Growing evidence suggests under-engagement in advance care planning (ACP) among ethnic minorities in the U.S. However, findings about factors affecting ACP among ethnic minorities are fragmented. The purpose of this study was to synthesize findings from prior research about ACP among ethnic minorities and identify facilitators and barriers toward it. Out of 633 studies identified through an extensive literature search, only 25 studies met our inclusion criteria such as primary evidence, study location (U.S.), publication year (since 2006), study purpose (ACP) and sample (ethnic minority adults or older adults). Four categories of facilitators and barriers were identified: Socio-demographic factors, health care experiences, cultural values, and spirituality. Socio-demographic factors such as education and financial resources showed inconsistent findings regarding their association with ACP engagement. However, health literacy (knowledge and awareness about ACP) and past experiences with ACP are a common facilitator for ACP across ethnic minority groups, whereas mistrust toward health care system was identified as a barrier only for Black Americans. Collectivistic/family-centered cultural values greatly influenced ACP engagement among Latinos and Asian Americans; however, spirituality/religion played an important role among Blacks. The results of this systematic review illuminate facilitators and barriers that can be utilized to promote ACP for ethnic minorities. Educational interventions can be an effective venue to facilitate ACP for ethnic minorities by improving awareness about ACP. In such interventions, health care professionals may need to consider including family members or clergy to address culturally unique barriers toward ACP.
Adolescents’ attitudes predict sexual behavior; therefore, attitudes are targeted in sexually transmitted infection (STI) and pregnancy prevention programs. However, attitudes and behaviors do not always align. Young adolescents who have had penile vaginal intercourse (PVI) and have attitudes supportive of PVI have two risk factors for future health risks while those with attitudes in conflict with PVI experience (i.e., attitudes not supportive of PVI) only have one risk factor, that is, early sexual debut. Rural sixth- to eighth-grade students in southern, central Florida who had PVI experience ( N = 162) completed surveys about their sexual history, substance use, PVI refusal skills, and PVI attitudes. Logistic regressions found that longer time since PVI, never trying other drugs, and better PVI refusal skills predicted higher odds of attitude-behavior conflict; thus, youth with attitude-behavior conflicts have fewer predictors of sexual health risk than those without attitude-behaviors conflicts. Those without attitude-behaviors conflicts likely need more focused and intensive interventions.
