BIOPSYCHOSOCIAL FACTORS ASSOCIATED WITH MEDICALLY ASSISTED REPRODUCTION: SCREENIVF VALIDATION AND APPLICATION IN CHINA

ABSTRACT

AIMS: THIS STUDY AIMED TO DESIGN, IMPLEMENT, AND EVALUATE A COMMUNITY-BASED LIFE-AND-DEATH EDUCATION PROGRAM FOR YOUTH VOLUNTEERS SERVING THE ELDERLY IN MACAO. THE RESEARCH SOUGHT TO INVESTIGATE THE PROGRAM'S EFFECTIVENESS IN ENHANCING PARTICIPANTS' DEATH COPING COMPETENCE, REDUCING DEATH ANXIETY, AND IMPROVING LIFE ATTITUDE, AS WELL AS TO ASSESS ITS FEASIBILITY AND ACCEPTABILITY IN A COMMUNITY SETTING. METHODOLOGY: THE STUDY EMPLOYED A CONVERGENT MIXED-METHODS, QUASI-EXPERIMENTAL DESIGN WITH AN EXPERIMENTAL GROUP (N = 49) AND A WAITLIST CONTROL GROUP (N = 44). QUANTITATIVE DATA WERE COLLECTED AT PRE-TEST, POST-TEST, AND A THREE-MONTH FOLLOW-UP USING THE COPING WITH DEATH SCALE (CDS-C), TEMPLER'S DEATH ANXIETY SCALE (C-TDAS), AND THE LIFE ATTITUDES SCALE (LAI-SF), AND WERE ANALYZED USING LINEAR MIXED-EFFECTS MODELS. CONCURRENTLY, QUALITATIVE INQUIRY WAS CONDUCTED WITH THE EXPERIMENTAL GROUP THROUGH SEMI-STRUCTURED IN-DEPTH INTERVIEWS AND PROCESS EVALUATION FORMS, WITH DATA ANALYZED USING THEMATIC ANALYSIS. RESULTS: QUANTITATIVE RESULTS REVEALED A STATISTICALLY SIGNIFICANT AND LASTING IMPROVEMENT IN DEATH COPING COMPETENCE FOR THE EXPERIMENTAL GROUP COMPARED TO THE CONTROL GROUP (P < .001). HOWEVER, NO SIGNIFICANT DIFFERENCES WERE FOUND BETWEEN THE GROUPS FOR DEATH ANXIETY OR LIFE ATTITUDE. QUALITATIVE ANALYSIS SHOWING THE PROGRAM TO BE HIGHLY FEASIBLE (74.2% RETENTION RATE) AND ACCEPTABLE (73.5% ATTENDANCE RATES). PARTICIPANTS REPORTED THAT THE PROGRAM PROVIDED A SAFE SPACE FOR DISCUSSION AND PRACTICAL INTERACTIVE TOOLS, LEADING TO A COGNITIVE REFRAMING OF THEIR VIEWS ON LIFE AND DEATH, AND ENHANCING THEIR COURAGE AND COMMUNICATION SKILLS FOR DISCUSSING DEATH-RELATED TOPICS IN BOTH FAMILY AND VOLUNTEER SETTINGS. DISCUSSION: THIS RESEARCH PROVIDES AN EVIDENCE-BASED, REPLICABLE BLUEPRINT FOR LIFE-AND-DEATH EDUCATION PROGRAMS FOR COMMUNITY ORGANIZATIONS IN MACAO. IT IS RECOMMENDED THAT FUTURE PROGRAMS EXTEND THEIR DURATION TO FACILITATE DEEPER EMOTIONAL PROCESSING AND TAILOR CONTENT TO MACAO'S SPECIFIC LEGAL AND CULTURAL REALITIES (E.G., ADVANCE DIRECTIVES). FURTHERMORE, ADOPTING A ""TRAIN THE TRAINER"" MODEL THAT PRIORITIZES KEY GROUPS LIKE UNIVERSITY STUDENTS AND TEACHERS, ALONG WITH ESTABLISHING A PROFESSIONAL CERTIFICATION SYSTEM, WOULD CONTRIBUTE TO THE PROGRAM'S SUSTAINABLE DEVELOPMENT AND DISSEMINATION. CONCLUSION: THIS STUDY IS THE FIRST IN MACAO TO SYSTEMATICALLY VALIDATE A LIFE-AND-DEATH EDUCATION INTERVENTION FOR A NON-HEALTHCARE POPULATION (YOUTH VOLUNTEERS), FILLING A GAP IN THE EXISTING LITERATURE. AGAINST THE CULTURAL BACKDROP OF DEATH TABOOS PREVALENT IN CHINESE SOCIETIES, THIS RESEARCH OFFERS A CULTURALLY SENSITIVE AND EVIDENCE-BASED MODEL. ITS FINDINGS HOLD SIGNIFICANT VALUE FOR COMMUNITY ORGANIZATIONS, EDUCATORS, AND POLICYMAKERS IN MACAO AND OTHER CHINESE REGIONS AIMING TO PROMOTE LIFE-AND-DEATH EDUCATION.