and emotionfocused adaptation,as well as the relationship between cognitive dissonance and emotionfocused adaption.Problem-focused and emotion-focused adaptation positively impact user engagement with SWHTs.Fourthly,based on the commitment theory,this paper proposes a model to explain how user engagement with SWHTs influences health behavior.Data were collected through questionnaires and Smart PLS 3.3.9 was used for data analysis and model test.The empirical results show that user engagement with SWHTs influence health behavior(taking physical activity level as an example of health behavior)through commitment.However,the dimensions of user engagement with SWHTs affect health behavior commitment differently.Specifically,sensory engagement influences health behavior through emotional commitment.Cognitive engagement and emotional engagement influence health behavior through normative commitment.Behavioral engagement and social engagement influence health behaviors through emotional commitment and normative commitment at the same time.The innovation of this study lies in three aspects.First,this paper introduces user engagement theory into the user behavior research in SWHTs settings for the first time.By proposing a new construct of user engagement with SWHTs,identifying its structural dimensions,and further developing a measurement scale,this study enriches the theoretical research in this field.The results of the nomological analysis show that user engagement with SWHTs significantly predicts continuance intention,and it has stronger explanatory power than the previous models based on general information system theories(such as Technology Acceptance Model and Expectation Confirmation Model).Second,this paper proposes a process model to explain the formation of user engagement with SWHTs.The model reveals that the primary appraisal represented by self-regulation affordances and cognitive dissonance drives problem-focused and emotion-focused adaptation strategies,and then promotes the formation of user engagement.Further,this paper discusses the boundary role of perceptual control in the process.Third,this paper reveals that user engagement with SWHTs influences health behaviors through commitment,and further discusses the specific paths through which SWHTs users’ sensory engagement,cognitive engagement,emotional engagement,behavioral engagement,and social engagement affect their health behaviors(taking physical activity as an example).