Level of shared decision making and associated factors among patients with mental illness in Northwest Ethiopia: Explanatory sequential mixed method study

by Agmas Wassie Abate, Wondimnew Desalegn, Assefa Agegnehu Teshome, Aklile Tsega Chekol, Mastewal Aschale

Shared decision-making is a patient–centered and a recovery-oriented mental health system in which consumers are encouraged to actively engage in illness management. Although shared decision-making research in mental health has evolved rapidly in the past two decades, there is a lack of studies examining the level and factors associated with shared decision-making practice in low-income countries like Ethiopia.

An institutional-based explanatory sequential mixed method study design was conducted from July 18 to September 18, 2022, at Bahir Dar city specialized hospitals. A systematic random sampling technique was used. The level of shared-decision making was measured by 9-item shared decision-making questionnaire among 423 patients with mental illness. Epicollect5 was used to collect data, which was then exported to the Statistical Package for social science version 25 for analysis. Variables with a P-value < 0.25 were considered candidates for the multivariate logistic regression analysis. The odds ratio with a 95% confidence interval was used to show the strength of the association. An in-depth interview was conducted among ten purposively selected participants.

Low shared decision-making practice was found to be 49.2% (95% CI 45.9%-55.7%). The Multivariate analysis showed that low perceived compassionate care (AOR = 4.45; 95%CI 2.52–7.89), low social support (AOR = 1.72; 95% CI 1.06–2.80), and no community-based health insurance (AOR = 1.96; 95%CI l.04–3.69) were positively associated with low shared decision making. The qualitative result showed that the most common barriers to shared decision-making were a lack of empathy and a shortage of mental health workers.

Almost half of the patients had low shared decision-making practices. This implies that shared decision-making requires high attention as it is essential for patient-centered care.