Adopting the lens of the COM-B behaviour change model to qualitatively explore and understand public health implications of young adults' attitudes towards death-talk.

Abstract

Background: The topic of death and dying holds universal significance, yet societal norms often discourage open discussions, leading to a culture of death-denial. This reluctance can hinder informed decision-making, end-of-life planning, and access to adequate care and grief support. While research has examined death-talk among older adults, clinical populations and healthcare professionals, young adults' perspectives remain underexplored. Understanding their attitudes is crucial, as early engagement with death-talk - framed within a life-course approach - can foster emotional resilience and contribute to developing compassionate communities. This study aims to explore the perceptions and attitudes of a non-clinical sample of young adults (aged 18-34) towards discussing death and dying.

Methods: A qualitative approach was employed, involving four focus groups with 33 young adults. Participants were selected using maximum variation sampling to ensure diversity in education, ethnicity, gender, and religious beliefs. Reflexive thematic analysis was performed to identify themes related to attitudes toward death-talk, utilising a critical realist stance. Findings were mapped using the Capabilities, Opportunities, Motivations, and Behaviour (COM-B) model of behaviour change, to identify potentially modifiable barriers and facilitators to engaging in death-talk.

Results: The analysis revealed four key themes which collectively illustrate the complex interplay between individual attitudes and broader cultural influences in shaping how young adults perceive and discuss death and dying. The themes highlighted how internal and external factors affect the ability and willingness of young adults to engage in meaningful discussions about death. Factors such as social stigma, fear of causing distress, and a lack of communication skills were identified as significant barriers. Conversely, the recognition of the importance of death-talk, personal experiences with bereavement, and a supportive social environment were found to facilitate these discussions.

Conclusions: This study provides valuable insights into the perceptions and experiences of death-talk amongst young adults, including barriers and facilitators. The findings suggest the need for targeted interventions to enhance death literacy among young people, emphasising the importance of normalising these conversations in everyday life. Recommendations are proposed for utilising these insights to inform public health strategies, education, and policy development aimed at fostering a more open dialogue about death and dying within the broader community.