Rapid economic development and accelerated urbanization have prompted large numbers of rural adults to migrate to cities for better job opportunities, leaving a large population of rural school-age children behind in their hometowns. The absence of parental affection and the breakdown of family functions have created significant challenges for the behavioral health of left-behind children, placing a crucial responsibility on rural education. This study employed semi-structured interviews and questionnaires to identify the demands of rural education among left-behind children. Applying the Kano model to analyze these demands revealed that, among 25 demand indicators, 6 were classified as must-be quality, 8 as one-dimensional quality, 6 as attractive quality, and 5 as indifferent quality. Subsequently, the AHP was used to identify the weight of each demand indicator. The study results identified and ranked the key demands in rural education that support the behavioral health of left-behind children, providing a basis for rural schools and teachers to formulate targeted strategies, and offering an operational pathway for promoting the behavioral health of left-behind children from the perspective of demand, thereby advancing the sustainable development of both the behavioral health of left-behind children and the rural education system.

The in-vehicle human-machine interface (HMI) plays a crucial role in driving safety and operational experience. However, existing designs mainly target young users and fail to fully consider the actual needs of the elderly group. This study takes elderly drivers as the research object, adopts a combined method of Kano model and Analytic Hierarchy Process (AHP) to construct an analysis framework for demand identification and priority ranking. After establishing a demand pool through literature review and interviews, the Kano model is used for attribute classification, and AHP is combined to calculate demand weights. The results show that the primary needs of elderly drivers focus on safety-related functions and simplified operation processes, among which functions such as emergency braking assistance, voice correction, and fatigue monitoring have the highest priority; demands such as adjustable font size, haptic feedback, and voice interaction play an important role in reducing cognitive burden and optimizing experience. Based on this, the study proposes core design strategies of "safety first, simple operation, clear presentation, multimodal support, and emotional care". The contribution of this research lies in the first systematic application of the Kano-AHP model in the age-friendly design of in-vehicle HMI, proposing a comprehensive method that combines qualitative and quantitative analysis, and providing empirically based design suggestions. The results not only expand the theoretical dimension of age-friendly design research but also provide practical references for the intelligent automobile industry to address the aging challenge.

The current design of seats in urban squares struggles to meet the diverse social, rest, and aesthetic needs of users, highlighting the systematic lack of humanized design in public facilities. This paper took Chengdu Tianfu Square and Mianyang Fucheng Wanda Plaza as the research objects. Through the User Journey Map (UJM), 23 user requirements were sorted out. The Fuzzy Kano Model was used to screen and classify the attributes of the requirement set, obtaining eight must-be requirements, seven one-dimensional requirements, and six attractive requirements. On this basis, the Structural Equation Model (SEM) was introduced to identify 11 core user requirements. The seat design scheme of Chengdu Tianfu Square was output based on 11 core requirements. The scheme was verified by using the Likert five-level scale and the System Usability Scale (SUS) score of 72.38, indicating good usability and higher satisfaction compared to existing benchmarks. This study verified that the UJM-Fuzzy KANO Model-SEM integrated model can effectively help the designers of urban square seats identify the core requirements in the fuzzy and complex user requirements. The approach can quickly clarify the design direction and improve the user satisfaction of urban square seats.

