Understanding hesitancy and decision postponement toward digital therapeutics for Insomnia: Roles of objective ambivalence and digital health literacy.

Abstract

Digital therapeutics (DTx) are evidence-based software interventions that require clinical validation and regulatory approval and, in many cases, are initiated through physician prescription. Despite demonstrated efficacy, their real-world uptake remains limited. This study conceptualized hesitancy toward DTx as a state of indecision and uncertainty, distinct from intention and categorical refusal, often manifesting as decision deferral. Building on vaccine hesitancy and attitudinal ambivalence research, we examined whether objective ambivalence (the coexistence of strong positive and strong negative evaluations) is positively associated with DTx hesitancy. We further tested whether hesitancy is negatively associated with the intention to use and is positively associated with the intention to postpone initiating insomnia DTx and whether digital health literacy (DHL) and calculation orientation moderate these associations. An online survey was administered to 500 Korean adults recruited through an online panel. After exposure to standardized information about prescription insomnia DTx, 367 respondents who answered both comprehension-screening items correctly were retained for analysis. The model was tested using partial least squares structural equation modeling. Objective ambivalence was positively associated with DTx hesitancy (β = 0.279, p < 0.001). Hesitancy was negatively associated with intention to use (β =  - 0.218, p < 0.001) and positively associated with intention to postpone (β = 0.427, p < 0.001), a pattern consistent with decision deferral. DHL showed a positive direct association with use intention; the negative hesitancy-use and positive hesitancy-postponement associations were weaker at higher levels of DHL, whereas the negative hesitancy-use association was stronger at higher levels of calculation orientation. The findings are consistent with a pre-adoption pattern in which greater objective ambivalence is associated with greater hesitancy, and hesitancy is associated with lower use intention and greater postponement intention. The moderation results also point to the potential value of DHL-sensitive communication and implementation support.