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Background <p>Digital transformation in healthcare, compounded by the erosion of informal caregiving reservoirs due to low fertility, has widened disparities in access to medical services among older adults. Medical visit companion services (MVCS) offer a promising solution. This study aims to explore the key determinants and hierarchical pathways influencing older adults’ willingness to use MVCS. </p> Methods <p>This study employed a quantitative cross-sectional design. A multistage stratified sampling method was used to recruit older adults in Zhejiang Province, China, from January to May 2024. Drawing on Andersen’s behavioral model, this study identified the determinants of older adults’ willingness to use MVCS through non-parametric tests and ordered logistic regression. Shapley value decomposition and interpretative structural modeling (ISM) were employed to quantify contributions and delineate the hierarchical mechanisms of influence.</p> Results <p>The study included 494 older adults, with a mean score for willingness to use MVCS of 3.27 ± 1.23. Shapley analysis revealed that need factors (45.97%), enabling resources (30.01%), and predisposing characteristics (24.02%) collectively explained variance in utilization willingness. ISM analysis revealed a three-tier hierarchical structure: (1) direct factors, including individual accompaniment demands and need for assistance from MVCS; (2) indirect factors, such as medical visit autonomy, self-rated health status, self-rated ease of medical visits, social support, and MVCS awareness; and (3) deep-rooted factors, comprising age, education, and number of children. These elements form a hierarchical path progressing from predisposing characteristics through enabling resources and evaluated needs, to perceived needs and, ultimately, utilization willingness.</p> Conclusions <p>Older adults’ willingness to use MVCS is primarily driven by perceived needs, which are structurally shaped by indirect enabling resources and deep-rooted predisposing characteristics. To effectively enhance this willingness, interventions should leverage the institutional authority of hospitals and community centers, facilitating the transition from general awareness to explicit utilization willingness. We recommend transforming MVCS from basic accompaniment to specialized medical navigation services to augment perceived service utility. Furthermore, policy efforts should prioritize precise resource allocation for vulnerable populations, particularly those characterized by poor health and diminished informal support from fewer children.</p>

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Factors influencing willingness to use medical visit companion services among older Chinese adults: a Logistic-ISM model approach

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月21日

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  • Jiabin Xu,
  • Jianming Wang,
  • Linyi Zhu,
  • Dandan Li,
  • Yan Cai,
  • Lulu Tang,
  • Yingying Chen,
  • Chenchen Gao

摘要

Background

Digital transformation in healthcare, compounded by the erosion of informal caregiving reservoirs due to low fertility, has widened disparities in access to medical services among older adults. Medical visit companion services (MVCS) offer a promising solution. This study aims to explore the key determinants and hierarchical pathways influencing older adults’ willingness to use MVCS.

Methods

This study employed a quantitative cross-sectional design. A multistage stratified sampling method was used to recruit older adults in Zhejiang Province, China, from January to May 2024. Drawing on Andersen’s behavioral model, this study identified the determinants of older adults’ willingness to use MVCS through non-parametric tests and ordered logistic regression. Shapley value decomposition and interpretative structural modeling (ISM) were employed to quantify contributions and delineate the hierarchical mechanisms of influence.

Results

The study included 494 older adults, with a mean score for willingness to use MVCS of 3.27 ± 1.23. Shapley analysis revealed that need factors (45.97%), enabling resources (30.01%), and predisposing characteristics (24.02%) collectively explained variance in utilization willingness. ISM analysis revealed a three-tier hierarchical structure: (1) direct factors, including individual accompaniment demands and need for assistance from MVCS; (2) indirect factors, such as medical visit autonomy, self-rated health status, self-rated ease of medical visits, social support, and MVCS awareness; and (3) deep-rooted factors, comprising age, education, and number of children. These elements form a hierarchical path progressing from predisposing characteristics through enabling resources and evaluated needs, to perceived needs and, ultimately, utilization willingness.

Conclusions

Older adults’ willingness to use MVCS is primarily driven by perceived needs, which are structurally shaped by indirect enabling resources and deep-rooted predisposing characteristics. To effectively enhance this willingness, interventions should leverage the institutional authority of hospitals and community centers, facilitating the transition from general awareness to explicit utilization willingness. We recommend transforming MVCS from basic accompaniment to specialized medical navigation services to augment perceived service utility. Furthermore, policy efforts should prioritize precise resource allocation for vulnerable populations, particularly those characterized by poor health and diminished informal support from fewer children.