Citywalk, a recently emerging form of leisure-oriented mobility, reflects increasing public interest in healthier lifestyles and more immersive urban experiences in Chinese metropolises. This study develops an integrative assessment framework combining Importance–Performance Analysis (IPA) and the Kano model to examine both functional and affective dimensions of pedestrian satisfaction. Based on a multidimensional assessment model that integrates 25 factors of pedestrian perception, large-scale surveys were conducted in Beijing, Shanghai, and Guangzhou, focusing on perceptions of spatial form, sensory atmosphere, accessibility, safety, and supporting facilities. A Satisfaction Scale (SS) and an Importance Scale (IS) were used to quantify responses, and the Kaiser–Meyer–Olkin (KMO) statistic indicated adequate sampling reliability. Results show that in Beijing and Shanghai, Biodiversity Visibility and Ecological Connection (LE5 = 3.706) and Street Furniture and Urban Amenity Integration (IN2 = 3.255) respectively rank first in terms of satisfaction, while Guangzhou showed highest satisfaction ratings with Pedestrian Infrastructure and Circulation Systems (IN3 = 3.206). It concludes that accessibility, safety, and route signage represent basic expectations whose absence substantially lowers satisfaction, and integration of cultural narratives were identified as effective design features associated with improved comfort and engagement. The framework and findings provide an empirical basis for analyzing pedestrian experience and identifying priorities for improving citywalk environments under different urban conditions.

With the rapid advancement of virtual reality technologies, the digital transformation of traditional ceramic crafts has become a key focus for innovative research. However, existing virtual ceramic creation systems largely remain limited to surface appearance and basic operations, with significant gaps in authentically reproducing core craft processes and cultural contexts. To address this challenge, this study proposes an integrated and systematic approach to user needs analysis and design optimization for virtual ceramic creation systems. Using the KJ method, eleven core user need categories and thirty-six specific design requirements were identified. These requirements were then classified and prioritized according to the Kano model. The FAST method was applied to decompose system functions and construct a functional framework. Finally, quality function deployment (QFD) was used to identify and prioritize five key quality characteristics: content creation and crafting, teaching assistance system, virtual assistant, user interface operations, and multisensory experience, clarifying their priority and central role in system development. Design requirements for the virtual ceramic system were analyzed across four dimensions: materiality, behavior, emotion, and sociality. Materiality is addressed through multisensory immersive experiences and physical material simulation to closely replicate ceramic texture and craft details. Behavior is supported by teaching assistance and virtual assistant systems to facilitate skill acquisition and provide real-time operational feedback. Emotion is fostered through diverse cultural styles and content generation, promoting cultural heritage and emotional resonance. Sociality is enhanced by multi-user collaboration and community interaction, strengthening user communication and co-creation. This study provides a systematic design methodology and theoretical foundation for the development of virtual ceramic creation systems, contributing to the advancement of digital ceramic crafts and the enhancement of user experience.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-22495-0.

Intraoperative urine output is a key indicator of fluid balance and renal function. With the rise of enhanced recovery after surgery (ERAS) protocols, there is a growing demand for non-invasive bladder monitoring alternatives to traditional catheterization, which poses risks such as infection and urethral injury. This study aimed to identify user-centered requirements for a non-invasive intraoperative bladder volume monitoring device using the Kano model. A cross-sectional survey was conducted among 388 surgical professionals, including anesthesiologists, surgeons, and nurses from tertiary hospitals. A Kano-based questionnaire evaluated 24 features related to device function, operation, and design. Image-assisted prototypes were used to enhance clarity. Features were classified using the Kano model and analyzed with Better-Worse coefficients. Seven features, including measurement accuracy, safety, and real-time monitoring, were identified as must-be attributes. Eight one-dimensional attributes, such as urine volume alarms and ergonomic design, positively influenced user satisfaction. Attractive features like trend analysis and affordable pricing showed high satisfaction potential. Role-specific preferences were observed across professional groups. This is the first Kano-based study assessing intraoperative non-invasive urine monitoring needs. Findings offer actionable insights for developing ERAS-compatible, user-centered monitoring technologies tailored to multidisciplinary workflows.

