Patient engagement in their healthcare decision making and associated factors among adult outpatients with non-communicable chronic diseases in public hospitals of North Shewa Zone, central Ethiopia: a mixed-method study.

backgroundPatient engagement, involving patients in their healthcare and decision-making, is vital for promoting beneficial health behaviors. Disengaged patients face worse health outcomes and higher health costs. Despite the emphasis of the World Health Organization and Ethiopia's national non-communicable diseases, studies in Africa, especially in Ethiopia, are limited and often overlook social support, a critical factor, which points to the need for comprehensive research. Therefore, this study assessed patients' engagement in their healthcare decision-making and associated factors among adult patients with chronic non-communicable diseases in public hospitals of North Shewa, central Ethiopia.

methodsA mixed-method study was conducted from June to July 2024. A total of 265 patients were selected using systematic random sampling, and data were collected through interviewer-administered questionnaires. Patient engagement is measured by 13 items using the standardized Patient Activation Measure questionnaire. Qualitative data were collected through in-depth interviews with 14 purposively selected participants. Quantitative data were entered into Epi Data version 4.6 and analyzed using SPSS version 24. A binary logistic regression analysis was used to test associations, where variables with a p-value < 0.25 in bivariate analysis were included in multivariable analysis. Significance was set at a p-value < 0.05. Qualitative data were manually sorted and themed, and the meaning units were cited with relevant details.

resultsOnly 24.9%, 95% CI (19.8%, 30.6%), had high engagement in decision-making. Higher patient engagement was positively associated with: urban residence (AOR = 3.35, 95% CI: 1.02, 11.03), longer duration of diagnosis (≥ 5 years) (AOR = 3.73, 95% CI: 1.22, 11.42), health literacy (AOR = 1.39, 95% CI: 1.14, 1.70), shared decision-making (AOR = 1.34, 95% CI: 1.15, 1.58), and autonomy in decision-making (AOR = 1.33, 95% CI: 1.12, 1.58). The qualitative study explored factors affecting patient engagement, such as physician-patient relationship, time shortage, lack of accessibility to healthcare information, organizational factors, and breach of patient autonomy.

conclusionPatient engagement in healthcare decision-making is generally low in the study area. Residence, diagnosis duration, health literacy, physician-patient relationship, shared decision-making, time shortage, lack of information, and autonomy breach influence patient engagement. Therefore, healthcare providers should enhance communication, improve information accessibility, and foster an environment that supports patient autonomy and informed participation.