Ying Xin
Jianzeng An
Jia Xu- School of History, Anhui Normal University, Wuhu, China
Introduction: China has limited formal care services and weak unpaid informal care support for older people, which has caused a care service shortage for them. Voluntary community care services are thus a type of formal care service that aims to meet older people's unmet care needs. However, the continuity of such voluntary community care services is important for the degree to which these unmet care needs of older people can be satisfied. Therefore, this study examines what motivates volunteers to provide voluntary community care services for older people in China. It argues that providing continuous voluntary community care services can be motivated by the interaction of volunteers' internal and external motivations.
Methods: This study employs the grounded theory approach, including open coding, axial coding, selective coding, and saturation testing, and derives the data from 15 semi-structured interviews with volunteers from September to December 2021 in Wuhu, China.
Results: The analysis identifies three internal motivations (altruism, social interaction, and self-fulfillment) and three external motivations (social support, standardized management, and relevant benefits) as well as the interaction between them as factors that impact volunteers' willingness to offer continuous voluntary community care services for older people.
Discussion: The study's findings highlight the impact of continuous volunteering on society, which is significant to provide voluntary community care services for older people. It thus contributes to the development of China's care policy and future care supply services as well as serves as a reference for care development models in other welfare states, particularly in places where both formal and informal care are underdeveloped such as China.
1. Introduction
Older people (e.g., those aged over 65 years old) often have an increased need for care services because of their higher frequency of healthcare problems. Most welfare states support formal care services or provide public funding for both homecare and residential care (1). The welfare state's co-funding of such formal care costs usually differs depending on recipients' care needs and the form of care provision in question (2). In addition, the welfare state encourages the development of informal care- which is a type of care that provided by family members to meet older people's unmet care needs- such as the provision of a supporting care allowance for family caregivers (2–4). However, older people in China still have high levels of unmet care needs (4) owing to the lack of informal care resources and insufficient formal care from both institutional and residential care (5). Furthermore, the relatively low level of assistance provided by China's care policy makes care services too expensive for older people to cover by themselves, despite the proportion paid by the state (6, 7).
Against this background, China has developed voluntary community care services to meet older people's unmet care needs (8). Voluntary community care services, a type of formal care service that aims to meet older people's unmet care needs, are organized by the community and financially supported by the municipality. Volunteer organizations are responsible for training volunteers to provide care to older people in the community and supported by municipalities through policy guidance and financial support (9). However, the quality and quantity of voluntary community care services are related not only to the actual realization of a higher quality of life for older people (10) but also to the feasibility of providing this type of care continuously (11). For example, providing voluntary community care services intermittently limits their ability to meet unmet care needs (8). While voluntary community care services can be organized and provided to older people continuously in several communities in China (12), the effectiveness and continuity of providing voluntary community care services are relatively poor in others (8).
Therefore, it is important to analyze what motivates volunteers to provide voluntary community care services and generalize the motivations that impact their willingness to do so. On the one hand, research has shown that internal motivations inspire voluntary activities. For example, the social value created by providing voluntary community care services for older people encourages volunteers to actively participate and enhances the continuity of their service provision (11, 12). Planalp and Trost (13) used the Volunteer Functions Inventory to review the motives of 351 US volunteers and showed that their internal motivations to participate in hospice care volunteering included helping others, improving themselves and their social relationships, and pursuing career goals; of these, helping others was the most important internal motivation. Voluntary services also depend on self-interest motivation (14). On the other hand, the provision of voluntary community care services for older people is directly affected by external factors such as the society and culture (15). For example, charitable contributions and volunteer participation are high in individualistic cultures (16). Previous research presents evidence that social morality and ethical norms form positive motivations behind voluntary behavior (17). Individuals who fully internalize social morality are more willing to help people outside their groups.
It is also interesting to explore what motivates volunteers to provide voluntary community care services continuously. Previous research has explained volunteer participation and retention based on the relationship between motivations and behavioral return [i.e., the satisfaction of motivations; (18)]. If an important motivation is satisfied through volunteering, it is easier for volunteers to continue their activity (19), increase their self-esteem (20), and have a strong incentive to understand older people (21). The more volunteers identify with their role and the more they have high autonomous motivation, the more they are likely to continue volunteering for longer (21, 22). Moreover, the relationship between volunteers and their environment (23), including family support and social interactions during volunteering, impacts the continuity of their voluntary behavior (24, 25). In addition, the social networks that volunteers build during volunteering affect the continuity of the provision of their volunteer services (26, 27). The relationship between volunteers and volunteer organizations thus has an important impact on shaping the continuity of volunteers' behavior (28). The closer volunteers' preferences fit with the incentives provided by volunteer organizations, the higher is their contribution in terms of time and participation (29). Volunteer organizations therefore enable volunteers to both provide volunteer services and realize their value preferences (30).
