Experiences and Acceptance of Community-Based Mobile Health Services Among People in Underserved Rural Areas of...

Community-based mobile health (mHealth) services are increasingly used to support chronic disease management in underserved rural populations facing workforce shortages, geographic isolation, and rapid aging. South Korea entered a super-aged society in December 2024, intensifying pressures in rural regions where multiple mHealth programs are embedded within primary care and public health systems. However, evidence on sustained use in real-world settings remains limited.

This study aimed to explore user experiences and acceptance of community-based mHealth services in an underserved rural area of South Korea and identify facilitators and barriers to sustained engagement, using the Unified Theory of Acceptance and Use of Technology 2 (UTAUT2).

A convergent mixed methods design was used, with qualitative and quantitative data collected in parallel, analyzed separately, and integrated at the interpretation stage. Overall, 24 participants with ≥6 months of experience using 1 of 4 publicly funded mHealth services in Pyeongchang County, Gangwon State, were purposively recruited. Semistructured interviews guided by the UTAUT2 were analyzed using directed content analysis, combining deductive and inductive coding. Structured questionnaires assessing usability and behavioral intention were analyzed using descriptive statistics. Findings were integrated through joint interpretation.

Participants had a mean age of 71.3 (SD 9.2) years, and 70.8% (17/24) were female; hypertension (18/24, 75%) and hyperlipidemia (15/24, 58.3%) were the most common. Perceived difficulty was low (mean 2.54, SD 2.06, on a 0-10 scale), intention for continued use was high (23/24, 95.8%), and recommendation intention was unanimous (24/24, 100%). Willingness to pay was reported by 79.2% (19/24), most commonly KRW 1000-5000 (US $1-3) per month. Qualitative findings identified performance expectancy, social influence, facilitating conditions, and habit as the most salient determinants of sustained use. Real-time monitoring enhanced health awareness, motivated dietary modification, and increased physical activity. Public health center nurses served as human-in-the-loop facilitators, providing continuous training, troubleshooting, and emotional support, while family and peers reinforced engagement. Habit formation emerged as a central mechanism, with 91.7% (22/24) integrating mHealth use into routines anchored to waking, exercise, and bedtime. Effort expectancy barriers among older participants were mitigated through nurse-led training, and hedonic motivation was driven by intrinsic satisfaction and peer interaction. Integrated analysis showed convergence for ease of use and behavioral intention, and partial divergence for willingness to pay.

Community-based mHealth services were successfully integrated into daily life and supported chronic disease self-management among older adults in an underserved rural setting. Sustained engagement was driven by perceived health benefits, continuous human support, and habit formation rather than technology features alone, underscoring the importance of relationship-centered, human-in-the-loop implementation models. Strengthening intuitive design, hands-on onboarding, multidisciplinary primary care teams, and stable financing will be essential for equitable digital health adoption in rural and aging communities.