Embracing smart wellness: Exploring perceptions of preventive healthcare technology in the digital era

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Smart healthcare tools like wearables and mobile health applications empower individuals to manage their health proactively. By leveraging these technologies, individuals can monitor chronic conditions like hypertension, diabetes, obesity, and cardiac issues, potentially preventing their detrimental consequences. This proactive approach not only enhances personal health management but also contributes to the overall well-being of society. Objective This study aims to understand individuals’ perceptions of smart technology usage and identify the antecedents influencing the adoption of smart healthcare technological applications. Methods This cross-sectional study used a structured questionnaire to collect the responses from 390 respondents in the Indian context. The data were analyzed using Partial Least Square Structural Equation Modeling. Findings and Conclusion The findings of this research show that antecedents such as self-efficacy, preventive awareness, technology promptness and innovativeness, and social influence play a significant role in the adoption of technology among individuals. Further, the study’s results will help to develop and promote technological applications to improve population health and have implications for healthcare providers, technology developers, marketers, and researchers. 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F1000Research 2025, 14 :125 ( https://doi.org/10.12688/f1000research.160126.3 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article Revised Embracing smart wellness: Exploring perceptions of preventive healthcare technology in the digital era [version 3; peer review: 1 approved, 1 approved with reservations] Debanjali Jairam 1 , Swathi K S https://orcid.org/0000-0002-9468-548X 1 , Smitha Nayak https://orcid.org/0000-0001-7171-2580 2 Debanjali Jairam 1 , Swathi K S https://orcid.org/0000-0002-9468-548X 1 , Smitha Nayak https://orcid.org/0000-0001-7171-2580 2 PUBLISHED 02 Sep 2025 Author details Author details 1 Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India 2 Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, Karnataka, India Debanjali Jairam Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Writing – Original Draft Preparation Swathi K S Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Supervision, Writing – Original Draft Preparation Smitha Nayak Roles: Conceptualization, Formal Analysis, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the Manipal Academy of Higher Education gateway. Abstract Background Technology is revolutionizing healthcare, making it more connected, efficient, and patient-centric. Smart healthcare tools like wearables and mobile health applications empower individuals to manage their health proactively. By leveraging these technologies, individuals can monitor chronic conditions like hypertension, diabetes, obesity, and cardiac issues, potentially preventing their detrimental consequences. This proactive approach not only enhances personal health management but also contributes to the overall well-being of society. Objective This study aims to understand individuals’ perceptions of smart technology usage and identify the antecedents influencing the adoption of smart healthcare technological applications. Methods This cross-sectional study used a structured questionnaire to collect the responses from 390 respondents in the Indian context. The data were analyzed using Partial Least Square Structural Equation Modeling. Findings and Conclusion The findings of this research show that antecedents such as self-efficacy, preventive awareness, technology promptness and innovativeness, and social influence play a significant role in the adoption of technology among individuals. Further, the study’s results will help to develop and promote technological applications to improve population health and have implications for healthcare providers, technology developers, marketers, and researchers. READ ALL READ LESS Keywords smart healthcare, preventive health, digital health, technology adoption Corresponding Author(s) Swathi K S ( [email protected] ) Smitha Nayak ( [email protected] ) Close Corresponding authors: Swathi K S, Smitha Nayak Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2025 Jairam D et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Jairam D, K S S and Nayak S. Embracing smart wellness: Exploring perceptions of preventive healthcare technology in the digital era [version 3; peer review: 1 approved, 1 approved with reservations] . F1000Research 2025, 14 :125 ( https://doi.org/10.12688/f1000research.160126.3 ) First published: 24 Jan 2025, 14 :125 ( https://doi.org/10.12688/f1000research.160126.1 ) Latest published: 02 Sep 2025, 14 :125 ( https://doi.org/10.12688/f1000research.160126.3 ) Revised Amendments from Version 2 In this revised version, we have carefully incorporated the reviewers’ suggestions to enhance the clarity and overall readability of the manuscript. We have revised the last paragraph of the introduction, highlighting the significance of this research to keep the readers' interest. Further, a few spelling/grammatical errors have been corrected in the literature review section, and a few of the research hypotheses have been modified to have more clarity. The discussion has been expanded to provide a more nuanced interpretation within the context of current literature, adding to the strengths of this research and revising the limitations of this study. In addition, we have revised the conclusion section by deleting a few of the overlapping points in the discussion section. This revision strengthens the manuscript's rigour, clarity, and comprehensiveness, improving its readability and relevance for both academic and industry readers. In this revised version, we have carefully incorporated the reviewers’ suggestions to enhance the clarity and overall readability of the manuscript. We have revised the last paragraph of the introduction, highlighting the significance of this research to keep the readers' interest. Further, a few spelling/grammatical errors have been corrected in the literature review section, and a few of the research hypotheses have been modified to have more clarity. The discussion has been expanded to provide a more nuanced interpretation within the context of current literature, adding to the strengths of this research and revising the limitations of this study. In addition, we have revised the conclusion section by deleting a few of the overlapping points in the discussion section. This revision strengthens the manuscript's rigour, clarity, and comprehensiveness, improving its readability and relevance for both academic and industry readers. See the authors' detailed response to the review by Catharina M van Leersum See the authors' detailed response to the review by Santosh Kumar READ REVIEWER RESPONSES 1. Introduction Health and health care are considered the most important elements of life. Inevitably, the current healthcare systems are experiencing extensive stress due to the continually increasing longevity of the population and the associated growth in chronic illnesses ( Andersen, 2023 ; Sharma & Popli, 2023 ). Along with other service sectors, healthcare has also experienced a profound change in digitalization and artificial intelligence due to emerging medical advancement and customer demand for exceptional standards of healthcare service ( Alowais et al., 2023 ). With the changing healthcare approach, healthcare focuses on transforming from reactive healthcare to more proactive and personalized ( Chawla, 2020 ). The usage of Smart Healthcare Technologies is widely accepted across the globe. Moreover, wearable gadgets, healthcare apps, and teleconsultation have become essential for daily usage. It enables both patients and clinicians to be constantly vigilant about their health risk of sickness and to take specific preventative steps depending on the results of their monitoring ( Massaro, 2023 ; Tian et al., 2019 ). Smart healthcare aims to assist patients by informing them about their health and medical conditions ( Rani et al., 2023 ). Smart healthcare makes it simpler to utilize the resources that are currently accessible. It lowers the user’s healthcare costs and aids patient remote monitoring. Additionally, it enables medical professionals to offer their services anywhere in the world ( Chau et al., 2019 ; Sundaravadivel et al., 2017 ). Smart Healthcare includes diverse innovation while using mere technological advances. With the advancement of medical digital technologies, it focuses more on patients rather than the traditional disease-centric protocols. The term “smart healthcare” describes a health service system that proactively monitors and intelligently responds to the needs of the healthcare environment. Smart healthcare connects people, resources, and healthcare organizations using wearables, IoT, and mobile Internet technologies. Smart healthcare can improve decision-making, ensure participants receive the needed services, promote communication between all healthcare stakeholders, and ensure utilization. optimize resources. The delivery of smart healthcare services involves many individuals, including doctors, patients, hospitals, and research organizations ( Tian et al., 2019 ; Kraus et al., 2021 ). Many diverse tactics and efforts are being used by health professionals and academics from many disciplines, including healthcare management science, health policy, and innovation management, to modernize healthcare delivery and prevent chronic health conditions. “Preventive medicine is the practice of promoting preventive health care to improve patient well-being.” The primary objective is to prevent illnesses, impairments, and fatalities ( American College of Preventive Medicine, 2019 ). According to the Ottawa Charter, “the process that enables people to increase control over their health and improve their overall health” is known as “health promotion” ( World Health Organization [WHO], 2020 ). Initiatives promoting health prioritize overall well-being and aim to forestall illnesses rather than predominantly concentrating on individuals with a heightened risk of specific diseases ( Sibeudu, 2022 ). These diseases require regular monitoring to intervene if any parameters are elevated promptly. Daily lifestyle changes can help improve health conditions and halt the onset of these diseases. Early detection and intervention would help curb the parameters ( Merck, 2017 ). Studies on the compulsion to use smart health technology by patients with chronic diseases owing to the extremity of their ailments have been done in the past. On the contrary, less is known about thriving individuals and their desire to sustain that state while attempting to prevent future ailments ( Bettiga et al., 2020 ). Presently, people already engage in self-care. Wearables and mobile health applications are examples of self-monitoring smart healthcare technologies ( Kreitmair, 2023 ; Stoumpos et al., 2023 ). Recent advancements in flexible biosensor technology, particularly WaveFlex biosensors, have demonstrated significant potential in real-time health monitoring and preventive care for continuous tracking of vital signs such as heart rate, hydration levels, and glucose concentration ( Kumar et al., 2024 ). Integrating WaveFlex biosensors into smart healthcare systems offers a proactive approach to disease prevention by facilitating early detection and personalized health interventions ( Zhang et al., 2024 ). Thus, wearable technology can be crucial for tracking the physiological data of people with disabilities or long-term conditions ( Partheniadis & Stavrakis, 2019 ; Koo & Fallon, 2018 ), as well as for lowering mortality and hospitalization rates in less developed nations where chronic diseases are more common ( Binyamin & Hoque, 2020 ). Due to regional differences in consumer cultural traits, technological adoption preferences, or both ( Chiu & Cho, 2021 ; Meier et al., 2020 ) , consumer behaviour connected to wearable technology may vary. As emphasized earlier, supporting healthcare efforts and prioritising disease prevention are extremely important in today’s culture. In order to better understand the factors impacting the general public’s behavioural propensity to embrace smart healthcare technology for illness prevention and healthcare promotion, the study set out to investigate the Indian perspective. The main aim was to find out how people felt about using smart technology, identify the variables influencing people’s intentions to use smart health technology, and identify the elements driving the adoption of smart healthcare applications. Among other smart healthcare technologies, despite many contributing factors of mobile health, some challenges impeded their successive usage, including legislative problems, stakeholder disputes, and technological constraints. These obstacles imply that providers of services are still uncertain about how to deliver mobile health to the market ( PwC, 2013 ). Due to the intelligence and intercommunication capabilities of its qualities, convenience is one of the significant relative benefits of adopting mobile health technology in comparison to conventional medical and healthcare services ( Gao et al., 2015 ; Iyanna et al., 2022 ; Yoon & Kim, 2008 ) . Guner and Acarturk (2020) suggested that the utilization of information and communication technology (ICT) by elderly individuals holds the potential to enrich their quality of life. Hence, this study enables us to better understand the preferences and expectations, enabling developers to enhance user experience and engagement with smart technologies. It also helps us to identify psychological, social, and technical barriers that impede the widespread adoption of smart health technologies. In order to close this gap, this study looks at hence, this study enables us to better understand the preferences and expectations, enabling developers to enhance user experience and engagement with smart technologies. It also helps us to identify psychological, social, and technical barriers that impede the widespread adoption of smart health technologies. This is explored in the backdrop of the Technology Acceptance Model (TAM). The Technology Acceptance Model (TAM) provides a theoretical foundation for the research endeavour and enables researchers to explore the interplay of two important antecedents of technology adoption (perceived usefulness and perceived ease of use) in the context of smart wellness products. The research paper is structured as follows: An explanation of the literature review and hypothesis development is presented first, followed by the methodology adopted for this study, which is explained in detail. The subsequent section explains the findings, practical implications, and suggestions for future studies. 