A qualitative research approach was employed, utilizing semi-structured interviews with African American adults from diverse backgrounds. Data analysis, conducted through thematic analysis using NVivo software, revealed key factors influencing ACP decisions, including medical mistrust rooted in historical injustices, the central role of religious beliefs, family-centered decision-making, and financial concerns. Participants expressed discomfort with discussing death, emphasizing the importance of family consensus and spiritual guidance in healthcare decisions.

A community-based intervention was implemented to address these challenges, incorporating educational workshops led by healthcare professionals, clergy, and community leaders. These sessions aimed to increase awareness, dispel misconceptions, and provide culturally relevant ACP resources. Post-intervention assessments demonstrated a positive shift in participants' knowledge, attitudes, and willingness to engage in ACP discussions. The study highlights the effectiveness of tailored, culturally competent approaches in fostering ACP engagement within African American communities.

The findings underscore the need for healthcare policies that prioritize cultural competence, community engagement, and systemic reforms to enhance ACP accessibility. Addressing historical mistrust, religious influences, and socioeconomic barriers, this research provides a framework for reducing disparities in end-of-life care. Future research should explore the long term sustainability of such interventions and their broader applicability to African American populations nationwide.

This study contributes to the growing literature on health equity and end-of-life care, advocating for patient-centered, culturally informed ACP initiatives to improve healthcare outcomes.