Beyond technical access in digital eldercare: how ethical lag shapes stratified responsiveness to institutional welfare in rural China

Digital elder care services have been widely promoted to address population ageing, yet their uptake among rural older adults remains limited even when access and affordability are ensured. Existing studies largely attribute this gap to digital literacy or technical barriers, while insufficient attention has been paid to the moral and ethical meanings through which older adults interpret institutional care.

This study adopted a mixed-methods design in Shapingba District, Chongqing, China. Quantitative data were collected from 400 rural older adults aged 60 and above and analysed using structural equation modelling. In-depth semi-structured interviews with 15 outliers from the quantitative phase were conducted to explore moral reasoning, care expectations, and lived experiences with digital services.

Quantitative results showed that Care Acceptability was the most consistent direct predictor of behavioral intention. By contrast, Privacy and Data Protection and Dignity in Care exerted weaker direct effects and were more likely to influence behavioral intention indirectly through perceived ease of use and perceived usefulness. Qualitative findings further identified three response patterns: adaptive translation, ethical dissonance, and translation failure. These patterns reflect an ethical lag, whereby localized care expectations adapt more slowly than technological reforms, leading to stratified engagement among rural older adults.

The findings suggest that limited uptake of digital elder care is closely tied to moral legitimacy and ethical recognition. Digital care services are more likely to be accepted when perceived as a supportive extension of, rather than a replacement for, family care responsibilities. Addressing ethical lag through culturally resonant service design and trusted community mediation may help reduce inequalities in engagement and improve the effectiveness of ageing-related service provision.