Rapid demographic aging poses a major challenge to China's health and care systems, as individuals over 65 years account for 13.5% of the country's population (31). However, the Chinese government has not yet developed a comprehensive LTC policy at the national level. The infrastructure of both formal care and residential care facilities remains poorly developed and the service provision differs considerably between rural and urban areas (4). Hence, despite some governmental efforts, a considerable mismatch between the provision of LTC services and demand for such services from older people is presented in practice (32). Therefore, most care-dependent older people still rely on informal care (33). However, family members' abilities to provide care is declining, as it is becoming more difficult for such caregivers (who are usually women) to reconcile their multiple care responsibilities with their work obligations (1, 3). Consequently, the Chinese government is restructuring its LTC system and extending formal care services to address older peoples' rising demand for care and the increasing pressure on families to provide such care; however, it mainly targets older people with limitations to their activities of daily living (34). Furthermore, approximately 50 Chinese cities have run pilot projects to test different LTC policy designs (4, 35).
However, experiences with the current Chinese LTC system and pilot projects have revealed challenges to developing a new LTC policy, particularly the challenge of insufficiently developed formal care provision, declining potential for family members to offer care, and insufficient public support for family caregivers (3, 36). Hence, a gap remains between care services for older people and their unmet care needs. Against this background, the provision of voluntary community care services could bridge this gap to some extent because governments globally are increasingly looking to the voluntary sector as potential welfare providers. According to Zhang and Tian (12), the number of registered volunteers in China reached 217 million by the end of 2021, representing around 1,500 registered volunteers per 10,000 people on average. China's voluntary community care services have also been found to have played an important role in supporting care for older people (12).
It is clear from previous literature that internal and external motivations impact volunteers' capacity to provide voluntary community care services continuously. This study examines what motivates volunteers to provide continuous voluntary community care services for older people in China and whether the interaction between internal and external motivations impacts such voluntary behavior. This study focuses on the provision of voluntary community care services in Wuhu, Anhui province, where volunteering services are roughly equivalent to the national average (12, 37). The Wuhu local government has organized volunteering training courses for volunteers that focus on care services and pandemic governance each year since 2013 (37). Further, it financially supports volunteer organizations that provide voluntary community care services (37).
2. Materials and methods
2.1. Materials
This study employed semi-structured face-to-face in-depth interviews with 15 volunteers, conducted from September to December 2021. Each of the in-person interviews lasted between 40 and 90 min. The semi-structured interviews used a prepared topic guide as a starting point, which included prompts and open-ended questions. They covered two main topics: (i) the factors that drove volunteers' continued provision of voluntary community care services for older people and (ii) the degree to which internal and external motivations encouraged them to provide care services. Two open-ended questions were included based on the volunteers' planned provision of voluntary community care services for older people in the next 5 years and the extent to which they expected to encourage family members and relatives to provide voluntary community care services. The interviews were concluded when the volunteers began to add no new information.
All the interviews were recorded and later transcribed. Informed consent (both written and verbal) was obtained before the interviews and the confidentiality and anonymity of the participants during the data analysis were ensured. Ethical approval was obtained from Anhui Normal University and this study was conducted in accordance with the ethical principles regarding human experimentation in the Declaration of Helsinki.
All the volunteers were interviewed individually in the meeting room of a community center. After each interview, three authors first sorted the interview records to avoid information loss, refined and summarized the recorded content, and formed concepts that described the motivations of the volunteers to provide voluntary community care services for older people. The transcripts were initially segmented by three authors. Coding was conducted by discussion of each participants response among all three authors; in rare cases when two authors disagreed, the third author acted as arbiter. Through this process, authors selected codes for the analysis of the research question. After assigning codes, all authors participated in the process of placing codes into sub- and superordinate categories. The consistency of the coding by these authors was high and the selected codes and coding results were rechecked by two authors again to avoid bias. Hence, the coding had high reliability. The different motivations that encouraged volunteers to provide voluntary community care services were further discussed by all three of the authors during meetings.
The datasets generated and analyzed during the current study are not publicly available. The anonymized data can be obtained only with the approval of all three authors at the same time as well as the approval of the local government, which provided partial financial support for the current study. Further, Anhui Normal University, which also provided partial financial support for the current study, must provide its approval.
2.2. Methods
2.2.1. Participants
The empirical analysis in this study is based on our interviews with 15 volunteers from Wuhu City, Anhui province in China, where the population size and age is considered to be moderate (9). Furthermore, Wuhu City's socioeconomic development is also average compared with other Chinese cities (38). The 15 interviewees were selected from six communities (see Table A1) based on the following inclusion criteria: (i) continuously participate in community volunteering, (ii) have joined at least one volunteer organization, and (iii) have at least 1 year of uninterrupted experience in providing voluntary community care services to older people. Participants were recruited by sending invitations and application forms to both voluntary organizations and communities. We then checked all applications and selected the participants based on our inclusion criteria. Finally, we sent the decision letter to potential participants. Any of the participants could have withdrawn from the study at any time for any reason.
