Exploring service demands of community-embedded elderly care based on the Kano model: a cross-sectional study in Hefei, China

BACKGROUND: With the rapid progression of population aging, elder care has gained prominence as a key societal issue in China. To address this challenge, the Chinese government has promoted community-embedded elderly care services. This study aims to investigate older adults' needs and priority preferences regarding these services through the application of the Kano model, thereby providing recommendations for optimizing delivery. METHODS: A cross-sectional survey was conducted from June to September 2024 using convenience sampling to recruit 382 elderly individuals aged 60 and above in Hefei, Anhui Province. Participants completed a self-designed questionnaire based on the Kano model, which included 30 community-embedded elderly care service items to categorize and prioritize service attributes. Sociodemographic data were also collected. Subgroup analyses were performed according to self-care ability to explore differences in service needs among older adults with varying functional status. RESULTS: Among the 30 services, 7 were classified as "must-be" attributes located in reserving zone IV, 5 as "one-dimensional" attributes in predominance zone I, 12 as "attractive" attributes in improving zone II, and 6 as "indifferent" attributes distributed in secondary improving zone III. Significant differences in Kano classifications were observed across self-care levels. Older adults with full self-care ability tended to classify services such as regular visits, rehabilitation guidance, smart device instruction, psychological counseling, and legal aid as indifferent attributes, whereas those with partial or no self-care ability regarded these services as attractive attributes (P < 0.05). CONCLUSIONS: This study highlights a shift in elderly needs from basic care to personalized and ongoing health management. Community-embedded care should prioritize must-be and one-dimensional attributes while addressing the diverse needs of older adults with varying self-care abilities to better support aging in place.