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Article(id=1241319150488965744, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241319148798669160, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202412454, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1735056000000, receivedDateStr=2024-12-25, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773883148070, onlineDateStr=2026-03-19, pubDate=1750780800000, pubDateStr=2025-06-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773883148070, onlineIssueDateStr=2026-03-19, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773883148070, creator=13701087609, updateTime=1773883148070, updator=13701087609, issue=Issue{id=1241319148798669160, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='12', pageStart='2113', pageEnd='2304', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773883147667, creator=13701087609, updateTime=1773885555254, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241329247004971040, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241319148798669160, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241329247004971041, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241319148798669160, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=2217, endPage=2222, ext={EN=ArticleExt(id=1241319150941950583, articleId=1241319150488965744, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Impact of social support on the value co-creation behavior of the elderly in community health services: a moderated mediation model, columnId=1228016572892119056, journalTitle=Modern Preventive Medicine, columnName=Primary Health Services, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the pathways through which social support influences value co-creation behaviors in older adults, clarify the mediating role of service co-creation literacy, and examine the moderating effect of sense of community.

Methods

A random sampling method was employed to select elderly individuals from communities in Changzhi City as research subjects from September to November 2024. Data from 424 community-dwelling elderly individuals were included in the analysis. The data were analyzed using SPSS 24.0, and the PROCESS macro with the bootstrap method was utilized to test mediating and moderating effects.

Results

(1) Social support has a significant direct effect on value co-creation behavior (β=0.114, 95% CI: 0.029-0.199, P=0.009); (2) Service co-creation literacy has a significant partial mediating effect between social support and value co-creation behavior, with a mediating effect size of 0.125(95% CI:0.060-0.189,P<0.001), accounting for 52.3% of the total effect; (3) Sense of community has a moderating effect on the impact of service co-creation literacy on value co-creation behavior (β=0.147,P<0.001).

Conclusion

This study reveals that by constructing a mechanism that emphasizes strengthening the social support system within community health services, cultivating service co-creation literacy among the elderly, and enhancing the sense of community, it is possible to effectively stimulate the elderly population’s participation in value co-creation behaviors in health services.

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目的

探讨社会支持对老年人价值共创行为的影响路径，明确服务共创素养在其中的中介作用，以及社区归属感的调节作用。

方法

采用随机抽样的方法，于2024年9月至11月期间选取长治市社区老年人为研究对象，将424例社区老年人数据纳入分析。采用SPSS 24.0对数据进行统计分析，并利用PROCESS插件bootstrap法对中介及调节效应进行检验。

结果

（1）社会支持对服务价值共创行为的直接效应显著（β＝0.114, 95% CI: 0.029~0.199, P=0.009）；（2）服务共创素养在社会支持与价值共创行为间的部分中介效应显著，效应值为0.125（95% CI: 0.060~0.189, P<0.001），占总效应的52.3%；（3）在服务共创素养对价值共创行为的影响中社区归属具有调节作用（β＝0.147, P<0.001）。

结论

通过构建社区健康服务中的社会支持、培育老年群体服务共创素养以及强化社区归属感机制，能够有效激发老年人参与健康服务的价值共创行为。

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郭银萍，E-mail：
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=RKwqYXTv897PXRD81XEHSQ==, magXml=OMuwxqgPd/dDO2m3eQsk7A==, pdfUrl=null, pdf=ZKDa4p/QWC366Fz2yWHvRw==, pdfFileSize=660311, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=gmu1TNdBGt25XhfuInyK+g==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=6i7tPPIxQJUOF2ZYrpzEKg==, mapNumber=null, authorCompany=null, fund=null, authors=

