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Shared decision-making among older adults with multimorbidity in Kerala’s primary care: a qualitative study using the socio-ecological model

Year: 2025

Type: article

Abstract: Introduction: Multimorbidity is an increasing public health challenge among older adults, particularly in Kerala, India. Shared decision-making (SDM) is central to person-centered care for this group, yet its implementation remains inconsistent in low- and middle-income countries (LMICs). Methods: This qualitative study explored the experiences and perspectives of older adults with multimorbidity regarding SDM in Kerala's primary care. Sixteen adults (aged 60+) were recruited from four primary health centers using purposive sampling. The Socio-Ecological Model guided the design and thematic analysis, examining SDM influences at individual, interpersonal, organizational, and sociocultural levels. Results: Key findings revealed that individual barriers, such as limited health literacy and low self-efficacy, led to passive participation. Family members played a central role in healthcare interactions, sometimes facilitating but occasionally overshadowing patient voices. Organizational barriers, including high patient load and time constraints, limited SDM, while positive provider communication and continuity enabled engagement. Sociocultural factors included strong respect for medical authority and pluralistic health-seeking, with patients often reluctant to disclose alternative treatments to allopathic doctors. Exclusion from SDM was linked to dissatisfaction and poor adherence. Conclusion: Addressing these barriers and leveraging enablers will require coordinated efforts in communication, health literacy, family engagement, and culturally sensitive practice to advance person-centered care.

Source: Frontiers in Public Health

DOI: 10.3389/fpubh.2025.1665368

Authors: Abhijith A. Kumar, Asha Kamath, Lena Ashok, Veena Ganesh Kamath, Varalakshmi Chandra Sekaran

Institutions: Manipal Academy of Higher Education, Kasturba Medical College, Manipal

Language: English

Topic: Patient-Provider Communication in Healthcare

Subfield: General Health Professions

Field: Health Professions

Domain: Health Sciences

SDGs: Good health and well-being, Reduced inequalities

Open Access status: gold

Estimated APC paid: $3,801