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Background: With the popularity of mobile Internet and social networks, an increasing number of social media-based health management systems (SocialHMS) have emerged in recent years. These social media-based systems have been widely used in registration, payment, decision-making, chronic diseases management, health information and medical expenses inquiry, etc., and they greatly facilitate the convenience for people to obtain health services. Objective: This study aimed to investigate the factors influencing sustained health engagement of SocialHMS by combining the theory of planned behavior (TPB) with the big-five theory and the trust theory. Method: We completed an empirical analysis based on the 494 pieces of data collected from Anhui Medical University first affiliated hospital (AMU) in East China through structural equation modeling and SmartPLS (statistical analysis software). Results: Openness to new experience has a significantly positive influence on attitude (path coefficient = 0.671, t = 24.0571, R 2  = 0.451), perceived behavioral control (path coefficient = 0.752, t = 32.2893, R 2  = 0.565), and perceived risk (path coefficient = 0.651, t = 18.5940, R 2  = 0.424), respectively. Attitude, perceived behavioral control, subjective norms, and trust have a significantly positive influence on sustained health engagement (path coefficients = 0.206, 0.305, 0.197, 0.183 respectively, t = 3.6684, 4.9158, 4.3414, and 3.3715, respectively). The explained variance of the above factors to the sustained health engagement of SocialHMS is 60.7% ( R 2  = 0.607). Perceived risk has a significantly negative influence on trust (path coefficient = 0.825, t = 46.9598, R 2  = 0.681). Conclusions: Attitude, perceived behavioral control, subjective norm, and trust are the determinants that affect sustained health engagement. The users' personality trait of openness to new experience and perceived risk were also found to be important factors for sustained health engagement. For hospital managers, there is the possibility to take appropriate measures based on users' personality to further enhance the implementation and utilization of SocialHMS. As for system suppliers, they can provide the optimal design for SocialHMS so as to meet users' needs.

Social Media-Based Health Management Systems and Sustained Health Engagement: TPB Perspective