徐家磊（1991—），男，博士，讲师，研究方向：社区健康服务管理

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Patient Experience Journal, 2024, 11(3): 215-245., articleTitle=Patient engagement and co-creation in healthcare services: a scoping review, refAbstract=null)], funds=[Fund(id=1241319158068073328, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319150488965744, awardId=2024W101, language=CN, fundingSource=2024年山西省高等学校哲学社会科学研究项目(2024W101), fundOrder=null, country=null), Fund(id=1241319158135182200, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319150488965744, awardId=2024BS09, language=CN, fundingSource=长治医学院2024年博士科研启动基金项目(2024BS09), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241319153525641881, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319150488965744, xref=1., ext=[AuthorCompanyExt(id=1241319153534030489, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319150488965744, companyId=1241319153525641881, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Department of Health Management, Changzhi Medical College, Changzhi, Shanxi 046000,China), AuthorCompanyExt(id=1241319153542419098, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319150488965744, companyId=1241319153525641881, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.长治医学院健康管理系，山西 长治 046000)]), AuthorCompany(id=1241319153634693790, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319150488965744, xref=2., ext=[AuthorCompanyExt(id=1241319153643082399, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319150488965744, companyId=1241319153634693790, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.内蒙古师范大学国家交流学院)])], figs=[ArticleFig(id=1241319155400495886, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319150488965744, language=EN, label=Fig.1, caption=Research Model of Service Co-creation Behavior Among Community-dwelling Older Adults, figureFileSmall=iELQcFgdZ5TWKfJR4NNTLQ==, figureFileBig=gmu1TNdBGt25XhfuInyK+g==, tableContent=null), ArticleFig(id=1241319155480187667, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319150488965744, language=CN, label=图1, caption=社区老年人服务共创行为及影响因素假设模型, figureFileSmall=iELQcFgdZ5TWKfJR4NNTLQ==, figureFileBig=gmu1TNdBGt25XhfuInyK+g==, tableContent=null), ArticleFig(id=1241319155668931362, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319150488965744, language=EN, label=Fig.2, caption=Slope Graph for the Moderating Effect of Sense of Community on the Relationship Between Service Co-creation Literacy and Value Co-creation Behavior, figureFileSmall=fI2f8801ukYhHPA6fgqsCA==, figureFileBig=sBhbfAsAx59DwXK95hOpFg==, tableContent=null), ArticleFig(id=1241319155752817449, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319150488965744, language=CN, label=图2, caption=社区归属感在服务共创素养与价值共创行为之间关系中的调节作用斜率图, figureFileSmall=fI2f8801ukYhHPA6fgqsCA==, figureFileBig=sBhbfAsAx59DwXK95hOpFg==, tableContent=null), ArticleFig(id=1241319155853480749, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319150488965744, language=EN, label=Table 1, caption=

Differences in Value Co-creation Behavior Across General Demographic Characteristics

, figureFileSmall=null, figureFileBig=null, tableContent=
变量项目频数（n）得分（）F或tP
性别2.046<0.001
男1774.680±0.475
女2474.799±0.665
年龄9.482<0.001
60~69岁2274.559±0.338
70~79岁1464.917±0.703
80岁以上484.813±0.462
教育水平8.504<0.001
小学及以下364.918±0.838
中学2234.802±0.538
中专/高中1224.741±0.602
大专204.071±0.401
本科及以上234.061±0.372
婚姻3.1340.017
已婚2204.836±0.510
未婚/离异/丧偶2044.656±0.665
居住情况-0.3460.289
独居1384.735±0.561
非独居2864.756±0.612
是否患有慢性病6.2360.007
无1914.556±0.508
有2334.906±0.617
社区健康服务的类型4.3540.001
常见病、多发病诊治1214.598±0.680
危急重症应急处置224.716±0.530
社区康复服务514.822±0.487
医疗服务协同1194.751±0.596
中医药服务565.037±0.523
社区健康教育服务504.689±0.467
其他55.186±0.214
居住类型-8.2030.003
农村2314.951±0.405
城镇1934.508±0.691
), ArticleFig(id=1241319156000281396, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319150488965744, language=CN, label=表1, caption=