2.2.2. Grounded theory and coding procedure
This study adopted grounded theory (a qualitative approach) to extrapolate the interview data (39). Grounded theory is a relatively scientific and effective method of analyzing data in qualitative research (39–42). The central idea when collecting interview data is the induction and summary of the original data material to reflect the core concepts of a social phenomenon (39). Through repeated data comparisons and coding analysis of the relationship between the concept and data thinking, comparison, analysis, classification, conceptualization, and category, a practical theoretical framework is built (43, 44). Grounded theory does not need a priori conclusions and assumptions based on empirical data to establish a concept (45) and mainly adopts qualitative analysis methods (46, 47). Its main advantage is its ability to compare and analyze interview data in order to propose categories, which has gained this method a good reputation for qualitative data analysis in many research fields (48, 49).
Coding is the most important way to implement grounded theory. The coding procedure has three categories, namely, open coding, axial coding, and selective coding, and saturation testing is used to analyze observational interview data (47). All the codes are derived from the repeated reading of the original data word by word. In this study, all the authors extracted codes in the form of concepts and constantly modified them. Furthermore, a theoretical saturation test is needed after the coding procedure to test the credibility and validation of the interview data (39). Although the number of volunteers used in the saturation test is unlimited in grounded theory (50, 51), the coding results are saturated when interview data are added into the coding model that do not contribute a new concept or conclusion (52, 53). Therefore, only 12 of our 15 volunteers (A01, A02, A03, A04, A05, A07, A08, A09, A10, A12, A13, and A15) were randomly selected for the coding analysis, while the remaining three (A06, A11, and A14) were used as samples for the theoretical saturation test.
3. Results
3.1. Open coding
Open coding is the first-level coding when conducting grounded theory research (54). In this step, through the repeated reading of the original data word by word, concepts are extracted in the form of codes and constantly modified. This is because the purpose of coding is to further discover the class, and this needs the constant summarization and abstraction of codes to form concepts.
The authors first analyzed the original data and summarized the conditions and influencing factors affecting volunteers' provision of voluntary community care services for older people into the following 17 concepts: sympathy, empathy, social responsibility, relationship construction, group belonging, value realization, beyond self, organizational support, community support, family support, public support, government support, standardized management, industry standards, spiritual benefits, self-development benefits, and material benefits. Table 1 shows the 48 typical representations representing these 17 concepts and explains the connotations of the concepts.
Table 1. List of open coding results.
3.2. Axial coding
The aim of the axial coding stage in this study was to overcome the drawbacks of the open coding stage owing to the unclear relationships found among the 17 concepts. Hence, to further understand the correlations among the 17 concepts, we needed to analyze the logic behind the provision of voluntary community care services for older people. Further axial coding (also known as associated coding) of the open coding results was also required. Therefore, the 17 concepts extracted from the open coding were classified into two main categories and six subcategories, as shown in Table 2.
Table 2. Axial coding results.
3.3. Selective coding
The aim of the selective coding stage in this study was to systematically mine the logical correlations and summarize the typical relationships among these categories (55), as shown in Table 3. We surmised that the continuous provision of voluntary community care services for older people occurs owing to both internal and external motivations. For example, volunteer A01 (September 8, 2021) volunteered because she is activated by both “altruism” and “self-fulfillment” (internal motivations) as well as “social support” (external motivation). Moreover, we found that these internal and external motivations do not need to be possessed at the same time. However, at least one motivation from both groups must be present for continuous voluntary participation to occur. This suggests that the interaction between internal and external motivations has a great impact on stimulating volunteers' continuous provision of voluntary community care services. We thus used saturation testing to verify the credibility of this finding.
Table 3. Selective coding results.
3.4. Saturation testing
As noted above, we randomly selected three volunteers (A06, A11, and A14) for the saturation testing (volunteer A06: September 8, 2021; volunteer A11: September 7, 2021; volunteer A14: November 15, 2021). The test results conformed to the typical relationship structure without finding new concepts/categories or new connections among the categories, which confirmed that the open coding, axial coding, and selective coding had reached saturation and that the interaction between the internal and external motivations was credible (see Table A2). The decision-making of rational individuals is often related to their values and the external conditions (56). Hence, this study argues that the continuous provision of voluntary community care services for older people depends not only on volunteers' inner value judgment of volunteering activities but also on the institutional rules, social support, and other external conditions.
4. Discussion
According to our coding analysis, we found six motivations (three each for internal and external motivations) that affect the provision of voluntary community care services for older people and its duration. These six motivations also explain the interaction between internal and external motivations and its impact on the continuity of providing voluntary community care services for older people.
