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Abstract
Objective To assess patients’ perceived involvement in clinical decision-making and associated factors among adult patients admitted at Jimma Medical Center, Oromia, Ethiopia, 2022.
Design An institution-based cross-sectional study was employed.
Setting A study was conducted at a governmental tertiary teaching and referral hospital located in Jimma Zone, Oromia region, southwestern part of Ethiopia. The study was conducted between 15 July and 7 September 2022.
Participants A total of 422 randomly selected adult patients admitted at Jimma Medical Center were enrolled, after excluding those who were acutely ill during the study period.
Methods Data were collected via a structured, interviewer-administered tool, entered into EpiData V.4.6 and exported to SPSS V.26 for analysis. Bivariable and multivariable logistic regression analyses were used to identify factors associated with the outcome variable. Significant factors were declared at p<0.05.
Main outcome measure Patients’ perceived involvement in clinical decision-making (adequate involvement/poor involvement).
Results A total of 51.4% (95% CI: 46.4 to 56.3) of respondents had adequate perceived involvement in clinical decision-making. Participants who were aged >60 years (adjusted OR (AOR): 2.01 (95% CI: 1.44 to 5.65)), college and above the level of education (AOR: 4.6 (95% CI: 1.6 to 13.26)), length of hospital stay >15 days (AOR: 2.8 (95% CI: 1.41 to 5.5)) and high health literacy level (AOR: 2.04 (95% CI: 1.34 to 4.21)) were more likely to be associated with adequate perceived involvement in clinical decision-making whereas non-prior hospitalisation (AOR: 0.493 (95% CI: 0.3 to 0.82)) and passive autonomy preference (AOR: 0.22 (95% CI: 0.13 to 0.37)) were less likely to be associated with adequate perceived involvement in clinical decision-making than each of their corresponding counterparts.
Conclusion Only nearly half of the respondents had adequate perceived involvement in clinical decision-making. Collaborative autonomy preferences, high educational levels, long length of hospital stay, high health literacy level and patients in the older age group were among the factors significantly associated with respondents’ adequate perceived involvement in clinical decision-making. Healthcare professionals have to consider empowering patients’ perceived involvement in clinical decision-making, and hospital management has to reinforce healthcare professionals’ efforts to promote patients’ perceived involvement in clinical decision-making.
- Decision-Making
- Patient Participation
- Inpatients
Data availability statement
Data are available upon reasonable request.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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STRENGTHS AND LIMITATIONS OF THIS STUDY
The study uses systematic random sampling approach and validated surveys that were translated for use with our population.
Though the shared clinical decision-making approach should be assessed from both the perspective of patients and healthcare providers, this study focuses only on patients’ perspectives.
The results of the study findings cannot be assumed to be generalisable to all the public hospitals of Jimma Zone, as other health facilities were not included.
The study design was cross-sectional, which cannot create causal attribution between independent and dependent variables.
A social desirability bias might also affect the result of the study.
