Factors Affecting Intention of Signing the Advance Directives in Middle Aged Adults in Korea Based on the Theory of Planned Behavior: A Cross-sectional Study

Objectives: The purpose of this study was to identify the factors influencing the intention of middle-aged adults to sign Advance Directives (AD) based on the Theory of Planned Behavior (TPB).Methods: The study subjects were 230 middle-aged adults in Korea. Data collection was conducted from June 15 to June 20, 2023 using an online survey. Data analysis was performed using percentages, means and standard deviations, independent t-test, ANOVA, Scheffé test, Pearson’s correlation coefficient, and hierarchical multiple regression with the SPSS 28.0.Results: The study found significant correlations between various factors such as perception of physical, psychological, social, spiritual, independent, and autonomous well-being, as well as attitudes, subjective norms, perceived behavioral control, and the intention to sign the AD. Hierarchical multiple regression analysis indicated that attitudes (β= 0.43, p< 0.001), subjective norms (β= 0.23, p< 0.001), perceived behavioral control (β= 0.16, p= 0.020), and timing for signing up for AD (β= 0.12, p= 0.021) significantly influenced the intention to sign the AD among middle-aged adults. The model explained 52% of the variance (F = 18.47, p< 0.001).Conclusions: Signing up for AD serves the purpose of preparing individuals for a dignified end-of-life experience. Therefore, increasing public awareness and providing education on ADs are essential to encourage more middle-aged adults to engage in the process.