An Insight into Patients’ Perspectives on their Participation in Medical Decision Making in Diabetes Mellitus Care in Malawi.

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Abstract Background: Patient participation in their own care has potential to improve experiences and responsiveness in chronic disease situations. Patient participation is a basic tenet for a patient centred care experience. However, the documented experiences show that patient participation in care decisions making is wanting. As Malawi strives to imbibe and institutionalise the concept of patient centred care, it is important to examine the experiences of patients regarding participation in their care as this may provide evidence to support policy implementation strategies on the same. Aim: The study therefore sought to describe DM patients’ experiences of participation in shared decision making in Malawi.Methods: This qualitative exploratory study involved patients attending DM clinics in four public health facilities in Southern Malawi. Using SHARE framework, we analysed data from 15 in-depth interviews and two focus group discussions. Results: From the perspective of DM patients, this study elucidated that participation in care was largely lacking in clinical encounters. Some of the prominent gaps identified in the interactional process of care included: i) unfavourable ambience for participation, ii) insufficient bidirectional informational exchange and iii) inconsideration for patients’ preferences and values, iv) paternalistic power tendencies and, v) lack of evaluation of decisions made. Conclusion: The study highlights gaps in the practice of patients’ participation in medical decisions. Patients’ reproof of paternalistic models of care confirms that transforming medical education through curriculum review for providers may be a good starting point. The review should focus on the content and effective delivery of competencies relating to provider roles and practices on patient participation.

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