A community-engaged cultural adaptation of the ADVANCED-Comfort 6M care planning tool for Chinese American families in nursing homes

Abstract

Chinese American families of nursing home residents with advanced dementia often encounter cultural and structural barriers to comfort-focused, person-centered care. Culturally responsive interventions are needed to address disparities in communication and care planning. This paper describes a community-engaged process to culturally adapt the ADVANCED-Comfort 6 M Care Planning Tool (What Matters, Meaningful Activities, Mealtime, Medications and Treatments, Mobility, and Make Personal Care Comfortable) to improve its relevance and usability for Chinese American caregivers. Guided by a Community Advisory Board (CAB) of Chinese American caregivers, clinicians, and community leaders, with personal or professional experience in Chinese American communities, we used a participatory, consensus-driven adaptation process. CAB discussions highlighted cultural definitions of comfort, which were systematically mapped to the 6M Care Planning Tool and used to iteratively refine intervention content, language, and design. Five key domains of comfort were identified, connection to culture and family, trust, respect, familiarity, and minimizing distress, and were integrated across the 6M domains. Adaptations included both content modifications and aesthetic and linguistic refinements, such as culturally resonant imagery, color schemes, and translated educational materials, to enhance usability and cultural relevance. This work demonstrates how community-engaged adaptation processes can operationalize cultural values within dementia care interventions. This approach provides a model for adapting care planning tools to better meet the needs of diverse populations and support more equitable, person-centered care in nursing homes.