Preparation and Planning for Future Care in the Deep South: Adapting a Validated Tool for Cultural Sensitivity

• Published in: The Gerontologist Vol. 59; no. 6; pp. e643 - e652
• Main Authors: Allen, Rebecca S, Oliver, JoAnn S, Eichorst, Morgan K, Mieskowski, Lisa, Payne-Foster, Pamela, Sörensen, Silvia
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 16-11-2019
• Subjects: Adult; Advance Care Planning; Advance directives; African Americans; African Americans - psychology; Aged; Alabama; Avoidance behavior; Cognitive interviews; Confirmatory factor analysis; Coping strategies; Cultural Competency; Cultural sensitivity; Culture; Early Detection of Cancer - psychology; Health Knowledge, Attitudes, Practice - ethnology; Health services; Humans; Interviews as Topic; Male; Measurement; Middle Aged; Nursing care; Nursing homes; Patient Care Planning; Planning; Prostatic Neoplasms - diagnosis; Prostatic Neoplasms - prevention & control; Psychometrics; Qualitative research; Quantitative psychology; Questionnaires; Rural Population; Surveys and Questionnaires; Transcultural nursing; Alabama; United States > US; Southern states; Qualitative research methods; Diversity and ethnicity; Advance care planning; Cultural competence practice; Rural and urban issues; African American
• ISSN: 0016-9013; 1758-5341
• DOI: 10.1093/geront/gny102

Abstract
Background and Objectives
This study describes the adaptation and validation of Sörensen et al. (2017)’s preparation for future care (PFC) scale with diverse samples including rural dwelling African Americans and certified nursing assistants (CNAs), and subsequent psychometric development.
Research Design and Methods
Responses to the five-subscale PFC survey from 33 rural African American men across 12 months and cognitive interviews with a subset of 12 of these men are described. Psychometric refinement included descriptive qualitative analyses of consultations with experienced lay research advisors (N = 4 and N = 7) regarding potential changes to the PFC and a confirmatory factor analysis of the resultant scale (N = 138).
Results
Cognitive interviews with rural African American men revealed difficulty understanding Eurocentric questions. Emergent themes included emotional avoidance of planning, considerations of nursing homes and possible care providers, and coping strategies. In two consultation meetings, trained lay research advisors recommended language modifications to the original questions and response options. Factor analyzing the resultant scale revealed support for the original subscale constructs (acceptable fit: χ2 = 205.03, df = 124, p < .001; root mean square error of approximation = .069 [.052–.085]; comparative fit index = .93; Tucker–Lewis index = .91).
Discussion and Implications
PFC and engagement in advance care planning is uncommon among African Americans, possibly due to distrust of and lack of cultural competency among health care professionals. The resulting tool and response options may be used as an interview guide/survey with African Americans to gain understanding about their preparation for future health care needs.