{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T00:07:19Z","timestamp":1788480439645,"version":"build-2803163510"},"reference-count":54,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"funder":[{"name":"the Youth Science Foundation Project for Higher Education of Hebei Province, China","award":["QN2025590"],"award-info":[{"award-number":["QN2025590"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Geriatr"],"DOI":"10.1186\/s12877-025-06282-0","type":"journal-article","created":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T11:39:25Z","timestamp":1754048365000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Exploring the decision-making process of Chinese older adults transitioning to continuing care retirement communities: a qualitative study"],"prefix":"10.1186","volume":"25","author":[{"given":"Meina","family":"Yuan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nan","family":"Ding","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinping","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Xue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinyi","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanshuo","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,8,1]]},"reference":[{"key":"6282_CR1","unstructured":"Gaigbe-Togbe V, Bassarsky L, Gu D, Spoorenberg T, Zeifman L. World Population Prospects 2022: Summary of Results| DESA Publications. 2022. https:\/\/desapublications.un.org\/publications\/world-population-prospects-2022-summary-results. Accessed 14 Nov 2024."},{"key":"6282_CR2","doi-asserted-by":"publisher","DOI":"10.1596\/978-1-4648-1075-6","volume-title":"Options for aged care in china: Building an efficient and sustainable aged care system","author":"E Glinskaya","year":"2018","unstructured":"Glinskaya E, Feng Z. Options for aged care in china: Building an efficient and sustainable aged care system. Washington, DC: World Bank; 2018."},{"key":"6282_CR3","doi-asserted-by":"crossref","unstructured":"Jeste DV, Glorioso D, Lee EE, Daly R, Graham S, Liu J et al. Study of Independent Living Residents of a Continuing Care Senior Housing Community: Sociodemographic and Clinical Associations of Cognitive, Physical, and Mental Health. 2020.","DOI":"10.1016\/j.jagp.2019.04.002"},{"key":"6282_CR4","unstructured":"State Council. May, China. The 12th Five-Year Plan for National Economic and Social Development (Full text). https:\/\/www.gov.cn\/2011lh\/content_1825838_2.htm. Accessed 16 2025."},{"key":"6282_CR5","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1177\/0891243202250734","volume":"17","author":"HJ Zhan","year":"2003","unstructured":"Zhan HJ, Montgomery RJV. Gender and elder care in china: the influence of filial piety and structural constraints. Gend Soc. 2003;17:209\u201329.","journal-title":"Gend Soc"},{"key":"6282_CR6","doi-asserted-by":"publisher","first-page":"188","DOI":"10.1007\/s12126-005-1011-1","volume":"30","author":"WK Lee","year":"2005","unstructured":"Lee WK, Hong-kin K. Differences in expectations and patterns of informal support for older persons in Hong kong: modification to filial piety. Ageing Int. 2005;30:188\u2013206.","journal-title":"Ageing Int"},{"key":"6282_CR7","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1177\/0164027520939321","volume":"43","author":"J Lu","year":"2021","unstructured":"Lu J, Zhang L, Zhang K. Care preferences among Chinese older adults with daily care needs: individual and community factors. Res Aging. 2021;43:166\u201376.","journal-title":"Res Aging"},{"key":"6282_CR8","doi-asserted-by":"publisher","first-page":"1362","DOI":"10.1016\/S0140-6736(20)32136-X","volume":"396","author":"Z Feng","year":"2020","unstructured":"Feng Z, Glinskaya E, Chen H, Gong S, Qiu Y, Xu J, et al. Long-term care system for older adults in china: policy landscape, challenges, and future prospects. Lancet Lond Engl. 2020;396:1362\u201372.","journal-title":"Lancet Lond Engl"},{"key":"6282_CR9","doi-asserted-by":"crossref","unstructured":"Wang X, Xia B, Skitmore M, Volz K, Shu B. Understanding the well-being of residents in Chinese continuing care retirement Communities\u2014a case of Shanghai. Front Public Health. 