4.1. Internal motivations and the continuity of providing voluntary community care services for older people
This study argues that voluntary action is driven by three internal motivations: altruism, social interaction, and self-fulfillment. First, altruism stands opposite to egoism, as it involves voluntarily helping others (57). Altruistic behavior does not have spiritual or material benefits as its primary purpose. It occurs when people know that providing their materials, time, and energy will not guarantee them any return. Actions taken based on altruism uphold moral logic—whether to act is decided according to ethical principles such as compassion, humanity, love, and justice, while material benefits and costs are ignored (58). Hence, voluntary behavior does not pursue self-interest, does not act on market principles, and has a natural correlation with altruistic motivation (volunteer A10: September 8, 2021). For example, volunteers help others voluntarily and expect no return, and society needs such people to provide voluntary community care services for older people in China (volunteer A08: September 8, 2021). The fact that such volunteers are willing to contribute their time and energy, rather than pursue direct returns, reflects their sense of social responsibility and community cohesiveness. Even without external rewards and motivations, people will take the initiative to help when they see a need for their services (volunteer A08: September 8, 2021). In conclusion, altruism prompts volunteers to help older people in need.
The second important motivation for volunteers' continuous provision of voluntary community care services for older people is social interaction. Individuals may feel lonely and scared without a social network. Volunteers find their lives to be more meaningful and interesting when volunteering, for example by making friends that have the same values (volunteer A02: September 8, 2021). Therefore, integrating into the community, entering society, and building social networks have become important for individuals deciding to provide voluntary community care services continuously. People want to build relationships and play a role in a team in order to avoid loneliness as well as gain social recognition, membership, and group affiliation (volunteer A11: September 7, 2021). Volunteers can communicate with the older people they assist, exchange information, develop communication skills, share experiences with other volunteers, build friendships with people who share their interests and values, expand their social networks, and reduce the sense of social alienation (volunteer A02: September 8, 2021).
Moreover, volunteer organizations, as a community network, provide volunteers with a sense of group ownership; volunteers who support each other and cooperate in the service process then also cultivate a sense of group ownership (volunteer A12: September 7, 2021). By serving the same volunteer organization, volunteers can deeply understand the close connection between their personal development and society, which enhances their sense of social belonging. Thus, the voluntary community care services provided by volunteers from volunteer organizations can help build their social belonging in the form of both tangible social belonging such as the circle of volunteers and volunteer organizations (volunteer A02: September 8, 2021) and the invisible social belonging existing in the form of ideas such as shared volunteerism and common altruistic values (volunteer A02: September 8, 2021). These two types of social belonging increase the frequency and depth of interpersonal communication at different levels, which can also enhance the trust, assistance, and reciprocity among volunteers (volunteer A08: September 8, 2021). It also increases the tendency for volunteers to take common actions such as providing continuous voluntary community care services for older people.
Finally, many volunteers are also motivated by their need for self-fulfillment, which is the third internal motivation. Self-fulfillment, the highest psychological need, occurs only when the needs pertaining to physiology, safety, belonging and love, and self-esteem are fulfilled (59). Self-implementers tend to pursue the values of truth, charity, and vitality rather than economic factors (60). The need for self-fulfillment motivates volunteers, in particular retiree volunteers, to start and continue to provide voluntary community care services. Further, their continuous willingness to volunteer strengthens as their satisfaction of self-fulfillment increases (volunteer A05: September 7, 2021). For example, retirees join volunteer organizations and provide voluntary community care services to older people with care needs because they want to show that they are still dynamic and useful to society (volunteer A03: September 7, 2021). Providing help to older people with care needs in their spare time for free indicates their social efficiency, demonstrates their social value, and confirms their feelings of being needed (volunteer A01: September 8, 2021).
4.2. External motivations and the continuity of providing voluntary community care services for older people
The continuity of volunteering behavior is also affected by three external motivations, namely, social support, standardized management, and relevant benefits. First, this study argues that social support, including voluntary organizations' support, community support, family support, government support, and public support, is an important external motivation for promoting continuity in the provision of voluntary community care services for older people. In detail, volunteer organizations support this provision by promoting volunteering and filial piety, activating the altruistic motivation of volunteers, training multiple volunteers to achieve the service goals set by those organizations, laying the resource foundation for the service, designing service plans, and implementing effective management techniques (e.g., volunteer A13: September 7, 2021; volunteer A08: September 8, 2021). When these organizations' work raises volunteers' satisfaction and enjoyment, volunteers are happy to continue to provide voluntary community care services (volunteer A08: September 8, 2021; volunteer A04: September 8, 2021). Support from the community also promotes their provision of voluntary community care services, with many volunteers even recommended by community committees. The community helps design volunteers' service projects and offers partial financial support for their involvement (volunteer A15: September 8, 2021). In addition, family support for volunteers is important to promote the provision of voluntary community care services for older people, especially when family members are also willing to provide such support, as this is when the continuity of voluntary actions greatly increases. Moreover, government support is important for volunteers to provide voluntary community care services (volunteer A14: November 15, 2021). The government is one of the main financial resources for voluntary community care services projects for older people. For example, the Chinese government has recently provided a reward for volunteers named as “good citizens” for the important work they perform. Two of our volunteers mentioned that the spirit of voluntary action is derived from government recognition and support (volunteer A12: September 7, 2021; volunteer A05: September 7, 2021). In addition, public support is significant since it offers public financial donations toward the provision of voluntary community care services for older people. More than half of our volunteers asserted that volunteer organizations and their services would be unsustainable without charitable donations (volunteer A09: September 8, 2021).