2. Review of literature and hypotheses development The theoretical underpinnings are borrowed from the Technology Acceptance Model (TAM) ( Davis, 1989 ). The Technology Acceptance Model (TAM) accounts for the unique use of smart healthcare technology for preventative healthcare ( Holden & Karsh, 2010 ). The two crucial elements of the “TAM” model are, “perceived usefulness (PU)” and “perceived ease of use (PEOU),” impacted by external influences. Both factors influence “Behavioural Intention to use (BI)” and “Attitude Towards using (ATT),” with BI being influenced by ATT. According to Davis (1989) , perceived usefulness is “the degree to which a person believes that using a particular system would enhance his or her job performance”, and perceived usability is “the degree to which a person believes that using a particular system would be free of effort.” TAM essentially holds that individual acceptance occurs in three stages: (i) external factors that relate to people’s beliefs influence their perceptions of the usefulness and usability of an IT system; (ii) the perceived usefulness and usability of the system influences behaviour; and (iii) the behaviour influences the actual use of the IT system. The pillars of the theoretical framework are PU and PEOU. Behavioural Intention is the central decision-making construct of the model used in this study. The conceptual framework of this study represents Prevention Awareness, Self-Efficacy, Technology Promptness, and Innovativeness as the antecedents. Prevention awareness and self-efficacy are the antecedents of the determinant of perceived usefulness, and technological promptness and innovativeness are the antecedents of perceived ease of use. Subjective Norms have been included as one of the main determinants of the model. The subjective norm reflects the social pressure that results from trying to live up to others’ expectations. Being a part of society, people may get advice and pressure from friends, family, coworkers, and peers regarding their lifestyle and health choices. Understanding how these external factors affect the adoption of mobile health advances is significant ( Bettiga et al., 2020 ). Perceived Usefulness is the extent to which a person thinks employing a particular system would improve his or her performance. According to ideas regarding consumption values, consumers’ choices are mostly influenced by functional values ( Davis, 1989 ). It denotes the value obtained from successfully completing a task and is connected to superiority over alternatives. Studies on the adoption of new technologies have lately presumed the relationship between perceived usefulness and intention to adopt since it has been carefully studied and verified by prior research with various settings, technologies, and consumer groups ( Ahmad, 2014 ; Edmunds et al., 2012 ; Indu & Raj, 2012 ). Consequently, the following hypothesis has been formulated: H1: PU has a significant influence on behavioural intention to adopt smart technology. Perceived ease of use is the idea that using a particular technology would be effortless. It is an inducer of personal technology usage. PEOU has a critical role in influencing the adoption of innovations since it may evaluate various technologies in terms of their time savings ( Collier & Kimes, 2013 ). PEOU has received widespread confirmation of its significance in forecasting technology adoption and is seen as a valuable indicator of a technology’s functional properties ( Davis & Venkatesh, 2004 ). H2: Perceived ease of use has a significant influence on behavioural intention to adopt smart technology. The term “subjective norm” refers to an individual’s assessment of the extent to which significant others endorse or disapprove of the target activity. Individuals do participate in intricate social networks and communities, which may impact their intents and behaviours ( Fishbein et al., 2007 ). Social influence can originate from numerous avenues, including fellow consumers of the same business or similar services, as shown in feedback, evaluations, and positive experiences. People engage in complex social networks and groups, which may influence their intentions and actions ( Bettiga et al., 2020 ). Thus, the following hypothesis has been formulated: H3: Subjective norms positively influence on behavioural intention to adopt smart technology. The healthcare systems of the most developed nations focused more on prevention due to the drop in chronic patients and hospitalizations. Further, TAM2 ( Venkatesh & Davis, 2000 ) reveals the influence of subjective norms and social influence on intentions to use. In developing countries, though, people are aware of disease prevention, and that drive must endure for years or even decades to experience the benefit of prevention ( Champion & Skinner, 2008 ; Mosca et al., 2010 ). Making people aware of the consequences of diseases and how using smart healthcare can be beneficial in preventing such health issues could influence the adoption of the same. So, the subsequent hypothesis has been developed: H4: Prevention awareness has a positive impact on the PU of smart technology. Self-efficacy is the conviction that one can independently do tasks or get desired results. Zhang et al. (2017) found that perceived usefulness has a more significant impact on adoption intention when a user has a high degree of self-efficacy when utilizing m-Health services. The influence of perceived utility on the intention to adopt is highlighted when users possess a strong self-efficacy in using novel technology services. On the other hand, a user who is unconfident in their capacity to utilize new technology efficiently might feel demoralized and choose not to adopt it ( Zhang et al., 2017 ). H5: Self-efficacy has a positive impact on PU of smart technologies. Technology promptness is believed to be a relevant antecedent of perceived ease of use because it makes access and usage easier. The concept of perceived technical promptness conveys all the underlying conditions that underpin technology usage, such as its prompt availability when required or other contextual drivers of use. Technology makes it easier for consumers to access and utilize services quickly in terms of time and geography ( Mallat et al., 2009 ). H6: Technology promptness has a significant positive impact on perceived ease of use. Innovativeness is a psychological condition shaped by cognitive facilitators that impact a person’s inclination to integrate new technologies. Perceived ease of use might be influenced by an individual’s ideas about cutting-edge technology when assessing the qualities of newly developed products or services and contemplating adopting them ( Lin et al., 2007 ; Schwarz & Ernst, 2009 ). H7: Innovativeness has a positive influence on the perceived ease of use of smart technology. Forecasting a person’s interest in utilizing the system in the future is possible by looking at their intention, which is their choice or plan to carry out a specific act independently. By assessing the constructs that are the antecedents and determinants of the model, the behavioural intention of people and their decision-making to adopt smart healthcare technologies could be identified. Though the researchers have studied the adoption intention in different countries worldwide, there is a dearth of literature on the Indian context. Hence, based on the literature, the researchers have proposed the following conceptual framework given in Figure 1 . Figure 1. Conceptual framework. Methods This cross-sectional empirical study aimed to assess people’s perception of adopting smart healthcare technologies like mobile health, e-health, wearables and telemedicine to prevent diseases and promote health. The study utilized a survey-based approach, where participants completed a structured questionnaire designed to assess behavioural intentions. The initial course of action was to create the survey questionnaire. The questionnaire was developed based on a review of existing literature and validated instruments where applicable. The first section of the questionnaire included questions related to the demographic particulars of the respondents, such as age, gender, and occupation. The second part of the questionnaire consisted of the constructs adapted from seminal theories, including the TAM ( Davis, 1989 ) and the extended Health Belief Model (HBM) ( Rosenstock et al., 1988 ; Ross et al., 2010 ). It encompassed seven independent variables: Prevention Awareness (PREV), Self-Efficacy (SE), Innovativeness (INN), Technology Promptness (TECH), Perceived Usefulness (PU), Perceived Ease of Use (PEOU), and Subjective Norms (SN). These variables were selected based on their relevance to understanding individuals’ behavioural intentions towards adopting smart healthcare technology. Specifically, the first four constructs (PREV, SE, INN, and TECH) were considered antecedents influencing individuals’ decision-making processes, while the subsequent three constructs (PU, PEOU, and SN) were identified as determinants of decision-making. The dependent variable under investigation was behavioural intention (BI), which reflects individuals’ intentions to adopt smart healthcare technologies. The questionnaire consisted of a total of 27 measurement items. A five-point Likert Scale was used to measure the items, with the scale ranging between “Strongly Disagree” being 1 and “Strongly Agree” being 5. Next, the content validity of the questionnaire was reviewed by academic experts from the healthcare and marketing management domains. Further, a pre-test of the questionnaire with a small group of participants was done to refine the language and prevent any potential confusion or ambiguous interpretations. All scales were validated as the Cronbach alpha of all scales was above 0.7, which is above the minimum threshold value required. The study population involved the general public in India. A non-random convenience sampling method was employed, which involves collecting the data from the respondents accessible to the researcher ( Sekaran and Bougie, 2016 ). The inclusion criteria for respondents were people above 18 years of age who are mentally stable, can read and write English, and have a Google account. Utilizing the sample size calculation formula for an infinite population, the study aimed to recruit 385 respondents. Following the validation of the questionnaire, the registration number for this trial was CTRI/2023/09/058164. Participants were provided with clear and comprehensive information regarding the purpose of the study. All personal data were anonymized to ensure privacy and used solely for research purposes. The researchers were able to collect a total of 398 responses. During data cleaning, eight responses were repetitive and incomplete submissions. Therefore, after data cleaning, 390 responses were considered for data analysis. The descriptive analysis of the data was done using statistical software Jamovi 2.4.11, and the model assessment and hypothesis testing were done using SmartPLS4, a multivariate data analysis technique of the second generation that enables testing of additive and linear models. 3. Analysis and Results 3.1 Demographic particulars The study considered 390 complete responses for final data analysis. The demographic particulars of the respondents are given in Table 1 . Of the total sample population, 39.2% are male, and 60.5% are female. In the age cohort distribution, 65.9 % of the respondents are 36-50 years old. Table 1. Demographic details of the respondents. Characteristics Total No. (N) Percentage (%) Gender Male 153 39.2 Female 236 60.5 Transgender 1 0.3 Age 18-35 104 26.7 36-50 257 65.9 >50 29 7.4 Education 10 th Pass 0 0 12 th Pass 8 2.1 Graduation 184 47.2 Post Graduation and Above 198 50.8 Occupation Salaried 170 43.6 Self-Employed 25 6.4 Professional 30 7.7 Homemaker 19 4.9 Retired 9 2.3 Student 137 35.1 Annual Household Income 15 Lakh 100 25.6 More than 97% of the respondents were graduates and postgraduates in the education level category. The second-generation multivariate data analysis software Smart PLS4 was used to assess the structural model and test the hypotheses ( Ringle et al., 2023 ). Assessing the structural model by PLS-SEM helps the researcher establish the model’s capability to predict the reliability and validity of the dependent factors or the constructs ( Hair et al., 2014 ). 3.2 Measurement model The reliability and validity of the model have been assessed by measuring Cronbach’s alpha, composite reliability, individual indicator reliability, and average variance extracted (AVE). The findings regarding reliability and convergent validity are summarized in Table 2 . All model constructs exhibited Cronbach alpha values exceeding 0.7, composite reliability values surpassing 0.8, and AVE values more excellent than the threshold of 0.5. Therefore, it ensures the reliability and validity of all the constructs of the measurement model. Table 2. Construct Reliability and Validity. Constructs Cronbach's Alpha Composite Reliability AVE BI 0.896 0.928 0.763 INN 0.730 0.844 0.645 PEU 0.659 0.813 0.595 PREV 0.861 0.915 0.782 PU 0.878 0.916 0.733 SE 0.877 0.915 0.730 SN 0.657 0.802 0.582 TECH 0.743 0.854 0.661 Further, the researchers measured the Fornell-Larcker criteria to confirm the discriminant validity of the model. Establishing discriminant validity implies that a construct is unique and captures facts not represented by other constructs in the model. It compares the square root of the AVE values with the latent variable correlations. The square root of each construct’s AVE should be greater than its highest correlation with any other construct, which ensures the discriminant validity attainment ( Hair et al., 2014 ). Table 3 displays the findings of the Fornell-Larcker criterion values for this research. The square root of each construct is greater than its correlation with other constructs, which indicates the presence of discriminant validity in the model. Table 3. Fornell-Lacker Criterion. BI INN PEU PREV PU SE SN TECH BI 0.874 INN 0.571 0.803 PEU 0.562 0.575 0.771 PREV 0.730 0.517 0.504 0.884 PU 0.626 0.462 0.513 0.686 0.856 SE 0.641 0.628 0.721 0.594 0.611 0.855 SN 0.519 0.453 0.508 0.491 0.512 0.470 0.763 TECH 0.642 0.602 0.602 0.636 0.581 0.629 0.434 0.813 3.3 Structural model assessment After determining the acceptable measurement model, the researchers assessed the structural model, which involved testing the significance of path coefficients and the coefficient of determination (R 2 value). We performed a bootstrap analysis with 5000 samples. The estimates for the structural model relationships or path coefficients show the correlation between the constructs ( Hair et al., 2014 ). The coefficient of determination, or R 2 value, is the metric for assessing the predictive relevance of the structural model. It represents the total effect of the external latent variables on the endogenous latent variable ( Hair et al., 2014 ). The structural model in Figure 2 portrays the path coefficients that demonstrate the relationship between independent and dependent variables and the coefficient of determination, R 2 values of the endogenous constructs PE, PEU, and BI. Figure 2. Path diagram showing the structural assessment of model. The path coefficient values of all the model constructs indicate stronger relationships as the values are above 0.10. The R 2 value of Behavioural Intention (BI) is 0.492, which explains the predictive relevance of the model. The literature states that R 2 values of 0.25, 0.50, and 0.75 for dependent variables denote the model’s weak, moderate, and substantial accuracy, respectively ( Becker et al., 2012 ; Collier & Bienstock, 2006 ). Here, the R 2 values of PU, PEU and BI are 0.534, 0.433 and 0.492, respectively, which proves the predictive relevance of the constructs in the model, confirming the research hypotheses of the study. The t-value and p-values are used to determine the statistical significance of the parameter estimations from the structural equation modelling. In the research, the association between the independent and dependent variables is significant as the t-value is greater than the threshold value of 1.964, and the p-value is less than 0.05. The results are given in Table 4 . Table 4. Significance testing results of the structural model path coefficients. Hypotheses Relations Path coefficients t-value H 1 PU -> BI 0.397 *** 7.862 H 2 PEU -> BI 0.267 *** 4.762 H 3 SN -> BI 0.180 *** 3.629 H 4 PREV -> PU 0.499 *** 9.778 H 5 SE -> PU 0.315 *** 6.468 H 6 TECH -> PEU 0.400 *** 7.837 H 7 INN -> PEU 0.334 *** 6.666 *** = p-value 0.001. The inner model results suggest a significant influence of preventive healthcare awareness and self-efficacy on PU. Further, it shows a significant effect of innovativeness and technology promptness on PEU. The R 2 value of PU is 0.534, and PEU is 0.433, showing a moderate predictive relevance of the model. In addition, the outer model results confirm that the PU, PEU, and SN are predictors of intention to adopt technological applications to promote health and prevent diseases. 