一般人口学特征上的价值共创行为差异比较

, figureFileSmall=null, figureFileBig=null, tableContent=
变量项目频数（n）得分（）F或tP
性别2.046<0.001
男1774.680±0.475
女2474.799±0.665
年龄9.482<0.001
60~69岁2274.559±0.338
70~79岁1464.917±0.703
80岁以上484.813±0.462
教育水平8.504<0.001
小学及以下364.918±0.838
中学2234.802±0.538
中专/高中1224.741±0.602
大专204.071±0.401
本科及以上234.061±0.372
婚姻3.1340.017
已婚2204.836±0.510
未婚/离异/丧偶2044.656±0.665
居住情况-0.3460.289
独居1384.735±0.561
非独居2864.756±0.612
是否患有慢性病6.2360.007
无1914.556±0.508
有2334.906±0.617
社区健康服务的类型4.3540.001
常见病、多发病诊治1214.598±0.680
危急重症应急处置224.716±0.530
社区康复服务514.822±0.487
医疗服务协同1194.751±0.596
中医药服务565.037±0.523
社区健康教育服务504.689±0.467
其他55.186±0.214
居住类型-8.2030.003
农村2314.951±0.405
城镇1934.508±0.691
), ArticleFig(id=1241319156117721916, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319150488965744, language=EN, label=Table 2, caption=

Pearson correlation analysis, mean values and standard deviations of variables

, figureFileSmall=null, figureFileBig=null, tableContent=
项目Mean±SD社会支持服务共创素养社区归属感价值共创行为
社会支持4.521±0.7031.000
服务共创素养4.619±0.8530.484a1.000
社区归属感4.454±0.9230.352a0.445a1.000
价值共创行为4.750±0.5960.282a0.370a0.325a1.000
), ArticleFig(id=1241319156209996612, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319150488965744, language=CN, label=表2, caption=

Pearson相关性分析、变量均值、标准差

, figureFileSmall=null, figureFileBig=null, tableContent=
项目Mean±SD社会支持服务共创素养社区归属感价值共创行为
社会支持4.521±0.7031.000
服务共创素养4.619±0.8530.484a1.000
社区归属感4.454±0.9230.352a0.445a1.000
价值共创行为4.750±0.5960.282a0.370a0.325a1.000
), ArticleFig(id=1241319157665420109, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319150488965744, language=EN, label=Table 3, caption=

Results of the Mediation Model Test for Service Co-creation Literacy

, figureFileSmall=null, figureFileBig=null, tableContent=
模型路径拟合指标系数显著性
RR2FPβ（95% CI）P
社会支持→服务共创素养0.4840.234128.837<0.0010.587（0.485~0.689）<0.001
社会支持→价值共创行为0.3860.15137.449<0.0010.114（0.029~0.199）0.009
服务共创素养→价值共创行为0.213（0.143~0.284）<0.001
社会支持→服务共创素养→价值共创行为0.2820.08036.508<0.001总效应：0.239（0.161~0.317）<0.001
间接效应：0.125（0.060~0.189）<0.001
), ArticleFig(id=1241319157761889111, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319150488965744, language=CN, label=表3, caption=

服务共创素养的中介模型检验结果

, figureFileSmall=null, figureFileBig=null, tableContent=
模型路径拟合指标系数显著性
RR2FPβ（95% CI）P
社会支持→服务共创素养0.4840.234128.837<0.0010.587（0.485~0.689）<0.001
社会支持→价值共创行为0.3860.15137.449<0.0010.114（0.029~0.199）0.009
服务共创素养→价值共创行为0.213（0.143~0.284）<0.001
社会支持→服务共创素养→价值共创行为0.2820.08036.508<0.001总效应：0.239（0.161~0.317）<0.001
间接效应：0.125（0.060~0.189）<0.001
), ArticleFig(id=1241319157849969503, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319150488965744, language=EN, label=Table 4, caption=

Results of the Moderated Mediation Model Test

, figureFileSmall=null, figureFileBig=null, tableContent=
模型拟合指标系数显著性
因变量自变量RR2FPβ（95% CI）P
价值共创行为社会支持0.161（0.787~0.243）<0.001
服务共创素养0.5350.28642.021<0.0010.185（0.117~0.254）<0.001
社区归属感0.165（0.104~0.225）<0.001
价值共创素养*社区归属感0.147（0.111~0.183）<0.001
), ArticleFig(id=1241319157959021415, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319150488965744, language=CN, label=表4, caption=

