从嵌入到内化：嵌入式医养结合模式下老年人健康行为改变的作用机制——基于N市的“小北医养”社区服务点的质性研究

From Embeddedness to Internalization: The Mechanism of Health Behavior Change among the Elderly under the Embedded Integrated Medical and Nursing Care Model—A Qualitative Study Based on the “Xiaobei Medical-Nursing Care” Community Service Site in N City

摘要: 在深度老龄化与超大城市治理的双重背景下，如何提升养老服务的供给效能成为关键议题。现有研究多聚焦于养老服务的宏观模式与中观协同机制，却普遍忽视了其终极作用对象——老年人自身的健康行为与实践。本研究旨在实现从服务供给到行为内化的视角转换，深入探究嵌入式医养结合服务如何促成老年人健康行为的改变。基于小北医养服务点的质性案例研究，本文融合嵌入性理论、协同治理理论、资源–服务功能观与实践理论，构建了“嵌入–协同–内化”三维分析框架。研究发现，健康行为的“内化”并非自发产生，而是通过认知重塑与意义建构、惯例打破与新惯习形成及身份认同与社区归属三重机制得以实现。而服务主体的“深度嵌入”(关系、制度、能力、资源)与多元主体的“精细协同”则为这三重机制的顺利运行提供了必要的前提、持续的保障与全面的支持网络。本研究提出“服务性嵌入”概念，将组织层面的结构性嵌入理论拓展至公共服务领域，揭示了服务通过与社区社会结构、文化网络及日常实践的深度融合，有效引导个体行为改变的内在逻辑，为优化养老服务供给、提升老年人健康福祉提供了新的理论视角与实践启示。

Abstract: Against the dual backdrop of deep aging and mega-city governance, how to enhance the supply efficiency of elderly care services has become a critical issue. Existing research predominantly focuses on the macro-level models and meso-level collaborative mechanisms of elderly care services, yet it largely overlooks the ultimate target of these services—the health behaviors and practices of the elderly themselves. This study aims to shift the analytical perspective from service supply to behavioral internalization, exploring how embedded integrated medical and nursing care services facilitate health behavior change among the elderly. Based on a qualitative case study of the Xiaobei Medical-Nursing Care service site, this paper integrates embeddedness theory, collaborative governance theory, the resource-service functional perspective, and practice theory to construct a three-dimensional analytical framework of “Embeddedness-Collaboration-Internalization”. The study finds that the internalization of health behaviors does not occur spontaneously but is achieved through three interrelated mechanisms: cognitive reconstruction and meaning construction, routine disruption and new habitus formation, and identity transformation and community belonging. The “deep embeddedness” of service providers (in relational, institutional, capacity, and resource dimensions) and the “fine-grained collaboration” among multiple actors provide the necessary preconditions, sustained support, and comprehensive networks for the smooth operation of these three mechanisms. This study proposes the concept of “service embeddedness”, extending the theory of structural embeddedness from the organizational level to the domain of public service provision. It reveals the internal logic by which services effectively guide individual behavior change through deep integration into community social structures, cultural networks, and daily practices, thereby offering new theoretical perspectives and practical insights for optimizing the supply of elderly care services and enhancing the health and well-being of the elderly.