Health Beliefs, Religiosity, Acculturation, and the Utilization of Advance Care Planning among Arab Americans
General Material Designation
[Thesis]
First Statement of Responsibility
Alwardat, Khaled
Subsequent Statement of Responsibility
Dee, Vivien
.PUBLICATION, DISTRIBUTION, ETC
Name of Publisher, Distributor, etc.
Azusa Pacific University
Date of Publication, Distribution, etc.
2021
PHYSICAL DESCRIPTION
Specific Material Designation and Extent of Item
148
DISSERTATION (THESIS) NOTE
Dissertation or thesis details and type of degree
Ph.D.
Body granting the degree
Azusa Pacific University
Text preceding or following the note
2021
SUMMARY OR ABSTRACT
Text of Note
The goal of this study was to examine the impact of health beliefs, religiosity, and acculturation on the readiness and engagement of Arab Americans (AAs) with Advance Care Planning (ACP). No previously existing studies focused on the cumulative impact of health beliefs, religiosity, and acculturation on ACP. Furthermore, none of these studies was conducted on AAs. Advance care planning involves setting goals for the actual or possible healthcare that is consistent with personal wishes and preferences when the individual is unable to make decisions or speak for himself or herself. As a large minority group under-represented in nursing research, AAs are more likely to face end-of-life (EOL) care without clear communication outlining their values and wishes, because healthcare providers are not familiar with how to approach them. This study used a quantitative descriptive, cross-sectional design with a sample of Arab-American adults, guided by the Sunrise model depicted in Leininger's Transcultural Care Theory. Along with demographic data concerning participants' characteristics, four instruments were utilized: the ARSAAII, measuring acculturation, the DUREL, measuring religiosity, the MHLC scale, which measures health beliefs, and the ACP engagement survey, which measures ACP readiness. A total of 281 Arab-American adults participated in this study, originating mostly from four countries (Jordan, Palestine, Syrian, and Egypt), although the study was open to any of the 22 Arab countries. Thirteen demographic variables were tested with the ACP. Five of these 13 variables were not correlated and were excluded from further analysis. The remaining seven variables indicating relationships were those of being Muslim, male, married, years in the United States (U.S., henceforth called U.S. years), number of children, income, and health insurance status. All variables along with the subscales: health beliefs, religiosity, acculturation, and ACP showed degrees of correlation between each other. Of the seven variables that showed correlations, five were selected to remain in the final analytic model based on the strength of their relationship with other variables; marital status and presence of health insurance were removed from the model. The suggested model was based on a multivariate multiple regression analysis, which included five exogenous variables (male sex, having children, being Muslim, U.S. years, and income) and 10 endogenous variables (acculturation [2], health belief [3], ACP engagement [2], and religiosity [3]). Results indicated statistically significant associations between demographic variables with the ACP readiness (R) and self efficacy (C) subscales. U.S. years revealed a direct effect with ACP-R. Income, being male, and having children revealed a direct effect on ACP-C. Only Muslim as a demographic variable did not show direct correlations with either ACP subscales C or R. Acculturation and health belief revealed strong relationships with ACP engagement. Religiosity, on the other hand, did not show a direct relationship; rather, it was correlated indirectly through acculturation and health beliefs. There is an imperative need for additional research to gain an understanding of the significant factors that could influence the utilization of ACP among AAs. Therefore, additional efforts are required to promote ACP engagement among AAs in the United States, making the case that AAs in this study were aware and confident in their ability to address ACP since it is part of their culture and belief; however, it needs to be explained, encouraged, and executed. Creating AA-focused training programs tailored to preparing healthcare providers to address AAs' specific needs is recommended, as well as a concerted effort to focus on increasing knowledge about minority groups to improve their knowledge and understanding about the importance of ACP.