Influencing Factors of Integrated Care-Based "Unaccompanied Care" Services Based on Social Ecosystem Theory: A Qualitative Study

Objective Guided by the social ecosystem theory, this study aims to explore the facilitators and barriers to the implementation of "unaccompanied care" services from the perspectives of key stakeholders, including service recipients, implementers, and administrators. The findings are expected to provide an evidence-based foundation for informing professional care management. Methods Employing a purposive sampling strategy guided by the principle of maximum variation, a total of 36 participants were recruited for this study. The sample comprised 21 hospitalized patients and their caregivers, as well as 15 healthcare professionals, including administrators, clinicians, and nurses, in addition to managers and caregivers from companion care companies. Results Data were collected through semi-structured interviews conducted from November 2024 to January 2025. Thematic analysis was performed using the seven-step method described by Colaizzi. Analysis revealed five main themes and twelve subthemes: Individual Level (Insufficient Service Awareness, Economic Constraints, and Dual Service Requirements); Interpersonal Level (Effective Family Support and Professional Support); Organizational Level (Opportunities for Hospital Development, Multi-Department Coordination and Collaboration); Social Environment Level(Constraints of Traditional Concepts and Increasing Demands of an Aging Population); Public Policy Level(Strengthen Publicity and Promotion Efforts, Phased Pilot Exploration Approach, and Medical Insurance System Protection). Conclusion The promotion of "unaccompanied care" services is confronted with multidimensional challenges, encompassing economic pressures, deeply entrenched traditional perceptions, and limitations within medical insurance policies. Therefore, we recommend a multi-pronged approach: (1) enhancing public awareness campaigns targeting both policy specifics and cultural barriers; (2) coordinating the development of infrastructure ("hardware") with service quality and workforce training ("software"), while simultaneously promoting cultural adaptation strategies; and (3) formulating supportive policies to facilitate the high-quality development of "unaccompanied care" services.