5.1. Discussion of Empirical Research Results
The results show that protection motivation can significantly affect the first-time participation behavior of the middle-aged and elderly. Wang et al. [
92] concluded that protection intention directly promoted people’s protection behaviors. These behaviors were defined as safe behaviors during travel, such as vaccinations and insurance. We applied protection behaviors to health behaviors associated with HRSM, based on the characteristics of the study. Our research was similar to that of Zhu, Wen, Chu, Zhang, and Liu [
65], with the difference that their research focused on the behavioral impact of protection motivation on social media risk-transmission stimuli. Middle-aged and elderly consumers show differences between their actual health status and their expectations when influenced by uncertain random factors. For example, the emergence of COVID-19 hit the physical and psychological health of elderly people, who showed relatively little resistance, although to varying degrees. According to Rogers [
93], people will conduct threat-appraisal and coping-appraisal when they perceive danger, and then take corresponding measures to implement self-protection behaviors. Middle-aged and older people face the pressures of death, loneliness, depression, and limited economic resources, and their behaviors, living environment, metabolic risks, and other health factors change as they transition from working age to retirement and pension. The perceived threat of health risks has a positive impact on protection motivation, which directly affects people’s use behavior [
61,
92]. Self-control is the ideal state for the safety behaviors produced by psychological factors when faced by the uncertainty of external variables, such as lockdowns and long distances from isolation [
62]. With their increased age and social experience, middle-aged and elderly individuals have the ability to maintain or improve their health through health prevention, lifestyle, and other healthy behaviors. In response to health risks, enhancement of self-efficacy can effectively mitigate the threats, promote health, and implement healthy aging [
94]. Therefore, if driven by protection motivation, the middle-aged and elderly can use HRSM to conduct safety protection behaviors, such as information searches, doctor–patient communication and seeking professional advice, and they can thereby improve their self-protection mechanism.
The findings illustrate that social motivation also has a significant and positive effect. Similarly, Wang [
84] points out that social motivation can modulate people’s attitudes towards media use, and directly affect their usage behavior. Middle-aged and older adults feel limited in relation to the rest of their lives, and their goals may incline towards emotional fulfilment. Whether it is due to a lack of career planning or retirement planning, the middle-aged and elderly frequently experience a sense of loneliness, both physically and psychologically. This requires the construction of a ‘virtual environment’ to promote connection, communication, and exchange in social activities, and to make up for the lack of social interaction in reality. At the level of social interaction, social media offers interactive features, such as co-viewing, sharing, and commenting [
95]. Social interactions can attract users to stay online longer, while strongly prompting users to comment, upload, etc. [
96,
97]. Online social interactions that break through the limitations of space and time can increase the opportunities for middle-aged and elderly individuals to communicate with the outside world, and can help alleviate the unpleasant emotions caused by a lack of interpersonal communication. In responding to this perceived need, HRSM have built an online social network for middle-aged and elderly consumers, thus increasing their social participation and reshaping their social identity. Middle-aged and elderly users will find friends with a more diverse age distribution on the internet, and interaction with other users can reduce the social loneliness of the elderly, relieve their emotional stress, and promote social connection [
24,
25]. Above all, as middle-aged and elderly people use HRSM, they will achieve online social interaction, which will enable them to develop and maintain human messaging and human-to-human interaction through their participation.
The results revealed that initial participation enhanced perceived usefulness and perceived entertainment. In other words, these were partially developed through HRSM participation. Users who participate in social media for health-related activities primarily aim to acquire information and entertainment, although their ultimate purpose is health [
98,
99]. HRSM are reliant on technology: the technology makes HRSM very different from traditional paper information, and it facilitates the collecting of information quickly, so as to grasp the latest developments, and to improve efficiency. The humanized technical design is adjusted to people’s living habits, attitudes, etc., and it renders social media more suitable for middle-aged and elderly users [
100]. In addition, by using technology, health-related information on social media can be disseminated in various forms, such as text, pictures, and videos. Middle-aged and elderly people tend to receive answers to their health-related questions, that are of an acceptable quality, from HRSM [
101]. HRSM can convey correct information by adjusting to users’ behavioral characteristics, to facilitate communication and decision-making [
102]. In addition to health information exchange, further advantages of social media are social and emotional support, fun, enjoyment, and self-status seeking [
87,
97,
98,
99]. Middle-aged and older adults who participate in HRSM in person have access to quick and easy technology, and to content that meets their needs and recreational activities, resulting in a perception of benefit. Furthermore, the application of the acquired knowledge, advice, and so on, can help improve the health literacy of the middle-aged and elderly. The ability to self-manage their health will be developed to a certain extent. Through practice, they can acquire health prevention and health care benefits. The entertainment functions, such as interactions, ‘likes’, and sharing, not only strengthen the connection between individuals and the outside world but also play a role in ‘killing time’ and generally enriching life. The benefits of HRSM use can enhance the subjective wellbeing of middle-aged and elderly adults, thereby creating a positive cycle of positive emotions.
