What might influence the elderly willingness to participate in "shared elderly care"? A mixed methods study.

Purpose: This study aimed to explore the core factors influencing participation in the "shared elderly care" model among urban Chinese seniors and propose targeted solutions to address the challenges of an aging society. Methods: A mixed-methods study was conducted. A questionnaire survey was conducted among 533 seniors in Zhengzhou. Data on demographic characteristics, health literacy, and environmental factors were analyzed using four machine learning algorithms: logistic regression, random forest, K-nearest neighbor, and support vector machine. Approximately 3 years later, qualitative validation was conducted through six focus group interviews. Themes were extracted using Colaizzi phenomenological analysis, and the predictions were validated. Results: Five hundred valid questionnaires were collected. The machine learning algorithm results showed that the random forest model had the best predictive performance (AUC = 0.652), revealing that e-health literacy and policy awareness were key drivers (jointly explaining 24.1% of the variance in participation intention), with age, environmental sensitivity, and social influence as significant cofactors. Qualitative analysis confirmed that technology usability and a sense of social belonging were core experiential elements of deep participation. Conclusion: Addressing the primary obstacles of digital literacy gaps and limited technological accessibility, we propose three countermeasures: increasing publicity and promotion of shared elderly care models; conducting community digital health literacy training; and increasing resource allocation to precisely match needs, thus providing an implementation path for building an inclusive shared elderly care ecosystem.