The Factors Influencing the Privacy Concerns of Users of Wearable Devices for Health Tracking, and Their Continued Usage Intentions

The advent and proliferation of technologically advanced wearable devices for health tracking (WDHT) have transformed how individuals engage with their health, providing crucial data-driven, actionable insights to users and vendors. Although the market for WDHT has growth potential, privacy concerns induced by users’ privacy threat perceptions have become a critical challenge that could inhibit users’ continued usage intentions. In response to these privacy threats, users implement coping appraisal mechanisms that act as coping responses, protection responses, or both. However, studies investigating the factors that create trade-offs and perform differing functions in influencing WDHT users’ privacy concerns and continued usage intentions are limited. Drawing on protection motivation theory (PMT), this research develops and tests a theoretical model in which cognitive appraisal factors, consisting of privacy threat appraisal (perceived privacy threat severity and perceived privacy threat vulnerability) and coping appraisal are hypothesised to impact WDHT users’ privacy concerns and continued usage intentions. The objectives of this research are to: (a) examine the factors influencing continued usage intentions of WDHT, concentrating on threat appraisal and coping appraisal, and the influence of these appraisals on WDHT users’ privacy concerns, (b) investigate the trade-off between these cognitive appraisals impacting on WDHT users’ privacy concerns, (c) explore the function of perceived personal control, including the perceived ability to control privacy-enhancing settings and the perceived ability to exercise the right to delete, as coping and as protection responses, (d) explore the function of perceived collective control as coping and as protection responses, (e) examine the differing contributions of individual (perceived personal control and privacy self-efficacy), institutional (proxy control), and social factors (collective control) to continued usage intentions, (f) examine the moderation influence of perceived privacy threat vulnerability on the relationship between perceived privacy threat severity and privacy concerns, (g) investigate the conceptualisation and measurement of WDHT users’ privacy concerns, (h) examine the mediating role of WDHT users’ privacy concerns, and (i) investigate the moderation influence of privacy self-efficacy on the relationship between perceived personal control and both WDHT users’ privacy concerns and continued usage intentions. SmartPLS 4 is used to analyse the conceptual model in the WDHT context using data collected from 512 WDHT users in the USA. The findings demonstrate that proxy control, acting as a coping response, mitigates users’ privacy threat perceptions and impacts context-specific privacy concerns. In contrast, the perceived ability to control privacy-enhancing settings and perceived collective control act as a protection response but not a coping response and influence users’ continued usage intentions. Interestingly, the findings reveal a negative association between the perceived ability to exercise the right to delete and continued usage intentions. The presence of robust privacy controls paradoxically influences usage intentions negatively due to heightened user vigilance. The results also demonstrate that perceived privacy threat vulnerability moderates the relationship between perceived privacy threat severity and privacy concerns, suggesting a compounding effect when both severity and vulnerability are at play. Furthermore, privacy self-efficacy does not influence perceptions of privacy concerns. Privacy self-efficacy also does not moderate the relationship between the perceived ability to control privacy-enhancing settings and either privacy concerns or continued usage intentions, nor does it moderate the relationship between the perceived ability to exercise the right to delete and either privacy concerns or continued usage intentions. The mediation analysis findings reveal that WDHT users’ privacy concerns mediate the influence of perceived privacy threat severity, perceived privacy threat vulnerability, and perceived proxy control on continued usage intentions. This study significantly enhances privacy research by drawing on the PMT framework, offering new insights into the interplay between threat and coping appraisals concerning privacy concerns. PMT framework reveals how users rely on cognitive processes to assess privacy threats, enriching theoretical discussions by connecting cognitive and motivational dimensions of user behaviour. It highlights the influence of perceived privacy threat severity and vulnerability, especially their direct and moderating impact on users’ privacy concerns, thus strengthening the explanatory power of PMT. Moreover, it examines privacy self-efficacy and control mechanisms, revealing their complex roles in user decision-making. Users perceive proxy control as an effective way to address privacy concerns, contributing to PMT discourse. The research shows that users’ perceived ability to control privacy-enhancing settings acts as a protection response and influences continued usage intentions, emphasising the impact of user capacity on privacy protection. The study uncovers the counterintuitive relationship between users’ perceived ability to exercise their right to delete and continued usage intentions, emphasising the complexity of agency control. It also helps clarify by concentrating on how enhanced privacy controls raise users' awareness of their susceptibility to privacy threats. Additionally, it expands PMT by showcasing how perceived personal control and perceived collective control function as both coping and protection responses in user behaviour. The mediation analysis reveals how cognitive appraisals influence behaviour, aligning with the need to explore indirect effects in information privacy dynamics. Lastly, this study proposes a context-specific privacy concerns measurement scale for WDHT users, addressing the need for contemporary measures in privacy research and deepening understanding of consumers' privacy perceptions, which are crucial in current marketing dynamics. Study findings also offer practical implications for WDHT vendors, marketers, and policymakers. By building users' confidence in the coping appraisal that mitigates their privacy threat perceptions and maintains data integrity, privacy-preserving ecosystems can be developed to nurture users’ continued usage intentions while protecting their information privacy.