3.4 Importance-performance map analysis (IPMA) IPMA is performed to extend the results of PLS-SEM further. It helps to draw conclusions based on the performance and importance of each construct. Thus, it facilitates drawing inferences on two dimensions, importance and performance, to provide administrative implications ( Hair et al., 2017 ). Hence, IPMA is done to help the target construct BI adopt smart technologies at both construct and indicator levels. The x-axis displays the total effects of the independent variables on the target construct. The y-axis displays the independents’ average construct scores or performance ( Hair et al., 2014 ). The construct level IPMA results are shown in Figure 3 . Figure 3. IPMA at construct level. The average performance score (PS) of all the constructs is 67.675, and the average total effect is 0.195. Here, the construct PEU’s performance score (PS) is 67.777, which is slightly greater than the average PS. However, the total effect of PEU on BI is 0.267, which is greater than the average importance score of 0.195. Hence, the PEU construct requires managerial attention to improve the BI to adopt smart technologies. In addition, the construct PU also needs greater attention in enhancing BI as its total effect is 0.395, though the PS is above the average PS of all the constructs. Further, indicator level IPMA is performed to provide more specific insights to improve BI, and the results are shown in Figure 4 . Figure 4. IPMA at the indicator level. The average PS is 66.878, and the average total effect is 0.071. Hence, it revealed six indicators that went to the prioritization quadrant. They are PEUI “Learning to use technological applications is easy” (β=0.137>0.071, PS=74.295>66.878), PREV1“Awareness on the importance of preventive healthcare services” (β=0.073>0.071, PS=70.705>66.878), PU1 “Using a smart healthcare technology will help in monitor one’s health condition periodically” (β=0.117>0.071, PS=72.308>66.878), PU3 “Using a smart healthcare technology will help to better perform in controlling health issues” (β=0.119>0.071, PS=70.641>66.878), PU4 “I believe that smart healthcare technology would lead to better health outcomes for me” (β=0.111>0.071, PS=70.000 > 66.878), and SN1 “People who are important to me to consider using smart healthcare technology” (β=0.10>0.071, PS=67.628 > 66.878). Hence, these attributes require more attention to improve individuals’ intention to adopt technological applications for health promotion and disease prevention. Further, policymakers and providers of smart healthcare technologies need to be notified of this fact to create awareness among people and enable them to adopt smart healthcare technologies. 4. Discussion and Implications The findings of this study reveal insights into the factors influencing individuals’ behavioural intentions to use technological applications for preventive and promotive healthcare. Our results support the underlying antecedent and determinant factors of the suggested model for adopting smart healthcare technologies among healthcare consumers. This study contributes mainly in three ways: first, it assessed the antecedents of PU of the technological applications; second, it assessed the antecedents of PEU of technological applications; and third, it assessed the determinants of behavioural intentions to adopt technological applications for healthcare. Our study revealed a positive effect of preventive healthcare awareness and self-efficacy on the PU of technology. This aligns with the previous research findings, which stated preventive healthcare awareness ( Bettiga et al., 2020 ; Palos-Sanchez et al., 2021 ) and self-efficacy ( Jokisch et al., 2022 ) as the key drivers of PU. People who are aware of the importance of disease prevention and who believe in the self-capacity to use technology consider that technology enables services to be more useful. The study findings reveal a significant effect of technology promptness and innovativeness on perceived ease of use, which confirms them as the antecedents of PEOU, similar to the findings of previous research ( Bettiga et al., 2020 ; Cheung et al., 2021 ; Chiu & Cho, 2021 ). Individuals who are fascinated towards technologies and innovation feel comfortable in the use of smart technologies due to the expertise they have acquired. Hence, healthcare providers can offer enough support to consumers who have less inclination towards new technologies. Empirical evidence shows a direct effect of perceived usefulness, perceived ease of use and subjective norms on intention to adopt smart technology. Inconsistent with the previous research, perceived usefulness emerges as a significant determinant of individuals’ intentions to adopt smart technologies for healthcare ( Cheung et al., 2021 ; Chiu & Cho, 2021 ). In addition, PEOU and SN also have a significant effect on the intention to adopt smart technologies, which is in line with the existing research findings ( Bettiga et al., 2020 ; Chiu & Cho, 2021 ). These findings have significant implications for policymakers and providers, indicating that enhancing perceived ease of use and social desirability, in addition to perceived usefulness, is essential to increasing adoption intentions of technological applications. Moreover, the literature states the significant influence of cultural values and regional healthcare infrastructure on the adoption of smart technologies in healthcare. In South Africa’s Cape Flats, cultural factors were more strongly associated with diabetes self-management behaviours than with the adoption of mobile health applications, indicating that cultural context can affect health behaviours differently than technology use ( Petersen, 2021 ). In Singapore, older adults face challenges in adopting healthcare technologies due to digital disparities and the need for technology to align with their daily lives and cultural expectations ( Low et al., 2021 ). A meta-analysis on wearable healthcare devices highlighted the moderation effect of national culture in the relationship between perceived usefulness and the intention to adopt these technologies ( Zhang et al., 2022 ). Even though providing a user-friendly technology and interface are critical determinants of the intention to accept smart health technologies, it is insufficient to encourage widespread adoption. Hence, technology providers should go beyond merely reducing system complexity; they must actively communicate and promote the utility of preventive healthcare systems to both the target individuals and their social networks. This approach ensures that the benefits of technology are understood and valued within the broader community, enhancing overall acceptance and use. These findings will be useful for healthcare providers, policymakers, researchers, and health technology marketers who are diffusing technological applications to promote health and prevent diseases. Practitioners and technology designers must employ user-centred design approaches based on empirical research in order to maximize end users’ access to and involvement with preventative healthcare technologies. It includes providing accessibility, customization, and trust-building strategies as top priorities at every stage of the development process. In order to encourage meaningful and long-lasting contact, technologies must be customized to fit users’ daily schedules, personal preferences, and differing levels of health literacy. Furthermore, identifying latent demands and future usability issues can be made easier by utilizing co-design techniques that involve end users early in the development process. Enhancing user receptivity also requires a focus on clearly communicating the advantages, integrating culturally sensitive content, and making sure the interface is easy to use. Finally, the integration of adaptive feedback mechanisms may further support long-term engagement and trust, thereby improving the overall effectiveness of smart wellness interventions in preventive healthcare. In addition, it can guide healthcare providers in implementing and promoting these technologies within their practice. Implementing user-friendly technological solutions based on study findings can improve patient engagement and healthcare delivery. Further, policymakers can use the study findings to inform the development of policies and regulations that support the adoption and integration of technological applications for health promotion and disease prevention. The study findings will be helpful for health technology marketers to tailor marketing strategies and messages that emphasize the benefits and usability of their products for preventive and promotive healthcare. Moreover, this study may benefit researchers who want to build upon the findings to conduct further investigations into specific factors influencing technology adoption in healthcare. 5. Conclusion and future research recommendations This research offers insights into the antecedent and determinant factors driving the adoption of technologies in healthcare. The study provides a foundation for future research on the effectiveness and sustainability of technological interventions in preventive and promotive healthcare. Overall, the study’s implications highlight the importance of collaboration among stakeholders to promote the adoption and diffusion of technological applications for health promotion and disease prevention. By translating research findings into actionable strategies, stakeholders can collectively contribute to improving population health outcomes and advancing healthcare delivery through innovative technologies. Despite the valuable findings, the study has limitations that suggest future research in this domain. First, there is a limitation regarding the generalizability of the findings, as this study used convenience sampling, a non-probability sampling method. Hence, future researchers are recommended to perform the research using the probability sampling method. Second, this study has taken an opinion on the acceptance of overall general smart healthcare technologies such as mhealth/mobile health, telehealth, online medicine purchases, and wearables like smartwatches etc. Future studies could be done on the specific smart healthcare technology to gain insights into respective technological applications. Third, this study has used a quantitative research approach, which often assumes objectivity, potentially overlooking the subjective nature of data collection and analysis processes. Hence, future research can be done using mixed methods, such that the qualitative approach may identify concerns people have if any, other than those that the study constructs. Further, as this study is performed in the Indian context, such studies can be performed in other countries’ contexts to gain more insights into adoption intention, as people might have different knowledge, opinions, and perceptions depending on the cultural and socioeconomic exposures and accessibility to smart technology. Also, considering a different demographic cohort (above 50) could display a comparison in technology adoption among age groups. In addition, future studies can incorporate a clinical health outcome and compare the efficacy of embracing smart wellness across various clinical outcomes. Further, future researchers can also determine the Technology Readiness index among segments that have displayed late adoption of smart wellness. Ethics and consent The complete protocol was submitted to the Institutional Ethics Committee-2 of Kasturba Medical College and Kasturba Hospital and received the approval on September 8, 2023 with the number IEC2:448/2023. Further, the study was registered with the Clinical Trial Registry of India, which subsequently approved the study’s conduct. After receiving approval, the questionnaire was sent to people of all ages using open media platforms, including email, LinkedIn, and WhatsApp. This study adhered to the ethical principles outlined in the Declaration of Helsinki. Participation in the survey was entirely voluntary, and informed written consent was obtained from all respondents prior to their participation. Author contributions • Debanjali Jairam: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Writing – original draft • Dr Swathi K S: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Supervision, Writing – original draft • Dr Smitha Nayak: Conceptualization, Formal analysis, Writing – review and editing Data availability statement Underlying data Figshare: Perception of smart technology adoption data.xlsx, https://doi.org/10.6084/m9.figshare.28016792.v3 ( Jairam et al., 2024 ). This project contains the following underlying data: • Perception of smart technology adoption dataset.xlsx Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). Extended data Figshare: Study tool – Smart Technology adoption, https://doi.org/10.6084/m9.figshare.28162109.v2 ( Jairam et al., 2025 ). This project contains the following underlying data: • Questionnaire – Smart Technology Adoption Intention.pdf Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). Software availability statement Smart PLS 4 is a subscription-based software; however, one can use R statistical software, which is a free software for PLS SEM analysis. References Ahmad BIE: User acceptance of health information technology (HIT) in developing countries: a conceptual model. Proc. Technol. 2014; 16 : 1287–1296. Publisher Full Text Alowais SA, Alghamdi SS, Alsuhebany N, et al. : Revolutionizing healthcare: the role of artificial intelligence in clinical practice. BMC Med. Educ. 2023; 23 (1): 689. PubMed Abstract | Publisher Full Text | Free Full Text American College of Preventive Medicine: What is Preventive Medicine?2019. Reference Source Andersen LL: Health promotion and chronic disease prevention at the workplace. Annu. Rev. 