Background With the rapid spread of short health videos, older adults frequently encounter commercialized health appeals. However, there is a lack of research on the mechanisms that drive cognitive and emotional responses and adoption decisions in such situations. Methods Based on the Health Belief Model (HBM) and the Heuristic–Systematic Model (HSM), this study develops a dual-path model to explain how intrinsic health needs and external persuasion cues jointly shape older adults’ emotions and behavioral intentions. Study 1 used a cross-sectional survey of older adults (aged >60 years) to test the structural relationships using the partial least squares structural equation model (PLS-SEM). Study 2 established causal evidence through a 2 × 2 between-subjects randomized experiment among active older short-video users. Results Study 1’s results show a positive correlation between chronic health anxiety and adoption intention through expectation trust (95% CI: 0.100, 0.191). Conversely, Study 2 reveals that experimentally induced acute anxiety reduces expectation trust, thereby weakening adoption intention (95% CI: -0.212, -0.071). The heuristic cues positively affect adoption intention through source trust (95% CI: 0.101, 0.182). In addition, media literacy attenuates the impact of heuristic cues on source trust (95% CI: -0.315, -0.179), and adult children’s intervention weakens the relationship between trust and adoption intention (95% CI: -0.289, -0.149). Conclusion Digital health adoption intention among older adults is a complex process driven jointly by internal health vulnerabilities and external heuristic triggers. Safeguarding this population requires a collaborative strategy: integrating strict algorithmic supervision, implementing precision literacy education to build cognitive shields, and actively empowering intergenerational family networks as decision gatekeepers.
Xuan et al. (Sun,) studied this question.