Strengthening death literacy in multicultural communities: Community-led interventions and cross-cultural validation...

Death literacy - the knowledge, skills, and capacity to navigate end-of-life care, advance care planning, dying, and death care - is shaped by cultural, religious, and linguistic factors. The Death Literacy Index (DLI) captures practical, experiential, factual, and community domains. Currently, there is limited evidence about death literacy levels among culturally and linguistically diverse communities in multicultural settings, and little is known about how translated versions of the DLI perform psychometrically in these groups or how culturally tailored, community-delivered interventions can strengthen death literacy.

(1) To evaluate the impact of culturally adapted, community-designed and delivered interventions on DLI subscale and total scores among Filipino, German, Italian, and Vietnamese communities in South Australia; and (2) to examine the preliminary psychometric properties (factor structure and reliability) of translated DLI instruments in these populations.

Pre-post intervention study.

Community leaders in each group co-designed and delivered a community-specific intervention over 3-5 months using culturally familiar channels (workshops, radio/podcasts, social media, and printed/online resources). Thus, four parallel but distinct interventions were implemented, one in each cultural/language community. The DLI was professionally translated (German, Italian, Tagalog, Vietnamese) with community review. Surveys were administered in preferred languages at baseline (T1) and ~6 weeks post-intervention (T2). Psychometrics (T1, n = 242): confirmatory factor analysis (CFA) and reliability. Impact (matched pairs, n = 100): Wilcoxon signed-rank tests.

Psychometrics (T1, n = 228): Subscale CFAs supported the translated DLI across groups, while the total-scale fit was poor - reinforcing a multidimensional construct; internal consistency was good-excellent overall, with weaker reliability for Talking Support subscale (Vietnamese) and some variability in Experiential Knowledge. Intervention impact (matched pairs, n = 100): Filipino participants showed significant increases in median scores across all four DLI subscales and the total DLI score (medium-large effects); Vietnamese participants showed significant decreases in Practical Knowledge and total DLI scores, with little change on other subscales; German and Italian groups demonstrated small, mostly non-significant increases on selected DLI subscales (particularly Factual and Community Knowledge), with minimal change in total DLI scores. Across groups, DLI subscales capturing knowledge of resources and supports generally improved.

Culturally tailored, community-delivered interventions can strengthen death literacy, but effects vary by cultural/linguistic context. DLI subscales function adequately across groups, whereas total-scale fit is poor. Future work should refine translations (e.g. DLI-R), address weaker domains, and adapt content and delivery to community preferences to enhance cultural responsiveness and equity in end-of-life literacy. The study demonstrates how death literacy can operate as a culturally responsive, community-level public health indicator and provides evidence to guide adaptation of both the DLI and community programs to advance equity in end-of-life literacy and care.