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PubMed Abstract | Publisher Full Text | Free Full Text Comments on this article Comments (0) Version 3 VERSION 3 PUBLISHED 24 Jan 2025 ADD YOUR COMMENT Comment Author details Author details 1 Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India 2 Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, Karnataka, India Debanjali Jairam Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Writing – Original Draft Preparation Swathi K S Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Supervision, Writing – Original Draft Preparation Smitha Nayak Roles: Conceptualization, Formal Analysis, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (3) version 3 Revised Published: 02 Sep 2025, 14:125 https://doi.org/10.12688/f1000research.160126.3 version 2 Revised Published: 24 Apr 2025, 14:125 https://doi.org/10.12688/f1000research.160126.2 version 1 Published: 24 Jan 2025, 14:125 https://doi.org/10.12688/f1000research.160126.1 Copyright © 2025 Jairam D et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Jairam D, K S S and Nayak S. Embracing smart wellness: Exploring perceptions of preventive healthcare technology in the digital era [version 3; peer review: 1 approved, 1 approved with reservations] . F1000Research 2025, 14 :125 ( https://doi.org/10.12688/f1000research.160126.3 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 3 VERSION 3 PUBLISHED 02 Sep 2025 Revised Views 0 Cite How to cite this report: van Leersum CM. Reviewer Report For: Embracing smart wellness: Exploring perceptions of preventive healthcare technology in the digital era [version 3; peer review: 1 approved, 1 approved with reservations] . F1000Research 2025, 14 :125 ( https://doi.org/10.5256/f1000research.187232.r411196 ) The direct URL for this report is: https://f1000research.com/articles/14-125/v3#referee-response-411196 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 17 Sep 2025 Catharina M van Leersum , University of Twente, Enschede, Netherlands Antilles; Open University of The Netherlands (Ringgold ID: 10198), Heerlen, Limburg, The Netherlands Approved VIEWS 0 https://doi.org/10.5256/f1000research.187232.r411196 I see how the authors have used the comments to ... Continue reading READ ALL I see how the authors have used the comments to revise their manuscript. I have no further comments to make. Competing Interests: No competing interests were disclosed. Reviewer Expertise: AI, eHealth, STS I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT van Leersum CM. Reviewer Report For: Embracing smart wellness: Exploring perceptions of preventive healthcare technology in the digital era [version 3; peer review: 1 approved, 1 approved with reservations] . F1000Research 2025, 14 :125 ( https://doi.org/10.5256/f1000research.187232.r411196 ) The direct URL for this report is: https://f1000research.com/articles/14-125/v3#referee-response-411196 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Version 2 VERSION 2 PUBLISHED 24 Apr 2025 Revised Views 0 Cite How to cite this report: van Leersum CM. Reviewer Report For: Embracing smart wellness: Exploring perceptions of preventive healthcare technology in the digital era [version 3; peer review: 1 approved, 1 approved with reservations] . F1000Research 2025, 14 :125 ( https://doi.org/10.5256/f1000research.180643.r399445 ) The direct URL for this report is: https://f1000research.com/articles/14-125/v2#referee-response-399445 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 19 Aug 2025 Catharina M van Leersum , University of Twente, Enschede, Netherlands Antilles; Open University of The Netherlands (Ringgold ID: 10198), Heerlen, Limburg, The Netherlands Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.180643.r399445 Dear authors, your manuscript discusses a relevant topic and is based on a well conducted and documented method. To make the paper more attractive to readers, I suggest some comments for improvement of presenting the study in your manuscript, especially ... Continue reading READ ALL Dear authors, your manuscript discusses a relevant topic and is based on a well conducted and documented method. To make the paper more attractive to readers, I suggest some comments for improvement of presenting the study in your manuscript, especially in the first part. Hopefully these advices can assist you in preparing an adjusted manuscript. Introduction The introduction is very informative, but it does not really inform me as a reader why I should read this paper and what you as a researcher are aiming to do. Make clear why I should read this paper and what is relevant about all the details/information provided. The last paragraph is not really informative since it does not provide any information which could not be expected by the reader. This could be removed. Minor remark: you use quite some capitals where these are not needed. Minor remark: please provide the full writing of IoT before providing/using the acronym. Literature and hypotheses I am not sure about the presentation of the different hypotheses. These are all going to discuss the ‘positive impact’ and that is fine, but then it would not be necessary in my opinion to make this into seven different hypotheses. Please diminish this use of words and use them differently. Because you mention the bulk of literature, but do not really discuss this and then suddenly present figure 1. I would like to get more information on figure 1 instead of all information you spread regarding seven not very interesting hypotheses. Start this section with this figure and then show how it informs your research and how you reach to the hypothesis that all the elements of TAM and HBM (or name the seven items specifically) will have a positive impact. Minor remark: you gave some acronyms like PU and PEOU, but then still use the full writing in some later occurrences. This is not needed and could be removed. Results I notice that there is a lack of information about the 50 years and older population. Could you please reflect on the lack of information about this older population. This might be valuable since this population uses healthcare quite often. Figure 2 is not really informative and only leave it with table 4 would be fine. However, it would be good to rename H1-7 and only leave it with the relations. Especially if you take my earlier comment into account. Minor remark: again with the acronyms. Here you use more acronyms for the seven items. Please start using the acronyms from the first instance you mention them. This is in the literature and hypotheses part, where you now only introduced PU and PEOU, but you already mention the wordings of all other acronyms. Be consistent is my message. Minor remark or question: PEU is the same as PEOU? Discussion From the start of the discussion I see the aim of this research. Thank you, and it would be great to read something about this earlier, see my first comment. It would be great to read a bit about your considerations towards the strengths and especially some limitations. See also my earlier comment regarding lack of data from the older population. Conclusions In this part as well as in the discussion part you talk a bit about future considerations and future research. Please combine these sections. I would prefer to read this at the end of the discussion, where you now already indeed mention something about this. Thus remove the future research from the conclusion back to the discussion and possibly this can assist you in overcoming to mention things twice. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: healthcare, artificial intelligence, eHealth, older adults I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT van Leersum CM. Reviewer Report For: Embracing smart wellness: Exploring perceptions of preventive healthcare technology in the digital era [version 3; peer review: 1 approved, 1 approved with reservations] . F1000Research 2025, 14 :125 ( https://doi.org/10.5256/f1000research.180643.r399445 ) The direct URL for this report is: https://f1000research.com/articles/14-125/v2#referee-response-399445 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 10 Sep 2025 Swathi K S , Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India 10 Sep 2025 Author Response Dear Reviewer, Thank you for the valuable suggestions for improving the quality of this manuscript. The responses to the comments are given below. Introduction The introduction is ... Continue reading Dear Reviewer, Thank you for the valuable suggestions for improving the quality of this manuscript. The responses to the comments are given below. Introduction The introduction is very informative, but it does not really inform me as a reader why I should read this paper and what you as a researcher are aiming to do. Make clear why I should read this paper and what is relevant about all the details/information provided. The last paragraph is not really informative since it does not provide any information which could not be expected by the reader. This could be removed. Minor remark: you use quite some capitals where these are not needed. Response: Thank you for the comment. The value added by the research has been added to the introduction section of the manuscript. This clearly explains “why” a researcher should read our article. In order to close this gap, this study looks at Hence, this study enables us to better understand the preferences and expectations, enabling developers to enhance user experience and engagement with smart technologies. It also helps us to identify psychological, social, and technical barriers that impede the widespread adoption of smart health technologies. This is explored in the backdrop of the Technology Acceptance Model (TAM). ). The Technology Acceptance Model (TAM) provides a theoretical foundation for the research endeavour and enables researchers to explore the interplay of two important antecedents of technology adoption (perceived usefulness and perceived ease of use) in the context of smart wellness products. 2. Minor remark: please provide the full writing of IoT before providing/using the acronym. Response: Noted and necessary changes have been incorporated. Reviewer comments : Literature and hypotheses I am not sure about the presentation of the different hypotheses. These are all going to discuss the ‘positive impact’ and that is fine, but then it would not be necessary in my opinion to make this into seven different hypotheses. Please diminish this use of words and use them differently. Because you mention the bulk of literature, but do not really discuss this and then suddenly present figure 1. I would like to get more information on figure 1 instead of all information you spread regarding seven not very interesting hypotheses. Start this section with this figure and then show how it informs your research and how you reach to the hypothesis that all the elements of TAM and HBM (or name the seven items specifically) will have a positive impact Response: Thank you for the review. We have revisited the hypothesis statements and incorporated the changes wherever necessary. 2. Minor remark: you gave some acronyms like PU and PEOU, but then still use the full writing in some later occurrences. This is not needed and could be removed. Response: We have included the necessary changes in the manuscript. Results I notice that there is a lack of information about the 50 years and older population. Could you please reflect on the lack of information about this older population? This might be valuable since this population uses healthcare quite often. Response: Yes we agree that the population above 50 displays an inclination to use smart technologies and we have only 8% of our responses in the cluster. When this study was conceptualized, “age” was not considered as a moderator and hence a representative sample was not drawn from each cluster. However, we have mentioned this in our limitations as a direction for future researchers to explore. 2. Figure 2 is not really informative and only leave it with table 4 would be fine. However, it would be good to rename H1-7 and only leave it with the relations. Especially if you take my earlier comment into account. Response: Figure 2 is the structural model adopted in this study and hence, researchers have decided to retain both figure 2 and table 4. 3. Minor remark: again with the acronyms. Here you use more acronyms for the seven items. Please start using the acronyms from the first instance you mention them. This is in the literature and hypotheses part, where you now only introduced PU and PEOU, but you already mention the wordings of all other acronyms. Be consistent is my message. Response: Thank you for the observation. Necessary changes have been incorporated. 4. Minor remark or question: PEU is the same as PEOU? Response: Yes. We apologize for the typo error. We have made the necessary changes in the manuscript. Discussion From the start of the discussion I see the aim of this research. Thank you, and it would be great to read something about this earlier, see my first comment. Response: We have incorporated the same in the introduction section. 2. It would be great to read a bit about your considerations towards the strengths and especially some limitations. See also my earlier comment regarding lack of data from the older population. Response: We have mentioned this is the limitations section of the manuscript. Conclusions In this part as well as in the discussion part you talk a bit about future considerations and future research. Please combine these sections. I would prefer to read this at the end of the discussion, where you now already indeed mention something about this. Thus remove the future research from the conclusion back to the discussion and possibly this can assist you in overcoming to mention things twice. Response: Thank you for the suggestion. We have aligned the manuscript according to established norms and journal considerations. Hence, the conclusion section not only presents the final comments but clearly spells out direction for future researchers. This has been placed in the last section of the manuscript. Dear Reviewer, Thank you for the valuable suggestions for improving the quality of this manuscript. The responses to the comments are given below. Introduction The introduction is very informative, but it does not really inform me as a reader why I should read this paper and what you as a researcher are aiming to do. Make clear why I should read this paper and what is relevant about all the details/information provided. The last paragraph is not really informative since it does not provide any information which could not be expected by the reader. This could be removed. Minor remark: you use quite some capitals where these are not needed. Response: Thank you for the comment. The value added by the research has been added to the introduction section of the manuscript. This clearly explains “why” a researcher should read our article. In order to close this gap, this study looks at Hence, this study enables us to better understand the preferences and expectations, enabling developers to enhance user experience and engagement with smart technologies. It also helps us to identify psychological, social, and technical barriers that impede the widespread adoption of smart health technologies. This is explored in the backdrop of the Technology Acceptance Model (TAM). ). The Technology Acceptance Model (TAM) provides a theoretical foundation for the research endeavour and enables researchers to explore the interplay of two important antecedents of technology adoption (perceived usefulness and perceived ease of use) in the context of smart wellness products. 2. Minor remark: please provide the full writing of IoT before providing/using the acronym. Response: Noted and necessary changes have been incorporated. Reviewer comments : Literature and hypotheses I am not sure about the presentation of the different hypotheses. These are all going to discuss the ‘positive impact’ and that is fine, but then it would not be necessary in my opinion to make this into seven different hypotheses. Please diminish this use of words and use them differently. Because you mention the bulk of literature, but do not really discuss this and then suddenly present figure 1. I would like to get more information on figure 1 instead of all information you spread regarding seven not very interesting hypotheses. Start this section with this figure and then show how it informs your research and how you reach to the hypothesis that all the elements of TAM and HBM (or name the seven items specifically) will have a positive impact Response: Thank you for the review. We have revisited the hypothesis statements and incorporated the changes wherever necessary. 2. Minor remark: you gave some acronyms like PU and PEOU, but then still use the full writing in some later occurrences. This is not needed and could be removed. Response: We have included the necessary changes in the manuscript. Results I notice that there is a lack of information about the 50 years and older population. Could you please reflect on the lack of information about this older population? This might be valuable since this population uses healthcare quite often. Response: Yes we agree that the population above 50 displays an inclination to use smart technologies and we have only 8% of our responses in the cluster. When this study was conceptualized, “age” was not considered as a moderator and hence a representative sample was not drawn from each cluster. However, we have mentioned this in our limitations as a direction for future researchers to explore. 