In response to the escalating aging population in China, this study undertakes a comprehensive requirement analysis and differentiation exploration of home-based elderly care (HBEC) services. 46 HBEC service items across five dimensions are designed by adopting Grounded Theory, including life services, intelligent services, health services, security services and spiritual services. In terms of methodology, an optimized questionnaire based interval Kano model, namely Candy model is proposed and verified. The newly proposed model changes the way requirements are classified and identifies a new category of requirements: critical requirement. By conducting questionnaire surveys, 5 Critical (C), 7 Must-be (M), 21 One-dimensional (O), 6 Attractive (A), and 7 Indifferent (I) requirements are analyzed. The analysis result of importance shows that the importance order of the five kinds of requirements is: C > M > O > A > I. The correlation coefficients between importance and satisfaction/dissatisfaction are both bigger than 0.9, indicating a strong positive correlation between the importance and satisfaction sensitivity. Furthermore, the differentiation analysis is conducted considering factors such as income level, relationship with children and self-care ability. The differentiation of requirements often occurs in the upstream and downstream requirements within the dynamic change pattern “I → A → O(C) → M”. This study offers valuable results for addressing the challenges associated with population aging.

The transformation of digital learning demands a quality approach that is contextual and student-centered. This article explores the integration of the Kano Model and Total Quality Management (TQM) as a strategic framework for improving the quality of digital learning based on student satisfaction. The Kano Model is employed to classify learning attributes into must-be, one-dimensional, and attractive categories, based on students’ perceptions of various digital learning features. Meanwhile, TQM provides a systemic structure for continuous improvement and stakeholder involvement in quality enhancement processes. This study uses a descriptive qualitative approach, with data collected through Kano-based questionnaires, interviews, and documentation. The results indicate that the Kano Model, when applied in digital learning, enables educators and administrators to classify learning service attributes based on their influence on learner satisfaction, ranging from must-be to one-dimensional to attractive qualities. Meanwhile, TQM provides a comprehensive management foundation that emphasizes continuous improvement, data-driven decision-making, and stakeholder engagement. The combination of both models contributes to building an adaptive, responsive, and learner-centered digital education environment. This integration not only enhances satisfaction but also strengthens institutional competitiveness and quality assurance in the era of digital transformation.

Growing consumer interest in natural wellness products, particularly essential oils, highlights the need to understand key quality product attributes affecting consumer satisfaction. In the digital era, customer reviews in marketplaces have become the main source of consumer-driven insights for improving production and service processes. However, conventional approaches often fail to systematically extract actionable insights from these unstructured data sources. This study proposes an integrated machine learning framework for three market on essential oils and their derivatives. This framework transforms thousands of online customer reviews into a structured analysis of satisfaction dimensions. The approach uniquely contributes by employing regression model combined with Explainable AI (SHAP) and KANO Classification to systematically applied based on SHAP insights to develop a marketing strategy based on three market segments for essential oil products and their derivatives. Eleven critical satisfaction dimensions were extracted, including aroma, price, packaging, delivery, and others. These segment-specific insights imply that producers should prioritize reliable pricing and delivery for low-tier markets, ensure strict price fairness and value consistency for mid-tier consumers, and, for high-tier segments, focus on integrating diffuser compatibility as a basic requirement while leveraging bonuses as emotional value-adds to enhance customer delight. Theoretically, this research introduces a scalable, Explainable AI-based approach for applying the Kano model to unstructured textual data, overcoming limitations of traditional survey methods. Despite its strengths, this study is limited by the absence of validation for the Kano categorization through survey-based procedures. Future work will address this limitation by conducting perception-based surveys or interviews to validate and refine the inferred categorizations. Nonetheless, this research contributes a methodology and provides actionable strategies for essential oil producers to align product improvements with consumer expectations in digital commerce environments.

