Dual Drivers of Experience and Trust: Exploring the Mechanisms of Elderly User Adoption of AI-HVAs from a UTAUT Perspective
DOI:
https://doi.org/10.4108/eetpht.11.11028Keywords:
AI-HVAs, elderly users, UTAUT, PAIE, PAIT, dual perspectiveAbstract
INTRODUCTION: With the accelerating aging of the population and the integrated development of artificial intelligence (AI) technology, AI health voice assistants (AI-HVAs) present a novel approach for enhancing health management among older adults. However, the adoption of this technology by the elderly population still faces multiple barriers, including cognition, trust, and user experience, and its adoption mechanisms have yet to be fully elucidated.
OBJECTIVES: This study aims to construct an AI-HVA adoption model applicable to China's elderly population, focusing on revealing the dual driving role of “experience (experiential rationality)” and “trust (relational rationality)” in the decision-making process of elderly users.
METHODS: Integrating the Unified Theory of Acceptance and Use of Technology (UTAUT) model, this study introduces two key variables—"Perceived AI Experience (PAIE)" and "Perceived AI Trust (PAIT)"—to form a dual-path hypothesis of "internal experience-external influence." Through a questionnaire survey of 413 elderly users, structural equation modeling (SEM) was employed to analyze the data and examine the influence relationships among variables.
RESULTS: (1)Internal Experience Path:PAIE significantly and positively influenced Performance Expectancy (PE) and Effort Expectancy (EE), and also directly promoted Behavioral Intention (BI). This indicates that the quality of the interaction experience is a key antecedent for elderly users forming perceptions of usefulness and ease of use . (2) External Influence Path:Social Influence (SI) did not exert a direct effect on BI but required mediation through PAIT, highlighting the pivotal bridging role of trust in the adoption decision . (3) BI and Facilitating Conditions (FC) jointly significantly promoted Usage Behavior (UB), supporting the applicability of the UTAUT model in the context of AI technology adoption among the elderly.
CONCLUSION: This study extends the explanatory boundaries of the UTAUT model in the field of digital technology adoption by older adults, revealing the complex psychological processes underlying their acceptance of AI-HVAs. On a practical level, the findings provide important insights for the age-friendly design, trust-building, and promotion strategies of AI health products.
Downloads
References
[1] He, M.J. Comparative Study on the Process and Outlook of Population Aging in China and the World.Gerontology Research.2023;11(12):36-51.
[2] Mannheim, I., Schwartz, E., Xi, W., Buttigieg, S. C., McDonnell-Naughton, M., Wouters, E. J. M., & van Zaalen, Y. Inclusion of older adults in the research and design of digital technology. International journal of environmental research and public health. 2019;16(19):3718. https://doi.org/10.3390/ijerph16193718
[3] Facchinetti, G., Petrucci, G., Albanesi, B., De Marinis, M.G., & Piredda, M. Can smart home technologies help older adults manage their chronic condition? A systematic literature review. International journal of environmental research and public health. 2023;20(2):1205. https://doi.org/10.3390/ijerph20021205
[4] Xu, L.Q. Development and Future of Mobile Smart Voice Assistants. Communications World. 2019;26(04):262-263.
[5] Jnr, B.A. User-centered AI-based voice-assistants for safe mobility of older people in urban context. AI & SOCIETY. 2025;40(2):545-568. https://doi.org/10.1007/s00146-024-01865-8
[6] Mathur, N., Dhodapkar, K., Zubatiy, T., Li, J., Jones, B., & Mynatt, E. A Collaborative Approach to Support Medication Management in Older Adults with Mild Cognitive Impairment Using Conversational Assistants (CAs). In: Proceedings of the 24th International ACM SIGACCESS Conference on Computers and Accessibility (ASSETS ’22); 2022; New York, NY, USA. New York, NY, USA: Association for Computing Machinery; 2022. p. 1-14. https://doi.org/10.1145/3517428.3544830
[7] Marziali, R.A., Franceschetti, C., Dinculescu, A., Nistorescu, A., Kristály, D.M., Moșoi, A.A., ..., & Di Rosa, M. Reducing loneliness and social isolation of older adults through voice assistants: literature review and bibliometric analysis. Journal of medical Internet research. 2024;26:e50534. https://doi.org/10.2196/50534
[8] China Internet Network Information Center (CNNIC). The 55th Statistical Report on China's Internet Development. Beijing, China: CNNIC; 2025. [Online]. Available: https://xdjy.sqzy.edu.cn/info/1067/1926.htm
[9] Venkatesh, V., Morris, M.G., Davis, G.B., & Davis, F.D. User acceptance of information technology: Toward a unified view. MIS Quarterly. 2003;27(3):425-478.
