Design optimization of health apps for rural older adults: enhancing usability and health effects based on Kano model and SEM method

Introduction: With the intensification of population aging in rural China, older adults face multiple challenges in health management, particularly barriers to using health apps, such as operational complexity, unfriendly interfaces, and insufficient contextual adaptation. This study aimed to optimize the design of health apps for rural older adults by identifying user requirements and examining how design optimization affects health management outcomes. Methods: This study employed an integrated Kano model and structural equation modeling (SEM) approach. First, the needs of rural older adults were investigated, and a set of health app design elements was constructed. Then, the Kano model was used to classify these design elements into Basic Requirements, Expected Requirements, and Attractive Requirements. Finally, SEM was used to analyze the relationships among design requirements, User Satisfaction, Intention to Use, and User Loyalty. Results: The findings showed that meeting Basic Requirements and Expected Requirements significantly improved User Satisfaction, Intention to Use, and User Loyalty among rural older users. Attractive Requirements further enhanced emotional experience and long-term loyalty through innovative features such as dialect support and social interaction. User Satisfaction was also found to play an important mediating role in strengthening users' intention and loyalty. Discussion: These findings suggest that the design optimization of health apps can effectively reduce usage barriers for rural older users and improve their health management outcomes. This study provides theoretical support for the age-friendly design of health apps and practical guidance for promoting the popularization and application of digital health management tools among rural older adults.