Uncovering the hierarchical determinants of continuous usage in online health communities: integrating meta-analysis with FUZZY-DEMATEL-AISM.

Despite growing interest in online health communities (OHCs), prior studies report inconsistent findings regarding the factors that drive users' continuous engagement. Furthermore, little is known about the relative importance of these factors and their hierarchical interactions. To address these gaps, this study poses two research questions: What are the key determinants of continuous OHC usage, and how do these determinants interact within a hierarchical structure? We conducted a meta-analysis of empirical studies to extract 16 critical factors, and applied the FUZZY-DEMATEL-AISM method to construct a multi-layered framework capturing their interrelationships. The findings reveal that attitude functions as the most direct top-level determinant, while trust, perceived value, and self-efficacy serve as transitional drivers. In contrast, system quality, service quality, and technology anxiety form the foundational layer influencing user behavior. This study contributes to theory by elucidating the structural logic underlying OHC engagement and to practice by providing actionable insights for enhancing user retention and optimizing digital health platform design. The results offer a systematic roadmap for researchers and practitioners aiming to understand and improve sustained user participation in digital health communities.