Health Education as a Means of Addressing Death in the Elderly

Evaluation of a knowledge-attitude-practice model based narrative life education program for community-dwelling older adults: a mixed-methods feasibility study

BACKGROUND

The global aging population presents challenges that are particularly acute in China. Older Chinese adults' attitudes towards death significantly impact their quality of life. Death education is crucial for promoting positive perspectives on life and death. Narrative education offers a promising approach to facilitating death education. Integrating the Knowledge-Attitude-Practice (KAP) model into death education will enhance the feasibility and acceptability of death education programs.

METHODS

This mixed-methods feasibility study included a quasi-experimental trial and semi-structured interviews. Older adults in the intervention group (N = 27) received a 6-week KAP-based narrative life education program in addition to standard community health education; participants in the control group (N = 20) received only the normal community health education. In both groups, attitudes toward death and the meaning of life were assessed at baseline and immediately after the intervention. A post-intervention semi-structured interview and satisfaction survey were also conducted for the intervention group.

RESULTS

Forty out of 47 older adults completed the program for an 85.1% retention rate. All of the older adults in the experiment were very satisfied and satisfied with the life education program, and no adverse events were reported. Compared to the control group, participants in the intervention group had a significant decrease in the fear of death (P = 0.028), and substantial improvement in their value of life (P = 0.031), goal of life (P = 0.035), freedom of life (P = 0.003), and the total score for purpose in life (P = 0.017). The qualitative results yielded four themes: profound recognition of life and death, contradiction between thoughts and action, conflict between one's acceptance and others' avoidance, and evaluation of the life education program.

CONCLUSIONS

The KAP-based narrative life education program is feasible and acceptable for older Chinese community-dwelling adults. It is also potentially effective in improving attitudes toward death attitudes and the meaning of life in this cohort.

TRIAL REGISTRATION

This study was retrospectively registered at China Clinical Trial Registry as ChiCTR2300069551 on 2023-03-20. URL of registration: https://www.chictr.org.cn/showproj.html?proj=183176 .

Construction of PARI public health education programs for Chinese undergraduates: a Delphi study

Objectives

The objective of this study is to develop a consensus among experts on a comprehensive and scientifically sound physical activity-related injuries (PARI) public health education program specifically tailored for undergraduates.

Methods

This study designed three rounds of expert consultation by using a Delphi method. A panel of 30 experts from the fields of public health education, sports medicine, anesthesia pain, emergency medicine, and emergency nursing participated in the study.

Results

This study successfully established a consensus among experts on the goals, content, teaching methods, and time allocation for the PARI Public Health Education Program for undergraduates. The program encompasses 10 objectives divided into 2 main categories: professional knowledge and skill goals. In terms of content, it includes 5 primary indicators, 22 secondary indicators, and 56 detailed tertiary indicators. Six teaching methods were identified as suitable. Additionally, a typical 60-min educational session was segmented into eight parts, with a proposed time arrangement for each, ensuring comprehensive coverage of all topics.

Conclusion

The consensus achieved in this study on the PARI Public Health Education Program for undergraduates lays a crucial foundation for the advancement of health literacy and proactive health management within this demographic. We presented a comprehensive framework for PARI public health education, integrating diverse learning methods and content areas. This systematic approach not only enriched the resources available for undergraduate health education, especially of PARI but also had the potential to significantly impact the implementation and effectiveness of health promotion strategies.

Effects of death education interventions on cancer patients in palliative care: A systematic review and meta-analysis

This review summarizes the best available evidence on the effects of death education in palliative care for cancer patients. A systematic literature review was conducted across 9 databases, revealing 22 eligible studies (N = 2,374). After two reviewers independently engaged in study selection, quality assessment, and data extraction, the results were synthesized through qualitative and quantitative analysis. Overall, the focus on death education for cancer patients showed an upward trend and consistently demonstrated significant positive effects with regards to the control of anxiety and depression, attitudes toward death, and quality of life. However, high-quality evidence regarding the effects of death education on cancer patients is lacking, warranting additional well-designed rigorous studies and standardized programs with specific and feasible steps.

Research on factors influencing Chinese parents' support for death education: a cross-sectional survey

Objective

This study aims to explore the factors influencing Chinese parents' attitudes toward death education. Given the current lack of such education in China, this research is particularly significant. Death education is vital for shaping the values of young people and alleviating mental health issues, such as depression and suicidal tendencies. By identifying these influencing factors, this study seeks to provide guidance for policymakers and educators in promoting the development and widespread adoption of death education.

Methods

To do so, a national cross-sectional quota sample of 12,435 Chinese parents was used. Borrowing from social-ecological theory, the researchers carried out multiple stepwise regression analyses to examine the individual, family, and social-level factors that shape the supportive attitudes of Chinese parents toward death education.

Results

The findings revealed that at the individual level, parent (β = 0.04, p < 0.001), education level (β = 0.07, p < 0.001), and religious belief (β = -0.02, p < 0.05) were significant predictors of Chinese parents' support for death education. Meanwhile, at the family and social level, average monthly household income (β = 0.07, p < 0.001), family health (β = 0.03, p < 0.05), family communication (β = 0.02, p < 0.05), social support (β = 0.15, p < 0.001), neighborhood relations (β = 0.11, p < 0.001), and social network size (β = 0.05, p < 0.001) were significant predictors of Chinese parents' supportive attitudes toward death education.

Conclusion

Based on these findings, it is suggested that the relevant development, planning, publicity, and public welfare groups and government departments should promote death education, provide more social support, and encourage neighborhood harmony. As higher education and average monthly household income were found to significantly impact the support, the government should improve access to higher education and actively work to increase residents' income to facilitate the development of death education.

