Translation, Cultural Adaptation and Validation of the Advance Care Planning Engagement Survey for Korean Older People

Introduction

The Advance Care Planning (ACP) Engagement Survey, initially developed in English, was designed to assess behaviour related to the ACP process. Although ACP is widely recognised globally, its adoption and practice differ considerably among countries, primarily due to unique cultural and policy-related factors. Therefore, ensuring appropriate translation and cultural validation of the tool is critical for its effective use in varied contexts. This study aimed to translate and culturally adapt the ACP Engagement Survey for use with Korean older people and to examine its psychometric properties.

Methods

This study used a cross-sectional survey design that was implemented in two phases. In phase 1, the ACP Engagement Survey underwent translation and cross-cultural adaptation from English to Korean by: (1) forward and backward translation, (2) committee review and (3) pretesting. In phase 2, psychometric properties of the finalised Korean version were examined via factor analysis, assessment of construct validity and analysis of internal consistency. The study sample comprised 235 community-dwelling older people with a mean age of 71.1 years.

Results

The final Korean version of the ACP Engagement Survey (K-ACP-ES 12) was composed of 12 items across three factors: readiness, contemplation and self-efficacy. Hypothesis testing demonstrated construct validity of the K-ACP-ES 12 by a statistically significant correlation with the AD Knowledge Scale (r = 0.26, p < 0.001). In addition, the Korean version showed acceptable reliability, with a Cronbach's alpha of 0.93.

Conclusions

The K-ACP-ES 12 demonstrated good reliability, acceptable structural validity and supported hypothesis-testing construct validity. Evaluating a patient's engagement in ACP is essential for assessing ACP quality, which constitutes a principal outcome of the ACP process. The findings highlight the necessity of tailoring and validating measurement tools within specific cultural and policy contexts to ensure accurate assessment of ACP outcomes and enhance the instrument's utility across varied populations.

Implications for Practice

The findings underscore the importance of tailoring and validating measurement tools within specific cultural and policy contexts to ensure accurate assessment of ACP outcomes and to enhance the instrument's applicability in both research and practice across diverse population.