Introduction
Patient involvement means the participation of the patient in decision-making or expressing opinions about different treatment methods, which includes sharing information, feelings and signs and accepting health team instructions.1 The term ‘patient involvement’ first originated in 1987 and is a complex concept, but recently it has been widely preferred as a key component of the 21st-century healthcare system in many nations around the world.1 2 Patient involvement is an important part of patient-centred care and the patient should be viewed as an active participant and involved in any decision-making processes as well as needed for safe and high-quality healthcare.3 Shared decision-making (SDM) is a process in which patients and clinicians work together to make decisions based on evidence, risk-benefit analyses, expected outcomes, and patient preferences and values in deciding about diagnosis, treatment or follow-up when more than one medically reasonable option is available or when patient preferences vary strongly.4 5
Patients are increasingly expected to be in charge of their health and to be involved in decisions about their health.4 Strategies that engage, support and empower patients are vital to the sustainability of healthcare systems worldwide.2 Informed patients are more likely to feel confident to report both positive and negative experiences and have increased concordance with mutually agreed care management plans, which not only improves health outcomes but also advances learning and improvement while reducing adverse events.6 Patient participation in decision-making can improve the care of chronic illness, increase patient satisfaction and adherence to treatment plans, decrease medical errors as well as treatment costs and eventually lead to a better quality of care.1 7 However, various potential obstacles can influence its implementation at the patient, healthcare worker and healthcare centre levels.7
Even though the majority of patients reported having a preference for involvement in clinical decision-making regarding their treatment during a clinical consultation, patients’ actual perceived level of involvement in it can be considered low; their capacity, desire and opportunities were limited or varied widely and the causes of this diversity have long been unknown.8–10 Current evidence shows that most medical decisions are made by clinicians with little input from patients.11 Patients were viewed as passive recipients of care, receiving only what the doctor ordered, despite the reported desire to be involved and the need for information exchange that would be a necessary step towards collaboration or sharing decisions about treatment with their care providers.12 Consequently, patients and their families are excluded from or are assumed to be incapable of discussing their current health conditions and treatment plans.13 Generally, in the current healthcare system worldwide, patient-centred care widely ensures that patients are placed at the centre of all healthcare decisions even though there was a discrepancy between patient’s preferences and their actual decision-making responsibility during clinical consultations.14 15 This emphasises the need to learn how patients perceive their involvement in clinical decision-making and the factors that influence their participation by focusing on patients’ perceived roles in decision-making as well as their healthcare experiences.16
In developing countries, SDM is still a challenge in providing patient-centred healthcare; because of a lack of SDM culture, healthcare providers paternalism, poor inter-professional relationships, lack of continuity of care, low patient literacy, lack of interest in decision-making along with trust in healthcare providers, poor patients family support and health conditions, as well as the health workers’ work overload makes difficult to implement it in terms of consultation time.17–19 Furthermore, patients with low involvement in clinical decision-making are more likely to be hospitalised, re-admitted and attended the emergency room frequently, resulting in higher healthcare expenses than patients with higher levels of involvement.19 Lack of healthcare engagement is also expected to impede chronic-care implementation, increasing the burden of chronic diseases and the likelihood of patients having unmet medical needs and deferring medical treatment.20 In Ethiopia, ‘compassion and respectful care’ is a reform agenda in the new national health sector transformation plan II, which highly supports the patients’ and families’ participation in decisions and care.21 However, the issue of patient’s perception of involvement in clinical decision-making is less emphasised, and there is a lack of information regarding patients’ perceived participation in clinical decision-making in general populations as well as in the current study area. Therefore, this study was carried out to assess the magnitude of patients’ perceived involvement in clinical decision-making and associated factors among adult patients admitted at Jimma Medical Center, Oromia region, Ethiopia, 2022.
Objectives
General objective
To assess the level of patients’ perceived involvement in clinical decision-making and associated factors among adult patients admitted at Jimma Medical Center, Oromia, South West Ethiopia, 2022.
Specific objective
To determine the level of patients’ perceived involvement in clinical decision-making and associated factors among adult patients admitted at Jimma Medical Center, Oromia, South West Ethiopia, 2022.
To identify factors associated with patients’ perceived involvement in clinical decision-making among adult patients admitted at Jimma Medical Center, Oromia, South West Ethiopia, 2022.
Methods
Study design
An institution-based cross-sectional study was implemented to assess the patients’ perceived involvement in clinical decision-making and associated factors among adult patients admitted at Jimma Medical Center, Oromia, South West Ethiopia, 2022.
Study setting and period
The study was conducted from 15 July to 7 September 2022. Jimma City is the capital of the Jimma Zone and is found in the southwestern direction from Addis Ababa, the capital city of Ethiopia. Jimma Medical Center is the only tertiary teaching and referral hospital serving the whole southwestern part of Ethiopia. The centre has 16 service departments and 970 total bed capacities, and an estimated total number of 16 000 adult patients are admitted annually.
Population
Source population
All adult patients admitted at Jimma Medical Center.
Study population
All randomly sampled adult patients admitted at Jimma Medical Center during the study period.
Eligibility criteria
All patients who were aged 18 years and above and who were admitted to medical, surgical, maternity, gynaecology and ophthalmology wards at Jimma Medical Center were included, while patients who were acutely or critically ill were excluded.
