Ho, Andy Hau Yan
(2016)
Health promoting palliative care through higher education reform: development and evaluation of a new humanities course in thanatology.
EdD thesis, University of Nottingham.
Abstract
Under a socio-cultural backdrop where death and loss is heavily stigmatized and community resources for the dying and the bereaved are lacking, Hong Kong requires a public health approach for empowering its people to become active participants in the governance of mortality. “Health-promoting palliative care” (HPPC) translates the hospice ideals of total person care into much broader public health languages and practices, focusing not only on palliation but also prevention, harm reduction, community action, policy advocacy, and most importantly, education and research. Despite their significance, life and death education and Thanatology research has received little attention in Hong Kong. The recent General Education (GE) reform for tertiary institutions, which aims to nurture students’ creativity and civility through the liberal arts, provides a timely opportunity to actualize HPPC.
The current study provides a formative account of the development and implementation of a new thanatology course, “The Last Dance: Understanding Death and Dying” offered by the University of Hong Kong, and critically examines its efficacy for reducing negative death perceptions and enhancing positive life attitudes among a group of undergraduate students. Adopting a mixed methods research design and a holistic approach to education evaluation, it utilizes: 1) a quantitative pretest-posttest survey to assess course effectiveness with the standardized tools of Death Attitude Profile-Revised, Meaning-in-Life Scale and Spirituality Scale, as well as a series of ad hoc items on traditional death taboos and death preparedness behaviors; and 2) a qualitative analysis of 100 randomly selected students’ reflective writings for identifying factors that facilitate effective learning.
Results from paired-sample t-test with 85 students who have successfully completed the pretest-posttest survey provide robust evidence that The Last Dance was effective in significantly reducing students’ fear of death, death avoidance tendency, and taboo beliefs that oppress death, while promoting active participation in the governance of mortality through increased death preparedness behaviors. Moreover, The Last Dance was found to be effective in enhancing students’ sense of meaning in life, spirituality and interconnectedness.
Framework analysis of Students’ reflective writing revealed 12 themes that illuminate the specific learning contents, pedagogy activities, key attitudinal and behavioral changes, as well as significant learning outcomes which supported the quantitative results. These 12 themes were organized into four categories: 1) “Mortality Matters”, which includes Consideration of Palliative Care and Euthanasia, Expression of Death via Arts and Media, and Exploration of Death Rituals and Spirituality; 2) “Teachable Moments” which includes Multi-Media Lectures, Funeral Home Visitation, and Examination of life; 3) “Shifting Perspectives”, which encompasses Cultivating Insights, Renewing Meaning, and Applying Knowledge; and 4) “Ego Awakening” which encompasses Normalization of death, Appreciation of Life, and Recognition of Common Humanity.
These 4 categories and their respective 12 themes together form a “Thanatology Pathway to Transformative Growth”, highlighting the vital significance of carefully integrating stimulating learning contents with engaging pedagogical activities for developing an effective and holistic thanatology curriculum; one that focuses not only on skills and knowledge transfer, but also on cultivating life appreciation and compassionate living through an enhanced understanding of death, dying and bereavement.
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