A structural generation mechanism of satisfaction with home-based elderly care community health intervention services: A case study of a community in Nanjing
居家养老社区健康干预服务满意度的结构性生成机制——以南京某社区为例

摘要

目的 本研究以南京市某典型社区为案例，深入探究在复杂的地方治理网络与多元主体互动中，健康干预服务满意度的结构性生成机制。方法 通过深度访谈、参与式观察及政策文本分析，构建了一个涵盖“制度供给-服务递送-主体互动-个体体验”四维度的整合性分析框架。结果 满意度并非服务结果的单向度量，而是一个在“政策刚性”与“实践弹性”的张力中，被服务流程的可见性、专业知识的可及性、社会关系的嵌入性以及个体期待的文化调适所共同塑造的动态建构过程。结论 本研究不仅揭示了居家养老服务满意度形成的“黑箱”，也为推动社区养老服务体系从“规模覆盖”向“质量深化”、从“被动管理”向“主动治理”的范式转型，提供了理论反思与政策创新的知识基础。

Abstract

Objective: This study takes a typical community in Nanjing as a case study to deeply explore the structural generation mechanism of satisfaction with health intervention services within complex local governance networks and multi-actor interactions.
Methods Through in-depth interviews, participatory observation, and policy text analysis, an integrated analytical framework covering four dimensions-“institutional supply, service delivery, actor interaction, and individual experience”-was constructed.
Results Satisfaction is not a unidirectional measure of service outcomes, but rather a dynamic construct shaped by the tension between “policy rigidity” and “practical flexibility,” co-produced by the visibility of service processes, accessibility of professional knowledge, embeddedness of social relationships, and cultural adaptation of individual expectations.
Conclusion   This study not only reveals the “black box” of satisfaction formation in home-based elderly care services but also provides a knowledge base for theoretical reflection and policy innovation, facilitating the paradigm shift of community-based elderly care service systems from “scale-oriented coverage” to “quality-oriented deepening,” and from “passive management” to “active governance.”