In traditional Chinese living environments, architecture and furniture have long complemented each other, forming a unified spatial aesthetic. However, in contemporary China, a disconnect has emerged between furniture design and architectural styles in terms of form and cultural meaning. This separation from regional architectural contexts disrupts the integration of traditional cultural elements between furniture and buildings, resulting in a lack of harmony between interior and exterior design styles and also weakening the role of furniture as a medium for cultural heritage preservation. To address this issue, this study takes the Lingnan region of China as a case study and aims to propose a comprehensive and systematic design and evaluation methodology for incorporating traditional regional architectural culture into the design of Neo-Chinese style seating. Through interviews, diverse design requirements for Neo-Chinese style seating were identified. On this basis, a KANO questionnaire was developed and distributed to 418 respondents to assess consumer preferences. The must-be, one-dimensional, and attractive attributes identified through the KANO model were structured into a hierarchical model using the Analytic Hierarchy Process (AHP), and the weight and priority of each indicator were calculated. Representative traditional Lingnan buildings were selected based on expert opinions, and their cultural elements were deconstructed for application in seating design. Guided by the analyzed user needs and extracted architectural elements, innovative design practices were conducted. The resulting seating designs were then evaluated using the Technique for Order Preference by Similarity to an Ideal Solution (TOPSIS). Evaluation results confirm the feasibility and effectiveness of the proposed framework in enhancing the quality of Neo-Chinese style seating design and meeting diverse consumer needs. This study offers a practical methodological and design reference for integrating traditional architectural elements into contemporary furniture design and contributes to the innovative expression of traditional regional architectural culture in modern contexts.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-21950-2.

ObjectiveThis study aimed to evaluate the efficacy of an artificial intelligence (AI) and digital twin (DT)-based telemedicine system in enhancing health outcomes among elderly adults in China's townships.MethodsA six-month controlled trial was conducted involving 252 adults aged ≥60 from 12 townships in Zhejiang Province. Participants were allocated to either an intervention group using the AI-DT telemedicine system or a control group receiving routine health monitoring. Health indicators including blood pressure, glucose levels, body mass index (BMI), and health anxiety were assessed pre- and postintervention. Statistical analyses were performed using SPSS, incorporating Chi-square tests, t-tests, and mediation analysis via the PROCESS macro.ResultsThe intervention group demonstrated significant improvements in systolic blood pressure (136.30–130.07 mmHg, q < 0.001), diastolic blood pressure (83.42–79.36 mmHg, q < 0.001), blood glucose (98.36–90.43 mg/dL, q < 0.001), BMI (23.80–22.90, q < 0.001), and health anxiety (43.17–30.58, q < 0.001). Mediation analysis indicated that reductions in health anxiety partially accounted for improvements in physiological metrics. Satisfaction survey results, analyzed using the Kano model, identified emergency alarms as a Must-be need and blood pressure monitors and glucose meters as One-dimensional needs.ConclusionThe AI-DT telemedicine system significantly enhances both physiological and psychological health outcomes among elderly adults in townships, demonstrating high acceptability and potential for broader implementation.

ObjectiveThis study aims to provide inputs for creating a child-friendly dental hospital by investigating the satisfaction and needs of children and their parents regarding the current environment of dental hospitals.Study designFirstly, the KJ method was used to construct evaluation indicators. Secondly, need indicators were classified with the Kano model. Thirdly, the weight of need indicators was evaluated using the Analytic Hierarchy Process (AHP) from both expert and user perspectives, thereby determining indicator priorities. Finally, the Kano-AHP model was used to fit indicator weights, and targeted optimization schemes were proposed.ResultsA total of 484 children aged 6–14 and their parents, along with 10 experts, participated in this study. (1) The Kano model shows that 9 Must-be needs are prioritized; 6 Attractive needs can significantly improve satisfaction; 12 One-dimensional needs call for continuous improvement; and 1 Indifferent needs can be postponed. (2) Based on AHP analysis, both experts and users prioritize needs for facilities and physical environment. After the improvement of weight, user needs shifted to equal emphasis on facilities and activities, indicating that the existing environment design can partially meet the must-be needs, with expectations for interactive experiences and emotional design significantly increasing. (3) A design priority sequence has been formed: “construct visual environment and interactive experiences - configure facilities and innovate treatment forms - enhance environmental safety and comfort - sustain advantageous projects”. (4) Five design strategies have been proposed.ConclusionFor dental hospitals, it is essential to strike a balance between the renovation of child-friendly environment and the integration of humanized services. The study findings may help designers and clinicians create child-friendly environments in dental hospitals, and provide references for similar dental hospitals to enhance children’s visiting experience.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12889-025-24989-y.

