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Exploring the factors that influence the continuous adoption of WOAs is helpful to strengthen the health education of middle-aged and elderly individuals.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>We developed a new theoretical model and explored the factors that influence middle-aged and elderly individuals' continuous usage intention for HM-WOA. Performance expectancy mediated the effects of the model in explaining continuous usage intention and introduced health literacy into the model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We established a hybrid theoretical model on the basis of the unified theory of acceptance and use of technology 2 model (UTAUT2), the health belief model (BHM), protection motivation theory (PMT), and health literacy. We collected valid responses from 396 middle-aged and elderly users aged\u2009\u2265\u200945\u00a0years in China. To verify our hypotheses, we analyzed the data using structural equation modeling.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Performance expectancy (\u03b2\u2009=\u20090.383,<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001), hedonic motivation (\u03b2\u2009=\u20090.502,<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001), social influence (\u03b2\u2009=\u20090.134,<jats:italic>P<\/jats:italic>\u2009=\u20090.049), and threat appraisal (\u03b2\u2009=\u20090.136,<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) positively influenced middle-aged and elderly users' continuous usage intention. Perceived health threat (\u03b2\u2009=\u2009\u2009\u2212\u20090.065,<jats:italic>P<\/jats:italic>\u2009=\u20090.053) did not have a significant effect on continuous usage intention. Both threat appraisal (\u03b2\u2009=\u20090.579,<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) and health literacy (\u03b2\u2009=\u20090.579,<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) positively affected performance expectancy. Threat appraisal indirectly affected continuous usage intention through performance expectancy mediation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our new theoretical model is useful for understanding middle-aged and elderly users' continuous usage intention for HM-WOA. Performance expectancy plays a mediation role between threat appraisal and continuous usage intention, and health literacy positively affects performance expectancy.<\/jats:p><\/jats:sec>","DOI":"10.1186\/s12911-021-01625-4","type":"journal-article","created":{"date-parts":[[2021,9,3]],"date-time":"2021-09-03T12:08:31Z","timestamp":1630670911000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Middle-aged and elderly users\u2019 continuous usage intention of health maintenance-oriented WeChat official accounts: empirical study based on a hybrid model in China"],"prefix":"10.1186","volume":"21","author":[{"given":"Lin","family":"Xu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pengfei","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaorong","family":"Hou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongfan","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tingting","family":"Tang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ting","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shoushu","family":"Xiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoqian","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheng","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,9,3]]},"reference":[{"issue":"4","key":"1625_CR1","doi-asserted-by":"publisher","first-page":"375","DOI":"10.3736\/jcim20120404","volume":"10","author":"C Huang","year":"2012","unstructured":"Huang C, Zhu YB, Liu ZJ. 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