有调节的中介模型检验结果

, figureFileSmall=null, figureFileBig=null, tableContent=
模型拟合指标系数显著性
因变量自变量RR2FPβ（95% CI）P
价值共创行为社会支持0.161（0.787~0.243）<0.001
服务共创素养0.5350.28642.021<0.0010.185（0.117~0.254）<0.001
社区归属感0.165（0.104~0.225）<0.001
价值共创素养*社区归属感0.147（0.111~0.183）<0.001
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社区健康服务中社会支持对老年人价值共创行为的影响：有调节的中介模型
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徐家磊 1 , 李菲 1 , 郭银萍 2
现代预防医学 | 基层卫生服务 2025,52(12): 2217-2222
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现代预防医学 | 基层卫生服务 2025, 52(12): 2217-2222
社区健康服务中社会支持对老年人价值共创行为的影响：有调节的中介模型
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徐家磊1, 李菲1, 郭银萍2
作者信息
  • 1.长治医学院健康管理系，山西 长治 046000
  • 2.内蒙古师范大学国家交流学院

    • 徐家磊（1991—），男，博士，讲师，研究方向：社区健康服务管理

通讯作者:

郭银萍，E-mail：
Impact of social support on the value co-creation behavior of the elderly in community health services: a moderated mediation model
Jia-lei XU1, Fei LI1, Yin-ping GUO2
Affiliations
  • Department of Health Management, Changzhi Medical College, Changzhi, Shanxi 046000,China
出版时间: 2025-06-25 doi: 10.20043/j.cnki.MPM.202412454
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摘要
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目的

探讨社会支持对老年人价值共创行为的影响路径，明确服务共创素养在其中的中介作用，以及社区归属感的调节作用。

方法

采用随机抽样的方法，于2024年9月至11月期间选取长治市社区老年人为研究对象，将424例社区老年人数据纳入分析。采用SPSS 24.0对数据进行统计分析，并利用PROCESS插件bootstrap法对中介及调节效应进行检验。

结果

（1）社会支持对服务价值共创行为的直接效应显著（β＝0.114, 95% CI: 0.029~0.199, P=0.009）；（2）服务共创素养在社会支持与价值共创行为间的部分中介效应显著，效应值为0.125（95% CI: 0.060~0.189, P<0.001），占总效应的52.3%；（3）在服务共创素养对价值共创行为的影响中社区归属具有调节作用（β＝0.147, P<0.001）。

结论

通过构建社区健康服务中的社会支持、培育老年群体服务共创素养以及强化社区归属感机制，能够有效激发老年人参与健康服务的价值共创行为。

社会支持  /  服务共创素养  /  价值共创行为  /  社区归属感
Objective

To explore the pathways through which social support influences value co-creation behaviors in older adults, clarify the mediating role of service co-creation literacy, and examine the moderating effect of sense of community.

Methods

A random sampling method was employed to select elderly individuals from communities in Changzhi City as research subjects from September to November 2024. Data from 424 community-dwelling elderly individuals were included in the analysis. The data were analyzed using SPSS 24.0, and the PROCESS macro with the bootstrap method was utilized to test mediating and moderating effects.

Results

(1) Social support has a significant direct effect on value co-creation behavior (β=0.114, 95% CI: 0.029-0.199, P=0.009); (2) Service co-creation literacy has a significant partial mediating effect between social support and value co-creation behavior, with a mediating effect size of 0.125(95% CI:0.060-0.189,P<0.001), accounting for 52.3% of the total effect; (3) Sense of community has a moderating effect on the impact of service co-creation literacy on value co-creation behavior (β=0.147,P<0.001).

Conclusion

This study reveals that by constructing a mechanism that emphasizes strengthening the social support system within community health services, cultivating service co-creation literacy among the elderly, and enhancing the sense of community, it is possible to effectively stimulate the elderly population’s participation in value co-creation behaviors in health services.

