What factors influence older people's intention to enrol in nursing homes? A cross-sectional observational study in Shanghai, China

Objectives Given the increasing need of long-term care and the low occupancy rate of nursing homes in Shanghai, this study attempts to explore what factors influence older people's intention to enrol in nursing homes. Design A cross-sectional observational study based on the theory of reasoned action was conducted. Survey data were collected from subjects during face-to-face interviews. Structural equation modelling was employed for data analysis. Setting This study was conducted in six community health service centres in Shanghai, China. Two service centres were selected in urban, suburban and rural areas, respectively. Participants A total of 641 Shanghai residents aged over 60 were surveyed. Results Structural equation modelling analysis showed that the research model fits the data well ((2)/df=2.948, Comparative Fit Index=0.972 and root mean squared error of approximation =0.055). Attitude (=0.41, p<0.01), subjective norm (=0.28, p<0.01) and value-added service (=0.16, p<0.01) were directly associated with enrolment intention, explaining 32% of variance in intention. Attitude was significantly influenced by loneliness (=-0.08, p<0.05), self-efficacy (=0.32, p<0.01) and stigma (=-0.24, p<0.01), while subjective norm was significantly influenced by life satisfaction (=-0.15, p<0.01) and stigma (=-0.43, p<0.01). Conclusions This study advances knowledge regarding the influencing factors of older people's intention to enrol in nursing homes. It suggests that Chinese older persons' perceived stigma has the strongest indirect effect on their intention to enrol in nursing homes. This is unique to the Chinese context and has practical implications for eldercare in China and other Asian countries with similar sociocultural contexts.