Literature-derived criteria and expert-perceived influence structure for age-friendly living environments among older adults living with HIV in China: a text-mining, fuzzy Delphi, and fuzzy DEMATEL study.

Authors

Quan Wen, Jing Zhang, Mazran Ismail, Muhammad Hafeez Abdul Nasir, Yanting Wu

Published in

Frontiers in public health. Volume 14. Pages 1873646. Epub Sep 22, 2026.

Abstract

Older adults living with HIV (OALHIV) may experience the demands of long-term HIV care together with frailty, stigma, privacy concerns, and barriers in their residential environment. This study developed an exploratory set of age-friendly living-environment criteria and examined how experts perceived influence among the resulting domains. It did not test epidemiological causality or measure regional service performance.
An English-language Web of Science corpus covering 2003-2023 was processed with term co-occurrence mapping and clustering. Fuzzy Delphi method (FDM) ratings from 28 experts were used to screen candidate criteria, followed by domain-level fuzzy decision-making trial and evaluation laboratory (FDEMATEL). Sensitivity analyses examined the FDM cutoff and fuzzy-attitude parameter, and FDEMATEL was calculated using the standard zero-diagonal convention.
The workflow included 1,487 records, 89 cleaned terms, 43 second-round candidates, and 22 retained criteria in five domains. The second-round mean FDM threshold was 0.4729. The same 22 criteria were retained for fixed thresholds from 0.453 to 0.478, for recalculated fuzzy-attitude parameters from 0.40 to 0.60, and under leave-one-criterion-out recalculation. In the zero-diagonal FDEMATEL analysis, healthcare accessibility (D-R = 0.320), social support network (0.683), and digital inclusion and assistive technology (0.866) occupied net-influencing positions; built-environment adaptation (-1.170) and psychological wellbeing and destigmatization (-0.699) occupied net-influenced positions. The sign classification matched the originally reported calculation, although magnitudes changed.
The framework is hypothesis-generating and reflects literature-derived concepts and expert judgement, not demonstrated causal effects or the directly reported priorities of OALHIV. Patient and community co-design, field measurement, and external validation are required before the criteria can guide resource allocation.

PMID:
42840041
Bibliographic data and abstract were imported from PubMed on 07 Oct 2026.

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