Preference for the Use of Home and Community-Based Services Among Older Adults With Hearing Loss in Rural China

The underutilization of home and community-based services (HCBS) among older adults with hearing loss (HL) in rural China exacerbates health disparities. This study employed a mixed-methods design, combining an analysis of the nationally representative CHARLS database (n = 10,745) with a community-based survey experiment in Guangzhou (n = 267), to examine HCBS utilization, its determinants, and care preferences. Nationally, only 18.22% of rural older adults with HL reported using HCBS, which is lower than the level in urban areas. Health-related HCBS were the most popular choice, and offspring support, number of children, pension and medical insurance were significantly associated with HCBS utilization. Experimental results further showed that participants showed stronger preferences for interventions emphasizing family welfare and demand-side financial subsidies, indicating strong intergenerational considerations in care decisions. These findings suggest that effective HCBS expansion should integrate intergenerational incentives and targeted subsidies with a family-centered focus on health-related services.