Determinants of willingness to use medical visit companion services among older adults in China: A Shapley value approach

Abstract Background The rapid digital transformation of healthcare, coupled with the increasing prevalence of empty-nest families in China, has widened disparities in healthcare access among older adults, especially in navigating technology-dependent services. Medical visit companion services (MVCS) may help address these challenges and reduce pressure on the healthcare system. However, as an emerging service in China, MVCS remain insufficiently studied regarding older adults' willingness to engage with them and the factors influencing this willingness. This study aimed to assess older adults’ willingness to use MVCS and to identify and quantify the determinants. Methods Drawing on Anderson’s health behavior model, we developed an analytical framework incorporating predisposing characteristics, enabling resources, and need factors to examine older adults’ willingness to use MVCS in China. Cross-sectional data from 494 participants in Zhejiang Province were analyzed using χ² tests, H tests, ordered logistic regression, and Shapley value decomposition to identify factors influencing MVCS willingness and to quantify their contributions. Results The mean score for willingness to use MVCS was 3.27 ± 1.23. Higher education level, MVCS awareness, monthly family income, individual accompaniment demand, and perceived need for assistance were positively associated with willingness. Older age, greater self-rated ease of medical visits, stronger social support, better self-rated health, and higher medical visit autonomy were negatively associated. Shapley value decomposition indicated that need factors (48.73%) were the primary drivers of willingness, with self-rated health (21.29%) as the most predictive. Enabling resources (26.90%) and predisposing characteristics (24.02%) also contributed substantially, together explaining most of the variance in willingness. Conclusions The willingness of Chinese older adults to engage with MVCS is influenced by predisposing characteristics, enabling resources, and need factors, with the need factors demonstrating the strongest explanatory power. To enhance older adults’ willingness to utilize MVCS and promote sustainable services development, improving health literacy may strengthen their capacity to recognize health problems and articulate their actual needs. Service providers should be equipped to identify older adults most likely to engage with MVCS. Tailoring services to meet diverse needs is essential to optimize MVCS effectiveness.