We also found that perceived usefulness and entertainment value positively affected the intention to continue participating in HRSM among middle-aged and older adults. These findings are in line with studies by Igbaria, Schiffman, and Wieckowski [
77] and by Davis, Bagozzi, and Warshaw [
78], who found that usefulness, fun, and enjoyment positively influence user attitudes and behaviors. Our study was about intention to sustain engagement: by using HRSM, middle-aged and elderly adults grasp the skills needed for Web 2.0 technology, which deepens their understanding of information, people, and society, among others. In addition, it improves electronic health literacy, and helps to improve self-efficacy and bring about certain aspects of health promotion. The fun, relaxation, and soothing emotions brought about by entertainment can relieve the mental stress of middle-aged and elderly users, and help them to fill their spare time [
103]. Perceived usefulness and entertainment can lead to a certain degree of satisfaction among middle-aged and elderly adults. This is beneficial for improving their perceptions of value, thereby prompting users to engage in interaction with health topics again [
86]. Participation in a closed loop creates a loop and, as a result, they prefer to continue using HRSM. Furthermore, we found that both the increasing and influencing effects of perceived usefulness were stronger than those of perceived entertainment. This may be because middle-aged and elderly adults have rich social experiences, and pay more attention to practicalities than, as they did when they were younger, to the pursuit of fun. This may also be because their acceptance and use of technology is lower than that of younger groups, so they either do not use or do not enjoy the entertainment functions during the use process [
104].
The relationship and difference between the study’s results and the existing studies are explained in detail. Reviewing the overall framework of the study, the first focus was on the evolution of motivation. Most of the existing studies were based on the variables of behavioral nature, to study the participation in HRSM. For example, Gonzalez, Mitra, and Turel [
41] took online health seekers as the research starting point, to explore users’ interest in using HRSM. Based on the theory of motivation, different motivations are not isolated from each other. Amabile [
34] matched motivation with work, to achieve corresponding motivation. In Amabile’s research, extrinsic motivation did not destroy intrinsic motivation, but cooperated. On this basis, the motivation of each stage was divided into two types: external and internal, and the two external motivations were related to each other. For protection psychology, more attention should be paid to whether the results are helpful. Furthermore, social motivation brings certain entertainment expectations. We connect the two stages of motivation evolution through the connection between initial participation and intention to continue participation. Yang, Li, Hu, and Wang [
59] studied open source software’s initial and continuous participation. The study took the two as dependent variables, to discuss the effect of word-of-mouth verse and observational learning. This study was to correlate the two, which was similar to the study of Ihm and Lee [
79]. They focused on the costs and benefits of social media, and used these two perceptions as a bridge. In the context of HRSM, we also studied the motivation of initial use, to make up for the research gap on perceived usefulness and entertainment after initial use. The overall process of the study focused on the coherence of user behavior.
Therefore, by exploring the initial motivation of middle-aged and elderly groups to use HRSM, and the related factors that affected their willingness to use HRSM, this paper clarified the impact of protection motivation and social motivation on the use of HRSM by middle-aged and elderly users. The related mechanisms of intention to continue use of HRSM have theoretical and practical significance.
5.2. Implications
With the development of technology, the user characteristics of the middle-aged and elderly groups also continue to change. In the past, most scholars worried that the digital divide would hinder the travel and consumption of middle-aged and elderly people. Now, addiction to the internet has become a noticeable phenomenon, especially in the live broadcast industry chain. Middle-aged and older people have a specific consumption ability, and are sometimes interested in emerging things. Therefore, the investigation and cognition of their behavior needed to be further explored. HRSM provide various health information channels and resources, based on the technology platform. For middle-aged and older people, HRSM are an effective tool for self-health management; however, there are relatively few studies on using HRSM for that group; and, among the users, the proportion of that group is always less than that of young people. Hence, we used motivation evolution to reveal the evolution mechanism of continuous participation attention. A two-stage motivation analysis was used to link the intention of initial and continuous participation as the key nodes. The analysis verified that protection motivation and social motivation could stimulate the participation of potential users; it also proved that perceptions of rationality and emotion could be improved after participating in HRSM. In addition, it was an essential breakthrough of this study to link initial participation and continuous use intention through two kinds of perception—the study analyzed the dynamic monitoring of HRSM users’ thinking and behavior through motivation evolution.
5.2.1. Theoretical Implications
This study enriches theory related to research on middle-aged and elderly adults. The antecedents of social media participation have received extensive attention from the academic community. However, the existing research has generally focused on younger people’s use of social media. Few studies have carried out in-depth explorations of social media use among middle-aged and elderly consumers. Adults in the middle and later periods of life differ from young adults in thought, technology use, and related behaviors. Based on this, this paper examined the impact of use motivation on users’ intentions and behaviors, from the perspectives of social motivation and protection motivation. The paper’s exploration of the motivation of the middle-aged and elderly to use HRSM provides a research paradigm for related research on the internet usage habits of middle-aged and elderly consumers. Furthermore, it promotes the development of middle-aged and elderly users’ participation in socially related internet research.
