From Social Capital to Digital Health Access: Attitude-Mediated Adoption of Healthcare Technology Among Older Adults In Hong Kong

Background and Purpose:
As health and social care systems increasingly digitize, older adults may face a double burden of health disadvantage and digital exclusion. In Hong Kong, high smartphone ownership among older adults has not translated into equivalent uptake of digital health services, suggesting that access depends not only on technology availability but also on social and psychological processes. Guided by Technology Acceptance Model and social capital theory, this study examined whether online informal social capital influences digital health adoption among older adults through perceived usefulness and technology attitudes. We hypothesized that online informal social capital would enhance perceived usefulness, that perceived usefulness would shape both positive and negative attitudes toward technology, and that attitudes would mediate the relationship between perceived usefulness and actual adoption of healthcare technology.

Methods:
A cross-sectional telephone survey was conducted in Hong Kong from July to August 2024. Participants were digitally active adults aged 55 and above recruited through stratified random sampling. The final analytic sample included 597 valid responses. Measures assessed online informal social capital, perceived usefulness, positive attitudes, negative attitudes, and healthcare technology adoption. Partial Least Squares Structural Equation Modeling was used to test direct and indirect pathways. Model fit was acceptable (SRMR = 0.076), and indirect effects were assessed using 5,000 bootstrap samples.

Results:
Online informal social capital was positively associated with perceived usefulness (beta = 0.246, p < .001). Perceived usefulness was positively associated with positive attitudes (beta = 0.450, p < .001) and negatively associated with negative attitudes (beta = -0.348, p < .001). However, perceived usefulness did not directly predict healthcare technology adoption (beta = 0.035, ns). Instead, both positive attitudes (beta = 0.145, p < .01) and negative attitudes (beta = -0.125, p < .05) significantly predicted adoption. Mediation analyses showed significant indirect effects through positive attitudes (indirect effect = 0.065, p = .017) and negative attitudes (indirect effect = 0.044, p = .016), indicating full mediation.

Conclusions and Implications:
Findings suggest that among older adults, recognizing the functional value of digital health services is not sufficient to produce adoption. Emotional responses to technology serve as the key mechanism linking perceived usefulness to actual use. For social work research and practice, this study highlights the importance of informal support networks in shaping digital health engagement and suggests that interventions should move beyond digital skills training alone. Community-based and age-friendly strategies that strengthen family support, peer mentoring, and emotionally supportive technology engagement may be more effective in reducing digital exclusion and promoting equitable access to digital health services among older adults.