Generation Mechanism and Optimization Path of Nurses’ Willingness to Participate in China’s “Internet+Nursing Service” Model: A Cross-National Comparative Study Based on Multicenter Data

Abstract

Background: Under the dual pressures of a global aging population and rising burden of chronic diseases, digital healthcare services have emerged as a core strategy for healthcare system transformation. Developed countries have established three paradigms: technology-driven transformation, institutional innovation, and payment incentive breakthroughs to shift nursing services from an “institution-centered” model to a “network ecosystem.” China faces more severe challenges: By 2021, the population aged 60 and above reached 264 million, with 44 million elderly individuals with partial or total functional impairments. However, the nurse-to-population ratio remains low at 3.18 per 1,000 people, exacerbating supply-demand imbalances. In response, China has piloted “Internet Plus Nursing Services”, connecting nurses and patients through an “online application, offline service” model to optimize resource allocation and meet home-based nursing needs. Aim: This study used Boolean operators to systematically search the literature in five databases. Based on the literature base, the authors conducted a survey of nurses in a tertiary hospital in Guangzhou City on their intention to participate in Internet home nursing care, and further comprehensively analyzed the influencing mechanisms of the nurses’ willingness to participate in home nursing care services in the typical countries and China in the past five years. Results: Findings indicate that Chinese nurses’ willingness to participate is influenced by factors such as professional title, education, income, marital status, and service perception. However, domestic studies suffer from methodological limitations, including imperfect measurement tools, small sample sizes, and insufficient regional representation, with most research focusing on general nurse populations rather than region-specific groups. Conclusion: As direct implementers of “Internet Plus Nursing Services”, nurses’ participation willingness and behavior are critical to service quality and industry development. Future research should develop multidimensional measurement tools, expand cross-regional sample sizes, and explore influencing factors in context-specific ways to provide scientific evidence for policymaking and standardized development. At the policy level, China must balance “innovation encouragement” and “regulated development”, reduce regional disparities in rules, and promote a transition toward a data-driven nursing ecosystem.