Usability and Behavioral Intention in Quasimandatory National Digital Health Systems: The Mediating Role of...

The rapid expansion of national digital health infrastructures has transformed the way citizens interact with healthcare systems. However, the long-term success of these platforms depends not only on technological implementation but also on users' perceptions and continued engagement. This study investigates how the usability of a national mobile health application influences users' behavioral intention through the mediating role of e-satisfaction. Drawing on usability and technology acceptance literature, the study proposes a research model in which the perceived usability of a mobile health application positively affects users' behavioral intention both directly and indirectly via e-satisfaction. Empirical data were collected from users of the Turkish national digital health platform e-Nabız through a structured survey. The proposed research model was tested using structural equation modeling techniques. The results indicate that mobile health application usability significantly enhances users' e-satisfaction, which in turn positively influences behavioral intention, including recommendation intention and continued preference intention. Interestingly, the analysis revealed that even negative usability perceptions were associated with increased e-satisfaction, likely reflecting the quasimandatory nature of the platform, where functional necessity and perceived value can outweigh usability difficulties. The findings also demonstrate the mediating role of e-satisfaction in the relationship between usability and behavioral intention. By focusing on a large-scale national digital health platform, this study contributes to the growing literature on digital health adoption by highlighting the importance of usability-driven user experience in quasimandatory digital health systems. The results provide practical insights for policymakers and digital health system designers seeking to improve citizen engagement and long-term utilization of national digital health infrastructures.