Abstract

As China transitions into a super-aged society, the demand for high-quality, technology-integrated elderly care services has increased substantially. Although the national government has invested heavily in smart healthcare infrastructure, regional disparities in technology adoption and service quality remain evident. This study examines the influence of Digital Readiness and Technological Infrastructure (DRTI), Citizen Participation and Engagement (CPE), and the Regulatory and Policy Environment (RPE) on Service Quality (SQ) in elderly care within Zigong, China, while emphasizing the mediating role of Adoption of Technological Innovation (ATI). Using survey data from 534 elderly residents across 174 care institutions and analyzed via Structural Equation Modeling (SEM), the results reveal that ATI has a substantial and significant direct effect on SQ (β = 0.618, p = 0.001). In contrast, CPE (β = 0.167, p = 0.090), DRTI (β = 0.082, p = 0.303), and RPE (β = 0.029, p = 0.718) do not directly predict SQ at statistically significant levels. However, all three antecedents significantly influence ATI: CPE (β = 0.416, p < 0.001), DRTI (β = 0.247, p < 0.001), and RPE (β = 0.375, p < 0.001). Furthermore, the indirect effects through ATI are statistically significant—CPE→ATI→SQ (β = 0.257, p = 0.005), DRTI→ATI→SQ (β = 0.153, p = 0.027), and RPE→ATI→SQ (β = 0.232, p = 0.004) indicating a full mediation effect. These findings underscore the pivotal role of ATI as the primary mechanism linking systemic and participatory factors to improved service outcomes. They suggest that investments in digital infrastructure must be complemented by strategies to enhance citizen involvement, regulatory alignment, and institutional capacity. The study offers valuable guidance for policymakers and care providers seeking to develop inclusive, resilient, and digitally empowered elderly care systems in rapidly transforming urban–rural settings.

Keywords

Adoption of Technological Innovation, Citizen Participation, Elderly Care, Public Service Quality, Structural Equation Modeling,

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