RESEARCH ON THE MARKETING EFFECTIVENESS MECHANISM PATH OF MOBILE HEALTH APPLICATIONS FOR PATIENTS WITH CHRONIC DISEASES

Abstract

Against the backdrop of intensifying global public health pressures and rapid digital transformation, chronic non-communicable diseases have gradually replaced infectious diseases as the primary threat to population health and social sustainability. Chronic diseases are characterized by long disease duration, high recurrence rates, and a strong reliance on continuous self-management and behavioral intervention. Traditional hospital-centered medical service models, which focus primarily on diagnosis and shortterm treatment, are increasingly inadequate in meeting patients’ long-term needs for disease monitoring, lifestyle modification, and sustained health management. Existing studies have examined the adoption and use of mobile health applications from perspectives such as technology acceptance, health behavior intervention, and user experience; however, most of these studies remain confined to isolated stages of use. There is a lack of systematic research explaining how patients with chronic diseases transition from cognitive evaluation to behavioral engagement, from behavioral engagement to health outcomes, and further to value transformation across the entire usage cycle. Addressing this research gap is of critical importance for advancing both theoretical development and practical decision-making in the fields of digital health and healthcare marketing. Accordingly, this study focuses on the core research question of how mobile health applications generate stable and sustainable marketing effectiveness among patients with chronic diseases. At the theoretical level, this study integrates the Technology Acceptance Model (TAM) and Self-Determination Theory (SDT) to explain both the initial adoption mechanisms and long-term usage mechanisms of mobile health applications among patients with chronic diseases. Specifically, TAM is employed to analyze the technology adoption stage, with particular emphasis on how perceived usefulness and perceived ease of use influence patients’ usage intention and subsequently their actual usage behavior. In addition, Self-Determination Theory is introduced to explain sustained usage behavior and behavioral adherence. By incorporating SDT, this study moves beyond examining whether patients use mobile health applications to explore why they are able to continue using them over time and consistently adhere to health management behaviors. Furthermore, external environmental support is incorporated into the analytical framework as a contextual variable to examine its moderating role in the relationship between usage behavior and psychological need satisfaction. External environmental xiv support includes institutional arrangements, platform function design, social atmosphere, and supporting services, all of which may enhance or weaken the effectiveness of mobile health application usage. Through this extension, the study transcends the explanatory boundaries of traditional technology acceptance research and situates patient behavior within a broader socio-technical system. Methodologically, this study adopts a quantitative research design and collects sample data from patients with chronic diseases through a questionnaire survey. Measurement scales are revised and adapted from established studies to capture key variables, including perceived usefulness, perceived ease of use, usage intention, actual usage behavior, psychological need satisfaction, intrinsic motivation, behavioral persistence, health outcomes, and willingness to pay. Structural Equation Modeling (SEM) is employed as the primary analytical method to empirically test the proposed theoretical framework. SEM is particularly suitable for this study because it allows for simultaneous analysis of multiple latent variables and complex causal pathways. Prior to hypothesis testing, reliability and validity analyses are conducted to ensure the robustness of the measurement model. Confirmatory factor analysis, internal consistency reliability tests, and average variance extracted (AVE) measures are applied to verify construct reliability and convergent validity. Common method variance is also assessed to reduce potential bias arising from self-reported data. Model fit indices are used to evaluate the overall adequacy of the structural model, and on this basis, direct effects, mediating effects, and moderating effects among variables are systematically tested to address the research questions and validate the proposed hypotheses. The empirical results provide strong support for the integrated theoretical framework. (1) At the technology adoption stage, perceived usefulness and perceived ease of use significantly enhances patients’ intention to use mobile health applications, and usage intention further promotes actual usage behavior. This finding confirms the applicability of the Technology Acceptance Model in the context of chronic disease management and highlights the critical role of functional value and usability in initial adoption. (2) At the stage of sustained usage and behavioral mechanisms, continuous usage behavior significantly improves user satisfaction and the satisfaction of basic psychological needs, while autonomy, competence, and related satisfaction further strengthen intrinsic motivation and behavioral persistence. These results indicate that xv long-term engagement with mobile health applications is not driven solely by technological features or external incentives but rather depends on the extent to which applications support patients’ psychological needs and intrinsic motivation. (3) External environmental support exerts a significant positive moderate effect on the relationship between usage behavior and psychological need satisfaction. This finding suggests that supportive institutional environments, well-designed platform functions, and positive social support atmospheres can amplify the positive psychological effects of usage behavior, thereby enhancing long-term engagement and behavioral adherence. (4) At the commercialization transformation stage, stable and perceptible improvements in health outcomes significantly increase patients’ willingness to pay for mobile health services. This result demonstrates that health improvement serves as a critical bridge linking behavioral engagement and economic value creation, enabling mobile health applications to transform from simple health management tools into sustainable business models. Overall, this study systematically elucidates the complete mechanism of “cognition–behavior–health outcomes–value transformation” in the use of mobile health applications among patients with chronic diseases, thereby extending the application boundaries of the Technology Acceptance Model and Self-Determination Theory in digital health and healthcare marketing research. Methodologically, it provides a comprehensive SEM-based analytical framework for examining multi-stage and complex behavioral mechanisms. Practically, the findings offer actionable empirical evidence for mobile health platforms, healthcare institutions, and policymakers to develop patientcentered marketing strategies and service optimization pathways that balance health value creation with commercial sustainability.