Patterns of social participation among older adults with chronic multimorbidity in the community: A qualitative study

Social participation significantly promotes health in older adults with chronic multimorbidity. However, their needs and characteristics of social participation demonstrate substantial heterogeneity due to multidimensional influences. Current standardized community service models inadequately address this population's diverse needs. User personas, as a group classification model derived from integrating the characteristics of target populations along specific dimensions, can provide a basis for addressing the current challenge in which standardized community services fail to meet the diverse needs of this population.

To characterize the social participation behaviors of older adults with multimorbidity, construct representative user personas, and establish foundations for personalized community interventions.

From November 2024 to May 2025, we conducted semi-structured interviews with 32 multimorbid older adults through purposive sampling at two community health centers in Guangzhou, Guangdong Province, China. Interview data were analyzed using content analysis to identify persona label dimensions. Based on these dimensions, user personas were constructed with manual extraction and clustering of individual characteristics. The personas were visualized through a combination of word clouds and tables.

Six key dimensions profiling social participation emerged: daily activities, physical health, psychological state, interpersonal relationships, participation in organized activities, and community environment concerns. Based on these dimensions, five distinct user personas were identified: the care-dependent withdrawers, the family-depleting strugglers, the functionally-compensated stabilizers, the self-pleasure enjoyers and the value-creation builders.

Multidimensional factors, including physical, psychological, familial and environmental, shape heterogeneous social participation patterns among multimorbid older adults. Future policies and interventions should be differentiated based on persona characteristics, integrating medical, psychological and environmental support to enhance the social participation level and quality of life of older adults with chronic multimorbidity.