As populations age, promoting healthy aging and enhancing healthcare delivery for older adults has become a global priority [1,2,3,4,5]. Digital technologies, particularly Virtual Coaching Systems (VCSs), offer promising solutions to these challenges by integrating and managing professional knowledge [6,7,8,9,10] to support healthy aging in a cost-effective way [11,12,13,14,15]. Powered by Artificial Intelligence (AI) and diverse data sources, VCSs deliver personalized support through real-time monitoring, feedback, and tailored recommendations [13, 16,17,18,19]. Key characteristics of VCSs include [11, 13, 16, 20, 21]: social ability to maintain user relationships, credibility and trustworthiness, context awareness for goal alignment, personalized advice through continuous learning, data collection and analysis (e.g.,., sensors, mood, sleep), proactivity in user engagement, use of behavior change models, support for future-oriented planning.

VCSs are gaining traction in both clinical and everyday settings [11, 14, 17, 22]. These systems have been applied to a variety of healthy ageing domains, including promoting and improving the levels of physical activity (e.g., [23,24,25]), nutrition (e.g., [20, 21, 26, 27]), physical activity motivation for the elderly individuals [28, 29], social interactions or cognitive maintenance over time [30].They have shown effectiveness across age groups [17] and offer scalable, cost-effective solutions for promoting healthy aging [31, 32].

Despite the growing reliance on digital technologies among older adults, the adoption of VCSs among those aged 60 and above remains low [33, 34]. Understanding the intentional use of VCSs is essential to uncover how these systems can effectively support healthy aging behaviors. Unlike traditional e-health systems, which primarily focus on medical care and health management, VCSs are distinguished by their emphasis on overall well-being, lifestyle improvement, and personalized, continuous support. Therefore, this research aims to shed light on the factors influencing individuals aged 60 + to adopt VCSs. Its central research question is:

Which are the determinants of adopting VCSs to enhance healthy aging practices?

To answer this research question, we developed and tested a theoretical model grounded in the original Technology Acceptance Model (TAM) formulation by Davis [35]. TAM is a widely recognized framework in healthcare research for examining the factors that affect the adoption of health technologies (e.g., [36,37,38]), and has been extensively applied in gerontology [39, 40]. Although TAM has undergone several modifications that have resulted in the development of different models, such as the TAM2 and the UTAUT [41], the original formulation by Davis [35] remains the most widely used by scholars across disciplines due to its proven robustness, predictive power, and cost-effectiveness [42,43,44,45].

Consistent with TAM, we considered behavioral intention to use as the dependent variable in our model, as it is a strong predictor of actual usage (e.g., [44]). Moreover, according to TAM, two primary antecedents influence an individual’s behavioral intention to use technology for a specific goal: perceived usefulness and perceived ease of use [35]. Perceived usefulness represents the extent to which an individual believes using a system will enhance their performance, while perceived ease of use signifies the degree to which a person believes using a system will be easy, allowing to avoid difficulties and complications.

In the context of VCSs, both are expected to positively influence intention. This is consistent with the cognitive rationale that individuals prefer technologies that address their needs efficiently while minimizing the learning curve associated with their usage. Prior studies confirm these relationships in the adoption of wellness devices and health information systems [46,47,48]. Therefore, it is reasonable to advance the following two hypotheses:

H1:

Perceived ease of use has a positive influence on the intention to use a VCS for healthy ageing.

H2:

Perceived usefulness has a positive influence on the intention to use a VCS for healthy ageing.

Furthermore, TAM proposes that perceived ease of use has a positive effect on perceived usefulness. This means that if an individual perceives a technology as easy to use, they are more likely to perceive it as useful in achieving their goals. This relationship has been widely confirmed by previous studies in healthcare (e.g., [39, 49, 50]). Therefore, based on the existing literature and the foundational premises of TAM, it is reasonable to advance the following hypothesis:

H3:

Perceived ease of use has a positive influence on the perceived usefulness of a VCS for healthy ageing.

In this study we expanded TAM’s original formulation by examining the role of three additional determinants, which have been found significant in the literature for health-related behaviors and are central to improvement strategies implemented by healthcare systems worldwide: (1) subjective norms, (2) health literacy, and (3) information technology literacy.

Subjective norms refer to the social influence exerted by individuals perceived as important by a person. Research shows that these norms significantly impact the intention to adopt new technologies especially when influenced by trusted individuals such as family or healthcare providers [51]. In the context of VCSs for healthy aging, this influence is particularly relevant, as older adults may lack digital experience and rely on opinions of their family members and doctors (e.g., [52]). However, this trend is evolving. According to the World Economic Forum, 70% of seniors are now online, reflecting a growing engagement with digital technologies. The opinions of others can positively influence an individual’s intention to use VCSs by affecting their perceptions of the technology’s ease of use and usefulness (e.g., [53, 54]). These opinions can be useful in developing a deeper understanding of the technology’s nature, features, and functionalities (e.g., [55, 56]).

Based on this evidence, it is reasonable to hypothesize that subjective norms will have a positive influence on an individual’s intention to use a VCS for healthy ageing. This influence may be partially mediated by perceived usefulness and perceived ease of use. Therefore, it is reasonable to advance the following hypothesis:

H4:

Subjective norms have a positive influence on the intention to use a VCS for healthy ageing with a partial mediation of (a) perceived usefulness and (b) perceived ease of use.

Health literacy is related to the capability of an individual to obtain, comprehend, apply, and communicate health information to make informed decisions [57]. Individuals who possess those skills will require little effort to use technological devices for their healthy aging needs [54, 58, 59]. According to Mackert et al. [57], American people with a higher health literacy perceived health information technology to be more useful and easier to use. Similarly, the perceived ease of using online health apps was found to be related to the ability to gather and interpret health information in Singapore and Taiwan [52, 60].

In the context of VCSs, recent research (e.g., [61, 62]. , suggest individuals with high levels of health literacy are likely to perceive a VCS as easier to use and more useful in helping them achieve their healthy ageing goals. Therefore, based on the existing literature and recent research on the topic, we make the following hypothesis:

H5:

When it comes to adopt a VCS for healthy ageing, health literacy has a positive influence on both the (a) perceived usefulness and (b) perceived ease of use.

Information technology literacy refers to an individual’s ability to use digital devices [63]. In the context of VCSs for healthy ageing, it is reasonable to hypothesize that information technology literacy will positively affect an individual’s intention to use such a system through the mediation of perceived ease of use (e.g., [62]). This, in turn, may increase their intention to use the system. Thus, we can advance this last hypothesis:

H6:

Information technology literacy positively affects intention to use a VCS for healthy ageing through the mediation of perceived ease of use.

Overall, Fig. 1 presents our theoretical framework and its main hypotheses. In addition, it shows the control variables included in the study: gender (male, female), civil status (married, not married), higher education level (has, does not have), employment status (employed, unemployed), whether the elderly individual lives in a city, and whether the elderly individual is affected by a pathology.

Fig. 1
figure 1

Theoretical model and hypotheses

Source link