The first Patient Right to Autonomy Act enacted in Asia in 2019 has enabled every Taiwanese citizen to plan for his/her end-of-life (EOL) in case of incompetency. Advance care planning (ACP) has been highly promoted for individuals with terminal, life-threatening illnesses, particularly in the mainstream society, and efforts have been made by the Taiwanese government to train health care providers in order to optimize patients’ quality of dying. However, such advanced decisions and discussions regarding life-sustaining treatment and EOL care remain scarce among older ethnically minority patients. A multiple-case study employing a mixed-method (n = 9) was undertaken to explore indigenous patients’ ACP perceptions. Both quantitative and qualitative information was obtained from indigenous patients, a minority group whose socio-economic and educational status are different from the general Taiwanese population. An initiative was made to describe ACP behavioral awareness, intention, and readiness of older terminal patients from four tribes with seven late-stage cancers in remote, mountainous areas of eastern Taiwan. Our findings showed that according to the Transtheoretical Model, terminal indigenous patients’ ACP readiness was at a precontemplation stage. Their lack of fundamental ACP awareness, insufficient healthcare resources, life-sustaining value in a Christian faith context, and the prevalent health disparity in the remote communities have negatively affected indigenous patients’ intention to participate in ACP. We provide suggestions to further promote ACP in this group and suggest that health information should be tailored at various readiness stages in order to overcome barriers and decrease ACP literacy discrepancies. This study calls attention to an understudied area of ACP behaviors, an overlooked need in EOL care for older cancer patients of unique cultural backgrounds, and the imperativeness to ensure cultural minority group’s EOL care is consistent with patients’ preferences.

Low levels of physical activity (PA) are of a health concern among high body mass index (BMI) women living a sedentary lifestyle and being overweight or obese during pregnancy is associated with increased risks of maternal and fetal health complications. Obstetricians often provide advice regarding recommended PA levels, yet this has not been easily achieved in this group to prevent adverse birth-related outcomes. The purpose of this study is to explore motivators/enablers and perceived barriers through in-depth qualitative inquiry, guided by a behavioral change model, for understanding of pregnant women’s decisions to engage, or refrain from PA practice. Thirteen overweight and obese pregnant women aged 28 to 45 years with an inactive, sedentary lifestyle in urban areas of northern Taiwan were recruited to participate in six focus group sessions for their intent and readiness for PA engagement in pregnancy. A thematic content analysis was performed with a constant comparison method to categorize interview data and generate themes. The findings illustrate the extent to which obese and overweight pregnant women’s readiness for PA is affected by multiple factors, including personal beliefs, perceived societal norms, peer support, and the competing priorities in the environment. PA interventions are to be effective by focusing on overcoming barriers, increasing motivations, and enhancing self-management. Strategies shared by participants shed lights for program developers to design preferable behavioral interventions for this group of women who are low self-esteem with low self-efficacy to increase PA and meet recommended levels. There is considerable potential for health care providers to provide accessible information, facilitate PA, and promote an active lifestyle during and after pregnancy.

The purpose of this study was to estimate and compare total gestational weight gain (GWG) and the trimester-specific mean rate of GWG based on pre-pregnancy body mass index (BMI) as recommended by the Institute of Medicine (IOM). The medical records of 470 participants who had received antenatal care at medical teaching hospitals in northern Taiwan and who delivered after 37 weeks of pregnancy were analyzed. The mean total GWG was 13.84 (SD = 4.33) kg, and nearly 60% of women had not complied with the current IOM recommendations for total GWG. The best-fit model for the mean GWG rate revealed that all groups had a GWG rate of zero in the 1st trimester and had an equivalent mean GWG rate in the 3rd trimester. Women tended to have excessive weekly GWG in the 2nd and 3rd trimesters, and women with a higher pre-pregnancy BMI were more likely to have excessive weekly GWG in the 2nd and 3rd trimesters. Moreover, the plurality of normal-weight (30.4%), overweight (75.8%) and obese (62.5%) women experienced excessive weekly weight gain during the 2nd and 3rd trimesters. Few women met the recommended 2009 IOM weekly weight-gain guidelines in the 2nd trimester, but more met them in the 3rd trimester. These findings indicate that most pregnant Taiwanese women currently exceed the total and weekly GWG recommendations of the IOM. More specifically, weekly GWG in excess of the IOM recommendations is common among normal-weight, overweight and obese women.