Mobile Usage Duration and Usability of Mobile Health Applications Among Older Adults in Saudi Arabia: A Usability-Centered Model Informed by Technology Acceptance Theory

Background: With the vast and fast-growing number of mHealth applications supporting health, disease management and self-care for older people, the usability of these applications has become a critical factor determining their acceptance and usage. In order to develop mHealth applications suitable for the aging population, it is important to investigate the relationship between older people’s experience with mobile technology in the past, their perception of the usability of mHealth applications and their subsequent use of these applications. Objective: This study investigated the impact of the length of mobile usage on the perceived mHealth application usability of older adults, and the impact of mHealth application usability on the mHealth application user satisfaction and frequency of use of older adults. Methods: This study is based on a cross-sectional survey among older individuals in Al-Ahsa, Saudi Arabia. The measurement model consisted of five distinct constructs with fifteen corresponding indicators including efficiency, learnability, memorability, error handling, and user satisfaction. In terms of analysis, this study included reliability and descriptive statistics as well as correlation and regression analysis, as well as simple and bootstrapped mediation analysis, and, finally, confirmatory factor analysis (CFA) and structural equation modeling (SEM). Based on discriminant validity, the findings suggest that four first-order dimensions, efficiency, learnability, memorability, and error handling, constitute second-order usability dimensions. Results: A total of 271 older adults were included in the final analysis. All constructs demonstrated satisfactory reliability and convergent validity, with Cronbach’s alpha values ranging from 0.797 to 0.862, Composite Reliability values ranging from 0.798 to 0.860, and Average Variance Extracted values ranging from 0.568 to 0.673. Structural equation modeling revealed that mobile usage duration significantly influenced usability (β = 0.616, p < 0.001), usability significantly influenced user satisfaction (β = 0.953, p < 0.001), and user satisfaction significantly influenced use frequency (β = 0.193, p = 0.002). The second-order structural model demonstrated excellent fit to the data (χ2/df = 1.824, CFI = 0.972, TLI = 0.966, GFI = 0.940, AGFI = 0.928, RMSEA = 0.055). Conclusions: Usability plays a central role in explaining the satisfaction of older people with mHealth services and their continuous use of applications. Older people’s experience with their smartphones is associated with their perceptions of the usability of mHealth applications. Higher perceived usability of mHealth applications is positively associated with greater user satisfaction and more frequent use of these applications among older adults. The findings are in line with a usability-centered technology acceptance model. Design of mHealth services should be based on user-centered design principles. In addition to other design principles, efficiency, learnability, memorability, error handling and other usability principles should be particularly addressed in order to increase acceptance of mHealth services by older people.