Adapting Advance Care Planning Interventions for Hispanic Communities Across the U.S.

CONTEXT

Health inequities in Hispanic populations require community-engaged solutions. Engaging Hispanic communities in research related to advance care planning (ACP) is critical to inform the development and evaluation of culturally appropriate interventions.

OBJECTIVES

To understand how to best adapt and implement Spanish-language ACP interventions in Hispanic communities across the US.

METHODS

We apply the Framework for Reporting Adaptations and Modifications to Evidence-based Interventions (FRAME) to detail experiences during implementation of the national Project Talk Trial (PTT) that delivers two ACP interventions using a community-based delivery model. Semi-structured interviews with Hispanic community event hosts and research assistants (RAs) were conducted to explore challenges and solutions to implementation. Thematic analysis was applied to transcripts.

RESULTS

Three themes from the community hosts (n = 9) were: (1) certified translation professional services were inadequate to successfully adapt interventions for diverse Hispanic communities; (2) a lack of Spanish-speaking RAs undermined the intention to address health inequities in the research; and (3) cultural norms, such as RSVP systems, differ in Hispanic populations. Themes from the RA interviews (n = 7) include: (1) discomfort with being unable to communicate appropriately with the research participants; and (2) improved connection and event flow when bilingual RAs attended events.

CONCLUSION

Our work highlights the value of a strong community-based delivery model, attention to local dialects and cultural nuances, the need for Spanish-speaking workforce and for balancing fidelity across national sites with adaptability when conducting rigorous research.

TRIAL REGISTERED

The trial titled "Engaging underserved communities in end-of-life conversations: a cluster, randomized controlled trial" is registered at clinicaltrials.gov [NCT04612738].