Interdependencies among factors related to participation in smart home-based elderly care platforms in China: an exploratory social network analysis

Abstract

Despite increasing policy investment in smart home-based elderly care platforms, participation among older adults and care institutions remains limited. Existing studies have primarily examined participation-related factors from either the demand or supply side, but have paid limited attention to how these factors are interconnected within platform-based elderly care systems. Consequently, the structural relationships among participation-related factors and the factors occupying key positions within the broader care system remain insufficiently understood. To explore the interdependencies among factors related to participation in smart home-based elderly care platforms among older adults and care institutions in China. A three-stage exploratory study design was adopted. First, potential participation-related factors were identified through prior ethnographic research. Second, the identified factors were refined using expert ratings, coefficients of variation, and fuzzy set membership analysis. Third, an expert-informed directed and weighted factor network was constructed based on expert assessments of inter-factor relationships. Social network analysis was applied to examine network structure, brokerage positions, and structural prominence through network-level analysis, block modeling, and node- and edge-level metrics. Factors demonstrating high structural prominence were identified by integrating node-level indicators with block model positions, and robustness was assessed through sensitivity analyses. Initially, 21 elderly-related and 14 institution-related factors were identified. After refinement, 27 factors were retained, forming a fully interconnected expert-informed network with a clear core-periphery structure. Platform-, governance-, and institution-related factors occupied structurally central and intermediary positions, whereas older adult-related factors were more structurally dependent within the network. Twelve structurally prominent factors were identified, including trust in service provision, family support, payment power, inadequacy of existing care arrangements, care service quality, platform quality, service accessibility, service delivery costs, government subsidy support, payment and settlement mechanisms, revenue allocation arrangements, and performance incentive structures. Sensitivity analyses further supported the stability of the network structure and structurally prominent factors. Participation-related conditions in smart home-based elderly care platforms appear to be embedded in interdependent structural relationships rather than operating as isolated factors. The findings suggest that institutional arrangements, platform governance, and service delivery conditions may play central roles in shaping participation dynamics. These findings highlight the value of a system-oriented perspective and suggest that improving participation may require coordinated strategies across service delivery, platform governance, payment mechanisms, institutional incentives, and policy support.