2024;12:1457022.","DOI":"10.3389\/fpubh.2024.1457022"},{"key":"6282_CR10","doi-asserted-by":"crossref","unstructured":"Yang H, Browning C, Thomas S. Challenges in the provision of community aged care in China. Fam Med Community Health. 2013;1:32\u201342.","DOI":"10.15212\/FMCH.2013.0206"},{"key":"6282_CR11","doi-asserted-by":"crossref","unstructured":"Feng Z, Zhan HJ, Feng X, Liu C, Sun M, Mor V. An industry in the making: the emergence of institutional elder care in urban China. J Am Geriatr Soc. 2011;59:738\u201344.","DOI":"10.1111\/j.1532-5415.2011.03330.x"},{"key":"6282_CR12","unstructured":"CCRC task force. Today\u2019s Continuing Care Retirement Community. Bing. https:\/\/cn.bing.com\/search?q=Today+\u2019s+Continuing+Care+Retirement+Community&form=ANNTH1&refig=674e917a8597407eb0d939885f781a41&pc=CNNDDB&ucpdpc=UCPD&adppc=EDGEESS. Accessed 3 Dec 2024."},{"key":"6282_CR13","doi-asserted-by":"publisher","first-page":"611","DOI":"10.1017\/S1041610214002415","volume":"27","author":"L Ayalon","year":"2015","unstructured":"Ayalon L. Perceptions of old age and aging in the continuing care retirement community. Int Psychogeriatr. 2015;27:611\u201320.","journal-title":"Int Psychogeriatr"},{"key":"6282_CR14","doi-asserted-by":"publisher","first-page":"641","DOI":"10.1093\/geront\/gnu121","volume":"56","author":"L Ayalon","year":"2016","unstructured":"Ayalon L, Greed O. A typology of new residents\u2019 adjustment to continuing care retirement communities. Gerontologist. 2016;56:641\u201350.","journal-title":"Gerontologist"},{"issue":"3","key":"6282_CR15","first-page":"26","volume":"31","author":"S Liu","year":"2024","unstructured":"Liu S, Li Y. CCRC nursing community model study on the caring design of the furniture suitable for the elderly living room. Furniture Interior Des. 2024;31(3):26\u201331.","journal-title":"Furniture Interior Des"},{"key":"6282_CR16","doi-asserted-by":"publisher","first-page":"1221","DOI":"10.1177\/0733464819879015","volume":"39","author":"S Shinan-Altman","year":"2020","unstructured":"Shinan-Altman S, Gum AM, Ayalon L. Moving to a continuing care retirement community or staying in the community? A comparison between American and Israeli older adults. J Appl Gerontol Off J South Gerontol Soc. 2020;39:1221\u20139.","journal-title":"J Appl Gerontol Off J South Gerontol Soc"},{"key":"6282_CR17","doi-asserted-by":"publisher","first-page":"266","DOI":"10.1093\/geront\/27.3.266","volume":"27","author":"E Litwak","year":"1987","unstructured":"Litwak E, Longino CF. Migration patterns among the elderly: a developmental perspective. Gerontologist. 1987;27:266\u201372.","journal-title":"Gerontologist"},{"key":"6282_CR18","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1177\/0733464810386463","volume":"30","author":"DE Bradley","year":"2011","unstructured":"Bradley DE. Litwak and longino\u2019s developmental model of Later-Life migration: evidence from the American community survey, 2005\u20132007. J Appl Gerontol. 2011;30:141\u201358.","journal-title":"J Appl Gerontol"},{"key":"6282_CR19","unstructured":"Competence environmentalpress. May, and the adaptation of older people| Home Modification Information Clearinghouse. https:\/\/www.homemods.info\/resources\/hminfo-libraries\/research-library\/competence-environmental-press-and-the-adaptation-of-older-people. Accessed 16 2025."},{"key":"6282_CR20","unstructured":"Erickson MA, Krout JA. Planning and Experiencing the Move to a Continuing Care Retirement. Elder's Advisor. 2001;3:9\u201312."},{"key":"6282_CR21","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1111\/j.1741-6612.2000.tb00168.x","volume":"19","author":"L Buys","year":"2008","unstructured":"Buys L. Care and support assistance provided in retirement villages: expectations vs reality. Australas J Ageing. 2008;19:149\u201351.","journal-title":"Australas J Ageing"},{"key":"6282_CR22","doi-asserted-by":"publisher","first-page":"236","DOI":"10.1177\/07364802021002007","volume":"21","author":"JA Krout","year":"2002","unstructured":"Krout JA, Moen P, Holmes HH, Oggins J, Bowen N. Reasons for relocation to a continuing care retirement community. J Appl Gerontol. 