2. Figure 2 is not really informative and only leave it with table 4 would be fine. However, it would be good to rename H1-7 and only leave it with the relations. Especially if you take my earlier comment into account. Response: Figure 2 is the structural model adopted in this study and hence, researchers have decided to retain both figure 2 and table 4. 3. Minor remark: again with the acronyms. Here you use more acronyms for the seven items. Please start using the acronyms from the first instance you mention them. This is in the literature and hypotheses part, where you now only introduced PU and PEOU, but you already mention the wordings of all other acronyms. Be consistent is my message. Response: Thank you for the observation. Necessary changes have been incorporated. 4. Minor remark or question: PEU is the same as PEOU? Response: Yes. We apologize for the typo error. We have made the necessary changes in the manuscript. Discussion From the start of the discussion I see the aim of this research. Thank you, and it would be great to read something about this earlier, see my first comment. Response: We have incorporated the same in the introduction section. 2. It would be great to read a bit about your considerations towards the strengths and especially some limitations. See also my earlier comment regarding lack of data from the older population. Response: We have mentioned this is the limitations section of the manuscript. Conclusions In this part as well as in the discussion part you talk a bit about future considerations and future research. Please combine these sections. I would prefer to read this at the end of the discussion, where you now already indeed mention something about this. Thus remove the future research from the conclusion back to the discussion and possibly this can assist you in overcoming to mention things twice. Response: Thank you for the suggestion. We have aligned the manuscript according to established norms and journal considerations. Hence, the conclusion section not only presents the final comments but clearly spells out direction for future researchers. This has been placed in the last section of the manuscript. Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 10 Sep 2025 Swathi K S , Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India 10 Sep 2025 Author Response Dear Reviewer, Thank you for the valuable suggestions for improving the quality of this manuscript. The responses to the comments are given below. Introduction The introduction is ... Continue reading Dear Reviewer, Thank you for the valuable suggestions for improving the quality of this manuscript. The responses to the comments are given below. Introduction The introduction is very informative, but it does not really inform me as a reader why I should read this paper and what you as a researcher are aiming to do. Make clear why I should read this paper and what is relevant about all the details/information provided. The last paragraph is not really informative since it does not provide any information which could not be expected by the reader. This could be removed. Minor remark: you use quite some capitals where these are not needed. Response: Thank you for the comment. The value added by the research has been added to the introduction section of the manuscript. This clearly explains “why” a researcher should read our article. In order to close this gap, this study looks at Hence, this study enables us to better understand the preferences and expectations, enabling developers to enhance user experience and engagement with smart technologies. It also helps us to identify psychological, social, and technical barriers that impede the widespread adoption of smart health technologies. This is explored in the backdrop of the Technology Acceptance Model (TAM). ). The Technology Acceptance Model (TAM) provides a theoretical foundation for the research endeavour and enables researchers to explore the interplay of two important antecedents of technology adoption (perceived usefulness and perceived ease of use) in the context of smart wellness products. 2. Minor remark: please provide the full writing of IoT before providing/using the acronym. Response: Noted and necessary changes have been incorporated. Reviewer comments : Literature and hypotheses I am not sure about the presentation of the different hypotheses. These are all going to discuss the ‘positive impact’ and that is fine, but then it would not be necessary in my opinion to make this into seven different hypotheses. Please diminish this use of words and use them differently. Because you mention the bulk of literature, but do not really discuss this and then suddenly present figure 1. I would like to get more information on figure 1 instead of all information you spread regarding seven not very interesting hypotheses. Start this section with this figure and then show how it informs your research and how you reach to the hypothesis that all the elements of TAM and HBM (or name the seven items specifically) will have a positive impact Response: Thank you for the review. We have revisited the hypothesis statements and incorporated the changes wherever necessary. 2. Minor remark: you gave some acronyms like PU and PEOU, but then still use the full writing in some later occurrences. This is not needed and could be removed. Response: We have included the necessary changes in the manuscript. Results I notice that there is a lack of information about the 50 years and older population. Could you please reflect on the lack of information about this older population? This might be valuable since this population uses healthcare quite often. Response: Yes we agree that the population above 50 displays an inclination to use smart technologies and we have only 8% of our responses in the cluster. When this study was conceptualized, “age” was not considered as a moderator and hence a representative sample was not drawn from each cluster. However, we have mentioned this in our limitations as a direction for future researchers to explore. 2. Figure 2 is not really informative and only leave it with table 4 would be fine. However, it would be good to rename H1-7 and only leave it with the relations. Especially if you take my earlier comment into account. Response: Figure 2 is the structural model adopted in this study and hence, researchers have decided to retain both figure 2 and table 4. 3. Minor remark: again with the acronyms. Here you use more acronyms for the seven items. Please start using the acronyms from the first instance you mention them. This is in the literature and hypotheses part, where you now only introduced PU and PEOU, but you already mention the wordings of all other acronyms. Be consistent is my message. Response: Thank you for the observation. Necessary changes have been incorporated. 4. Minor remark or question: PEU is the same as PEOU? Response: Yes. We apologize for the typo error. We have made the necessary changes in the manuscript. Discussion From the start of the discussion I see the aim of this research. Thank you, and it would be great to read something about this earlier, see my first comment. Response: We have incorporated the same in the introduction section. 2. It would be great to read a bit about your considerations towards the strengths and especially some limitations. See also my earlier comment regarding lack of data from the older population. Response: We have mentioned this is the limitations section of the manuscript. Conclusions In this part as well as in the discussion part you talk a bit about future considerations and future research. Please combine these sections. I would prefer to read this at the end of the discussion, where you now already indeed mention something about this. Thus remove the future research from the conclusion back to the discussion and possibly this can assist you in overcoming to mention things twice. Response: Thank you for the suggestion. We have aligned the manuscript according to established norms and journal considerations. Hence, the conclusion section not only presents the final comments but clearly spells out direction for future researchers. This has been placed in the last section of the manuscript. Dear Reviewer, Thank you for the valuable suggestions for improving the quality of this manuscript. The responses to the comments are given below. Introduction The introduction is very informative, but it does not really inform me as a reader why I should read this paper and what you as a researcher are aiming to do. Make clear why I should read this paper and what is relevant about all the details/information provided. The last paragraph is not really informative since it does not provide any information which could not be expected by the reader. This could be removed. Minor remark: you use quite some capitals where these are not needed. Response: Thank you for the comment. The value added by the research has been added to the introduction section of the manuscript. This clearly explains “why” a researcher should read our article. In order to close this gap, this study looks at Hence, this study enables us to better understand the preferences and expectations, enabling developers to enhance user experience and engagement with smart technologies. It also helps us to identify psychological, social, and technical barriers that impede the widespread adoption of smart health technologies. This is explored in the backdrop of the Technology Acceptance Model (TAM). ). The Technology Acceptance Model (TAM) provides a theoretical foundation for the research endeavour and enables researchers to explore the interplay of two important antecedents of technology adoption (perceived usefulness and perceived ease of use) in the context of smart wellness products. 2. Minor remark: please provide the full writing of IoT before providing/using the acronym. Response: Noted and necessary changes have been incorporated. Reviewer comments : Literature and hypotheses I am not sure about the presentation of the different hypotheses. These are all going to discuss the ‘positive impact’ and that is fine, but then it would not be necessary in my opinion to make this into seven different hypotheses. Please diminish this use of words and use them differently. Because you mention the bulk of literature, but do not really discuss this and then suddenly present figure 1. I would like to get more information on figure 1 instead of all information you spread regarding seven not very interesting hypotheses. Start this section with this figure and then show how it informs your research and how you reach to the hypothesis that all the elements of TAM and HBM (or name the seven items specifically) will have a positive impact Response: Thank you for the review. We have revisited the hypothesis statements and incorporated the changes wherever necessary. 2. Minor remark: you gave some acronyms like PU and PEOU, but then still use the full writing in some later occurrences. This is not needed and could be removed. Response: We have included the necessary changes in the manuscript. Results I notice that there is a lack of information about the 50 years and older population. Could you please reflect on the lack of information about this older population? This might be valuable since this population uses healthcare quite often. Response: Yes we agree that the population above 50 displays an inclination to use smart technologies and we have only 8% of our responses in the cluster. When this study was conceptualized, “age” was not considered as a moderator and hence a representative sample was not drawn from each cluster. However, we have mentioned this in our limitations as a direction for future researchers to explore. 2. Figure 2 is not really informative and only leave it with table 4 would be fine. However, it would be good to rename H1-7 and only leave it with the relations. Especially if you take my earlier comment into account. Response: Figure 2 is the structural model adopted in this study and hence, researchers have decided to retain both figure 2 and table 4. 3. Minor remark: again with the acronyms. Here you use more acronyms for the seven items. Please start using the acronyms from the first instance you mention them. This is in the literature and hypotheses part, where you now only introduced PU and PEOU, but you already mention the wordings of all other acronyms. Be consistent is my message. Response: Thank you for the observation. Necessary changes have been incorporated. 4. Minor remark or question: PEU is the same as PEOU? Response: Yes. We apologize for the typo error. We have made the necessary changes in the manuscript. Discussion From the start of the discussion I see the aim of this research. Thank you, and it would be great to read something about this earlier, see my first comment. Response: We have incorporated the same in the introduction section. 2. It would be great to read a bit about your considerations towards the strengths and especially some limitations. See also my earlier comment regarding lack of data from the older population. Response: We have mentioned this is the limitations section of the manuscript. Conclusions In this part as well as in the discussion part you talk a bit about future considerations and future research. Please combine these sections. I would prefer to read this at the end of the discussion, where you now already indeed mention something about this. Thus remove the future research from the conclusion back to the discussion and possibly this can assist you in overcoming to mention things twice. Response: Thank you for the suggestion. We have aligned the manuscript according to established norms and journal considerations. Hence, the conclusion section not only presents the final comments but clearly spells out direction for future researchers. This has been placed in the last section of the manuscript. Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Version 1 VERSION 1 PUBLISHED 24 Jan 2025 Views 0 Cite How to cite this report: Kumar S. Reviewer Report For: Embracing smart wellness: Exploring perceptions of preventive healthcare technology in the digital era [version 3; peer review: 1 approved, 1 approved with reservations] . F1000Research 2025, 14 :125 ( https://doi.org/10.5256/f1000research.175959.r373523 ) The direct URL for this report is: https://f1000research.com/articles/14-125/v1#referee-response-373523 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 01 Apr 2025 Santosh Kumar , Koneru Lakshmaiah Education Foundation, Vaddeswaram, India Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.175959.r373523 Some of the suggestions that could improve the quality of this work include: Sampling from convenient sites may introduce bias To enhance generalizability, exploratory studies can also adopt probability sampling techniques and larger representative, population-based studies ... Continue reading READ ALL Some of the suggestions that could improve the quality of this work include: Sampling from convenient sites may introduce bias To enhance generalizability, exploratory studies can also adopt probability sampling techniques and larger representative, population-based studies should further investigate these findings. Discuss the few WaveFlex Biosensors in the literature survey to get interest in the readers. Broaden the research to include culture comparisons; as well as comparing perceptions in regions with different health care systems and different access to technologies. Instead of conducting a holistic review, study smart healthcare technologies like wearables, tele health, or mHealth apps. Pair it with qualitative methods — interviews or focus groups — that can help flesh out user issues and attitudes beyond the numbers. Develop a longitudinal research method to see how technology adoption behavior changes over time, including with an external force snipe like a policy or technology change. To ascertain whether adopting smart health technologies translates into health benefits, include objective health outcomes. Formulate actionable recommendations for practitioners and/or technology designers on how to better reach and engage end-users. More consideration of possible biases due to use of self-reported data and triangulation of findings with either objective health data or application usage metrics Develop a technology readiness index (TRI) based on the extent to which respondents correspond to readiness for smart healthcare technology use and capability to adapt to smart healthcare technology. Is the work clearly and accurately presented and does it cite the current literature? No Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? No Competing Interests: No competing interests were disclosed. Reviewer Expertise: Sensor I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Kumar S. Reviewer Report For: Embracing smart wellness: Exploring perceptions of preventive healthcare technology in the digital era [version 3; peer review: 1 approved, 1 approved with reservations] . F1000Research 2025, 14 :125 ( https://doi.org/10.5256/f1000research.175959.r373523 ) The direct URL for this report is: https://f1000research.com/articles/14-125/v1#referee-response-373523 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 26 Apr 2025 Swathi K S , Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India 26 Apr 2025 Author Response Response to Reviewer’s Comments 1. Sampling from convenient sites may introduce bias To enhance generalizability, exploratory studies can also adopt probability sampling techniques and larger representative, population-based studies should further ... Continue reading Response to Reviewer’s Comments 1. Sampling from convenient sites may introduce bias To enhance generalizability, exploratory studies can also adopt probability sampling techniques and larger representative, population-based studies should further investigate these findings. Response: We acknowledge your valuable observation regarding the potential bias introduced by convenience sampling. As this study was exploratory in nature, convenience sampling was adopted to gain initial insights within the constraints of available resources and accessibility. We agree that this may limit the generalizability of the findings. Hence, we have mentioned it as one of the limitations of this study in the conclusion section and included a recommendation for future research using a more representative sampling method. 2. Discuss the few WaveFlex Biosensors in the literature survey to get interest in the readers. Response: In response to your suggestion, we have added the literature on WaveFlex biosensors that have been reported in recent studies in the second paragraph of introduction section while discussing about the recent advancements. This addition highlights the practical relevance and innovation in wearable smart technology. 3. Broaden the research to include culture comparisons; as well as comparing perceptions in regions with different health care systems and different access to technologies. Response: Thank you for this insightful suggestion. We acknowledge the importance of incorporating cultural comparisons and examining regional differences in healthcare systems and access to technology. In the revised manuscript, we have expanded the discussion to include a cross-cultural perspective on the adoption of smart technology for preventive healthcare. 4. Instead of conducting a holistic review, study smart healthcare technologies like wearables, telehealth, or mHealth apps. Response: We appreciate the reviewer’s suggestion to focus specifically on smart healthcare technologies such as wearables, telehealth, or mHealth apps. Our intention was to capture the broader landscape of smart technologies in preventive healthcare and understand their interrelated roles in fostering proactive health management. However, in future research, we will focus on a specific technological application such as wearables, telehealth or mHealth, and we have mentioned it in the future research scope section in the concluding paragraph. 5. Pair it with qualitative methods — interviews or focus groups — that can help flesh out user issues and attitudes beyond the numbers. Response: Thank you for this valuable suggestion. We appreciate the insight that integrating qualitative methods such as interviews or focus groups can provide a more nuanced understanding of user issues and attitudes toward smart technology in preventive healthcare. While the current study focused on a quantitative empirical approach to examine broad patterns and associations, we acknowledge the importance of complementing this with qualitative insights. Hence, we have added a note in the limitations and future research scope section, highlighting the potential for future studies to adopt a mixed-methods approach. 6. Develop a longitudinal research method to see how technology adoption behavior changes over time, including with an external force snipe like a policy or technology change. Response: Yes this is a perfect research gap that we have already initiated work. A longitudinal research design would enable us to compare adoption, which is our next phase of research. However, we have adopted this manuscript a cross-sectional approach that enabled us to capture the intention to adopt small wellness, laying a foundation for our subsequent project. 7. To ascertain whether adopting smart health technologies translates into health benefits, include objective health outcomes. Response: This is a valid suggestion, and we thank you for it. Health outcomes can be very broad, and we need to narrow down on which health outcomes we are focusing on ( fitness, weight, sugar levels, wellness etc.). As this is a behavioural study, we have not included it in the scope of the study. Further studies can work on this gap, and we have incorporated it in the direction for the future research section of the manuscript. 8. Formulate actionable recommendations for practitioners and/or technology designers on how to better reach and engage end-users. Response: Thank you for the observation. We have incorporated our suggestions in the implications paragraph of the discussion and implications section in the revised manuscript. 9. More consideration of possible biases due to use of self-reported data and triangulation of findings with either objective health data or application usage metrics. Response: As mentioned in our response to review comment no 2, the objective of the manuscript to capture the behavioural dimension and not impact on clinical outcome. In social science research, established Likert scales are adopted to capture intention, and hence, we proceeded with this study after validating the questionnaire with a pilot study. We have incorporated the same in the last paragraph of the Method section of the manuscript. 10. Develop a technology readiness index (TRI) based on the extent to which respondents correspond to readiness for smart healthcare technology use and capability to adapt to smart healthcare technology. Response: The TRI is a tool for measuring technology readiness by evaluating users' acceptance and capability in using new technologies across four core dimensions (optimism, innovativeness, discomfort, and insecurity) as proposed by Parasuraman(2000). All four dimensions have not been incorporated in this manuscript as this research was conceived to measure intention to embrace smart wellness The research team unanimously opined that the respondent segment we were targeting was aware and into the adoption of the technology innovation adoption cycle. However, future researchers can explore this, and hence, it has been incorporated as a direction for future research. Thank you Response to Reviewer’s Comments 1. Sampling from convenient sites may introduce bias To enhance generalizability, exploratory studies can also adopt probability sampling techniques and larger representative, population-based studies should further investigate these findings. Response: We acknowledge your valuable observation regarding the potential bias introduced by convenience sampling. As this study was exploratory in nature, convenience sampling was adopted to gain initial insights within the constraints of available resources and accessibility. We agree that this may limit the generalizability of the findings. Hence, we have mentioned it as one of the limitations of this study in the conclusion section and included a recommendation for future research using a more representative sampling method. 2. Discuss the few WaveFlex Biosensors in the literature survey to get interest in the readers. Response: In response to your suggestion, we have added the literature on WaveFlex biosensors that have been reported in recent studies in the second paragraph of introduction section while discussing about the recent advancements. This addition highlights the practical relevance and innovation in wearable smart technology. 3. Broaden the research to include culture comparisons; as well as comparing perceptions in regions with different health care systems and different access to technologies. Response: Thank you for this insightful suggestion. We acknowledge the importance of incorporating cultural comparisons and examining regional differences in healthcare systems and access to technology. In the revised manuscript, we have expanded the discussion to include a cross-cultural perspective on the adoption of smart technology for preventive healthcare. 4. Instead of conducting a holistic review, study smart healthcare technologies like wearables, telehealth, or mHealth apps. Response: We appreciate the reviewer’s suggestion to focus specifically on smart healthcare technologies such as wearables, telehealth, or mHealth apps. Our intention was to capture the broader landscape of smart technologies in preventive healthcare and understand their interrelated roles in fostering proactive health management. However, in future research, we will focus on a specific technological application such as wearables, telehealth or mHealth, and we have mentioned it in the future research scope section in the concluding paragraph. 5. Pair it with qualitative methods — interviews or focus groups — that can help flesh out user issues and attitudes beyond the numbers. Response: Thank you for this valuable suggestion. We appreciate the insight that integrating qualitative methods such as interviews or focus groups can provide a more nuanced understanding of user issues and attitudes toward smart technology in preventive healthcare. While the current study focused on a quantitative empirical approach to examine broad patterns and associations, we acknowledge the importance of complementing this with qualitative insights. Hence, we have added a note in the limitations and future research scope section, highlighting the potential for future studies to adopt a mixed-methods approach. 6. Develop a longitudinal research method to see how technology adoption behavior changes over time, including with an external force snipe like a policy or technology change. Response: Yes this is a perfect research gap that we have already initiated work. A longitudinal research design would enable us to compare adoption, which is our next phase of research. However, we have adopted this manuscript a cross-sectional approach that enabled us to capture the intention to adopt small wellness, laying a foundation for our subsequent project. 7. To ascertain whether adopting smart health technologies translates into health benefits, include objective health outcomes. Response: This is a valid suggestion, and we thank you for it. Health outcomes can be very broad, and we need to narrow down on which health outcomes we are focusing on ( fitness, weight, sugar levels, wellness etc.). As this is a behavioural study, we have not included it in the scope of the study. Further studies can work on this gap, and we have incorporated it in the direction for the future research section of the manuscript. 8. Formulate actionable recommendations for practitioners and/or technology designers on how to better reach and engage end-users. Response: Thank you for the observation. We have incorporated our suggestions in the implications paragraph of the discussion and implications section in the revised manuscript. 9. More consideration of possible biases due to use of self-reported data and triangulation of findings with either objective health data or application usage metrics. Response: As mentioned in our response to review comment no 2, the objective of the manuscript to capture the behavioural dimension and not impact on clinical outcome. In social science research, established Likert scales are adopted to capture intention, and hence, we proceeded with this study after validating the questionnaire with a pilot study. We have incorporated the same in the last paragraph of the Method section of the manuscript. 10. Develop a technology readiness index (TRI) based on the extent to which respondents correspond to readiness for smart healthcare technology use and capability to adapt to smart healthcare technology. Response: The TRI is a tool for measuring technology readiness by evaluating users' acceptance and capability in using new technologies across four core dimensions (optimism, innovativeness, discomfort, and insecurity) as proposed by Parasuraman(2000). All four dimensions have not been incorporated in this manuscript as this research was conceived to measure intention to embrace smart wellness The research team unanimously opined that the respondent segment we were targeting was aware and into the adoption of the technology innovation adoption cycle. However, future researchers can explore this, and hence, it has been incorporated as a direction for future research. Thank you Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 26 Apr 2025 Swathi K S , Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India 26 Apr 2025 Author Response Response to Reviewer’s Comments 1. Sampling from convenient sites may introduce bias To enhance generalizability, exploratory studies can also adopt probability sampling techniques and larger representative, population-based studies should further ... Continue reading Response to Reviewer’s Comments 1. Sampling from convenient sites may introduce bias To enhance generalizability, exploratory studies can also adopt probability sampling techniques and larger representative, population-based studies should further investigate these findings. Response: We acknowledge your valuable observation regarding the potential bias introduced by convenience sampling. As this study was exploratory in nature, convenience sampling was adopted to gain initial insights within the constraints of available resources and accessibility. We agree that this may limit the generalizability of the findings. Hence, we have mentioned it as one of the limitations of this study in the conclusion section and included a recommendation for future research using a more representative sampling method. 2. Discuss the few WaveFlex Biosensors in the literature survey to get interest in the readers. Response: In response to your suggestion, we have added the literature on WaveFlex biosensors that have been reported in recent studies in the second paragraph of introduction section while discussing about the recent advancements. This addition highlights the practical relevance and innovation in wearable smart technology. 