ABSTRACT With the rise of sustainable development concepts and intelligent livestock farming, China’s swine farming industry is transitioning from traditional methods to more efficient and environmentally friendly models. To address the evolving farming requirements and their complex relationship with intelligent housing space design, this study employs the Kano, AHP, and QFD models to refine vague requirements into specific design features, exploring the process and methodology of intelligent swine housing space design. The research establishes four functional requirements (including 14 design attributes) and 16 key design characteristics, ranked by priority. The results indicate that in the design of intelligent swine housing spaces, priority should be given to sustainable materials selection, easy-to-construct and stable structures, modular design approaches, and optimized spatial density. Based on this, the design of intelligent swine livestock housing is divided into areas requiring innovative design exploration and domains where technologies are already mature. Furthermore, the study demonstrates that the application of the integrated Kano-AHP-QFD model not only effectively captures changes in user requirements – overcoming subjectivity in decision-making – but also enhances design precision, providing theoretical and practical guidance for intelligent livestock housing design.

Survey on nursing caring behaviors needs of older adult inpatients based on Kano model and analysis of factors: A cross-sectional study.

The study aims to determine the extent of user satisfaction of the M-Tix application on Android devices. User satisfaction analysis was conducted using the E-Servqual method and the Kano Model. The data collection method was carried out by distributing questionnaires to 100 respondents who met the criteria with 21 research attributes describing the E-Servqual Dimension. The results showed that there were 3 attributes that had satisfied M-Tix Application users. 18 attributes still needed to be improved, because they had a negative E-Servqual Gap. Attributes categorized as category M were 10 attributes. Attributes with category A had 9 attributes. Meanwhile, attributes categorized O and I each had one attribute. Based on this, there were 3 attributes that needed to be maintained, 17 attributes that needed to be improved, while the remaining one attribute could be removed.

In home-based elder care, kitchen cabinets serve a critical function in the daily lives of older adults. However, most cabinets currently available in the Chinese furniture market are designed for young and middle-aged users, neglecting the specific requirements of the elderly population. To improve user satisfaction with age-friendly kitchen cabinet products, this study proposed a conceptual design method based on the Kano-QFD-FBS integration model. First, customer requirements were identified through behavioral observation and in-depth interviews, then systematically categorized and prioritized using the Kano model. Subsequently, Quality Function Deployment (QFD) was employed to translate customer requirements into actionable design requirements. Finally, the seven key design elements derived from this process were incorporated into the Function-Behavior-Structure (FBS) model to determine the product’s structural components. This integrated approach enables a precise mapping from customer requirements to design elements, facilitating the development of age-friendly kitchen cabinet concepts. The study demonstrates the feasibility and effectiveness of the Kano-QFD-FBS model in age-friendly design research, providing valuable guidance and innovative perspectives for age-friendly kitchen design in China.

Purpose This study aims to enhance administrative service quality in higher education by developing an integrated framework for registrar’s office operations. It addresses a notable research gap by applying the HESQUAL model alongside quality function deployment (QFD) and the Kano Model, which are rarely used together in educational administration. This integration allows for capturing student needs, translating them into technical actions and prioritizing service improvements based on impact. Design/methodology/approach An exploratory sequential mixed-methods design was used. Qualitative interviews and focus groups with students were used to construct a HESQUAL-informed survey instrument. The final survey, refined through expert validation and pilot testing, was administered to 286 respondents. Quantitative analysis included QFD matrix construction and Kano classification. Internal consistency was confirmed with a Cronbach’s alpha of a = 0.805, indicating acceptable reliability. Findings Six out of ten service attributes were classified as “must-be” requirements. Responsiveness, clarity and timely assistance emerged as top priorities. The House of Quality highlighted interventions such as queue management systems, digital interface redesign and staff training. Kano analysis emphasized foundational service elements as critical to satisfaction, underscoring the need for reliable and student-centered service delivery. Practical implications Findings provide institutional leaders with actionable strategies to align registrar services with student expectations, strengthen frontline support and enhance student satisfaction. Originality/value To the best of the authors’ knowledge, this study is the first to integrate HESQUAL, QFD and the Kano Model in the context of a registrar’s office. It offers a replicable, evidence-based framework that bridges theory and practice, advancing service quality innovation in higher education administration.