Sample size determination and sampling technique
The sample size was calculated using a single population proportion formula by considering the proportion (P) of patients’ perceived involvement in clinical decision-making and associated factors; p=50% as there was no published article in the study context, margin of error (d)=5% and 95% CI. The calculated total sample size was 384. By considering a 10% nonresponse rate, the final sample size was 422 participants. According to data from Jimma Medical Center’s inpatient service, the average total flow reports of adult patients admitted to all wards in the prior months were 1644, which were obtained from 6-month reports. From them, a total of 1166 adult patients were admitted to five selected wards. The calculated final sample size was allocated proportionally for each selected ward depending on the average total number of monthly adult patients admitted to five selected wards.
To proportionate the number of study participants for each ward, the formula n=n× nf/N was used, where n=number of adult patients in each ward, nf=final sample size and N=the average total number of monthly adult patients admitted to five selected wards. Accordingly, 261 (94) patients from the medical ward, 351 (127) patients from the surgical ward, 135 (49) patients from the gynaecology ward, 265 (96) patients from the maternity ward and 154 (56) patients from the ophthalmology ward were selected by using a systematic random sampling technique. For the selection of respondents, the sampling interval (K) was calculated by dividing the number of the source population by the sample size which gave the approximate result of 4. The list of existing adult patients admitted into each ward was prepared from the Hospital Admission Registration book and updated daily. The first respondent was selected by the simple random sampling lottery method. Respondents from each ward were assigned systematically and waited until their discharge. They were then interviewed on the day of discharge from each ward, every four respondents, starting with the second respondent, until the required sample size was reached (for more details, see online supplemental figures).
Supplemental material
Study variables
Dependent variable
Patients’ perceived involvement in clinical decision-making.
Independent variables
Sociodemographic variables: age, gender, educational status, marital status, religion and place of residence.
Patients’ clinical characteristics variables: history of hospitalisation, length of hospital stay, routine health check-up, duration of diagnosis with illness and perceived severity of current illness.
Health-seeking behaviour variables: patients’ preference for autonomy, health literacy level of respondents.
Operational definitions
Level of patients’ perceived involvement: determines the magnitude of a patient’s perceived involvement in clinical decision-making, the cut-off points to define ‘adequate involvement’ and ‘poor involvement’ were considered using the calculated overall mean score for all items for each respondent (mean±SD, n) under the tool, and this number was taken as a cut-off point: ‘adequate involvement’ for respondents whose score is above or equal to the cut-off point and ‘poor involvement’ for respondents whose score is below the cut-off point.18 22
Autonomy preferences: the role preference of the respondents is to use their ‘own experiences, beliefs and values’ to decide on their health and medical care.19 23 24
Health literacy: the ability of the patients to seek and acquire knowledge that helps them in using health information at various levels as required for self-management and communication with healthcare professionals to decide on their health and medical care.25 26
Data collection tools and techniques
Standard, reliable, structured questionnaires adapted from available literature and guidelines were used to collect the data.27–29 The instrument comprised 4 sections and a total of 36 items. The first section contained eight items of sociodemographic characters merged with a developed five-item patient clinical characteristics questionnaire and asked according to the manner of items. The second part was a 12-item OPTION instrument that was used to measure the patient’s perceptions about their involvement in the clinical decision-making process.27 Initially, the scale was developed by Elwyn et al (2003) to measure the extent to which clinicians involved patients in the decision-making process by observing and rating a consultation.30 For this study, the scale was used to assess patients’ perceptions of the consultation rather than the doctor’s perceptions. Validity and reliability of 12-item OPTION scale instruments were established and reported by Alrawiai et al for use as a self-response Likert scale.27 It was scored as a self-response Likert scale that ranges from strongly disagree to strongly agree after instructing respondents to choose an option that best matches their level of agreement with their perceived involvement in each statement of the overall decision-making process as was the case in other studies.18 27 31
The third section contained a standard, five-item autonomy preference status questionnaire modified from existing empirical measures.28 32 Scores were recorded as strongly agree with 5, agree with 4, neutral with 3, disagree with 2 and strongly disagree with 1. The last part was the five-item health literacy questionnaire which was initially tested for its validation and psychometric properties.29 Scores were recorded as strongly agree with 5, agree with 4, neutral with 3, disagree with 2 and strongly disagree with 1. Data were collected by using pretested, face-to-face, interviewer-administered questionnaires and conducted on the day of discharge of study participants. For OPTION scale questionnaires, the concept of perceived shared clinical decision-making was first explained briefly by the data collectors before starting interview questions. Three BSc public health officers and one MSc nurse supervisor were selected and assigned outside of the study settings after considering their previous experience in data collection.