3. Broaden the research to include culture comparisons; as well as comparing perceptions in regions with different health care systems and different access to technologies. Response: Thank you for this insightful suggestion. We acknowledge the importance of incorporating cultural comparisons and examining regional differences in healthcare systems and access to technology. In the revised manuscript, we have expanded the discussion to include a cross-cultural perspective on the adoption of smart technology for preventive healthcare. 4. Instead of conducting a holistic review, study smart healthcare technologies like wearables, telehealth, or mHealth apps. Response: We appreciate the reviewer’s suggestion to focus specifically on smart healthcare technologies such as wearables, telehealth, or mHealth apps. Our intention was to capture the broader landscape of smart technologies in preventive healthcare and understand their interrelated roles in fostering proactive health management. However, in future research, we will focus on a specific technological application such as wearables, telehealth or mHealth, and we have mentioned it in the future research scope section in the concluding paragraph. 5. Pair it with qualitative methods — interviews or focus groups — that can help flesh out user issues and attitudes beyond the numbers. Response: Thank you for this valuable suggestion. We appreciate the insight that integrating qualitative methods such as interviews or focus groups can provide a more nuanced understanding of user issues and attitudes toward smart technology in preventive healthcare. While the current study focused on a quantitative empirical approach to examine broad patterns and associations, we acknowledge the importance of complementing this with qualitative insights. Hence, we have added a note in the limitations and future research scope section, highlighting the potential for future studies to adopt a mixed-methods approach. 6. Develop a longitudinal research method to see how technology adoption behavior changes over time, including with an external force snipe like a policy or technology change. Response: Yes this is a perfect research gap that we have already initiated work. A longitudinal research design would enable us to compare adoption, which is our next phase of research. However, we have adopted this manuscript a cross-sectional approach that enabled us to capture the intention to adopt small wellness, laying a foundation for our subsequent project. 7. To ascertain whether adopting smart health technologies translates into health benefits, include objective health outcomes. Response: This is a valid suggestion, and we thank you for it. Health outcomes can be very broad, and we need to narrow down on which health outcomes we are focusing on ( fitness, weight, sugar levels, wellness etc.). As this is a behavioural study, we have not included it in the scope of the study. Further studies can work on this gap, and we have incorporated it in the direction for the future research section of the manuscript. 8. Formulate actionable recommendations for practitioners and/or technology designers on how to better reach and engage end-users. Response: Thank you for the observation. We have incorporated our suggestions in the implications paragraph of the discussion and implications section in the revised manuscript. 9. More consideration of possible biases due to use of self-reported data and triangulation of findings with either objective health data or application usage metrics. Response: As mentioned in our response to review comment no 2, the objective of the manuscript to capture the behavioural dimension and not impact on clinical outcome. In social science research, established Likert scales are adopted to capture intention, and hence, we proceeded with this study after validating the questionnaire with a pilot study. We have incorporated the same in the last paragraph of the Method section of the manuscript. 10. Develop a technology readiness index (TRI) based on the extent to which respondents correspond to readiness for smart healthcare technology use and capability to adapt to smart healthcare technology. Response: The TRI is a tool for measuring technology readiness by evaluating users' acceptance and capability in using new technologies across four core dimensions (optimism, innovativeness, discomfort, and insecurity) as proposed by Parasuraman(2000). All four dimensions have not been incorporated in this manuscript as this research was conceived to measure intention to embrace smart wellness The research team unanimously opined that the respondent segment we were targeting was aware and into the adoption of the technology innovation adoption cycle. However, future researchers can explore this, and hence, it has been incorporated as a direction for future research. Thank you Response to Reviewer’s Comments 1. Sampling from convenient sites may introduce bias To enhance generalizability, exploratory studies can also adopt probability sampling techniques and larger representative, population-based studies should further investigate these findings. Response: We acknowledge your valuable observation regarding the potential bias introduced by convenience sampling. As this study was exploratory in nature, convenience sampling was adopted to gain initial insights within the constraints of available resources and accessibility. We agree that this may limit the generalizability of the findings. Hence, we have mentioned it as one of the limitations of this study in the conclusion section and included a recommendation for future research using a more representative sampling method. 2. Discuss the few WaveFlex Biosensors in the literature survey to get interest in the readers. Response: In response to your suggestion, we have added the literature on WaveFlex biosensors that have been reported in recent studies in the second paragraph of introduction section while discussing about the recent advancements. This addition highlights the practical relevance and innovation in wearable smart technology. 3. Broaden the research to include culture comparisons; as well as comparing perceptions in regions with different health care systems and different access to technologies. Response: Thank you for this insightful suggestion. We acknowledge the importance of incorporating cultural comparisons and examining regional differences in healthcare systems and access to technology. In the revised manuscript, we have expanded the discussion to include a cross-cultural perspective on the adoption of smart technology for preventive healthcare. 4. Instead of conducting a holistic review, study smart healthcare technologies like wearables, telehealth, or mHealth apps. Response: We appreciate the reviewer’s suggestion to focus specifically on smart healthcare technologies such as wearables, telehealth, or mHealth apps. Our intention was to capture the broader landscape of smart technologies in preventive healthcare and understand their interrelated roles in fostering proactive health management. However, in future research, we will focus on a specific technological application such as wearables, telehealth or mHealth, and we have mentioned it in the future research scope section in the concluding paragraph. 5. Pair it with qualitative methods — interviews or focus groups — that can help flesh out user issues and attitudes beyond the numbers. Response: Thank you for this valuable suggestion. We appreciate the insight that integrating qualitative methods such as interviews or focus groups can provide a more nuanced understanding of user issues and attitudes toward smart technology in preventive healthcare. While the current study focused on a quantitative empirical approach to examine broad patterns and associations, we acknowledge the importance of complementing this with qualitative insights. Hence, we have added a note in the limitations and future research scope section, highlighting the potential for future studies to adopt a mixed-methods approach. 6. Develop a longitudinal research method to see how technology adoption behavior changes over time, including with an external force snipe like a policy or technology change. Response: Yes this is a perfect research gap that we have already initiated work. A longitudinal research design would enable us to compare adoption, which is our next phase of research. However, we have adopted this manuscript a cross-sectional approach that enabled us to capture the intention to adopt small wellness, laying a foundation for our subsequent project. 7. To ascertain whether adopting smart health technologies translates into health benefits, include objective health outcomes. Response: This is a valid suggestion, and we thank you for it. Health outcomes can be very broad, and we need to narrow down on which health outcomes we are focusing on ( fitness, weight, sugar levels, wellness etc.). As this is a behavioural study, we have not included it in the scope of the study. Further studies can work on this gap, and we have incorporated it in the direction for the future research section of the manuscript. 8. Formulate actionable recommendations for practitioners and/or technology designers on how to better reach and engage end-users. Response: Thank you for the observation. We have incorporated our suggestions in the implications paragraph of the discussion and implications section in the revised manuscript. 9. More consideration of possible biases due to use of self-reported data and triangulation of findings with either objective health data or application usage metrics. Response: As mentioned in our response to review comment no 2, the objective of the manuscript to capture the behavioural dimension and not impact on clinical outcome. In social science research, established Likert scales are adopted to capture intention, and hence, we proceeded with this study after validating the questionnaire with a pilot study. We have incorporated the same in the last paragraph of the Method section of the manuscript. 10. Develop a technology readiness index (TRI) based on the extent to which respondents correspond to readiness for smart healthcare technology use and capability to adapt to smart healthcare technology. Response: The TRI is a tool for measuring technology readiness by evaluating users' acceptance and capability in using new technologies across four core dimensions (optimism, innovativeness, discomfort, and insecurity) as proposed by Parasuraman(2000). All four dimensions have not been incorporated in this manuscript as this research was conceived to measure intention to embrace smart wellness The research team unanimously opined that the respondent segment we were targeting was aware and into the adoption of the technology innovation adoption cycle. However, future researchers can explore this, and hence, it has been incorporated as a direction for future research. Thank you Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Comments on this article Comments (0) Version 3 VERSION 3 PUBLISHED 24 Jan 2025 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 Version 3 (revision) 02 Sep 25 read Version 2 (revision) 24 Apr 25 read Version 1 24 Jan 25 read Santosh Kumar , Koneru Lakshmaiah Education Foundation, Vaddeswaram, India Catharina M van Leersum , University of Twente, Enschede, Netherlands Antilles; Open University of The Netherlands (Ringgold ID: 10198), Heerlen, The Netherlands Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 van Leersum C. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 17 Sep 2025 | for Version 3 Catharina M van Leersum , University of Twente, Enschede, Netherlands Antilles; Open University of The Netherlands (Ringgold ID: 10198), Heerlen, Limburg, The Netherlands 0 Views copyright © 2025 van Leersum C. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions I see how the authors have used the comments to revise their manuscript. I have no further comments to make. Competing Interests No competing interests were disclosed. Reviewer Expertise AI, eHealth, STS I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) van Leersum CM. Peer Review Report For: Embracing smart wellness: Exploring perceptions of preventive healthcare technology in the digital era [version 3; peer review: 1 approved, 1 approved with reservations] . F1000Research 2025, 14 :125 ( https://doi.org/10.5256/f1000research.187232.r411196) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-125/v3#referee-response-411196 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 van Leersum C. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 19 Aug 2025 | for Version 2 Catharina M van Leersum , University of Twente, Enschede, Netherlands Antilles; Open University of The Netherlands (Ringgold ID: 10198), Heerlen, Limburg, The Netherlands 0 Views copyright © 2025 van Leersum C. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Dear authors, your manuscript discusses a relevant topic and is based on a well conducted and documented method. To make the paper more attractive to readers, I suggest some comments for improvement of presenting the study in your manuscript, especially in the first part. Hopefully these advices can assist you in preparing an adjusted manuscript. Introduction The introduction is very informative, but it does not really inform me as a reader why I should read this paper and what you as a researcher are aiming to do. Make clear why I should read this paper and what is relevant about all the details/information provided. The last paragraph is not really informative since it does not provide any information which could not be expected by the reader. This could be removed. Minor remark: you use quite some capitals where these are not needed. Minor remark: please provide the full writing of IoT before providing/using the acronym. Literature and hypotheses I am not sure about the presentation of the different hypotheses. These are all going to discuss the ‘positive impact’ and that is fine, but then it would not be necessary in my opinion to make this into seven different hypotheses. Please diminish this use of words and use them differently. Because you mention the bulk of literature, but do not really discuss this and then suddenly present figure 1. I would like to get more information on figure 1 instead of all information you spread regarding seven not very interesting hypotheses. Start this section with this figure and then show how it informs your research and how you reach to the hypothesis that all the elements of TAM and HBM (or name the seven items specifically) will have a positive impact. Minor remark: you gave some acronyms like PU and PEOU, but then still use the full writing in some later occurrences. This is not needed and could be removed. Results I notice that there is a lack of information about the 50 years and older population. Could you please reflect on the lack of information about this older population. This might be valuable since this population uses healthcare quite often. Figure 2 is not really informative and only leave it with table 4 would be fine. However, it would be good to rename H1-7 and only leave it with the relations. Especially if you take my earlier comment into account. Minor remark: again with the acronyms. Here you use more acronyms for the seven items. Please start using the acronyms from the first instance you mention them. This is in the literature and hypotheses part, where you now only introduced PU and PEOU, but you already mention the wordings of all other acronyms. Be consistent is my message. Minor remark or question: PEU is the same as PEOU? Discussion From the start of the discussion I see the aim of this research. Thank you, and it would be great to read something about this earlier, see my first comment. It would be great to read a bit about your considerations towards the strengths and especially some limitations. See also my earlier comment regarding lack of data from the older population. Conclusions In this part as well as in the discussion part you talk a bit about future considerations and future research. Please combine these sections. I would prefer to read this at the end of the discussion, where you now already indeed mention something about this. Thus remove the future research from the conclusion back to the discussion and possibly this can assist you in overcoming to mention things twice. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise healthcare, artificial intelligence, eHealth, older adults I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 10 Sep 2025 Swathi K S, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India Dear Reviewer, Thank you for the valuable suggestions for improving the quality of this manuscript. The responses to the comments are given below. Introduction The introduction is very informative, but it does not really inform me as a reader why I should read this paper and what you as a researcher are aiming to do. Make clear why I should read this paper and what is relevant about all the details/information provided. The last paragraph is not really informative since it does not provide any information which could not be expected by the reader. This could be removed. Minor remark: you use quite some capitals where these are not needed. Response: Thank you for the comment. The value added by the research has been added to the introduction section of the manuscript. This clearly explains “why” a researcher should read our article. In order to close this gap, this study looks at Hence, this study enables us to better understand the preferences and expectations, enabling developers to enhance user experience and engagement with smart technologies. It also helps us to identify psychological, social, and technical barriers that impede the widespread adoption of smart health technologies. This is explored in the backdrop of the Technology Acceptance Model (TAM). ). The Technology Acceptance Model (TAM) provides a theoretical foundation for the research endeavour and enables researchers to explore the interplay of two important antecedents of technology adoption (perceived usefulness and perceived ease of use) in the context of smart wellness products. 2. Minor remark: please provide the full writing of IoT before providing/using the acronym. Response: Noted and necessary changes have been incorporated. Reviewer comments : Literature and hypotheses I am not sure about the presentation of the different hypotheses. These are all going to discuss the ‘positive impact’ and that is fine, but then it would not be necessary in my opinion to make this into seven different hypotheses. Please diminish this use of words and use them differently. Because you mention the bulk of literature, but do not really discuss this and then suddenly present figure 1. I would like to get more information on figure 1 instead of all information you spread regarding seven not very interesting hypotheses. Start this section with this figure and then show how it informs your research and how you reach to the hypothesis that all the elements of TAM and HBM (or name the seven items specifically) will have a positive impact Response: Thank you for the review. We have revisited the hypothesis statements and incorporated the changes wherever necessary. 2. Minor remark: you gave some acronyms like PU and PEOU, but then still use the full writing in some later occurrences. This is not needed and could be removed. Response: We have included the necessary changes in the manuscript. Results I notice that there is a lack of information about the 50 years and older population. Could you please reflect on the lack of information about this older population? This might be valuable since this population uses healthcare quite often. Response: Yes we agree that the population above 50 displays an inclination to use smart technologies and we have only 8% of our responses in the cluster. When this study was conceptualized, “age” was not considered as a moderator and hence a representative sample was not drawn from each cluster. However, we have mentioned this in our limitations as a direction for future researchers to explore. 2. Figure 2 is not really informative and only leave it with table 4 would be fine. However, it would be good to rename H1-7 and only leave it with the relations. Especially if you take my earlier comment into account. Response: Figure 2 is the structural model adopted in this study and hence, researchers have decided to retain both figure 2 and table 4. 3. Minor remark: again with the acronyms. Here you use more acronyms for the seven items. Please start using the acronyms from the first instance you mention them. This is in the literature and hypotheses part, where you now only introduced PU and PEOU, but you already mention the wordings of all other acronyms. Be consistent is my message. Response: Thank you for the observation. Necessary changes have been incorporated. 4. Minor remark or question: PEU is the same as PEOU? Response: Yes. We apologize for the typo error. We have made the necessary changes in the manuscript. Discussion From the start of the discussion I see the aim of this research. Thank you, and it would be great to read something about this earlier, see my first comment. Response: We have incorporated the same in the introduction section. 2. It would be great to read a bit about your considerations towards the strengths and especially some limitations. See also my earlier comment regarding lack of data from the older population. Response: We have mentioned this is the limitations section of the manuscript. Conclusions In this part as well as in the discussion part you talk a bit about future considerations and future research. Please combine these sections. I would prefer to read this at the end of the discussion, where you now already indeed mention something about this. Thus remove the future research from the conclusion back to the discussion and possibly this can assist you in overcoming to mention things twice. Response: Thank you for the suggestion. We have aligned the manuscript according to established norms and journal considerations. Hence, the conclusion section not only presents the final comments but clearly spells out direction for future researchers. This has been placed in the last section of the manuscript. View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern van Leersum CM. Peer Review Report For: Embracing smart wellness: Exploring perceptions of preventive healthcare technology in the digital era [version 3; peer review: 1 approved, 1 approved with reservations] . F1000Research 2025, 14 :125 ( https://doi.org/10.5256/f1000research.180643.r399445) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-125/v2#referee-response-399445 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Kumar S. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 01 Apr 2025 | for Version 1 Santosh Kumar , Koneru Lakshmaiah Education Foundation, Vaddeswaram, India 0 Views copyright © 2025 Kumar S. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Some of the suggestions that could improve the quality of this work include: Sampling from convenient sites may introduce bias To enhance generalizability, exploratory studies can also adopt probability sampling techniques and larger representative, population-based studies should further investigate these findings. Discuss the few WaveFlex Biosensors in the literature survey to get interest in the readers. Broaden the research to include culture comparisons; as well as comparing perceptions in regions with different health care systems and different access to technologies. Instead of conducting a holistic review, study smart healthcare technologies like wearables, tele health, or mHealth apps. Pair it with qualitative methods — interviews or focus groups — that can help flesh out user issues and attitudes beyond the numbers. Develop a longitudinal research method to see how technology adoption behavior changes over time, including with an external force snipe like a policy or technology change. To ascertain whether adopting smart health technologies translates into health benefits, include objective health outcomes. Formulate actionable recommendations for practitioners and/or technology designers on how to better reach and engage end-users. More consideration of possible biases due to use of self-reported data and triangulation of findings with either objective health data or application usage metrics Develop a technology readiness index (TRI) based on the extent to which respondents correspond to readiness for smart healthcare technology use and capability to adapt to smart healthcare technology. Is the work clearly and accurately presented and does it cite the current literature? No Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? No Competing Interests No competing interests were disclosed. Reviewer Expertise Sensor I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 26 Apr 2025 Swathi K S, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India Response to Reviewer’s Comments 1. Sampling from convenient sites may introduce bias To enhance generalizability, exploratory studies can also adopt probability sampling techniques and larger representative, population-based studies should further investigate these findings. Response: We acknowledge your valuable observation regarding the potential bias introduced by convenience sampling. As this study was exploratory in nature, convenience sampling was adopted to gain initial insights within the constraints of available resources and accessibility. We agree that this may limit the generalizability of the findings. Hence, we have mentioned it as one of the limitations of this study in the conclusion section and included a recommendation for future research using a more representative sampling method. 2. Discuss the few WaveFlex Biosensors in the literature survey to get interest in the readers. Response: In response to your suggestion, we have added the literature on WaveFlex biosensors that have been reported in recent studies in the second paragraph of introduction section while discussing about the recent advancements. This addition highlights the practical relevance and innovation in wearable smart technology. 3. Broaden the research to include culture comparisons; as well as comparing perceptions in regions with different health care systems and different access to technologies. Response: Thank you for this insightful suggestion. We acknowledge the importance of incorporating cultural comparisons and examining regional differences in healthcare systems and access to technology. In the revised manuscript, we have expanded the discussion to include a cross-cultural perspective on the adoption of smart technology for preventive healthcare. 4. Instead of conducting a holistic review, study smart healthcare technologies like wearables, telehealth, or mHealth apps. Response: We appreciate the reviewer’s suggestion to focus specifically on smart healthcare technologies such as wearables, telehealth, or mHealth apps. Our intention was to capture the broader landscape of smart technologies in preventive healthcare and understand their interrelated roles in fostering proactive health management. However, in future research, we will focus on a specific technological application such as wearables, telehealth or mHealth, and we have mentioned it in the future research scope section in the concluding paragraph. 5. Pair it with qualitative methods — interviews or focus groups — that can help flesh out user issues and attitudes beyond the numbers. Response: Thank you for this valuable suggestion. We appreciate the insight that integrating qualitative methods such as interviews or focus groups can provide a more nuanced understanding of user issues and attitudes toward smart technology in preventive healthcare. While the current study focused on a quantitative empirical approach to examine broad patterns and associations, we acknowledge the importance of complementing this with qualitative insights. Hence, we have added a note in the limitations and future research scope section, highlighting the potential for future studies to adopt a mixed-methods approach. 6. Develop a longitudinal research method to see how technology adoption behavior changes over time, including with an external force snipe like a policy or technology change. Response: Yes this is a perfect research gap that we have already initiated work. A longitudinal research design would enable us to compare adoption, which is our next phase of research. However, we have adopted this manuscript a cross-sectional approach that enabled us to capture the intention to adopt small wellness, laying a foundation for our subsequent project. 7. To ascertain whether adopting smart health technologies translates into health benefits, include objective health outcomes. Response: This is a valid suggestion, and we thank you for it. Health outcomes can be very broad, and we need to narrow down on which health outcomes we are focusing on ( fitness, weight, sugar levels, wellness etc.). As this is a behavioural study, we have not included it in the scope of the study. Further studies can work on this gap, and we have incorporated it in the direction for the future research section of the manuscript. 8. Formulate actionable recommendations for practitioners and/or technology designers on how to better reach and engage end-users. Response: Thank you for the observation. We have incorporated our suggestions in the implications paragraph of the discussion and implications section in the revised manuscript. 9. More consideration of possible biases due to use of self-reported data and triangulation of findings with either objective health data or application usage metrics. Response: As mentioned in our response to review comment no 2, the objective of the manuscript to capture the behavioural dimension and not impact on clinical outcome. In social science research, established Likert scales are adopted to capture intention, and hence, we proceeded with this study after validating the questionnaire with a pilot study. We have incorporated the same in the last paragraph of the Method section of the manuscript. 10. Develop a technology readiness index (TRI) based on the extent to which respondents correspond to readiness for smart healthcare technology use and capability to adapt to smart healthcare technology. Response: The TRI is a tool for measuring technology readiness by evaluating users' acceptance and capability in using new technologies across four core dimensions (optimism, innovativeness, discomfort, and insecurity) as proposed by Parasuraman(2000). All four dimensions have not been incorporated in this manuscript as this research was conceived to measure intention to embrace smart wellness The research team unanimously opined that the respondent segment we were targeting was aware and into the adoption of the technology innovation adoption cycle. However, future researchers can explore this, and hence, it has been incorporated as a direction for future research. Thank you View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Kumar S. Peer Review Report For: Embracing smart wellness: Exploring perceptions of preventive healthcare technology in the digital era [version 3; peer review: 1 approved, 1 approved with reservations] . F1000Research 2025, 14 :125 ( https://doi.org/10.5256/f1000research.175959.r373523) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-125/v1#referee-response-373523 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. 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