2002;21:236\u201356.","journal-title":"J Appl Gerontol"},{"key":"6282_CR23","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1300\/J081v14n01_03","volume":"14","author":"P Moen","year":"2001","unstructured":"Moen P, Erickson MA. Chapter 3: Decision-Making and satisfaction with a continuing care retirement community. J Hous Elder. 2001;14:53\u201369.","journal-title":"J Hous Elder"},{"key":"6282_CR24","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1016\/S1525-8610(05)70544-2","volume":"3","author":"RE Remsburg","year":"2002","unstructured":"Remsburg RE, Bennett RG, Inez Wendel V, Durso SC. Demographic and health characteristics of residents choosing to use on-site medical care in a newly opened continuing care retirement community (CCRC). J Am Med Dir Assoc. 2002;3:297\u2013301.","journal-title":"J Am Med Dir Assoc"},{"key":"6282_CR25","doi-asserted-by":"publisher","first-page":"577","DOI":"10.1177\/1049732318780350","volume":"29","author":"O Green","year":"2019","unstructured":"Green O, Ayalon L. Home is where my couch is: the role of possessions in the process of moving and adjusting to continuing care retirement communities. Qual Health Res. 2019;29:577\u201388.","journal-title":"Qual Health Res"},{"key":"6282_CR26","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1186\/s12877-023-04615-5","volume":"24","author":"X Xu","year":"2024","unstructured":"Xu X, Li P, Ampon-Wireko S. The willingness and influencing factors to choose institutional elder care among rural elderly: an empirical analysis based on the survey data of Shandong Province. BMC Geriatr. 2024;24:17.","journal-title":"BMC Geriatr"},{"key":"6282_CR27","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1186\/s12877-023-04559-w","volume":"24","author":"W Ren","year":"2024","unstructured":"Ren W, He R, Tarimo CS, Sun L, Wu J, Zhang L. Willingness and influencing factors of old-age care mode selection among middle-aged and older adults in Henan province, China. BMC Geriatr. 2024;24:72.","journal-title":"BMC Geriatr"},{"key":"6282_CR28","doi-asserted-by":"publisher","first-page":"410","DOI":"10.1186\/s12913-019-4259-y","volume":"19","author":"N Chen","year":"2019","unstructured":"Chen N, Li X, Yuan N, Zhou C, Wang C. Utilization willingness of institutional care between disabled and non-disabled seniors: evidence from jiangsu, China. BMC Health Serv Res. 2019;19:410.","journal-title":"BMC Health Serv Res"},{"key":"6282_CR29","doi-asserted-by":"publisher","first-page":"583","DOI":"10.1017\/S0144686X09990596","volume":"30","author":"RJ-A Chou","year":"2010","unstructured":"Chou RJ-A. Willingness to live in eldercare institutions among older adults in urban and rural china: a nationwide study. Ageing Soc. 2010;30:583\u2013608.","journal-title":"Ageing Soc"},{"key":"6282_CR30","doi-asserted-by":"publisher","first-page":"280","DOI":"10.1186\/s12877-020-01679-5","volume":"20","author":"C-S Wu","year":"2020","unstructured":"Wu C-S, Rong J-R. Relocation experiences of the elderly to a long-term care facility in taiwan: a qualitative study. BMC Geriatr. 2020;20:280.","journal-title":"BMC Geriatr"},{"key":"6282_CR31","doi-asserted-by":"crossref","unstructured":"Hu X, Xia B, Hu Y, Skitmore M, Buys L. What hinders the development of Chinese continuing care retirement community sector? A news coverage analysis. Int J Strateg Prop Manag. 2019;23:108\u2013116.","DOI":"10.3846\/ijspm.2019.7436"},{"key":"6282_CR32","doi-asserted-by":"crossref","unstructured":"Chou R. Willingness to live in eldercare institutions among older adults in urban and rural China: A nationwide study. Ageing Soc.2010;30:583\u2013608.","DOI":"10.1017\/S0144686X09990596"},{"key":"6282_CR33","doi-asserted-by":"publisher","DOI":"10.4135\/9781452230153","volume-title":"Basics of qualitative research: techniques and procedures for developing grounded theory","author":"J Corbin","year":"2008","unstructured":"Corbin J, Strauss A. Basics of qualitative research: techniques and procedures for developing grounded theory. 