Materials and methods
Study design and target population
This study was conducted cross-sectional. The population of the study consisted of Turkish adults with chronic illness living in the community in a city in the Eastern Black Sea region of Turkey. The participants registered at the family health center in the city center were contacted with the convenience sampling method and were included in the study.
Using G*Power V. 3.1.9.7 program and data from a pilot study with 30 people, the number of cases to be included in the study was determined to be 201 with 99% confidence (1-α), 99% test power (1-β), f2 = 0.204 effect size and 9 independent variables. When the estimating case loss rate of 10%, we included 225 people in the study. The pilot study was excluded data from. Participants were aged 18 years and older with clinically diagnosed a chronic disease (such as hypertension, diabetes mellitus, cardiovascular system diseases, respiratory system diseases) and no communication problems.
Data were collected through face-to-face interviews between February and May of 2023 when the patients with chronic diseases applied to the family health center for a routine checkup and counseling. The study was carried out in accordance with the principles of the Declaration of Helsinki and with the written consent of the participants before the data collection tools were applied. Researchers distributed questionnaires to literate participants and read and recorded them to the illiterate participants. Each data collection form took approximately 15-20 minutes to complete.
Instruments
Data was collected using the Patient Information Form, Death Literacy Index (DLI) and Turkish Death Anxiety Scale (TDAS).
Patient Identification Form: Prepared by the researchers, this form consisted of a total of 11 questions regarding the participants' age, gender, educational status, marital status, income, employment status, place of residence and chronic disease [7,16].
Death Literacy Index (DLI): The DLI was developed (Leonard et al.), adapted into Turkish (Semerci et al.,) is 29 items on a 5-point format [12,18]. The sub-dimensions include practical knowledge (talking support-hands on care), experiential knowledge, factual knowledge and social knowledge (accessing help-community support groups). A high total score on the DLI indicates that individuals have a heightened level of death literacy. Among Turk community dwelling individuals aged 18 and over the Cronbach's alpha value of the adapted scale was 0.90; subscales were 0.68 talking support, 0.71 hands on care, 0.84 experiential knowledge, 0.90 factual knowledge, 0.90 accessing help and 0.89 community support groups [18]. In this study, the Cronbach alpha value of the scale was 0.90; for sub-dimensions were 0.77 talking support, 0.84 hands on care, 0.82 experiential knowledge, 0.91 factual knowledge, 0.91 accessing help and 0.90 community support groups.
Turkish Death Anxiety Scale (TDAS): The TDAS was developed (Sarıkaya and Baloglu), is 20 items on 5-point format. The sub-dimensions include uncertainty of death, exposure, and suffering. The scale is scored between 0-80, with higher scores reflecting a more severe level of death anxiety. There are no reverse items in the scale. Among university student and adult, the Cronbach's alpha value of the scale was 0.95; subscales were 0.94 for uncertainty of death, 0.92 for exposure and 0.76 for suffering [19]. In this study, the Cronbach alpha value of the scale was 0.95; for sub-dimensions were 0.91 for uncertainty of death, 0.92 for exposure and 0.78 for suffering.
Data Analysis
International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS) version 25.0 program (Armonk, NY: IBM Corp.) was used for data analysis. Whether the data was normally distributed was evaluated by kurtosis and skewness [20]. Descriptive statistics, pearson correlation, independent samples t test, One-Way ANOVA and multiple linear regression analysis were used to dissect the data. Prior to Multiple linear regression analysis (enter method), the dataset was tested for multicollinearity and autocorrelation (Variance Inflation Factor (VIF) < 10; Tolerance > 0.1; Durbin-Watson = 1.666). Statistical significance level was accepted as p < 0.05. STROBE checklist was followed in the reporting of the study.
Ethical Considerations
The study was approved by XXXX University Ethics Committee (Approval No: 2023-01/16). The purpose of the study was explained to the participants, and it was confirmed that their information would be kept confidential and that they could withdraw from the study at any time.