Experiences of Chinese advanced cancer patients after attending a "four-stage" death education programme: A qualitative study

PURPOSE

This study aimed to explore the experiences of cancer patients who participated in and completed a "four-stage" death education programme based on knowledge-attitude-practice theory.

METHODS

This study employed a qualitative descriptive design. Semistructured interviews with an interview guide were used to collect data. Fifteen cancer patients who participated in and completed the "four-stage" death education programme (from November 10, 2021, to December 29, 2021) were recruited via purposive sampling. The "four-stage" death education programme model was developed based on knowledge-attitude-practice theory and included eight death education modules. Each interview was audio-recorded and transcribed verbatim. Generic analysis was used to conduct data analysis by coding, classifying, and extracting themes.

RESULTS

Five themes were identified: the gradual shift of death cognition towards objective reality, a decrease in death anxiety, patients' early thoughts concerning issues related to death and preparation ahead of death, patients' improved ability to respond to death incidents, and patients' increased focus on cherishing the remainder of their lives and living in the moment.

CONCLUSIONS

Cancer patients accept and respond effectively to the implementation of a "four-stage" death education programme based on knowledge-attitude-practice theory. These findings can help cancer patients improve their reasonable perception of death and reduce their doubts and confusion concerning death.

The Influence of Cultural Snapshots on Pre-service Teachers' Attitudes Towards Death Education

Cultural snapshots may be a didactic resource that promotes the understanding of death and provides teachers with tools that can be used to work with students. This study aims to analyse pre-service teachers' attitudes towards death education. A quantitative longitudinal panel design with pre-test and post-test measures was applied, with descriptive, inferential, and predictive approaches. The sample consisted of 161 pre-service primary teachers from a Spanish university who responded to the validated questionnaire "Death Education Attitudes Scale-Teachers" (DEAS-T). The results reveal an improvement in their attitudes towards death education after implementing cultural snapshots in class, producing significant differences between the pre-test and post-test according to gender, in favour of the male participants. The variables of death anxiety and adequate training are relevant for predicting the attitudes of both genders, in addition to the motivation variable in male participants and the variable of interest towards the topic in female participants.

Exploring the needs and barriers for death education in China: Getting answers from heart transplant recipients' inner experience of death

Background

Promoting reflection about death may support better living, and how to carry out death education is an important issue to be addressed across the world. The purpose of the current study was to explore the attitude of heart transplant recipients toward death and their inner real experience to provide information for the development of death education strategies.

Methods

A phenomenological qualitative study was conducted using a snowball method. A total of 11 patients who had undergone heart transplantation more than 1-year ago were recruited for the current study for semi-structured interviews.

Results

A total of five themes were identified: "Not avoid talking about death," "Feeling fear about the pain in the process of death", "Wanting a good death at the end of life," "The richness of feelings during near-death is surprising," and "Being close to death makes people more receptive to death."

Conclusion

Heart transplant recipients have a positive attitude toward death and wish for "good death" at the end of life. These patients' near-death experiences and positive attitudes toward death during the course of their illness provided evidence of the need for death education in China and supported the experiential approach to death education.

Influencing factors of attitudes towards death and demands for death education among community-dwelling Chinese older adults: a cross-sectional study

Background

Considering older adults are getting closer to the end-of-life and face death more directly. Attitudes to death not only affect the physical and mental health of older adults, but also affect their acceptance of hospice care, even the quality of death. This study aims to explore the status, influencing factors of attitudes toward death and demands of death education among the community-dwelling older adults in southwestern China.

Methods

A cross-sectional survey was adopted to investigate 683 community-dwelling older adults in Chongqing, China. Non-parametric test and multiple linear regression analysis was used to explore the influencing factors of different attitudes toward death of older adults in community.

Results

The multiple linear regression models showed that different dimensions of death attitudes were affected by one or more factors including number of diseases, discussion about life and death, marital status, and average income per month. And community-dwelling older adults have high level demand for death education.

Conclusions

Under the taboo culture of death in China, this study is one of the few studies on the attitudes toward death and the demands for death education of the community-dwelling older adults. This study contributes to enrich the global death studies and provide reference for the death education for older adults.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13655-2.

Construction of life-and-death education contents for the elderly: a Delphi study

BACKGROUND

Life-and-death education is intimately related to palliative-and-hospice care. It should be implemented among groups of all ages, especially for the elderly. This study aims to establish expert consensus on a set of scientific and systematic life-and-death education contents for the elderly and provide reference for the practice on the elderly.

METHODS

This study designed three rounds of expert consultation by using a Delphi method. A panel of 22 experts from the fields of palliative-and-hospice care, life-and-death education, geriatric nursing, humanities and ethics, and geriatric psychology participated in the study.

RESULTS

This study finally reached expert consensus on the contents of life-and-death education for the elderly, containing 4 first-level items, Life-and-death literacy promotion in the elderly; Life-and-death concept establishment of the elderly; Life-and-death planning of the elderly; Life-and-death thoughts of the elderly with affiliated 9 second-level items, and corresponding 23 detailed third-level items.

CONCLUSIONS

The life-and-death education contents for the elderly offer a basis for publicity for health professionals, promote dialogues on death, preparation, and planning for death and dying. The life-and-death education contents system was clear in coherence containing definite and comprehensive contents, which enriched life-and-death education resources globally. The results could assist in the planning of palliative-and-hospice care services to improve quality of death of the elderly.