ArticleBMC geriatrics2026
Factors influencing willingness to use medical visit companion services among older Chinese adults: a Logistic-ISM model approach.
Article in BMC geriatrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundDigital 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.
methodsThis 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.
resultsThe 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.
conclusionsOlder 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.
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