Factors Affecting Acceptance of Life Education in Mainland China: National Cross-Sectional Study

Background: In traditional Chinese culture, discussing death has always been taboo. The social environment characterized by fear, reluctance, and apprehension toward death significantly impedes the development of palliative care. Therefore, establishing a correct view of life and death and promoting life education are prerequisites for the successful implementation of palliative care. Objective: This study aimed to investigate the public acceptance of life education among individuals in China and analyze the explanatory variables. Methods: This national cross-sectional study was conducted from June 20 to August 31, 2022, encompassing 23 provinces, 5 autonomous regions, and 4 municipalities directly under the central government. A total of 21,875 participants were included. The generalized linear model was used to analyze influencing factors. Gender, major in medicine, place of residence, education level, family health, media use, etc, were analyzed as the potential variables. Acceptance scores were calculated based on a visual analog scale (VAS). Further subgroup analyses were carried out in different age and major subgroups. Results: The median (P25, P75) acceptance score for life education in the survey was 71.00 (50.00-95.00) points. Compared with females, males had lower acceptance (β=-2.39; 95% CI -3.08 to -1.69). Respondents who were majoring in medicine (β=3.13; 95% CI 1.11-5.14), residing in urban areas (β=1.25; 95% CI 0.46-2.04), processing a bachelor's degree or higher (β=4.05; 95% CI 2.97-5.12), or having higher scores on the media use (β=0.49; 95% CI 0.41-0.57) had higher acceptance. Compared with people aged 12-17 years, those aged 25-44 years (β=-6.00; 95% CI -7.34 to -4.66), aged 45-64 years (β=-4.55; 95% CI -5.88 to -3.22), and 65 years or older (β=-2.16; 95% CI -3.78 to -0.55) had lower acceptance. For people majoring in medicine, place of residence, family health, and media use were uniquely relevant factors. Higher scores on the Perceived Social Support Scale (PSSS) and Health Literacy Scale-Short Form (HLS-SF) were also significantly associated with greater acceptance of life education. Conclusions: Gender, place of residence, education level, age, media use, perceived social support, and health literacy were identified as key factors influencing acceptance of life education, providing important evidence to inform targeted policy and educational interventions.