Second, standardized management is another necessary external motivation that motivates volunteers to provide voluntary community care services. Volunteers join volunteer organizations and actively provide voluntary community care services for older people because they trust these organizations (volunteer A04: September 8, 2021) owing to their standardized management and regulated principles. These volunteer organizations are, in principle, formal organizations with structured systems and clear rules in place, which attract volunteers' trust and sense of belonging. The volunteer organizations to which most of our interviewees belonged have strict personnel management systems, clear project management systems, relatively strong financial management systems, clear service quality assessment criteria, performance evaluation standards, and motivational systems to encourage volunteers with clear goals (volunteer A07: November 15, 2021). Besides, many volunteers in the same volunteer organization are friends, neighbors, colleagues, and even family members, which makes it easy for them to develop trust and feel happy when they cooperate (volunteer A02: September 8, 2021; volunteer A07: November 15, 2021). Municipality and community committees' issuance of administrative regulations on volunteer organizations' services and assessment criteria as well as the social rights of volunteers also enhance the standardization of the management practices of volunteer organizations (volunteer A07: November 15, 2021). Volunteers experience a decreased sense of service anxiety and concern about unforeseen circumstances under clear management regulation, while their enthusiasm for providing care services for older people increases (volunteer A08: September 8, 2021; volunteer A12: September 7, 2021). Therefore, standardized management is an external motivation that contributes to the continuous provision of voluntary community care services for older people.
Third, volunteers obtain relevant benefits when providing voluntary community care services for older people, including spiritual benefits, self-development benefits, and material benefits. First, for spiritual benefits, volunteers might feel valuable by offering care services, which increases their self-evaluation and confidence (volunteer A05: September 7, 2021). Second, for self-development benefits, volunteers might actively strive to realize their self-worth, such as by enjoying friendships and social recognition, as well as gain social responsibility and develop a positive outlook on life (volunteer A09: September 8, 2021). Moreover, volunteer organizations usually arrange various training programs for volunteers to enhance their communication skills, management skills, and social work skills, thereby increasing their service efficiency (volunteer A05: September 7, 2021). Third, for material benefits, volunteers might be financially rewarded by volunteer organizations, the community, and the local government for being “good citizens” (volunteer A06: September 8, 2021). For example, many volunteer organizations have established volunteer service points systems, which provide volunteers with service points based on the quality and frequency of their provision of care services in the city. These points can be used in charity supermarkets to purchase items such as food and drink. Older volunteers can also buy for-profit long-term voluntary community care services with these points (volunteer A12: September 7, 2021). These benefits can raise the possibility of providing continuous voluntary community care services for older people.
4.3. Interaction of internal and external motivations and its impact on the continuity of providing voluntary community care services for older people
The correlation between these six internal and external motivations is essential. On the one hand, we found that in the cases when all three internal and three external motivations are present in volunteers, it aids the continuity of their provision of voluntary community care services for older people. We argue that if volunteers are only driven by either internal or external motivations, their voluntary behavior may occur occasionally instead of continuously and their care service provision may be fragmented instead of systematic. On the other, we found that voluntary community care services can be provided continuously when volunteers have only one or two motivations from the internal and external motivation categories. This indicates that there is no direct correlation between the three motivations of each motivation category and that the roles of internal and external motivations are not interchangeable. Instead, this shows that internal and external motivations affect continuous voluntary behavior differently and that the role of these two motivation categories cannot replace one another. Thus, although the analysis of the interview data shows that the continuous provision of voluntary community care services for older people requires both internal and external motivations, it is not necessary that all six motivations are present.
According to our interview data, the desire to volunteer to provide voluntary community care services for older people is determined partly by internal motivations, as they frame volunteers' social and organizational roles. In short, a person may be altruistic under certain external motivations; however, this does not correspond to the continuity of providing voluntary community care services. Hence, although internal motivations can promote volunteers' willingness to provide voluntary community care services for older people, the provision of such care services in practice also needs the support of institutions such as volunteer organizations. It seems that external motivations provide volunteers with a basic guarantee of being able to supply voluntary community care services. Therefore, internal and external motivations are necessary but not sufficient separately to ensure the continuous volunteering of voluntary community care services. Only through the simultaneous presence of external and internal motivations and the interaction between them can the continuous provision of voluntary community care services for older people be promoted. Consequently, internal and external motivations interact to help provide continuous voluntary community care services for older people. The behavior of volunteers that provide voluntary community care services for older people differs mainly because volunteers experience different motivation interactions.
