Abstract
Advance Care Planning (ACP) has been globally advocated as a key public health issue to ensure that individuals' future care preferences are understood and respected. While it is reported to have potential benefits, engagement with ACP remains significantly lower amongst diaspora groups compared with mainstream populations. This disparity is often attributed to cultural influences on the acceptability and engagement with ACP, yet public health initiatives are rarely culturally sensitive or tailored. Despite being one of the largest and fastest-growing diaspora groups globally, and in the UK and Northern Ireland, the Chinese diaspora remains under-researched in the context of ACP.Aim: To explore understanding, experiences, and perceptions of advance care planning among the Chinese diaspora residing in the Northern Ireland and identify components and strategies for developing public health culturally sensitive ACP intervention.
Methods: An exploratory sequential mixed methods design incorporating three phases: 1) A systematic integrative review analysing the Chinese diaspora's understanding, experience, and factors influencing engagement with ACP. 2) Qualitative exploratory study with 17 participants connected to voluntary Chinese organizations in the UK. 3) Cross-sectional correlational study to assess the knowledge, attitude and engagement in ACP among members of the Chinese diaspora population (n=284).
Findings: The synthesis of findings highlighted the significant role of culture in influencing ACP engagement among the Chinese diaspora. Building on this, interviews revealed an interplay between participants’ divergent cultures, resulting in low awareness, misconceptions, and limited participation. Survey results suggested that whilst awareness and engagement with ACP remains low for this population, opportunities to engage with ACP exist. However, to iii align ACP with the Chinese diaspora requires acknowledgement and recognition of the influence of cultural backgrounds on individuals' values, beliefs, and preferences.
Conclusion: Cultural influences, such as cultural identity, filial piety, the role of authority, shape Chinese diaspora's awareness and engagement in ACP. To promote equitable ACP access, public health initiatives are recommended to consider culturally diverse populations. Further research is needed to develop and test ACP intervention for this population, and additional psychometric testing of the newly developed ACP instrument is recommended to strengthen its measurement properties.
Thesis is embargoed until 31st January 2028
| Date of Award | Jan 2026 |
|---|---|
| Original language | English |
| Supervisor | Sonja McIlfatrick (Supervisor), Felicity Hasson (Supervisor) & Esther Ruth Beck (Supervisor) |
Keywords
- advance care planning
- culture
- Chinese diaspora
- theory of planned behaviour
- social ecological model
- mixed methods research