JMIR Publications

ABSTRACT

Background:

In China,multimorbidity is widespread among older adults,requiring continuous and comprehensive management.Whole-course disease management,which relies on digital health technologies,may address these long-term needs,yet its dependence on digital engagement may influence how older adults perceive and express their service needs.Existing studies largely treat these needs as homogeneous,lacking empirical exploration of need-based subgroup structures and the role of enabling factors such as digital capability in shaping need patterns.

Objective:

This study aimed to assess the overall level and dimensional characteristics of whole-course disease management service needs among older adults with chronic conditions in China,identify independent associated factors,and use latent profile analysis to reveal the underlying subgroup structure of service needs to inform stratified and targeted service design.

Methods:

A cross-sectional survey was conducted from June to November 2024 among patients aged 60 years or older with chronic conditions in Hunan Province,China,using multistage stratified sampling.Service needs were measured using a self-developed Whole-Course Disease Management Service Needs Scale(Cronbachα=0.923),covering 3 dimensions:diagnosis and treatment services,information services,and disease management services.Friedman tests,multiple linear regression,and latent profile analysis(LPA)were performed.

Results:

A total of 724 patients were included(response rate 96.5%).Participants had a mean age of 70.9 years(SD 8.1)and reported a mean of 4.0 chronic conditions(SD 2.8).The mean overall need score was 3.75(SD 1.15),indicating moderate-to-high needs,with disease management scoring highest among the 3 dimensions.The Friedman test showed significant differences across dimensions(χ²=15.49,P<.001)but a very small effect size(Kendall W=0.011).Multiple linear regression showed that digital device proficiency,self-rated health status,family support for whole-course disease management services,family as the primary source of social support,and other living arrangements were significantly associated with service needs(all P<.05).The number of comorbidities was not a significant independent predictor.LPA identified 4 need profiles:low-need autonomous maintenance(13%),moderate-low-need passive adaptation(21%),moderate-high-need active engagement(32%),and high-need support-dependent(34%),with model entropy of 0.987 and posterior classification probabilities exceeding 98.9%for all profiles.

Conclusions:

Older adults with chronic conditions in China reported moderate-to-high whole-course disease management service needs,with disease management being the most prominent dimension.These needs were shaped not solely by disease burden but also by digital capability,perceived health,family support,and living context.The 4 latent profiles highlight substantial within-population heterogeneity,suggesting that standardized service models may be insufficient.In the future,comprehensive care management services for chronic diseases among older adults should adopt a differentiated strategy based on needs stratification,integrate digital and non-digital service pathways,and proactively identify older patients with a heavy disease burden but who do not adequately express their needs,in order to reduce potential inequalities in service accessibility.