Social support  /  Service co-creation literacy  /  Value Co-creation behavior  /  Sense of community
徐家磊, 李菲, 郭银萍. 社区健康服务中社会支持对老年人价值共创行为的影响：有调节的中介模型. 现代预防医学, 2025 , 52 (12) : 2217 -2222 . DOI: 10.20043/j.cnki.MPM.202412454
Jia-lei XU, Fei LI, Yin-ping GUO. Impact of social support on the value co-creation behavior of the elderly in community health services: a moderated mediation model[J]. Modern Preventive Medicine, 2025 , 52 (12) : 2217 -2222 . DOI: 10.20043/j.cnki.MPM.202412454
正文
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1　引言
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《“十四五”城乡社区服务体系建设规划》明确提出，要加强社区服务设施建设，优化服务质量，推动基本公共服务资源向社区下沉，优先发展社区养老服务，以满足老年人群体的健康需求。这一规划凸显了社区健康服务在老年人健康管理中的关键作用[1]。因此，如何优化社区健康服务的供给体系，充分满足老年人的健康需求，成为提升健康服务整体价值的重要议题。
在这一背景下，价值共创在社区健康服务中的应用尤为重要。通过价值共创，不仅可以提升医疗质量、患者满意度和健康水平，还能有效控制医疗成本，实现服务价值最大化[2-3]。然而，许多老年人在复杂的医疗体系中面临健康服务时面临多重障碍，难以有效参与健康服务[4]。对此，Davey和Grönroos（2019）提出的“服务共创素养”概念，为健康服务中的协作提供了新的视角[5]。该素养强调患者与服务提供者的共同参与，推动患者理解自身健康状况、表达需求、加强互动，并最终提升服务的价值[5-6]。同时，社会支持作为影响健康服务价值共创行为的重要因素，能够显著提升老年人的服务共创素养[6-7]。此外，老年人感受到社区归属感时，更愿意主动表达健康需求、积极参与健康活动，并与服务提供者建立协作关系，从而为健康服务共创营造了积极的心理环境[8-10]。
尽管现有研究对社会支持、服务共创素养与价值共创行为之间的关系进行了初步探讨，但三者之间的内在机制尚未得到充分揭示，尤其是在不同社区归属感水平下的调节作用尚不明确。然而，社区归属感作为一种情感性社会认同，其作用主要体现在个体在已有认知和能力基础上激发实际参与行为的动机[9, 11]。通过强化个体与社区的情感联结，成为推动认知向实践转化的关键激励要素[10, 12]。换言之，归属感在认知转化为行动的过程中发挥作用，而非直接影响资源吸收或素养形成的早期过程。因此，本研究旨在探讨社会支持如何通过服务共创素养影响社区成员参与健康服务价值共创行为，并进一步检验社区归属感在服务共创素养对价值共创行为的影响中的调节作用，为优化社区健康服务供给提供理论依据和实践指导。提出的假设模型如图1所示。
2　研究对象与研究方法
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2.1　研究对象
本研究于2024年9月至11月期间，针对长治市社区老年人群体开展了两轮问卷调查。研究团队与长治市内多个社区合作，通过街道办事处和社区居委会获取老年人登记名单，并结合社区卫生服务中心的档案补充抽样框架。为确保样本的代表性，研究团队采用分层随机抽样方法，根据年龄（60-69岁、70-79岁、80岁及以上）和性别对老年人进行分层，每层按比例随机抽取样本。正式调查前，组织所有调查员进行统一培训，内容包括问卷结构讲解、逐题释义以及应对老年受访者常见问题的方法。调查过程中采用两人一组的形式，一人提问、一人记录，确保访谈流程与数据填写的规范性。问卷回收后，由两名独立成员分别进行数据录入，问卷回收后采用双人独立录入与交叉核查的方式进行数据整理，排除逻辑错误与缺失项，进一步提升数据的准确性与完整性。问卷由课题组成员通过面对面访谈方式进行发放和收集，共回收有效问卷424份。研究对象的纳入标准如下：① 年龄在60岁及以上的社区居民；② 曾有使用社区健康服务的实际经验。本研究获得长治医学院伦理委员会的审批（批号：RT2025003），并获得参与者的知情同意。