3rd ed. Thousand Oaks, CA, US: Sage Publications, Inc; 2008.","edition":"3"},{"key":"6282_CR34","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","volume":"19","author":"A Tong","year":"2007","unstructured":"Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care J Int Soc Qual Health Care. 2007;19:349\u201357.","journal-title":"Int J Qual Health Care J Int Soc Qual Health Care"},{"key":"6282_CR35","doi-asserted-by":"publisher","first-page":"364","DOI":"10.1097\/00006199-196807000-00014","volume":"17","author":"BG Glaser","year":"1968","unstructured":"Glaser BG, Strauss AL, Strutzel E. The discovery of grounded theory; strategies for qualitative research. Nurs Res. 1968;17:364.","journal-title":"Nurs Res"},{"key":"6282_CR36","doi-asserted-by":"publisher","first-page":"617","DOI":"10.1002\/jcop.20118","volume":"34","author":"C-K Cheung","year":"2006","unstructured":"Cheung C-K, Kwon AY-H, Ng SH. Impacts of filial piety on preference for kinship versus public care. J Community Psychol. 2006;34:617\u201334.","journal-title":"J Community Psychol"},{"key":"6282_CR37","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1016\/j.archger.2018.05.018","volume":"79","author":"D Lambotte","year":"2018","unstructured":"Lambotte D, De Donder L, Van Regenmortel S, Fret B, Dury S, Smetcoren A-S, et al. Frailty differences in older adults\u2019 use of informal and formal care. Arch Gerontol Geriatr. 2018;79:69\u201377.","journal-title":"Arch Gerontol Geriatr"},{"key":"6282_CR38","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1080\/08959420801977574","volume":"20","author":"JL Wolff","year":"2008","unstructured":"Wolff JL, Kasper JD, Shore AD. Long-term care preferences among older adults: a moving target? J Aging Soc Policy. 2008;20:182\u2013200.","journal-title":"J Aging Soc Policy"},{"key":"6282_CR39","doi-asserted-by":"publisher","first-page":"603","DOI":"10.1080\/10410236.2016.1146568","volume":"32","author":"L Chang","year":"2017","unstructured":"Chang L, Basnyat I. Exploring family support for older Chinese Singaporean women in a Confucian society. Health Commun. 2017;32:603\u201311.","journal-title":"Health Commun"},{"key":"6282_CR40","doi-asserted-by":"publisher","first-page":"531","DOI":"10.1177\/0164027515593346","volume":"38","author":"M Guo","year":"2016","unstructured":"Guo M, Chi I, Silverstein M. Trajectories and determinants of elder care in rural China during an 8-Year period: why having sons makes a difference. Res Aging. 2016;38:531\u201353.","journal-title":"Res Aging"},{"key":"6282_CR41","doi-asserted-by":"publisher","first-page":"298","DOI":"10.1111\/phn.12163","volume":"32","author":"S-L Cheng","year":"2015","unstructured":"Cheng S-L, Zhao J-Z, Bai J, Zang X-Y. Continuity of care for older adults with chronic illness in china: an exploratory study. Public Health Nurs Boston Mass. 2015;32:298\u2013306.","journal-title":"Public Health Nurs Boston Mass"},{"issue":"1","key":"6282_CR42","first-page":"87","volume":"21","author":"X Bu","year":"2022","unstructured":"Bu X, Yang J, Cheng J. Three dimensions of supply-demand disequilibria in aged care service in urban China. Chin Public Policy Rev. 2022;21(1):87\u2013106.","journal-title":"Chin Public Policy Rev"},{"key":"6282_CR43","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1093\/geront\/47.1.96","volume":"47","author":"F Oswald","year":"2007","unstructured":"Oswald F, Wahl H-W, Schilling O, Nygren C, F\u00e4nge A, Sixsmith A, et al. Relationships between housing and healthy aging in very old age. Gerontologist. 2007;47:96\u2013107.","journal-title":"Gerontologist"},{"key":"6282_CR44","first-page":"101","volume":"23","author":"X Hu","year":"2017","unstructured":"Hu X, Xia B, Skitmore M, Buys L, Zuo J. Retirement villages in australia: a literature review. Pac Rim Prop Res J. 2017;23:101\u201322.","journal-title":"Pac Rim Prop Res J"},{"key":"6282_CR45","unstructured":"Chow N. The practice of filial piety and its impact on long-term care policies for elderly people in Asian Chinese communities. Asian J Gerontol Geriatr. 2006;1:31\u201335."