Cultural Determinants of Assistive Health Technology Acceptance in Asian Older Adults in Low- and Middle-Income Countries: A Mixed-Methods Systematic Review with Evidence Predominantly from East Asia.

Purpose: This mixed-methods systematic review synthesizes evidence on how cultural determinants influence acceptance of assistive health technologies (AHTs) among older adults aged 60 years and over in Asian low- and middle-income countries (LMICs). Despite increasing availability of digital health technologies, adoption rates among elderly populations in these settings remain critically low, and the dominant technology acceptance frameworks, developed in Western contexts, may inadequately account for cultural dimensions prevalent in Asian societies. Methods: Following a protocol pre-registered on the Open Science Framework (DOI: 10.17605/OSF.IO/8E9CD), systematic searches were conducted across PubMed, Scopus, IEEE Xplore, and Web of Science. From 488 records identified, 20 underwent full-text screening against five eligibility criteria. The most critical criterion required that cultural factors be explicitly investigated as a variable or theme. Six studies met all criteria. Quality assessment used design-matched tools: the JBI Critical Appraisal Checklist for Qualitative Research (10 items), the JBI Checklist for Analytical Cross-Sectional Studies (8 items), and the Mixed Methods Appraisal Tool (MMAT, 5 items). Synthesis followed a convergent integrated approach per JBI methodology. Results: Six studies (3 qualitative, 2 quantitative, 1 mixed-methods) from China (n=4), India (n=1), and Thailand (n=1) were included. Five overarching cultural themes emerged: (1) family and filial piety as a double-edged enabler; (2) stigma and face culture (mianzi); (3) collectivist social norms; (4) trust and traditional health beliefs; and (5) digital literacy as a culturally mediated gap. Methodological quality was good: qualitative studies scored 8/10 to 10/10, the cross-sectional studies scored 6/8 and 8/8, and the mixed-methods study scored 5/5. Conclusion: Cultural determinants exert pervasive influence on AHT acceptance. Current acceptance frameworks require cultural adaptation. The evidence is geographically concentrated in East Asia, predominantly China, indicating an urgent need for studies from Southeast and South Asian LMICs.