This study contributes to the fields of community psychology as well as personality and social psychology since it deals with the development of volunteering through different types of motivations. It helps clarify the continuous provision of care services for older people to improve their quality of life while meeting their unmet care needs. However, while this study is a good reference for other countries organizing voluntary community care services, it also has limitations concerning the number of interviews and restricted coverage of older people, which limit the generalizability of its results. This study is also limited since it only focuses on one region in China and lacks broader research in different regions at diverse stages of socioeconomic development.
Future research should focus on discovering whether the lack of interaction between internal and external motivations is driven by the lack of value support and meaning construction or the lack of structural support. In addition, more factors could be included in the analysis of internal and external motivations and their impact on the continuity of providing voluntary community care services for a broader group of people such as vulnerable populations. Future research could also compare continuous voluntary behavior across China.
Data availability statement
The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.
Ethics statement
The study protocol was approved by the Ethic Committee of Anhui Normal University of China (Approval No. AHNU-ET2022046). The patients/participants provided their written informed consent to participate in this study. Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.
Author contributions
YX collected the interview data on the community care services and analyzed and interpreted the interviews with JA. JA and JX contributed to the writing, structure, and design of the manuscript. All authors read and approved the final manuscript.
Funding
This work was supported by the Social Science Research Project for Universities under Grant SK2019A0264, granted by the Council for Social Science of Anhui province in China. The role of the funding body is to support study design and data collection.
Acknowledgments
We thank our interviewees for their contribution. We also thank our student assistants for their support.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
References
1. Zhu H, Walker A. Why China needs an active social policy on ageing. Asian Pop Stud. (2021) 18:190–205. doi: 10.1080/17441730.2021.1955444
2. Zhu Y, Österle A. China's policy experimentation on long-term care insurance: Implications for access. Int J Health Plann Manag. (2019) 34:1661–74. doi: 10.1002/hpm.2879
3. Yang W, Tan SY. Is informal care sufficient to meet the long-term care needs of older people with disabilities in China? Evidence from the China health and retirement longitudinal survey. Ageing Soc. (2021) 41:980–99. doi: 10.1017/S0144686X1900148X
4. Dai W, Yu Y. Fragmentation and integration of Chinese LTC policy pilot plans. J Jiangxi Univ Finan Econ. (2021) 134:55–65. doi: 10.13676/j.cnki.cn36-1224/f.2021.02.006
5. Greaney ML, Wallington SF, Rampa S, Vigliotti VS. Assessing health professionals' perception of health literacy in Rhode Island community health centers: a qualitative study. BMC Pub Health. (2020) 20:1–10. doi: 10.1186/s12889-020-09382-1
6. Chen Y, Wu F, Wu Y, Li J, Yue P, Deng Y, et al. Development of interventions for an intelligent and individualized mobile health care system to promote healthy diet and physical activity: using an intervention mapping framework. BMC Pub Health. (2019) 19:1311. doi: 10.1186/s12889-019-7639-7
7. Evandrou M, Falkingham J, Feng Z, Vlachantoni A. Ethnic inequalities in limiting health and self-reported health in later life revisited. J Epidemiol Commun Health. (2016) 70:653–62. doi: 10.1136/jech-2015-206074
8. Zhou K, Tan J, Watanabe K. How does perceived residential environment quality influence life satisfaction? Evidence from urban China. J Community Psychol. (2021) 49:2454–71. doi: 10.1002/jcop.22545
9. Wuhu Bureau of Statistics. The Statistical Bulletin of Wuhu National Economic and Social Development in 2020. (2021). Wuhu Daily. Available online at: https://www.wuhu.gov.cn/mlwh/tjgb/30158021.html (accessed March 24, 2021).
10. Joseph BM, Carolissen R. Volunteer leadership: a silent factor in student volunteer retention. J Commun Psychol. (2022) 50:3006–22. doi: 10.1002/jcop.22811
11. Scharlach AE. Estimating the value of volunteer-assisted community-based aging services: A case example. Home Health Care Serv Quart. (2015) 34:46–65. doi: 10.1080/01621424.2014.999902
12. Zhang Y, Tian F. Report on the Development of Voluntary Services in China. (2021-2022). Beijing: Social Sciences Academic Press (2022).