2.2　变量选取
本研究采用多种调查与测量工具以全面分析研究变量。一般情况调查表收集了受访者的基本信息，包括社区健康服务类型、疾病类型、患病年限、性别、学历、年龄、婚姻状况和家庭收入等。
社会支持问卷基于文献分析[7, 13]设计，包含18个条目，分为工具性支持、情感支持、信息支持和同伴支持四个维度。在本研究中，该量表的Cronbach α系数为0.915。
服务共创素养量表由Pham等人[6]参考Mende等人[14]的医疗服务素养量表修订而成，用于测量老年人在健康服务中的服务共创能力。示例条目包括“我熟悉社区的健康服务程序”，“我能轻松理解社区健康服务过程中的说明”等。该量表的Cronbach α系数为0.867。
价值共创行为量表由Russo等人[15]编制，并结合Yi和Gong等人的研究[16]进行了修订，适用于健康服务情境，分为患者健康参与行为（包括信息获取、信息分享、责任行为和个人互动）和患者市民行动（包括反馈、倡导、帮助和宽容）两部分。该量表的Cronbach α系数为0.931。
社区归属感量表则根据杜宗斌与苏勤[17]的研究设计，包括“我在本社区感到舒适愉快”，“如果搬离社区我会感到很留恋”等五个题项。该量表的Cronbach α系数为0.869。
一般情况调查表以外，其它量表均采用Likert 7级评分法，从“完全不正确”到“完全正确”计1～7分。这些工具共同构成了本研究测量体系，为研究的科学性和数据可靠性提供了支持。
2.3　统计学方法
本研究使用SPSS 24.0统计软件进行数据分析，首先对数据进行了正态分布检验。统计描述采用均值分析，并通过独立样本t检验和单因素方差分析探讨组间差异。相关性分析采用Pearson方法，进一步揭示变量间的关系。此外，借助Hayes[18]提出的Process模型4和14，对中介效应及调节型中介效应进行了深入检验，以验证研究假设并揭示变量间的复杂交互机制。
3　研究结果
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3.1　共同方法偏差分析
本研究采用Harman单因子检验对共同方法偏差进行检测。共提取出11个特征值大于1的因子，这些因子累计解释了总方差的70.505%。其中，第一个因子的方差解释率为23.535%，未超过总方差解释率的50%。因此，研究数据中不存在显著的共同方法偏差问题。
3.2　健康共创行为在人口学特征上的差异
在424名社区老年人健康共创行为中，性别、年龄、教育水平、婚姻、是否患有慢性病、社区健康服务类型、居住地址具有统计学意义（P<0.05）。然而，居住情况未表现出显著性差异，无统计学意义（P=0.967）。详见表1。
3.3　相关性分析
对社会支持、服务共创素养、健康价值共创行为进行Pearson相关性分析，三者得分之间互相正相关，为假设提供了初步的证据（见表2）。
3.4　服务共创素养的中介作用
以性别、年龄、教育水平、婚姻、是否患有慢性病、社区健康服务的类型、居住类型作为控制变量，以社会支持为自变量、服务共创素养作为中介变量、价值共创行为作为因变量构建中介模型。通过PROCESS model 4进行检验，社会支持对服务共创素养和价值共创行为的总效应的标准化回归系数为0.282，对应的决定系数R2为0.080，表明社会支持能解释价值共创行为变异的8%。这一效应的F值为36.508，且P值小于0.001，说明统计结果显著。各变量间的关系结果表明，社会支持对共创价值行为预测作用显著（β＝0.114，95% CI：0.029~0.199，P=0.009）。加入中介变量后，社会支持对服务共创素养预测作用显著（β＝0.587，95% CI：0.485~0.0689，P <0.001）。服务共创素养对价值共创行为预测作用显著（β＝0.213，95% CI：0.143~0.284，P <0.001）。此外，社会支持不仅对价值共创行为具有直接效应（β＝0.114，95% CI：0.029~0.199，P =0.009），还通过服务共创素养产生显著的间接效应（β＝0.125，95% CI：0.060~0.189，P <0.001），这表明服务共创素养起部分中介作用（见表3）。
在上述媒介效果模型的基础上，加入社区归属感作为调节变量构建调节中介模型，以探讨其在服务共创素养与价值共创行为之间的调节作用。将社区归属感放入模型后，采用 PROCESS model 14进行检验。结果表明服务共创素养与社会归属感的交乘项对价值共创行为具有显著的预测作用（β＝0.147，95% CI：0.111~0.183，P<0.001），验证了社区归属感在服务共创素养和价值共创行为间正向的调节作用（见表4）。
