{"title":"Bridging accessibility gaps in urban community-based basic older adult care: a comprehensive framework validated in Xi'an, China.","authors":"Yuyuan Zhang, Ming Zhou, Jinrong Hu, Ruoying Wang","doi":"10.3389/fpubh.2025.1535987","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>Accessibility is a critical factor in ensuring equitable public services. In urban older adult care systems, resource allocation and service disparities present unique challenges. The classical \"5A\" theory-availability, accessibility, affordability, adaptability, and acceptability-provides a robust framework for evaluating service delivery. However, its application in urban older adult care, especially in rapidly aging societies like China, remains limited. This study aims to develop and validate a framework to address affordability, resource allocation, and service mismatches in urban older adult care systems.</p><p><strong>Methods: </strong>A web-based cross-sectional study was performed in 2023. A multi-phase methodology was adopted to construct the framework, grounded in the \"5A\" theory. Indicators were refined through expert consultations using the Delphi method, involving 20 experts, while the entropy weight method ensured objective indicator weighting. The framework was empirically validated in Xi'an, China, using survey data collected from 438 older adult residents across urban strata. A fuzzy comprehensive evaluation (FCE) method was employed to assess accessibility and identify key service gaps.</p><p><strong>Results: </strong>This study constructs a comprehensive evaluation framework for basic older adult care services (BECS), structured around 5 primary dimensions, 14 sary indicators, and 37 tertiary indicators. Empirical validation in Xi'an further demonstrates the framework's scientific rigor and practical applicability. While the framework identifies strong spatial accessibility (3.8815), it also reveals critical gaps in affordability (3.1347) and psychological care (3.0862), confirming its effectiveness in diagnosing systemic disparities and guiding policy interventions.</p><p><strong>Conclusion: </strong>This study introduces a novel accessibility evaluation framework tailored for basic older adult care services, addressing critical gaps in affordability, psychological care, and service responsiveness. Empirical results validate the framework's practicality and its alignment with the real-world conditions of urban aging societies. Furthermore, an innovative \"Matching-Realization-Satisfaction\" improvement pathway is proposed, offering actionable strategies to enhance accessibility and optimize service delivery. This framework serves as a replicable model for advancing equitable older adult care in rapidly aging urban communities.</p>","PeriodicalId":12548,"journal":{"name":"Frontiers in Public Health","volume":"13 ","pages":"1535987"},"PeriodicalIF":3.4000,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11896861/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Frontiers in Public Health","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3389/fpubh.2025.1535987","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH","Score":null,"Total":0}
引用次数: 0
Abstract
Objectives: Accessibility is a critical factor in ensuring equitable public services. In urban older adult care systems, resource allocation and service disparities present unique challenges. The classical "5A" theory-availability, accessibility, affordability, adaptability, and acceptability-provides a robust framework for evaluating service delivery. However, its application in urban older adult care, especially in rapidly aging societies like China, remains limited. This study aims to develop and validate a framework to address affordability, resource allocation, and service mismatches in urban older adult care systems.
Methods: A web-based cross-sectional study was performed in 2023. A multi-phase methodology was adopted to construct the framework, grounded in the "5A" theory. Indicators were refined through expert consultations using the Delphi method, involving 20 experts, while the entropy weight method ensured objective indicator weighting. The framework was empirically validated in Xi'an, China, using survey data collected from 438 older adult residents across urban strata. A fuzzy comprehensive evaluation (FCE) method was employed to assess accessibility and identify key service gaps.
Results: This study constructs a comprehensive evaluation framework for basic older adult care services (BECS), structured around 5 primary dimensions, 14 sary indicators, and 37 tertiary indicators. Empirical validation in Xi'an further demonstrates the framework's scientific rigor and practical applicability. While the framework identifies strong spatial accessibility (3.8815), it also reveals critical gaps in affordability (3.1347) and psychological care (3.0862), confirming its effectiveness in diagnosing systemic disparities and guiding policy interventions.
Conclusion: This study introduces a novel accessibility evaluation framework tailored for basic older adult care services, addressing critical gaps in affordability, psychological care, and service responsiveness. Empirical results validate the framework's practicality and its alignment with the real-world conditions of urban aging societies. Furthermore, an innovative "Matching-Realization-Satisfaction" improvement pathway is proposed, offering actionable strategies to enhance accessibility and optimize service delivery. This framework serves as a replicable model for advancing equitable older adult care in rapidly aging urban communities.
期刊介绍：
Frontiers in Public Health is a multidisciplinary open-access journal which publishes rigorously peer-reviewed research and is at the forefront of disseminating and communicating scientific knowledge and impactful discoveries to researchers, academics, clinicians, policy makers and the public worldwide. The journal aims at overcoming current fragmentation in research and publication, promoting consistency in pursuing relevant scientific themes, and supporting finding dissemination and translation into practice.
Frontiers in Public Health is organized into Specialty Sections that cover different areas of research in the field. Please refer to the author guidelines for details on article types and the submission process.
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