TRUST IS AN IMPLEMENTATION OUTCOME: A QUALITATIVE STUDY OF DIGITAL AIR QUALITY INFORMATION ADOPTION IN A RESOURCE-CONSTRAINED URBAN SETTINGS
Author(s)
Shahan Salim, PhD.
University of Waterloo, Waterloo, ON, Canada.
University of Waterloo, Waterloo, ON, Canada.
OBJECTIVES: To identify the determinants of adoption, perceived usefulness, and sustained use of digital air quality information among residents of Ulaanbaatar, Mongolia.
METHODS: Twenty-five semi-structured interviews were conducted with adults living in urban and ger-area communities in Ulaanbaatar. Interviews explored experiences with air pollution, use of existing information sources, expectations of real-time and predictive alerts, digital comfort, and trust in institutions and information providers. Analysis used an extended Technology Acceptance Model framework incorporating perceived usefulness, perceived ease of use, attitude, behavioural intention, and trust.
RESULTS: Participants valued air quality information when it was timely, hyperlocal, easy to interpret, and accompanied by specific health recommendations. Perceived usefulness was strongly shaped by whether information enabled concrete decisions, such as modifying outdoor activity, protecting children, using air filtration, or seeking care. Digital comfort, education, household responsibilities, health concerns, and access to resources moderated adoption. Trust emerged as central to acceptance and included both epistemic credibility, defined as confidence in the competence and integrity of the information source, and relational familiarity, defined as whether the source was accessible, responsive, and culturally credible. Participants frequently identified clinicians, researchers, non-governmental organizations, and community leaders as trusted intermediaries. Participants also described potential harms when alerts communicated high risk without feasible actions, including anxiety, frustration, and disengagement.
CONCLUSIONS: Digital environmental health tools should be evaluated as health interventions whose effectiveness depends on adoption, trust, equity, and sustained use. Implementation strategies should integrate trusted intermediaries, multi-channel communication, and action-oriented recommendations to increase the real-world value of risk information.
METHODS: Twenty-five semi-structured interviews were conducted with adults living in urban and ger-area communities in Ulaanbaatar. Interviews explored experiences with air pollution, use of existing information sources, expectations of real-time and predictive alerts, digital comfort, and trust in institutions and information providers. Analysis used an extended Technology Acceptance Model framework incorporating perceived usefulness, perceived ease of use, attitude, behavioural intention, and trust.
RESULTS: Participants valued air quality information when it was timely, hyperlocal, easy to interpret, and accompanied by specific health recommendations. Perceived usefulness was strongly shaped by whether information enabled concrete decisions, such as modifying outdoor activity, protecting children, using air filtration, or seeking care. Digital comfort, education, household responsibilities, health concerns, and access to resources moderated adoption. Trust emerged as central to acceptance and included both epistemic credibility, defined as confidence in the competence and integrity of the information source, and relational familiarity, defined as whether the source was accessible, responsive, and culturally credible. Participants frequently identified clinicians, researchers, non-governmental organizations, and community leaders as trusted intermediaries. Participants also described potential harms when alerts communicated high risk without feasible actions, including anxiety, frustration, and disengagement.
CONCLUSIONS: Digital environmental health tools should be evaluated as health interventions whose effectiveness depends on adoption, trust, equity, and sustained use. Implementation strategies should integrate trusted intermediaries, multi-channel communication, and action-oriented recommendations to increase the real-world value of risk information.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HSD18
Topic
Health Service Delivery & Process of Care
Disease
Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)