Data quality control and management
The questionnaire was translated from English to the local languages (Afaan Oromo and Amharic) by a multilingual translator before data collection and then backtranslated to English by another multilingual translator after data were collected. The data were collected by local language questionnaires, and data collectors were fluent speakers of both Afaan Oromo and Amharic. All questionnaire contents were contextualised to Ethiopian patients. Two weeks before the actual data collection, questionnaires were pretested on 5% of the final sample size at Shenen Gibe Hospital outside of the main study by using interviewer-administered techniques on a similar study population. During this period, all the instruments were checked for clarity, simplicity, feasibility, conceptuality, applicability, understandability, reliability and coherence. Internal consistency of the OPTION instrument, autonomy preference index, and health literacy items was evaluated, and the Cronbach’s alpha value was 0.87, 0.82 and 0.87, respectively. Based on the feedback, all the necessary amendments were made. Some items were contextually clarified.
Two days of training were given to the data collectors to ensure that they had a common understanding of the study instrument and followed the same procedures. Training deals with the objectives of the study, confidentiality, data-collection techniques, and how to approach and forward questions to patients. Continuous follow-ups were made by the principal investigator and supervisor throughout the data collection period. Daily review or check-off of the completed questionnaires was made by the principal investigator to ensure completeness and consistency of the collected data.
Data collectors obtained written informed consent from each participant after explaining the aim and importance of the study to ensure that they were voluntary and had the right to refuse or withdraw at any point in time from the interview. The information provided by the individual respondents was kept strictly confidential. Personal identifiers, such as names, addresses and private information of study participants, were never collected throughout the study. Respondents were also informed that there would be no incentive or harm to their participation in the study, and their responses to the interview were grouped with responses from other participants and reported as part of a research study. In the end, respondents who had heard and agreed with the information signed the consent to take part in the study.
Data processing and analyses
The collected data were coded, cleaned, reviewed, checked for completeness and entered into EpiData V.4.6 to point out errors made during data collection and then exported automatically to SPSS V.26 for analysis. Descriptive analyses were performed first to understand the general characteristics of all the study variables. The frequency distribution and percentages were used to calculate all categorical variables, while mean and SD were used to calculate all continuous variables. For patients’ perceived involvement, 12 questions each had a five-point Likert scale with a minimum score of 1 and a maximum score of 5. OPTION scale instrument was a normal data distribution and ranges from 0 to 100 in nature. However, in this study, the mean value was used to categorise it for use, as the purpose of the study was to predict the overall level of patients’ perceived involvement in clinical decision-making during clinical consultation rather than to focus on a level of every individual aspect of shared clinical decision-making items.18
For health literacy questionnaires, the calculated overall mean score for all items for each respondent (mean±SD, n) under the tool was used, and this number was taken as a cut-off point and then categorised as ‘high health literacy’ for those respondents who score above or equal to the cut-off point and ‘low health literacy’ for those who score below the cut-off point.26 The mean score for the five items was then calculated for each participant, with a maximum of 5 and a minimum of 1. For autonomy preferences status, the calculated total mean score for all items for each respondent (mean±SD, n) under the tool was used, and this number was taken as a cut-off point and treated as a binary variable for those respondents who score above or equal to the cut-off point ‘collaborative role’ and below the cut-off point ‘passive role’.32 33 The mean score for the five items was then calculated for each participant, with a maximum of 5 and a minimum of 1.