},{"key":"6282_CR46","doi-asserted-by":"publisher","first-page":"759","DOI":"10.1046\/j.1365-2648.2000.01346.x","volume":"31","author":"M Nolan","year":"2000","unstructured":"Nolan M, Dellasega C. I really feel i\u2019ve let him down: supporting family carers during long-term care placement for elders. J Adv Nurs. 2000;31:759\u201367.","journal-title":"J Adv Nurs"},{"key":"6282_CR47","doi-asserted-by":"publisher","first-page":"47","DOI":"10.2307\/2060063","volume":"3","author":"ES Lee","year":"1966","unstructured":"Lee ES. A theory of migration. Demography. 1966;3:47\u201357.","journal-title":"Demography"},{"key":"6282_CR48","doi-asserted-by":"publisher","first-page":"167","DOI":"10.2307\/2979181","volume":"48","author":"EG Ravenstein","year":"1885","unstructured":"Ravenstein EG. The laws of migration. J Stat Soc Lond. 1885;48:167\u2013235.","journal-title":"J Stat Soc Lond"},{"key":"6282_CR49","volume-title":"Housing choices and aspirations of older people: research from the new horizons programme","author":"K Croucher","year":"2008","unstructured":"Croucher K. Housing choices and aspirations of older people: research from the new horizons programme. London: Department for Communities and Local Government; 2008."},{"key":"6282_CR50","doi-asserted-by":"publisher","first-page":"306","DOI":"10.1177\/0898264308315431","volume":"20","author":"M Korporaal","year":"2008","unstructured":"Korporaal M, van Broese MI, van Tilburg TG. Effects of own and spousal disability on loneliness among older adults. J Aging Health. 2008;20:306\u201325.","journal-title":"J Aging Health"},{"key":"6282_CR51","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1016\/j.jcomdis.2016.06.002","volume":"62","author":"AD Palmer","year":"2016","unstructured":"Palmer AD, Newsom JT, Rook KS. How does difficulty communicating affect the social relationships of older adults? An exploration using data from a National survey. J Commun Disord. 2016;62:131\u201346.","journal-title":"J Commun Disord"},{"key":"6282_CR52","doi-asserted-by":"publisher","first-page":"683","DOI":"10.1080\/13607863.2013.875122","volume":"18","author":"R Hagan","year":"2014","unstructured":"Hagan R, Manktelow R, Taylor BJ, Mallett J. Reducing loneliness amongst older people: a systematic search and narrative review. Aging Ment Health. 2014;18:683\u201393.","journal-title":"Aging Ment Health"},{"key":"6282_CR53","doi-asserted-by":"publisher","first-page":"481","DOI":"10.1017\/S1041610220000393","volume":"33","author":"M Boyd","year":"2021","unstructured":"Boyd M, Calvert C, Tatton A, Wu Z, Bloomfield K, Broad JB, et al. Lonely in a crowd: loneliness in new Zealand retirement village residents. Int Psychogeriatr. 2021;33:481\u201393.","journal-title":"Int Psychogeriatr"},{"key":"6282_CR54","doi-asserted-by":"publisher","first-page":"396","DOI":"10.1177\/1049732312468506","volume":"23","author":"L Ayalon","year":"2013","unstructured":"Ayalon L, Green V. Social ties in the context of the continuing care retirement community. Qual Health Res. 2013;23:396\u2013406.","journal-title":"Qual Health Res"}],"container-title":["BMC Geriatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12877-025-06282-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12877-025-06282-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12877-025-06282-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T12:56:26Z","timestamp":1757336186000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcgeriatr.biomedcentral.com\/articles\/10.1186\/s12877-025-06282-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,1]]},"references-count":54,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["6282"],"URL":"https:\/\/doi.org\/10.1186\/s12877-025-06282-0","relation":{},"ISSN":["1471-2318"],"issn-type":[{"value":"1471-2318","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,1]]},"assertion":[{"value":"24 February 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 July 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 August 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was conducted in compliance with the Helsinki Declaration, and the protocol was approved by the Ethics Committee of Hebei Medical University, approval number (2023008). Written informed consent was obtained from all participants before their inclusion in the study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"578"}}