Behavioral Dynamics of AI Trust and Health Care Delays Among Adults: Integrated Cross-Sectional Survey and Agent-Based Modeling Study.

backgroundWhile artificial intelligence (AI) holds significant promise for health care, excessive trust in these tools may unintentionally delay patients from seeking professional care, particularly among patients with chronic illnesses. However, the behavioral dynamics underlying this phenomenon remain poorly understood.

objectiveThis study aims to quantify the influence of AI trust on health care delays through integrated survey-based mediation analysis and real-world research, and to simulate intervention efficacy using agent-based modeling (ABM).

methodsA cross-sectional online survey was conducted in China from December 2024 to May 2025. Participants were recruited via convenience sampling on social media (WeChat and QQ) and hospital portals. The survey included a 21-item questionnaire measuring AI trust (5-point Likert scale), AI usage frequency (6-point scale), chronic disease status (physician-diagnosed, binary), and self-reported health care delay (binary). Responses with completion time <90 seconds, logical inconsistencies, missing values, or duplicates were excluded. Analyses included descriptive statistics, multivariable logistic regression (α=.05), mediation analysis with nonparametric bootstrapping (500 iterations), and moderation testing. Subsequently, an ABM simulated 2460 agents within a small-world network over 14 days to model behavioral feedback and test 3 interventions: broadcast messaging, behavioral reward, and network rewiring.

resultsThe final sample included 2460 adults (mean age 34.46, SD 11.62 years; n=1345, 54.7% female). Higher AI trust was associated with increased odds of delays (odds ratio [OR] 1.09, 95% CI 1.00-1.18; P=.04), with usage frequency partially mediating this relationship (indirect OR 1.24, 95% CI 1.20-1.29; P<.001). Chronic disease status amplified the delay odds (OR 1.42, 95% CI 1.09-1.86; P=.01). The ABM demonstrated a bidirectional trust erosion loop, with population delay rates declining from 10.6% to 9.5% as mean AI trust decreased from 1.91 to 1.52. Interventions simulation found broadcast messaging most effective in reducing delay odds (OR 0.94, 95% CI 0.94-0.95; P<.001), whereas network rewiring increased odds (OR 1.04, 95% CI 1.04-1.05; P<.001), suggesting a "trust polarization" effect.

conclusionsThis study reveals a nuanced relationship between AI trust and delayed health care-seeking. While trust in AI enhances engagement, it can also lead to delayed care, particularly among patients with chronic conditions or frequent AI users. Integrating survey data with ABM highlights how AI trust and delay behaviors can strengthen one another over time. Our findings indicate that AI health tools should prioritize calibrated decision support rather than full automation to balance autonomy, odds, and decision quality in digital health. Unlike previous studies that focus solely on static associations, this research emphasizes the dynamic interactions between AI trust and delay behaviors.