Bivariable binary logistic regression analysis was done to sort candidate variables with a p value less than or equal to 0.25 for multivariable binary logistic regression. Multivariable binary logistic regression analysis was conducted to identify factors strongly associated with the outcome variable. The model fitness test was checked with the Hosmer-Lemeshow goodness-of-the-fit test at p>0.05 and an omnibus likelihood test at p<0.05. Accordingly, the result from the Hosmer-Lemeshow goodness-of-fit model adequately fits at a p value of 0.501. Multicollinearity test was done by the variance inflation factor and tolerance test. For each variable, frequencies, adjusted OR (AOR), 95% CI and p value at 5% were computed to measure the strength and/or a level of significance of the association. In multivariable logistic regression analysis, variables having a p value ≤0.05 were used to declare statistical significance. The data were described and presented using narrative text, tables and figures.
Patient and public involvement
No patient or public is involved.
Result
Sociodemographic characteristics of respondents
A total of 403 patients participated, and the response rate was 95.5%. Among the total respondents, about 187 (46.4%) were aged 20–39 years and 207 (51.4%) were females. Regarding clinical characteristics, almost half 204 (50.6%) of respondents have a history of hospitalisations, and 134 (33.3%) of respondents have a length of hospital stay greater than 15 days (table 1).
Distribution of respondents by sociodemographic characteristics (n=403)
Overall level of patients’ perceived involvement in clinical decision-making
Each respondent’s total mean score for all OPTION scale items was 2.7±0.7 (mean±SD, n=403). Accordingly, of all respondents (n=403), 207 (51.4%) have adequate involvement (mean score >2.7), while 196 (48.6%) have poor involvement (mean score <2.7) in clinical decision-making (table 2).
Overall level of patients’ perceived involvement in clinical decision-making on the 'OPTION' scale of respondents (n=403)
Respondent’s overall autonomy preference status
The total mean score and SD of each respondent for all five items was 2.5±0.8 (mean±SD, n=403). Accordingly, of all the respondents (n=403), 190 (47.1%) patients have collaborative preference (mean score >2.5), while 213 (52.9%) have passive preference (mean score <2.5) (table 3).
Overall autonomy preference index of respondents (n=403)
Overall health literacy level of respondents
The total mean score and SD of each respondent for all five items was 2.5±0.9 (mean±SD, n=403). Accordingly, of all the respondents (n=403), 186 (46.2%) have high health literacy (mean score >2.5), while 217 (53.8%) have low health literacy (mean score <2.5) (table 4).
Overall health literacy status of respondents (n=403)
Bivariate and multivariate analyses of factors associated with the outcome variable
All predictors were entered into bivariate logistic regression. Respondents’ age, marital status, educational level achieved, history of hospitalisation, length of hospital stay since admission, duration of diagnosis with the diseases, perceived severity of current illness, health literacy and preference for autonomy variables were selected to be factors for multivariable logistic regression analysis at a significant level (p value) <0.25. Finally, after controlling confounding variables, variables such as age, level of education, history of hospitalisation, length of hospital stay, health literacy and preference for autonomy were significantly associated with the outcome variable at 95% CI and a p value <0.05 in multivariable logistic regression analysis.
Respondents who were aged >60 years were two times more likely to have adequate perceived involvement in clinical decision-making than those 20–39 years (AOR: 2.01, 95% CI: 1.40 to 5.65). Respondents who have college and above level of education were nearly five times more likely to have adequate perceived involvement in clinical decision-making than those who did not read and write (AOR: 4.60, 95% CI: 1.60 to 13.26). Respondents who had a length of hospital stay >15 days were nearly three times more likely to have adequate perceived involvement in clinical decision-making than those whose length of hospital stay was <5 days (AOR: 2.80, 95% CI: 1.41 to 5.50). Respondents who have high health literacy were two times more likely to have adequate perceived involvement in clinical decision-making than those who have low health literacy (AOR: 2.04, 95% CI: 1.34 to 4.21).
