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

Abstract

Background: While 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. Objective: This 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). Methods: A 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. Results: The 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