Understanding Hmong Elders' Care Preferences for the Dying Process

Hmong elders, who moved to the United States as political refugees from Southeast Asia have sought to maintain their cultural traditions and find that having those traditions honored at end of life (EOL) may prove to be difficult. This difficulty arises from healthcare providers having limited knowledge on providing culturally sensitive EOL care to Hmong elders. The dearth of knowledge contributed to Hmong elders experiencing a dying process that is not culturally sensitive (Culhane-Pera, 2003a). Additionally, acculturation and intercultural adaptation could impact traditional methods of EOL care. The religion, spiritual beliefs, and spiritual rituals that Hmong elders have and practice could also influence their EOL care preferences. This qualitative study sought to explore Hmong elders' care preferences for the dying process with regard to their acculturation, intercultural adaptation, religion, and spiritual beliefs and practices. Semi-structured interviews conducted with 30 Hmong elders who were not terminally ill explored their acculturation strategies and care preferences for the dying process. Transcripts were analyzed via conventional and directed content analysis with Berry's acculturation typology (1997; 2005; 2015) and Ward's intercultural adaptation framework (2001) guiding the directed content analysis portion. Findings were related to Hmong elder participants' EOL care preferences with regard to the physical, psychosocial, and cultural care domains. Directed content analysis resulted in four categories of acculturation strategies: separation, separation & integration, integration, and integration & assimilation. Results suggested that some participants have adapted psychologically and socioculturally, while others have not. Participants reported some adaptations in response to their adult children's adaptations. Christian participants believed in prayers as part of their EOL care and preferred to receive prayers. Animist participants spoke of soul loss and preferred spiritual rituals such as soul calling to be conducted. Participants also recognized the impact of the Western culture on their traditional caregiving methods. Findings have practice, policy, and research implications. Social workers and healthcare professionals should ensure that culturally sensitive assessments and care are provided to Hmong elders. Policies should promote culturally sensitive services for Hmong and other refugees and immigrant communities. Future research should include interviews with Hmong adult children as they are most likely the preferred caregivers.