Migration as a transformative force shaping beliefs about and readiness for advance care planning among Thai...

Advance care planning (ACP) engagement remains low among culturally and linguistically diverse populations, including immigrant communities, where cultural norms, family expectations, and migration may shape attitudes toward healthcare decision-making. Although Thai immigrants represent a growing population in Australia, little is known about how migration influences their perceptions of and readiness for ACP. This study aimed to explore how Thai immigrants in Australia perceive and engage in ACP within a new social and healthcare context.

A qualitative descriptive phenomenological study was conducted in Victoria, Australia. Seventeen Thai immigrants were recruited through purposive and snowball sampling via Thai community networks. Semi-structured interviews were conducted in Thai or English, audio-recorded, transcribed, translated, and analyzed using reflexive thematic analysis informed by phenomenological techniques.

Four key themes were constructed through reflexive thematic analysis of the interviews: (1) the "old Thai way," characterized by family-centered decision-making, deference to authority, and avoidance of death-related discussions; (2) migration as a disruptive force, with exposure to autonomy-based healthcare prompting reflection and adaptation; (3) tension between cultural values, highlighting challenges in balancing filial obligation with individual autonomy; and (4) reconstructing belief systems, wherein participants developed hybrid identities, integrating Thai and Australian values.

Migration disrupts traditional Thai norms surrounding family roles, communication, and decision-making, thereby reshaping how participants understand and approach readiness for ACP. Thai immigrants reinterpret family roles, faith, and autonomy within a new cultural context, emphasizing the need for culturally responsive ACP approaches that respect family influence, indirect communication, and the role of community mediators.