The study also indicated that respondents who do not have a history of hospitalisation were about 51% less likely to have adequate perceived involvement in clinical decision-making than those who have a history of hospitalisation (AOR: 0.493, 95% CI: 0.30 to 0.82). Participants who had a passive preference for autonomy were also 78% less likely to have adequate perceived involvement in clinical decision-making than those who had a collaborative preference for autonomy (AOR: 0.22, 95% CI: 0.13 to 0.37) at a p value <0.05 (table 5).
Binary and multivariable logistic regression analyses of factors associated with patients’ perceived involvement in clinical decision-making (n=403)
Discussion
Globally in the current healthcare system, patient-centred care widely ensures that patients are placed at the centre of all healthcare decisions during the clinical consultation care process. Involvement in decision-making allows patients to have self-awareness to express their emotions, fears, personal values, beliefs, roles, specific health information needs and preferences about their health conditions, diagnosis or treatment in reaching a shared decision with their healthcare providers,13 although patients desire participation in health-related decision-making to a different extent.33 This study aimed to assess the levels of patients’ perceived involvement in clinical decision-making and associated factors among adult patients admitted at Jimma Medical Center, Oromia, southwest Ethiopia. Accordingly, this study found that nearly half (51.4% (95% CI: 46.4 to 56.3)) of the respondents reported adequate perceived involvement in clinical decision-making. It also identified that patients’ perceived involvement in clinical decision-making was significantly associated with age, level of education, length of hospital stay, history of hospitalisation, health literacy level and autonomy preference status.
The result of the present study is lower than the study done in Saudi Arabia, China, New York and Japan, where 57%, 60%, 61.0% and 71% of survey respondents reported having adequate perceived involvement in clinical decision-making, respectively.5 34–36 Use of a large sample size and sociodemographics could make a difference. In addition, the high perception of involvement in clinical decision-making was due to the study population (patients with diabetes have relatively good adherence to therapy, and therefore they were more likely perceived to be actively involved in managing their illness) similar to a study conducted in Japan. The current study finding is higher when compared with a study done in Uganda, in which 11.3% of the respondents had adequate perceived participation in clinical decision-making.18 This inconsistency might be due to differences in sample size (a relatively small number of respondents have participated) and study setting (as respondents were from primary healthcare) in the previous study.14
The finding of the current study is analogous to the studies conducted in Germany, which found older patients had adequate perceived involvement when a decision was made about their treatment.37 This could be evidenced that the older the patients get, the more they might experience informal education and become more concerned about their illness, thereby agreeing and consenting to the recommendations of the healthcare providers. In contrast, studies conducted in China,5 the United Kingdom38 and Malaysia showed that younger patients’ perceived better involvement in clinical decision-making than older patients. This study also showed that respondents who achieved the tertiary (college and above) level of education had adequate perceived involvement in clinical decision-making compared with those who could not read and write. This finding was supported by the study conducted in Malaysia.31 The reason might be that highly educated patients are more confident, have a better comprehension of the medical information provided by healthcare providers and are also able to seek and/or verify information inside and outside the health system to monitor their health condition.5 18 The present study finding shows that respondents who had a history of hospital admission were more likely to have adequate perceived involvement in clinical decision-making than their counterparts, and this was consistent with the studies conducted in China,5 Australia,39 Canada40 and Birmingham.41 This could be evidenced that patients’ perceived involvement in clinical decision-making may change over time towards a greater desire for involvement as patients’ experiences with illness and/or treatment develop, which increases their confidence in building a rapport with healthcare providers and helps them adapt their self-care. However, these may sometimes depend on a patient’s particular diagnosis or illness, as their perceived participation in decision-making varies widely.39
According to this study, respondents who had a length of hospital stay longer than 15 days were more likely to have better perceived involvement in clinical decisions about their health than those who stayed less than 5 days, as supported by the studies conducted in Chicago42 and Italy.43 The possible reason might be that as patients stay longer in the hospital, their attitudes about their illness can change, and their relationships with healthcare providers could also develop, which results in patients becoming more knowledgeable about their disease and expressing a desire to work with healthcare providers to decide on the best treatment option. In addition, healthcare providers may have sufficient time to discuss the best treatment methods with patients and involve them in the decision-making process by carefully considering their opinions.43 In the current study, respondents who preferred an autonomy (an active or collaborative) role had a higher perceived involvement in making clinical decisions with their healthcare providers than those who preferred a nonautonomous (passive) role during healthcare delivery. This implies that patients who could use their own beliefs, values and experiences in making decisions about their health condition and/or medical care had an innate incentive to make decisions on their behalf, which was justified by various pieces of evidence.19 23 24 33
The present study finding also reveals that respondents who have high health literacy levels reported higher perceived involvement in clinical decision-making about their health than those who have low health literacy levels. This is in line with the studies conducted in the United Kingdom44 and Ethiopia.19 26 This indicates that patients can initiatively ask questions about the best treatment options as they build up health information about their health problems and treatments. If patients are aware of these relationships and are questioned directly about their preferences, both healthcare providers and patients will be able to interact more successfully to decide on better clinical care. On the contrary, unlike other studies, the present study findings did not show any significant differences between genders,27 37 38 44 marital status,33 38 duration of diagnosis with the disease19 38 and perceived severity with the disease,41 44 among study participants.
