Co-designing a culturally-sensitive theory-driven advance care planning game with Chinese older adults and healthcare providers.

Abstract

Advance care planning can be challenging because discussing end-of-life care often has negative connotations. Gamification is a novel approach to encourage advance care planning conversations in Western culture. To co-design a game with multiple stakeholders to promote advance care planning in Chinese communities. A two-phase design guided by the Medical Research Council framework for developing complex interventions was adopted between May 2019 and August 2020. In phase I, a game prototype was developed based on literature review, expert consultation and end-user consultation. In Phase II, the game prototype was tested among end-users and refined according to their feedback and expertise of a multi-disciplinary team through an iterative process. Experts in the field of aged care, palliative care, life education and game development and Chinese community-dwelling adults aged 60 years or older. A board game called '<i>The Five Tastes Found in a Grocery Store</i>' was developed. The game design was shaped by Bandura's Self-efficacy theory and feedback from experts and end-users. The participants generally found the gaming experience enjoyable and appreciated the opportunity to discuss end-of-life care openly. This study is the first to develop an evidence-informed, theory-based, culturally sensitive game for promoting advance care planning in the Chinese community using a co-design approach.