Experiences and Acceptance of Community-Based Mobile Health Services Among people in Underserved Rural Areas of Korea: A Mixed-Methods Study (Preprint)

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Abstract
BACKGROUND Chronic disease management requires sustained engagement, trust, and collaboration among patients, families, and primary care teams. In underserved rural areas with aging populations, mobile health (mHealth) services offer opportunities to support remote monitoring and self-management; however, real-world user experiences and determinants of sustained adoption remain underexplored. OBJECTIVE This study explored the lived experiences and acceptance of community-based mHealth services among residents of an underserved rural area in South Korea, using the Unified Theory of Acceptance and Use of Technology 2 (UTAUT2) framework. METHODS A convergent mixed-methods design was employed. Twenty-four participants using community-based mHealth services were recruited through public health centers. In-depth semi-structured interviews were analyzed using directed content analysis guided by UTAUT2 constructs, with inductive coding for emergent themes. Quantitative survey data on usability, service use, and willingness to pay were analyzed descriptively to complement qualitative findings. RESULTS Participants were predominantly older adults (mean age 71.3 years) with multimorbidity, most commonly hypertension, hyperlipidemia, and diabetes. Performance expectancy, social influence, facilitating conditions, and habit emerged as the strongest drivers of acceptance and sustained use. Real-time visualization of health data motivated lifestyle changes and reinforced perceived health benefits. Nurse-involved, human-in-the-loop support-including troubleshooting, interpretation of data, and group-based activities-was critical in overcoming early usability challenges and fostering trust. Habit formation was evidenced by the integration of monitoring activities into daily routines. Perceived ease of use varied by age and prior digital experience, with older participants requiring longer adaptation periods. Nineteen participants expressed willingness to pay for continued access, whereas others cited sufficient self-management confidence or device-related issues as reasons for discontinuation. CONCLUSIONS Community-based mHealth services embedded within nurse-involved and relationship-centered care models can be successfully integrated into daily life among rural older adults. Sustained adoption depends not only on technology usability but also on continuous human support, social engagement, and habit formation. Digital health strategies for underserved rural communities should prioritize intuitive design, structured onboarding, and long-term investment in primary care teams to promote equity, sustainability, and effective chronic disease self-management.

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