13. Planalp S, Trost M. Motivations of hospice volunteers. Amer J Hosp Palliat Med. (2009) 26:188–92. doi: 10.1177/1049909108330030
14. Handy F, Srinivasan N. Valuing volunteers: an economic evaluation of the net benefits of hospital volunteers. Nonprofit Voluntary Sector Quart. (2004) 33:28–54. doi: 10.1177/0899764003260961
15. O'Dea E, Wister A, Canham S. Cultural generativity in perspective: motivations of older Jewish volunteers. Ageing Soc. (2021) 22:1–19. doi: 10.1017/S0144686X21000477
16. Kemmelmeier M, Jambor EE, Letner J. Individualism and good works: cultural variation in giving and volunteering across the United States. J Cross-Cultural Psychol. (2006) 37:327–44. doi: 10.1177/0022022106286927
17. Reynolds SJ, Ceranic TL. The effects of moral judgment and moral identity on moral behaviour: an empirical examination of the moral individual. J Appl Psychol. (2007) 92:1610–24. doi: 10.1037/0021-9010.92.6.1610
18. Cuskelly G. Volunteer retention in community sport organisations. Eur Sport Manag Quart. (2004) 4:59–76. doi: 10.1080/16184740408737469
19. Kim M, Chelladurai P. Trail GTA model of volunteer retention in youth sport. J Sport Manag. (2007) 21:151–71. doi: 10.1123/jsm.21.2.151
20. Ferrari JR, Luhrs T, Lyman V. Eldercare volunteers and employees: Predicting caregiver experiences from service motives and sense of community. J Prim Prev. (2007) 28:467–79. doi: 10.1007/s10935-007-0108-6
21. Haivas S, Hofmans J, Pepermans R. Volunteer engagement and intention to quit from a self-determination theory practice. J Appl Soc Psychol. (2013) 43:1869–80. doi: 10.1111/jasp.12149
22. Grube JA, Piliavin JA. Role identity, organizational experiences, and volunteer performance. Person Soc Psychol Bull. (2000) 26:1108–19. doi: 10.1177/01461672002611007
23. Uny IW. Factors and motivations contributing to community volunteers' participation in a nursery feeding project in Malawi. Dev Prac. (2008) 18:437–45. doi: 10.1080/09614520802030649
24. Choi N, Chou R. Time and money volunteering among older adults: the relationship between past and current volunteering and correlates of change and stability. Ageing Soc. (2010) 30:559–81. doi: 10.1017/S0144686X0999064X
25. Hidalgo MC, Moreno P. Organizational socialization of volunteers: the effect on their intention to remain. J Commun Psychol. (2009) 37:594–601. doi: 10.1002/jcop.20317
26. Cho H, Li C, Wu Y. Understanding sport event volunteers' continuance intention: an environmental psychology approach. Sport Manag Rev. (2020) 23:615–25. doi: 10.1016/j.smr.2019.08.006
27. Kim S. Human, social and cultural predictors of productive activities in later life. Ageing Soc. (2020) 40:328–47. doi: 10.1017/S0144686X18000922
28. Haski-Leventhal D, Meijs L, Hustinx L. The third-party model: enhancing volunteering through governments, corporations and educational institutes. J Soc Pol. (2010) 39:139–58. doi: 10.1017/S0047279409990377
29. Fokkema T, Cela E, Ambrosetti E. Giving from the heart or from the ego? Motives behind remittances of the second generation in Europe. Int Migr Rev. (2013) 47:539–72. doi: 10.1111/imre.12032
31. National Bureau of Statistics. Seventh National Census Communique, 4.–Nr. 7. (2021). Available online at: http://www.stats.gov.cn/tjsj/ (accessed May 13, 2021).
32. Yang W, Wu B, Tan SY, Li B, Lou VWQ, Chen ZA, et al. Understanding health and social challenges for aging and long-term care in China. Res Aging. (2021) 43:127–35. doi: 10.1177/0164027520938764
33. Feng Z. Filial piety and old age support in China: Tradition, continuity and change. In: X Zang, LX Zhao, Handbook on the Family and Marriage in China (Cheltenham: Edward Elgar), 266–85 (2017).
34. Chinese Central Government. The 14th Five Year Plan of China. (2021). Available online at: https://www.gov.cn/xinwen/2021-03/13/content_5592681.htm (accessed January 30, 2021).
35. Hu B. Projecting future demand for informal care among older people in China: the road towards a sustainable long-term care system. Health Econ Pol Law. (2019) 14:61–81. doi: 10.1017/S1744133118000221
36. Zhu Y, Österle A. Rural-urban disparities in unmet long-term care needs in China: The role of the hukou status. Soc Sci Med. (2017) 191:30–7. doi: 10.1016/j.socscimed.2017.08.025
37. Wuhu Local Government. The “14th Five-Year” Civil Affairs Development Plan in Wuhu City. (2021). Available online at: https://www.wuhu.gov.cn/openness/public/6596211/32911501.html (accessed November 30, 2021).
38. Wuhu Bureau of Statistics. Wuhu city seventh national population census leading group office. Wuhu city, the seventh national population census bulletin. (2021). Wuhu Daily. Available online at: https://tjj.wuhu.gov.cn/openness/public/6596741/30588061.html (accessed May 24, 2021).
39. Glaser BG, Strauss AL. The Discovery of Grounded Theory: Strategies for Qualitative Research. New York, NY: Routledge (2017).
40. Glaser BG, Strauss AL. The Discovery of Grounded Theory: Strategies for Qualitative Research. Chicago: Aldine (1967).