This study also fills a gap in research on health-related social media. With the continuous improvement of people’s standards of living, the concept of a healthy lifestyle has received widespread attention in societies. Most previous HRSM studies focused on participation behavior, and some studies explored initial participation and continuous participation [
59,
85,
102,
105,
106]. However, users’ first use affects their subsequent behaviors to a large extent [
107], so it is of critical importance to explore the influence of initial behavior on intention to continue using. In this study, the initial motivations and sojourn-stage motivations were linked with initial participation. Perceived usefulness and perceived entertainment were introduced, to explore continuous intention to use HRSM in middle-aged and elderly consumers. This enriches the research results relating to HRSM, and promotes the development of relevant theories.
5.2.2. Practical Implications
The aging trend of the population has affected the ‘greying’ of social media. The growing power of middle-aged and elderly adults on social media cannot be underestimated. From a practical point of view, it is of crucial significance to explore the internet usage habits of middle-aged and elderly users. Therefore, to help HRSM understand their users better, and to utilize the positive effects of HRSM, the results of this study highlight the influence of two kinds of original motivation and two perceptions of HRSM on usage intention. Specifically, this study has the following implications, outlined below, for the middle-aged and elderly, for HRSM-related technology platforms, and for governments.
For middle-aged and elderly users, improving self-efficacy is critical. The first requirement is to improve health literacy. After obtaining health information, middle-aged and elderly users need to understand, effectively identify, and retain the information, so as to make appropriate adjustments in their health behaviors. In this way, middle-aged and elderly adults can avoid invalid information, exaggerated false information, and risky information that would negatively affect their use of health information and its perceived usefulness. The second requirement is to improve their mastery and proficiency in the technology. In particular, learning some basic skills can greatly help middle-aged and elderly people to understand and use HRSM more effectively. In addition, middle-aged and elderly adults should adjust their ideation regarding loneliness and self-discipline. Furthermore, they should use the HRSM-related entertainment functions rationally, and participate in HRSM entertainment activities according to their situation.
For the platforms, this study can help HRSM platforms identify the platform usage habits of middle-aged and elderly users better, and thus help them improve the relevance of their content, so that their design is better suited for these age groups. From the perspective of protection, the platforms need to introduce and strengthen content review mechanisms, to guide health information, health knowledge, and public opinion correctly. It is necessary to add humanized design—for example, by setting time reminders to reduce and avoid the negative health effects of excessive use. At the social level, the platforms should develop an interactive format that is more suitable for middle-aged and elderly individuals. They should attract this group to want to participate in the sharing, commenting, and disseminating of high-quality and scientific health information. For instance, they should carry out activities that have health-related content, with themes that are suited to their middle-aged and elderly users. Meanwhile, from the perspectives of the technology and information content, the platforms can increase the intention of middle-aged and elderly users to continue to participate, by providing convenient and fast technology, professional health information, humorous activities, etc.
With regard to governments, they should provide constraints and guidance to platforms from a macro perspective, and effectively control information and public opinion. They should supervise the operation of platforms through policies, laws, regulations, and other means, and establish and implement mechanisms of control. Governments can also encourage technological innovation, and commercialize the HRSM technology, through age-friendly design. Another issue to be considered is that middle-aged and elderly people are vulnerable to scams. Thus, governments should publicize and popularize HRSM, including the correct use of HRSM—for example, by providing public welfare education and training courses. On the one hand, this could help middle-aged and elderly people to establish cybersecurity in their thinking, by enhancing their cybersecurity literacy and emphasizing information-screening and usage time. On the other hand, through specific behavioral guidance, the middle-aged and the elderly could experience and master the entertainment functions available from participating in HRSM, thereby enhancing their joy in life, and helping the middle-aged and elderly integrate better into the Web 2.0 era.
5.3. Limitations and Future Research Directions
Our work had some limitations that could be improved on in future research. Firstly, at the data level, the data collected in the empirical part of this study all came from China, and this may have limited the generalizability of the findings to other countries, due to socio-cultural differences and variations in economic development. Future studies could conduct cross-country comparisons, to identify potential differences in pathway models, for better generalizability. Secondly, the data in this paper were cross-sectional data, and subjective. In the future, longitudinal investigation and qualitative analysis could be applied, to verify the model. Thirdly, the definition of HRSM in this study was general, and did not distinguish between different types of social media. Future research could conduct comparative research on different social media types. Fourthly, other factors, in addition to protection and social motivation, influenced initial participation. Similarly, the factors that affected the intention to continue participating were not only ‘perceived usefulness’ and ‘perceived entertainment’, but also ‘perceived risk’ and ‘perceived performance’. Future research could use theories such as self-determination theory and expectation confirmation theory, to enrich the research model. Fifthly, this study focused on the transmission and evolution of motivation. Future research could analyze protection motivation and social motivation in greater detail, from the perspective of demand; it could also explore the impact of intention on specific continuous participation behaviors. In addition, the number of samples in this paper was 384, which was more than the minimum standard for the structural equation model; however, further expansion of the sample size would effectively improve the accuracy of the evaluation. Relevant factors affecting the sustained intention of middle-aged and elderly users could also be further explored, through interviews or other methods.