Beyond functional utility: ethical stewardship as a driver of digital healthcare platform adoption in low-resource settings

BACKGROUND: Digital healthcare platforms (DHPs) hold transformative potential for bridging healthcare gaps in resource-constrained settings. However, their adoption is hampered by ethical concerns and distrust. This study investigates how perceptions of transparency, health data security, and ethicality influence adoption intentions. METHOD: We analyzed survey data from 240 primary healthcare recipients in Tanzania using a two-wave, time-lagged design. Data were analyzed using partial least squares structural equation modeling (PLS-SEM) to test the direct and mediated relationships between the ethical constructs and adoption intention. RESULTS: Both perceived transparency (β = 0.27, p < 0.01) and health data security (β = 0.30, p < 0.01) significantly influenced adoption intention. Perceived ethicality was the strongest predictor (β = 0.32, p < 0.01) and explained how transparency and security influence intention, indicating that users interpret these features as signs of an ethical platform. CONCLUSIONS: For DHPs to succeed in low-resource contexts, they must be perceived as ethical. Developers should prioritize user-friendly, transparent designs and offline features, while policymakers should establish clear data governance rules. Focusing on ethics is key to ensuring DHPs improve healthcare access for all.