[10] Chen, G., Fan, J. and Azam, M. Exploring artificial intelligence (AI) chatbots adoption among research scholars using unified theory of acceptance and use of technology (UTAUT). Journal of librarianship and information science, 2024. p.09610006241269189. https://doi.org/10.1177/09610006241269189
[11] Norman, D.A. The Design of Everyday Things. Beijing: China Citic Press; 2007.
[12] Jampala, R., Kola, D.S., Gummadi, A.N., Bhavanam, M., & Pannerselvam, I.R. The evolution of voice assistants: From text-to-speech to conversational ai. In: Proceedings of the 2024 2nd International Conference on Intelligent Data Communication Technologies and Internet of Things (IDCIoT); January 2024; Location not specified. Piscataway, NJ: IEEE; 2024. p. 1332-1338.
[13] Sindoni, M.G. The femininization of AI-powered voice assistants: Personification, anthropomorphism and discourse ideologies. Discourse, Context & Media. 2024;62:100833. https://doi.org/10.1016/j.dcm.2024.100833
[14] Rousseau, D.M., Sitkin, S.B., Burt, R.S., & Camerer, C. Not so different after all: A cross-discipline view of trust. Academy of management review. 1998;23(3):393-404. https://doi.org/10.5465/amr.1998.926617
[15] Li, J., Tan, T.T., & Liu, S.X. Differences between interpersonal trust and human-computer trust. Journal of Zhejiang University (Science Edition). 2025;52(05):549-560+566.
[16] Cao, C. Reshaping Companionship: A Study on Emotional Support Needs and AI Usage Among the Elderly Under the Technology Acceptance Model. Science & Technology Communication. 2025;17(02):9-17. https://doi.org/10.16607/j.cnki.1674-6708.2025.02.012.
[17] Calvaresi, D., Eggenschwiler, S., Mualla, Y., Schumacher, M., & Calbimonte, J.P. Exploring agent-based chatbots: a systematic literature review. Journal of ambient intelligence and humanized computing. 2023;14(8):11207-11226. https://doi.org/10.1007/s12652-023-04626-5
[18] Kiwa, F.J., Muduva, M., & Masengu, R. AI voice assistant for smartphones with NLP techniques. In: AI-driven marketing research and data analytics. Hershey, PA: IGI Global Scientific Publishing; 2024. p. 30-47.
[19] Leini, Z., & Yaolei, S. Study on speech recognition method of artificial intelligence deep learning. In: Journal of Physics: Conference Series; February 2021; Location not specified. Bristol, UK: IOP Publishing; 2021. p. 012183. https://doi.org/10.1088/1742-6596/1754/1/012183
[20] Dao F., Ding M., Yuan C., et al. Establishment and Application of a Comprehensive Evaluation Model for In-Vehicle Intelligent Voice Assistants. Automotive Digest, 2023, (04): 12-17. https://doi.org/10.19822/j.cnki.1671-6329.20220252.
[21] Zhong, R., Ma, M., Zhou, Y., Lin, Q., Li, L., & Zhang, N. User Acceptance of Smart Home Voice Assistants: A Comparison Among Young, Middle-Aged, and Elderly Users. Universal Access to Information Society. 2024;23(1):275-292. https://doi.org/10.1007/s10209-022-00936-1
[22] Cao, X., Zhang, H., Zhou, B., Wang, D., Cui, C., & Bai, X. Factors influencing older adults’ acceptance of voice assistants. Frontiers in Psychology. 2024;15:1376207. https://doi.org/10.3389/fpsyg.2024.1376207
[23] Faraon, M., Rönkkö, K., Milrad, M., & Tsui, E. International perspectives on artificial intelligence in higher education: an explorative study of students’ intention to use ChatGPT across the nordic countries and the USA. Education and Information Technologies. 2025;1-46. https://doi.org/10.1007/s10639-025-13492-x
[24] Hou G., Li Y.Empirical Study on How Reading Experiences Influence Older Adults' Intent to Continue Information-Seeking Behaviors . Journal of the National Library of China, 2021, 30(02): 54-66.
[25] Zhang Y. Enhancing the Efficiency of Science and Technology Journal Editing with WPS AI. Journal of Editing, 2023, 35(S1): 144-146.
[26] Cai F., Zhu J. AI-Assisted Design Cloud Platform Achieves Dual Breakthroughs in Efficiency and Innovation . China Construction Informatization, 2025, (20): 20-23.
[27] Wang, X., Lee, C.F., Jiang, J., Zhang, G., & Wei, Z. Research on the factors affecting the adoption of smart aged-care products by the aged in China: extension based on UTAUT model. Behavioral Sciences. 2023;13(3):277. https://doi.org/10.3390/bs13030277
[28] Chen Y. Research on influencing factors of elderly users' intention to use 'Internet + nursing services' based on UTAUT model [M.S. thesis]. Lanzhou, China: Lanzhou University; 2023. https://doi.org/10.27204/d.cnki.glzhu.2023.000991.
