End-of-Life Health Literacy and Advance Care Planning Engagement Among Older Adults in Baguio City, Philippines

Introduction: As the Philippines’ population ages, deeply ingrained cultural taboos about mortality hinder critical discussions. Evaluating End-of-Life (EoL) health literacy and Advance Care Planning (ACP) engagement is essential to facilitate informed, values-aligned decision-making. Aim: This study evaluated EoL health literacy and ACP engagement among older adults in Baguio City and examined their correlation. Methods: his study employed a quantitative, correlational, cross-sectional design involving 260 cognitively intact and literate older adults, recruited via multistage random sampling from 20 barangays in Baguio City. Data were gathered using two validated instruments: the Subjective End-of-Life Health Literacy Scale (S-EOL-HLS), which demonstrated excellent internal consistency (α = 0.93), and the Advance Care Planning Questionnaire, which showed strong content validity (S-CVI = 0.96) and reliability (KR20 = 0.82). Descriptive statistics (means) summarized the data, while Spearman’s rank correlation was applied to determine the relationship between variables. The protocol received formal ethical clearance from the Saint Louis University Research Ethics Committee (SLU-REC 2024-290). Results: Older adults in Baguio City exhibited moderate levels of both EoL health literacy (x̄ = 8.77) and ACP engagement (x̄ = 17.10). Sub-domain analysis revealed moderate literacy across the functional (x̄ = 2.09), interactive (x̄ = 3.73), and critical (x̄ = 2.95) domains. Furthermore, there was adequate engagement in health-related ACP (x̄ = 6.81), whereas engagement in relationship (x̄ = 4.12), legal/financial (x̄ = 3.15), and funerary (x̄ = 3.02) domains was moderate. A weak but significant positive correlation was identified between overall EoL health literacy and ACP engagement (r = 0.229, p = 0.0001). Conclusion: Although older adults in Baguio City demonstrate moderate EoL health literacy, this knowledge does not robustly translate into active ACP engagement, especially within legal, financial, and funerary domains. These findings underscore that health literacy is a necessary but insufficient prerequisite for action; instead, EoL preparation is a complex behavioral outcome dictated by the intersection of cultural taboos, familial collectivism, and systemic healthcare barriers. To bridge this gap, culturally sensitive, multifaceted strategies are urgently needed to enhance both EoL health literacy and ACP engagement among older Filipinos.