Advancements in global healthcare and declining birth rates have accelerated population aging, intensifying challenges such as workforce shortages and increasing the demand for tailored solutions to enhance the quality of life for the elderly. This study addresses a critical gap in the design of smart products for seniors by proposing a two-stage user satisfaction framework that integrates the Kano model, Quality Function Deployment (QFD), and Fuzzy Axiomatic Design (FAD) to manage uncertainties in user evaluations. Using a case study of Senior Hearing Aids (SHAs), the framework identifies nine key design factors and prioritizes improvements based on Importance Coefficients (ICs): environmental mode audio noise reduction (FR7, IC = 0.9140), battery systems (FR₄, IC = 0.3416) for extended usage, and lightweight structure (FR₃, IC = 0.3219) for comfort. Secondary improvements focus on modular design (FR₅) and audio components (FR₆) to ease maintenance and enhance sound clarity. Lower-priority features, such as simple button interaction and easy-to-remove components, are optimized through integrated design strategies. Uncertainty analysis using FAD, combined with expert validation, demonstrates the framework’s practicality and offers a scalable approach for aging-focused product design, with broader implications for smart healthcare innovations.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-17546-5.

Healthcare quality is critical to patient satisfaction and the effectiveness of the healthcare system. Understanding patient perspectives and needs leads to higher patient satisfaction and client loyalty, and models, such as the Kano model, systematically evaluate client expectations. This literature review examines the application of the Kano model in healthcare settings and analyzes studies conducted from 2017 to 2025. The findings confirm its effectiveness in assessing patient expectations, especially when integrated with other methodologies, such as the balanced scorecard and the SERVQUAL dimensions. However, there are still challenges that need to be overcome. The successful implementation of this model depends on an appropriate sample size, rigorous procedures, and attention to cultural differences.

The rapid advancement of artificial intelligence technologies has fundamentally transformed higher education, encouraging universities to develop comprehensive institutional policies for AI implementation across academic and administrative processes. This study presents Kherson State University's institutional experience developing regulatory frameworks for implementing AI-based services. The research employs the Kano model methodology to assess user satisfaction and prioritize AI-based services among university participants. A comprehensive survey involving 502 students, 141 academic staff members, and 61 non-academic staff members was conducted to determine preferences and satisfaction levels with the 13 most demanded worldwide AI-based services, including ChatGPT, Google Gemini, Gamma, and others. The study introduces a conceptual distinction between routine and creative intellectual activities, establishing a framework for appropriate AI utilization. Based on survey results, a four-tier typology of AI-based services usage was developed: mandatory use, recommended use, not recommended use, and prohibited use. This classification system addresses different participant groups and activity types within educational, scientific, administrative, and management domains. Key findings reveal that ChatGPT (35.1%), students consider Gamma (21.1%), and Google Gemini (19.7%) most functional, while academic staff prioritize ChatGPT (55.3%), Google Gemini (46.1%), and Gamma (38.3%). Notable differences emerged between natural science and humanities students regarding specific AI tool preferences. The research resulted in comprehensive institutional regulations that define ethical principles, security requirements, and implementation guidelines for AI-based services. The study provides practical recommendations for enterprise-level AI tools, including security protocols for confidential data processing and integration with university authentication systems. This institutional model offers valuable insights for other universities developing AI governance frameworks, contributing to responsible AI adoption in higher education while maintaining academic integrity and educational quality standards.