Media

Life-and-death education, as an integral part of value education, cultivates in the general public a more positive understanding of bereavement, dying, and death, eventually better preparing individuals and families for the loss of their loved ones and their final stage of life. There is a growing need for this education among individuals with intellectual disabilities, who are increasingly experiencing bereavement due to outliving their caregivers and longer life expectancy.

Still, challenges remain in promoting life-and-death education to the segment of the population with intellectual disabilities. On the one hand, individuals with intellectual disabilities are often constrained by their cognitive ability in seeking to fully understand issues of life and death; on the other, the caregivers of these individuals may lack the competence to effectively communicate the ideas central to life-and-death education.

To further the effectiveness and reach of life-and-death education in Hong Kong, The Board of Management of the Chinese Permanent Cemeteries Fund (BMCPC) funded an expressive arts-based programme – “Stellar Moments: An Expressive Arts-Based Life Education Program for Persons with Intellectual Disabilities in Hong Kong”. The project was launched by the Centre on Behavioral Health (CBH) at The University of Hong Kong (HKU) from November 2022 to December 2024. The evaluative study is the first-ever scientific study in Hong Kong evaluating the use of expressive arts in life-and-death education for individuals with intellectual disabilities.

The programme has four components: (1) public engagement activities aiming to sensitize the general public to the importance of life-and-death education as an integral part of value education, with a specific focus on the psychosocial needs of individuals with intellectual disabilities and Expressive Arts Therapy (EXAT) as a medium of intervention; (2) a Train-the-Trainer program designed specifically for frontline workers, (3) an art exhibition and the publication of a booklet showcasing the artworks by individuals with intellectual disabilities in the trainer-led community workshops, and (4) a research evaluation assessing the effectiveness and feasibility of adopting expressive arts in life-and-death education and fostering the positive living of individuals with intellectual disabilities.

The project research team conducted two rounds of questionnaire surveys, one before and one after the trainee-led expressive arts-based community workshops. The team received in total 325 complete paired responses from individuals with intellectual disabilities. At the press conference hosted by CBH on December 12, 2024, the project research team shared the experience of running the project and released findings from a questionnaire survey on the effectiveness of the project.

The questionnaire survey adopted the Chinese version of Templer’s Death Anxiety Scale (CT-DAS) to gauge the changes in respondents’ death views throughout the community workshops. The scale consists of 15 questions. Using death-related scenarios and meanings (e.g., discussing death, receiving surgical treatment, and feeling the shortness of life), the scale is instrumental in measuring respondents’ level of death anxiety. The results from the questionnaire survey revealed that the expressive arts-based community workshops have significantly reduced death anxiety in individuals with intellectual disabilities. With the maximum score of 15 indicating the highest possible, the level of death anxiety of all participants dropped from an average of 7.25 to 6.69 throughout the workshops. While participants who had experienced bereavement reported a higher average level at baseline (7.97) than those who had not (6.85), both groups showed a similar degree of decrease in death anxiety upon completion of the workshops.

In addition, the questionnaire survey also contains three questions related to respondents’ views towards behavioural preparation for their passing, including making a will, arranging a burial, and registering for organ donation. The results showed that individuals with intellectual disabilities demonstrated a significantly higher motivation in volunteering for organ donation, after participating in the community workshops. The proportion of participants who reported having the motivation to register for organ donation rose from 23.7% to 32% throughout the workshops. The research team concluded that an expressive-arts-based life-and-death education programme can effectively reduce death anxiety in individuals with intellectual disabilities, and incentivise them to get prepared for their passing.

“The influence of Chinese culture that has treated issues of life and death as subjects of social taboo. However, Hong Kong has seen a steady rise in education programmes addressing these topics in recent years. Such programmes seek to galvanise community knowledge, foster dialogue, and shift societal views on death. Additionally, some scientific research has revealed the often unspoken and overlooked needs of individuals with intellectual disabilities in coping with bereavement. As the first-ever scientific study in Hong Kong evaluating the use of expressive arts in life-and-death education for individuals with intellectual disabilities, the data collected from this study are instrumental in illuminating the effectiveness of incorporating expressive arts into life-and-death education for individuals with intellectual disabilities,” said Professor Rainbow Ho, Director, Centre on Behavioral Health, HKU.

About HKU Centre on Behavioral Health
Founded in 2002, Centre on Behavioral Health was set up under the Faculty of Social Sciences of The University of Hong Kong.  The Centre integrates Western and Eastern philosophies to promote holistic well-being. Through education, research, training, and clinical services, the centre emphasizes holistic health encompassing body, mind, and spirit. With a diverse team of professionals, including social workers, counselors and researchers, they provide services, training and conduct research in the areas related to wellness promotion, stress management, counseling, mindfulness, mindful self compassion, life & death education and expressive arts therapy.

About The Board of Management of the Chinese Permanent Cemeteries Fund (BMCPC)
Established in 1913, BMCPC is one of the well-established private cemetery operators in Hong Kong. It is a statutory body which operates, manages, and develops four Chinese Permanent Cemeteries at Aberdeen, Tsuen Wan, Chai Wan, and Junk Bay on non-profit-making basis. Since 1991, BMCPC has funded approximately 3,500 charitable projects, with total donations over HK$1,100 million for millions of beneficiaries.

For media enquiries and more details, please contact Ms. Amy Choi (Centre on Behavioral Health, HKU; Tel: 2831 5163; amychoi@hku.hk) or Dr. Adrian Wan (Centre on Behavioral Health, HKU; Tel: 2831 5578; awan@hku.hk).