PurposeThis study investigated the underlying influence mechanism between mHealth service quality (SQ) and users' adoption intention and compared the differences of consumer individual decision-making behaviors between the pre-adoption stage and the post-adoption stages.Design/methodology/approachThis study built the pre-adoption and post-adoption models based on the stimulus-organism-response (S-O-R) model. Besides, this study collected 14,221 independent samples from 40 studies of pre-adoption intention to use and 12,876 independent samples from 36 studies of post-adoption intention to continue using and used meta-analysis structural equation modeling (MASEM) method to explore the formation of mHealth service quality influence on consumers toward adoption intention.FindingsThe results showed that (1) service quality positively trigger users' cognition response (i.e. perceived usefulness, perceived ease of use and perceived trust) and further positively drove the adoption and continuance intention; (2) there are similarities and differences in the relative importance of users' cognitive response between service quality and adoption intention at pre-adoption and post-adoption stages; (3) perceived trust (PTRU) played the most significant mediator in predicting users' adoption intention in both two stages; (4) perceived usefulness had a stronger influence than perceived ease of use (PEOU) on the adoption intention in pre-adoption while the result was just opposite in post-adoption stage.Practical implicationsThis study could help service providers effectively allocate their limited resources to improve user adoption intention.Originality/valueThis study is the first one to open the black box of the underlying influence mechanisms between mHealth service quality and individual adoption intention in mHealth services and show differences in consumer decision-making according to the adoption stage. It provides a new perspective to the research in mHealth.