Hierarchical Analysis of Rural Elderly Care Service Demand Based on Kano Model: A Case Study of a Province in central China

Abstract Background This study aimed to investigate the demand for elderly care services among rural seniors in Shanxi Province and to clarify the hierarchy of care service demands and their influencing factors to guide the optimization of elderly care. Methods A questionnaire survey using multi-stage sampling assessed expectations, dependence, and importance of various service demands based on the Kano model. Descriptive statistics, factor analysis, and multiple regression were used to identify the hierarchical demand levels and related factors. Results The results showed that the Average Satisfaction Coefficient (ASC) for rural elderly care service demands ranked highest for health care services (0.426 ± 0.072), followed by psychosocial support services (0.390 ± 0.055) and living support services (0.232 ± 0.094). Within these, the hierarchy from highest to lowest ASC were health management and prevention (0.474 ± 0.023), psychosocial support (0.390 ± 0.055), professional medical care (0.353 ± 0.054), emergency and assistance support (0.300 ± 0.075), and basic daily support (0.165 ± 0.023). Positive influencing factors included income, educational attainment, exercise frequency, and number of chronic diseases, while negative factors included activities of daily living impairment, depression symptoms, self-rated health status, long distance to services, and limited caregiver capacity. Conclusions Health management and prevention constitute primary demands for rural elderly populations. Addressing aging challenges requires prioritizing health-centered care systems, enhancing service accessibility, and encouraging healthy lifestyles and social participation. Family members should also strengthen caregiving responsibilities to help build an age-friendly society.