Changing contexts of death and dying: Influence of the COVID-19 pandemic and voluntary assisted dying legislation on death literacy in Australia.

Background: The COVID-19 pandemic and the introduction of voluntary assisted dying (VAD) legislation in Australia are major societal exposures that altered the social context around death and dying. Although death literacy is a socially embedded concept, there are limited studies assessing how death-related societal events like COVID-19 and VAD legislation influence its development. Objective: To examine associations of the COVID-19 pandemic and VAD legislation introduction with death literacy, and whether these societal exposures functioned as contextual pathways linking social capital, attitudes, and supportive actions around death and dying with death literacy outcomes. This study assessed death literacy as operationalised by the Death Literacy Index. Design: A cross-sectional national survey. Methods: Participants were recruited through the Online Research Unit from a representative online non-probability panel of 1202 Australian adults, stratified by age, gender, and geographic region. Death literacy was measured using the Revised Death Literacy Index. Multivariate regression examined associations of COVID-19 and VAD legislation with death literacy after adjusting for relevant covariates. Mediation analyses explored whether these societal exposures functioned as indirect contextual pathways linking social factors with death literacy. Results: Of the 1202 participants, 56.4% were female and 43.6% male. Over 40% (483) reported some form of COVID-related experience, while nearly 12% (139) reported experience related to VAD. Multivariate analysis showed that perceived gain of knowledge during the pandemic (B=0.179) and VAD legislation introduction (B=0.319) were positively associated with death literacy, whereas experiencing COVID-related death had a negative association. Social capital, social attitudes toward death, and supportive actions to carers demonstrated significant positive indirect effects, partially mediated by the pandemic and VAD exposure. Personal attitudes toward death showed negative indirect effects. Conclusion: This study highlights the importance of public health palliative care approaches that promote death literacy, especially during public health crises or policy change. Findings reinforce that death literacy does not develop in isolation but is shaped by social environments that enable or limit the exposure, awareness, and engagement to death, dying, and bereavement.