Participant Perceptions of a Trauma-Informed Advanced Care Planning Intervention: A Qualitative Study

Abstract

Background:

Low-income communities are at higher risk for adverse childhood experiences and have low rates of advance care planning.

Objectives:

This study explored subsidized housing residents’ perceptions of the trauma-informed components of an advance care planning intervention to address these inequities.

Design:

We used a qualitative descriptive design to analyze the post-intervention qualitative interviews.

Setting/Subjects:

In a Southeast Nashville subsidized housing community, we recruited adult (aged 18+) residents who had not completed an advance directive to participate in an intervention study. Interviews were conducted in an on-site apartment reserved for community service and research.

Measurements:

An expert-informed and Substance Abuse and Mental Health Services Administration trauma-informed care model-informed semi-structured guide was used to conduct face-to-face, audio-recorded, and one-time post-intervention debrief interviews. Using thematic analysis, two trained coders coded transcripts, resulting in a hierarchical codebook. Codes were individually reapplied as coding evolved. The final themes were inductively informed by participant quote patterns and deductively informed by the trauma-informed care model.

Results:

Most interview participants (n = 29) identified as male (n = 15), Black or African American (n = 18), and Christian (n = 26) (median age: 60). Three themes emerged: Meet me where I am, I don’t want anyone in my business, and this was an eye-opener.

Conclusions:

This study expanded the advance care planning literature by using a trauma-informed lens, suggesting a strong need for privacy with aging adults across socioeconomic levels. Research, policy, and practice recommendations are discussed to spread trauma-informed processes at the organizational and community levels.