Multilevel drivers of digital transformation in long-term elderly care services: evidence from the Qinghai-Tibet Plateau, a high-altitude and resource-limited region of China

Multilevel drivers of digital transformation in long-term elderly care services: evidence from the Qinghai-Tibet Plateau, a high-altitude and resource-limited region of China | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Multilevel drivers of digital transformation in long-term elderly care services: evidence from the Qinghai-Tibet Plateau, a high-altitude and resource-limited region of China Guorong Chai, Yunhua Wang, Jiancheng Wang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8152985/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Objective This study examines the multilevel drivers influencing the digital transformation of long-term elderly care services in the Qinghai-Tibet Plateau, a high-altitude and resource-constrained region of China. It aims to clarify the causal influence, hierarchical structure and system roles of environmental, organizational, technological and individual drivers. Methods A multi-method analysis was conducted using expert assessments from government officials, institutional managers and academic experts. Potential drivers were identified through a literature review and a two-round expert consultation. The DEMATEL, ISM and MICMAC methods were applied to analyze causal relationships, delineate hierarchical pathways and classify system roles. Results Environmental drivers, particularly economic development and policy support, demonstrated the strongest causal influence and formed the foundational layer of the transformation system. The hierarchical model revealed a three-level structure in which environmental drivers occupied the deepest level. Organizational and technological drivers formed the intermediate layer, which was dominated by technological drivers, while the surface layer was primarily shaped by organizational drivers, with individual drivers distributed across both layers. The MICMAC classification further indicated that environmental drivers functioned as independent system drivers, whereas organizational and technological drivers showed high dependence. The absence of linkage factors suggests that digital transformation in the Qinghai-Tibet Plateau remains at an early stage and is characterized by a predominantly top-down pattern of implementation. Conclusion Digital transformation in long-term elderly care services in the Qinghai-Tibet Plateau is driven by a multilevel system anchored in macro-environmental conditions. Strengthening policy support and fiscal capacity is essential to facilitate progress. Enhancing organizational capability, improving technological infrastructure and advancing the digital competencies of frontline staff are necessary to convert enabling conditions into effective service delivery. These findings provide evidence to inform context-sensitive digital health and long-term care strategies in remote and underserved regions. Digital transformation Long-term elderly care services Multilevel drivers Resource-limited region Qinghai-Tibet Plateau Full Text Additional Declarations No competing interests reported. Supplementary Files SupplementaryMaterials.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 15 Feb, 2026 Reviewers agreed at journal 14 Jan, 2026 Reviewers invited by journal 07 Jan, 2026 Editor assigned by journal 05 Jan, 2026 Editor invited by journal 24 Nov, 2025 Submission checks completed at journal 24 Nov, 2025 First submitted to journal 24 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8152985","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":570674706,"identity":"36181f2c-3f59-4637-bd84-1b8c08c92b27","order_by":0,"name":"Guorong Chai","email":"","orcid":"","institution":"Lanzhou University","correspondingAuthor":false,"prefix":"","firstName":"Guorong","middleName":"","lastName":"Chai","suffix":""},{"id":570674707,"identity":"195443e1-42a2-4e1e-8bd8-5057b2faeb83","order_by":1,"name":"Yunhua Wang","email":"","orcid":"","institution":"Lanzhou 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China","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Digital transformation, Long-term elderly care services, Multilevel drivers, Resource-limited region, Qinghai-Tibet Plateau","lastPublishedDoi":"10.21203/rs.3.rs-8152985/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8152985/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThis study examines the multilevel drivers influencing the digital transformation of long-term elderly care services in the Qinghai-Tibet Plateau, a high-altitude and resource-constrained region of China. It aims to clarify the causal influence, hierarchical structure and system roles of environmental, organizational, technological and individual drivers.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA multi-method analysis was conducted using expert assessments from government officials, institutional managers and academic experts. Potential drivers were identified through a literature review and a two-round expert consultation. The DEMATEL, ISM and MICMAC methods were applied to analyze causal relationships, delineate hierarchical pathways and classify system roles.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eEnvironmental drivers, particularly economic development and policy support, demonstrated the strongest causal influence and formed the foundational layer of the transformation system. The hierarchical model revealed a three-level structure in which environmental drivers occupied the deepest level. Organizational and technological drivers formed the intermediate layer, which was dominated by technological drivers, while the surface layer was primarily shaped by organizational drivers, with individual drivers distributed across both layers. The MICMAC classification further indicated that environmental drivers functioned as independent system drivers, whereas organizational and technological drivers showed high dependence. The absence of linkage factors suggests that digital transformation in the Qinghai-Tibet Plateau remains at an early stage and is characterized by a predominantly top-down pattern of implementation.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eDigital transformation in long-term elderly care services in the Qinghai-Tibet Plateau is driven by a multilevel system anchored in macro-environmental conditions. Strengthening policy support and fiscal capacity is essential to facilitate progress. Enhancing organizational capability, improving technological infrastructure and advancing the digital competencies of frontline staff are necessary to convert enabling conditions into effective service delivery. These findings provide evidence to inform context-sensitive digital health and long-term care strategies in remote and underserved regions.\u003c/p\u003e","manuscriptTitle":"Multilevel drivers of digital transformation in long-term elderly care services: evidence from the Qinghai-Tibet Plateau, a high-altitude and resource-limited region of China","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-09 20:11:13","doi":"10.21203/rs.3.rs-8152985/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-02-15T18:23:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"205952323602504970956507983359799092168","date":"2026-01-14T06:20:07+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-07T08:01:08+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-05T09:09:48+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-11-24T15:42:12+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-24T13:40:00+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2025-11-24T13:34:43+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b726b0dc-43ce-4eaa-a7a1-477bf2179197","owner":[],"postedDate":"January 9th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-01-09T20:11:14+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-09 20:11:13","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8152985","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8152985","identity":"rs-8152985","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}