Empowering Patients Through Mobile Health: Understanding Continuance Intention and Shared Decision-Making

Abstract

Mobile health (mHealth) applications are increasingly used to support patient engagement and self-management; however, ensuring users remain actively engaged over the long term remains a challenge. This study investigates the factors influencing continuance intention and shared decision-making in the mHealth context. Drawing on patient-centered healthcare perspectives, the research examines the roles of digital patient agency, perceived personalization, and app usability in shaping patient empowerment and e-patient satisfaction. Data was collected through a survey of mHealth users and analyzed using structural equation modeling. The results indicate that digital patient agency, perceived personalization, and app usability significantly enhance patient empowerment and e-patient satisfaction. In turn, patient empowerment strongly predicts continuance intention and shared decision-making, while e-patient satisfaction positively influences shared decision-making. The findings highlight the central role of patient empowerment in sustaining mHealth engagement and fostering collaborative healthcare interactions, offering insights for researchers, healthcare providers, and digital health developers seeking to design more patient-centered mHealth solutions.

Introduction

Healthcare is increasingly shifting toward patient-centered care through the adoption of mobile health (mHealth) technologies, including smartphone applications, wearable devices, and remote monitoring systems. These technologies improve disease management, patient monitoring, and communication with healthcare providers, contributing to better health outcomes. However, despite their benefits, long-term user engagement remains a major challenge, with many users discontinuing use due to limited perceived value, reliability concerns, or lack of satisfaction. Existing studies have primarily focused on initial adoption rather than continued usage.

This study addresses this gap by examining the factors influencing the continuance intention of mHealth applications and their role in promoting patient empowerment and shared decision-making. Based on technology acceptance and patient engagement theories, the proposed conceptual model investigates how digital patient agency, perceived personalization, and app usability enhance patient empowerment and e-satisfaction, which subsequently influence continuance intention and collaborative healthcare decisions. The study formulates hypotheses linking these constructs and employs a cross-sectional quantitative survey of mHealth users in Saudi Arabia. The collected data are analyzed using Structural Equation Modeling (SEM) to validate the proposed relationships and provide insights for designing patient-centered, sustainable digital healthcare services.

Conclusion

This study examined the factors that influence sustained engagement with mHealth applications and their implications for patient empowerment and shared decision-making. By integrating technological factors (perceived personalization and app usability) with patient-related capabilities (digital patient agency), the study developed and tested a model explaining how these elements shape patient empowerment, e-patient satisfaction, continuance intention, and collaborative healthcare decisions. The results show that digital patient agency, perceived personalization, and app usability significantly enhance patient empowerment and e-patient satisfaction. In turn, patient empowerment was found to strongly influence both continuance intention and shared decision-making, highlighting its critical role in sustaining mHealth engagement and enabling more collaborative healthcare interactions. Additionally, e-patient satisfaction was found to positively contribute to shared decision-making, indicating that positive digital health experiences encourage patients to participate more actively in healthcare decisions.These findings reinforce the growing importance of digital health technologies in supporting patient-centered care. mHealth applications can empower patients by providing accessible health information, self-monitoring tools, and communication channels that strengthen collaboration between patients and healthcare providers (Mesko et al., 2025; Wu et al., 2026). As healthcare systems increasingly integrate digital technologies into clinical practice, understanding the factors that promote sustained engagement with mHealth tools becomes essential. Overall, This study advances digital health research by emphasizing the pivotal role of patient empowerment in linking technology design features with long-term mHealth usage and shared decision-making. The findings provide valuable insights for researchers, healthcare providers, and digital health developers seeking to design more effective, user-centered mHealth solutions that enhance patient participation and improve healthcare outcomes.

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Copyright © 2026 Saleh Alarifi. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.