[29] Su, J., Wang, Y., Liu, H., Zhang, Z., Wang, Z., & Li, Z. Investigating the factors influencing users’ adoption of artificial intelligence health assistants based on an extended UTAUT model. Scientific Reports. 2025;15(1):18215. https://doi.org/10.1038/s41598-025-01897-0
[30] Choi, T.R., & Drumwright, M.E.“OK, Google, why do I use you?” Motivations, post-consumption evaluations, and perceptions of voice AI assistants. Telematics and Informatics. 2021;62:101628. https://doi.org/10.1016/j.tele.2021.101628
[31] Kim, S.; Zhong, Y.; Wang, J.; Kim, H.-S. Exploring technology acceptance of healthcare devices: The moderating role of device type and generation. Sensors. 2024;24(24):7921. https://doi.org/10.3390/s24247921.
[32] Liu, J., Wang, X., & Zhang, J. Investigating Elderly Individuals’ Acceptance of Artificial Intelligence (AI)-Powered Companion Robots: The Influence of Individual Characteristics. Behavioral Sciences. 2025;15(5):697. https://doi.org/10.3390/bs15050697
[33] Malodia, S., Islam, N., Kaur, P., & Dhir, A. Why do people use artificial intelligence (AI)-enabled voice assistants?. IEEE Transactions on Engineering Management. 2021;71:491-505. https://doi.org/10.1109/TEM.2021.3117884.
[34] Zhan, X., Abdi, N., Seymour, W., & Such, J. Healthcare voice AI assistants: factors influencing trust and intention to use. Proceedings of the ACM on Human-Computer Interaction. 2024;8(CSCW1):1-37. https://doi.org/10.1145/3637339
[35] Chen F. Study on the intention of young-old adults to use smart elderly care products and services: Analysis based on UTAUT model. Aging Scientific Research 2024;12(5):36-49. https://doi.org/10.3969/j.issn.2095-5898.2024.05.004
[36] Wang, X.W., Zhao, K.Y., Liu, Y.T., & Luo, R.. Factors influencing user adoption of intelligent voice interaction and configuration analysis of usage behaviors. Library Forum.2023;43(12):147-160.
[37] Wang, X., Lee, C.F., Jiang, J., & Zhu, X. Factors influencing the aged in the use of mobile healthcare applications: an empirical study in China. Healthcare. 2023;11(3):396. https://doi.org/10.3390/healthcare11030396
[38] Subhash, S., Srivatsa, P.N., Siddesh, S., Ullas, A., & Santhosh, B. Artificial intelligence-based voice assistant. In: Proceedings of the 2020 Fourth World Conference on Smart Trends in Systems, Security and Sustainability (WorldS4); July 2020; Location not specified. Piscataway, NJ: IEEE; 2020. p. 593-596. https://doi.org/10.1109/WorldS450073.2020.9210344.
[39] Kaur, D., Uslu, S., Rittichier, K.J., & Durresi, A. Trustworthy artificial intelligence: a review. ACM computing surveys (CSUR). 2022;55(2):1-38. https://doi.org/10.1145/3491209
[40] Walczuch, R., Lemmink, J., & Streukens, S. The effect of service employees’ technology readiness on technology acceptance. Information & Management. 2007;44:206-215. https://doi.org/10.1016/j.im.2006.12.005
[41] Jackson, D.L. Revisiting sample size and number of parameter estimates: Some support for the N: Q hypothesis. Structural equation modeling, 10(1);128-141. https://doi.org/10.1207/S15328007SEM1001_6
[42] Fornell, C., & Larcker, D.F. Evaluating structural equation models with unobservable variables and measurement error. Journal of Marketing Research. 1981;18(1):39-50. https://doi.org/10.1177/002224378101800104
[43] Jackson, D.L., Gillaspy, J.A. Jr., & Purc-Stephenson, R. Reporting practices in confirmatory factor analysis: An overview and some recommendations. Psychological Methods.2009;14(1):6-23. https://doi.org/10.1037/a0014694
[44] Kline, R.B. Principles and practice of structural equation modeling. 4th ed. New York: Guilford Press; 2015.
[45] Whittaker, T.A. A beginner’s guide to structural equation modeling. New York: Taylor & Francis; 2011.
[46] Cohen, J.. Statistical power analysis for the behavioral sciences. New York: Psychology Press;1988.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Xiang Wang, Jia-Bei Jiang, Jian-Jun Hou, Xiao-Yang Zhu

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
This is an open access article distributed under the terms of the CC BY-NC-SA 4.0, which permits copying, redistributing, remixing, transformation, and building upon the material in any medium so long as the original work is properly cited.
