Integrating Health Belief Model, Technological Self-efficacy, and the PEN-3 cultural model: Conceptualizing the impact of culture and technology on health for advancing Sustainable Smart Health

As people record, visualize, analyze, share, reflect on, etc. their everyday life using digital and network technologies, how can researchers and designers empower them to engage both the technologies and health about themselves? Though the Health Belief Model (HBM) has been used to explain and predict healthrelated behaviors, and the Technological Self-efficacy (TSE), and the PEN-3 cultural model has been used as constructs of technological and cultural self-efficacy, it remains a challenging task to tease out the impact of cultural and technological factors for people to improve their health conditions and well-being by taking direct and indirect actions. With the aim to develop a conceptual framework to overcome such a challenge, this study examined and selected a few constructs from the TSE and PEN-3 cultural models, respectively, and then use them to enrich the HBM so that the impact of cultural and technological factors can be better integrated and examined. The integrated model can be used as an analysis tool for both researchers and designers to identify first the relevant cultural and technological factors (using selected constructs), and then formulate and then test hypotheses regarding how these factors shape their health and technology actions (using the causal modeling of the enriched HBM).The integrated model proposed and illustrated in this study shows the ways in which both cultural and technological factors can be conceptualized to explain and predict health-related behaviors via perceived beliefs (often related to technology and health). For example, self-tracking visualization involves both cultural and technological factors that may facilitate or impede health-related behaviors.