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.

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.

(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).

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.