The Impact of Perceived Usefulness of Wearable Devices on Treatment Adherence in Fracture Patients: The Chain Mediating Roles of Self-Efficacy and Meaning in Life

Xiaoxue Tan,1,2,* Shanshan Cai,3,* Yanan Kan,1,2 Nan Xu,1,2 Ying Chen,1,2 Min Xu,2 Donghong Huang1,2 1Department of Orthopaedics & Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang Provincial Hospital of Chinese Medicine, Hangzhou, Zhejiang Province, People’s Republic of China; 2Department of Nursing, The First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang Provincial Hospital of Chinese Medicine, Hangzhou, Zhejiang Province, People’s Republic of China; 3Division of Biomedical and Life Sciences, Faculty of Health and Medicine, Lancaster University, Lancaster, UK*These authors contributed equally to this workCorrespondence: Min Xu; Donghong Huang, Email yudi1212@163.com; dongdong112700@126.comBackground: Fractures patients often exhibit low treatment adherence, resulting in prolonged recovery and increased complications. Wearable devices provide real-time monitoring and feedback and are expected to improve adherence, but the psychological mechanisms remain underexplored. This study is among the first to extend the Technology Acceptance Model (TAM) to fracture rehabilitation by incorporating self-efficacy and meaning in life as mediators.Objective: The purpose of this study was to analyze the effect of perceived usefulness of wearable devices on treatment adherence of fracture patients and its internal mechanism.Methods: A cross-sectional study was conducted with 473 fracture patients (45.5% male, mean age 44.42 ± 16.24 years) from four tertiary hospitals in Zhejiang, China, between May and June 2025. Participants completed validated scales assessing perceived usefulness, self-efficacy, meaning in life, and treatment adherence. Structural equation modeling and SPSS Macro Process Model 6 with bias-corrected bootstrapping were used to test direct and mediating effects.Results: Perceived usefulness significantly predicted treatment adherence β = 0.167, 95% CI = [0.042, 0.291]. Self-efficacy (indirect effect = 0.089, 95% CI=[0.019, 0.174]) and meaning in life (indirect effect = − 0.135, 95% CI=[− 0.215, − 0.033]) mediated this relationship, with a chain mediation effect through both variables (indirect effect = 0.149, 95% CI = [0.077, 0.229]). The total effect accounted for 62% of adherence variance.Conclusion: The findings reveal a complex psychological mechanism wherein the perceived usefulness of wearable devices influences fracture patients’ treatment adherence through multiple pathways, involving both positive and negative mediating effects. This underscores the importance of addressing patients’ self-efficacy and meaning in life to maximize the effectiveness of technology-based rehabilitation interventions.Keywords: wearable devices, perceived usefulness, fracture patients, treatment adherence, self-efficacy, meaning in life