Digital healthcare services in the context of age-friendly community initiatives in China: a realist evaluation

TL;DR

This study evaluates how digital healthcare services work in age-friendly communities in China, focusing on what makes them effective for older adults.

Contribution

The paper introduces a realist evaluation methodology to understand digital healthcare services in top-down age-friendly community initiatives.

Findings

Six context-mechanism-outcome configurations were identified in digital healthcare service implementation.

Government-led initiatives and bottom-up approaches both play critical roles in improving outcomes for older adults.

Collaboration between healthcare professionals and local monitoring can enhance the sustainability of these services.

Abstract

Understanding digital healthcare services in age-friendly community (AFC) initiatives and their implementation is crucial for developing evidence-based policies and practices. In this study, we aim to explore the question, “What is it about digital healthcare services that work, for whom, and under what circumstances?” in top-down AFC initiatives using Shanghai, China, as a representative case.

We employed a novel realist evaluation methodology and gathered insights from critical informants and users, including policymakers, community officers responsible for implementing AFC initiatives, and older adults.

The findings revealed six context-mechanism-outcome configurations. The government-led top-down AFC initiative, along with its related policies, serves as a critical context for supporting the provision of digital healthcare services and improving outcomes for older adults and their communities. A bottom-up approach values individual demand-oriented methods, providing digital healthcare services in AFC initiatives by considering older adults’ health and social situation as a critical context, utilizing digital care services and support as resources, and enhancing user experience. A feasible path forward is to support healthcare professional-led collaboration in developing and implementing digital healthcare services, aligning bottom-up and top-down practices, and focusing on individual demand, social equity, privacy concerns, and data-driven feedback.

Top-up support, active engagement of providers, and closer local monitoring of digital healthcare service implementation in AFC initiatives may encourage long-term effectiveness and sustainability.

The online version contains supplementary material available at 10.1186/s12913-025-13846-8.

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