Development and evaluation of a grid-based palliative care intervention model to improve death literacy among middle-aged and older adults in resource-limited areas of China: a multi-stage mixed-methods study protocol

Background As population aging intensifies, improving death literacy through community-based palliative care is critical. However, the quality of dying and death in China remains suboptimal, ranking 53rd out of 81 countries and regions in 2021, indicating substantial room for improvement in end-of-life care and related services. This gap is exacerbated by significant regional disparities in healthcare resources, disproportionately affecting resource-limited regions. Therefore, Northern Guizhou urgently needs to explore tailored intervention models to address its considerable challenges in palliative care services and public awareness. Death literacy—the knowledge and skills to access, understand, and apply palliative care information—is associated with care utilization and end-of-life outcomes. However, evidence-based community interventions targeting middle-aged and older adults remain lacking. This study aims to develop and implement a palliative care intervention model based on community grid management (hereinafter referred to as the “grid-based palliative care intervention model”) and to preliminarily evaluate its feasibility, acceptability, and changes in relevant outcomes. The findings are intended to inform the delivery of community-based palliative care services in resource-limited settings. Methods This three-phase study will be conducted in Honghuagang and Huichuan districts, Zunyi City. Phase 1 will use a sequential explanatory mixed-methods design: Phase 1A, a multi-stage stratified cluster survey of 480 community-dwelling adults aged ≥40 using the Chinese Death Literacy Index (DLI); Phase 1B, semi-structured interviews with 15–20 residents; and Phase 1C, a SWOT analysis (strengths, weaknesses, opportunities, and threats), will integrate quantitative and qualitative findings and produce a needs assessment report. Phase 2 will develop a grid-based palliative care intervention model based on Phase 1 findings and a literature review. Phase 3 will employ an exploratory quasi-experimental design and will recruit 96 participants (48 in the intervention group and 48 in the control group) to preliminarily evaluate the feasibility, acceptability, and trends in relevant outcome measures after 12 months of implementation of the intervention model. Discussion The findings will inform health authorities and primary care providers in optimizing community palliative care, improving grid worker training, and fostering multi-stakeholder collaboration, while providing a basis for future multicenter, cluster-designed trials. Clinical trial registration http://www.chictr.org.cn/ , identifier ChiCTR2600120816.