Psychological factors affecting home modification decision-making among older adults in low-income communities

Home modifications (HMs) are essential to enable aging-in-place for older adults; however, the adoption rate of HMs remains low. The decision-making processes influencing HM adoption among older adults are not fully understood, particularly the role of psychological factors across different cognitive stages.

This cross-sectional study aimed to assess the impact of psychological factors across three phases of the decision-making process: pre-HM, on-HM, and post-HM. Employing an optimised consumer decision-making model, the study involved three groups of older adults (N = 167) in Shanghai to evaluate the influence of psychological factors on three main decision-making behaviours (application, implementation, and recommendation or re-HMs).

The results showed that the decision-making flow about HMs included three components: input stimuli, decision-making process, and influencing factors. The motivation for HMs arose from the input stimuli, which resulted from the interaction between personal capabilities and the home environment. The decision-making behaviours of older adults during the HM process were influenced by psychological factors. In the pre-HM phase, barriers to applying HMs included the perceptual bias of needs, underestimation of environmental risks, and doubts about the effectiveness and affordability of HMs. During the on-HM phase, older adults experienced a loss of the meaning of home, reduced self-efficacy, and a diminished sense of control, which hindered their decision to proceed with implementation. In the post-HM phase, satisfaction and perceived usefulness promoted positive attitudes towards HMs, encouraging recommendations for others to adopt HMs.

This study contributes to understanding the psychological barriers and facilitators that affect older adults’ progression through the HM decision-making process. The findings provide valuable insights for policymakers and service providers to develop targeted interventions that address specific issues at each decision-making stage. To assist older adults in their decision-making process, it is recommended to implement educational programs, encourage user engagement, and conduct outcome evaluations.