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.

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.