41. Glaser BG, Bailyn L, Fernandez W, Holton JA, Levina N. What grounded theory is…. Acad Manag Proc. (2013) 1:11290. doi: 10.5465/ambpp.2013.11290symposium
42. Urquhart C, Lehmann H, Myers MD. Putting the ‘theory' back into grounded theory: guidelines for grounded theory studies in information systems. Inf Syst J. (2010) 20:357–81. doi: 10.1111/j.1365-2575.2009.00328.x
43. Lassig C. Attributes of rigorous grounded theory research and reporting: illustrations from a grounded theory of adolescent creativity. Educ Res. (2022) 51:98–108. doi: 10.3102/0013189X211069571
44. Li H, Duan B, Wang Y, Di H, Ge H. Study on the influencing factors of online learning and its operation mechanism among Chinese college students during the COVID-19 pandemic: an empirical analysis based on a mixed method. Int J Environ Res Public Health. (2022) 19:15161. doi: 10.3390/ijerph192215161
45. Engward H. Understanding grounded theory. Nurs Stand. (2013) 28:37. doi: 10.7748/ns2013.10.28.7.37.e7806
46. Chong CH, Yeo KJ. An overview of grounded theory design in educational research. Asian Soc Sci. (2015) 11:258. doi: 10.5539/ass.v11n12p258
47. Vollstedt M, Rezat S. An introduction to grounded theory with a special focus on axial coding and the coding paradigm. Compend Early career. Res Math Educ. (2019) 13:81–100. doi: 10.1007/978-3-030-15636-7_4
48. Gao W, Feng W, Xu Q, Lu S, Cao K. Barriers associated with the public use of sports facilities in China: a qualitative study. BMC Pub Health. (2022) 22:1–9. doi: 10.1186/s12889-022-14441-w
49. Rowlands T, Waddell N, McKenna B. Are we there yet? A technique to determine theoretical saturation. J Comput Inf Syst. (2016) 56:40–7. doi: 10.1080/08874417.2015.11645799
50. Hammersley M. Sampling and thematic analysis: a response to Fugard and Potts. Int J Soc Res Methodol. (2015) 18:687–8. doi: 10.1080/13645579.2015.1005456
51. Wang N. Study of the application of three-stage coding of grounded theory to thematic words extraction. Libr J. (2018) 37:74–81. doi: 10.13663/j.cnki.lj.2018.05.011
52. Braun V, Clarke V. To saturate or not to saturate? Questioning data saturation as a useful concept for thematic analysis and sample-size rationales. Qual Res Sport. (2021) 13:201–16. doi: 10.1080/2159676X.2019.1704846
53. Sim J, Saunders B, Waterfield J, Kingstone T. Can sample size in qualitative research be determined a priori? Int J Soc Res Methodol. (2018) 21:619–34. doi: 10.1080/13645579.2018.1454643
54. Walker D, Myrick F. Grounded theory: an exploration of process and procedure. Qual Health Res. (2006) 16:547–59. doi: 10.1177/1049732305285972
55. Chamberlain K. Using grounded theory in health psychology. In:M Murray, K Chamberlain, , editors. Qualitative Health Psychology: Theories and Methods (Thousand Oaks: Sage Publications), 183–201 (1999).
56. Dahl RA, Lindblom CE. Politics Economics and Welfare: Planning and Politico-economic Systems Resolved into Basic Social Processes. New York, NY: Harper and Brothers (1953).
57. Dang L, Seemann AK, Lindenmeier J, Saliterer I. Explaining civic engagement: the role of neighborhood ties, place attachment, and civic responsibility. J Commun Psychol. (2022) 50:1736–55. doi: 10.1002/jcop.22751
58. Cooper TL. The Responsible Administrator: An Approach to Ethics for the Administrative Role. New York, NY: John Wiley and Sons (2012).
60. Stebbins RA. Leisure and the Motive to Volunteer: Theories of Serious, Casual and Project-Based Leisure. London: Palgrave Macmillan (2015).
Appendix
Table A1. Information on the volunteers.
Table A2. Saturation testing.
Keywords: community, care service, older people, volunteerism, China
Citation: Xin Y, An J and Xu J (2023) Continuous voluntary community care services for older people in China: Evidence from Wuhu. Front. Public Health 10:1063156. doi: 10.3389/fpubh.2022.1063156
Received: 06 October 2022; Accepted: 16 December 2022;
Published: 10 January 2023.
Edited by:
Jiayuan Wu, Affiliated Hospital of Guangdong Medical University, ChinaReviewed by:
Marianne Sundlisæter Skinner, Norwegian University of Science and Technology, NorwayRen Chen, Anhui Medical University, China
Benjamin Costello, University of Birmingham, United Kingdom
Copyright © 2023 Xin, An and Xu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Jianzeng An, 
an992598@ahnu.edu.cn
†ORCID: Ying Xin orcid.org/0000-0001-9430-2170
Jianzeng An orcid.org/0000-0002-6759-0610
Jia Xu orcid.org/0000-0001-9962-6617