斜率分析表明（图2），社会归属感低时，社会支持对价值共创行为具有正向预测作用；社会归属感较高时，社会支持对价值共创行为具有正向预测作用更大，这表明随着社会归属感的提高，社会支持对价值共创行为的预测作用逐渐增大。
4　讨论
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4.1　服务共创素养的中介作用
研究结果表明，服务共创素养在社会支持与价值共创行为之间起到部分中介作用。基于服务主导逻辑（Service-Dominant Logic, SDL）的理论视角，社区居民不仅是健康服务价值的受益者，更是价值创造的核心主体[9-10]。社会支持通过提供情感慰藉、信息资源及工具性帮助，显著降低了老年人参与健康服务的心理与实际成本，增强了其对服务流程的理解与协作能力[6, 9, 19]。这种支持不仅提升了老年人的自我效能感与控制感，还通过扩充信息资源减少了服务不确定性，从而间接促进了服务共创素养的提升，并最终推动了价值共创行为的发生。这一发现揭示了社会支持通过赋能个体能力建设进而影响价值共创行为的内在机制。
4.2　社区归属感的调节作用
本研究发现，社区归属感在服务共创素养与价值共创行为之间起到显著的调节作用。服务共创素养作为个体在健康服务中获取、整合与应用资源的能力，是驱动价值共创行为的重要前提[6]。然而，这种能力的有效转化往往依赖于具体情境中的心理资源支持[20]。社区归属感作为一种关键的心理资源，通过提供情感支持与社会认同感，显著增强了老年人在健康服务互动中的信心与动力[10]。具体而言，社区归属感不仅强化了个体对社区的信任与合作意愿，还通过营造积极的心理环境，提升了其在健康服务中的参与深度与广度[9]。当个体感受到与社区成员之间的紧密联系时，更倾向于在健康服务互动中表现出积极的共创行为。这一结果凸显了社区归属感在健康服务价值共创中的重要作用，为优化社区健康服务设计提供了理论依据。
4.3　总结
基于研究结论，提出以下政策建议：（1）制度层：强化社区健康服务中的社会支持体系。政府和社区应积极推动与健康服务相关的政策，通过培训专业健康服务人员、志愿者等，为老年人提供社会支持。（2）组织层：社区健康服务中心应定期组织培训或活动。举办健康教育讲座，模拟互动服务场景，或设立老年人互助小组，增强其健康服务的知识、技能和协作能力。（3）文化层：深化社区共同体建设，组织健康社区联谊活动、成立健康服务兴趣小组等，以提升老年人对社区的信任感和归属感。
本研究仍存在一定局限性：首先，研究对象主要集中于特定社区的老年群体，样本的地域覆盖范围有限，可能影响研究结论的普适性；其次，对心理资本、自我效能感等潜在心理资源的作用机制尚未充分探讨。未来研究可从以下方面展开：一是扩大样本范围，开展跨区域、跨文化的比较研究，验证研究结论的广泛适用性；二是深入探索心理资源与外部支持的协同作用机制，为制定更加精细化、个性化的健康服务干预策略提供理论支撑。
基金
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  • 2024年山西省高等学校哲学社会科学研究项目(2024W101)
  • 长治医学院2024年博士科研启动基金项目(2024BS09)
文献
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2025年第52卷第12期
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doi: 10.20043/j.cnki.MPM.202412454
  • 接收时间：2024-12-25
  • 首发时间：2026-03-19
  • 出版时间：2025-06-25
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  • 收稿日期：2024-12-25
基金
2024年山西省高等学校哲学社会科学研究项目(2024W101)
长治医学院2024年博士科研启动基金项目(2024BS09)
作者信息
    1.长治医学院健康管理系，山西 长治 046000
    2.内蒙古师范大学国家交流学院

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郭银萍，E-mail：
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