However, the study has some limitations. The study was conducted only by taking into account the viewpoints of patients without including healthcare providers’ perspectives, and the authors indicated possible implications that the scope, objectives and methodological aspects of the current study delineated those study subjects. Additionally, the study was conducted at a single public hospital, and the results cannot be assumed to be generalisable to all health facilities found in the Jimma Zone. However, the authors stated that the hospital was the only tertiary teaching and referral hospital serving all nearby communities, had the highest flow rates of patients and had different kinds of healthcare delivery service compared to any other health facilities found in the study area. Furthermore, a cross-sectional study design cannot provide any information about true cause-and-effect relationships, but only about associations, and social desirability bias might also affect the result of the study.
Conclusion and recommendation
According to the present study finding, only nearly half of the respondents had adequate perceived involvement in clinical decision-making. The level of patients’ perceived involvement in clinical decision-making was low among respondents. Age, level of education, length of hospital stay, history of hospitalisation, health literacy and autonomy preference status were significant predictor variables of patients’ perceived involvement in clinical decision-making. Healthcare professionals have to consider empowering patients’ perceived involvement in clinical decision-making, and hospital management has to reinforce healthcare professionals’ efforts to promote patients’ perceived involvement in clinical decision-making in the area. The Ethiopian Ministry of Health should also promote a strategy that supports a policy of shared clinical decision-making. Future work is expected from researchers to conduct an interventional study and identify the pathway by which cultural backgrounds, diagnosis type and involvement of family and/or friends might affect the degree of patients’ perceived involvement in clinical decision-making.
Data availability statement
Data are available upon reasonable request.
Ethics statements
Patient consent for publication
Ethics approval
The research was reviewed and approved by the Jimma University Institute of Health Review Board (JUIHRB) (Ref. No. JUIHRB-73/22). Then, a formal letter was submitted to the Jimma Medical Center Chief Executive Director Directorates. Subsequent permission and cooperation were obtained from the head departments of Jimma Medical Center. Written informed consent was obtained from each of the respondents who agreed to participate in the research after explaining the aim and the importance of the study. Participants were informed that they had the right to participate or not in the research. They were also assured about the confidentiality of the obtained data and that it was used for research purposes only. No name was written on the paper, but rather a code was provided to maintain confidentiality.
Acknowledgments
We would like to thank Jimma University Institute of Health, School of Nursing, for the opportunity and the staff of Jimma Medical Center for their kind information and cooperation during data collection. We also express our sincere gratitude to the study participants, supervisors and data collectors for their contribution to this study.
References
Footnotes
Collaborators No collaborator.
Contributors KDD and YGD conceptualised the idea. KDD, YGD, WWD and GBB made substantial contributions to the design of the work, acquisitions, analysis or interpretations of the data for work. KDD and YGD wrote the original draft. WWD and GBB supervised the overall study. All authors contributed to drafting the article or revising it critically for important intellectual content, gave final approval of the version to be published and agreed to be accountable for all aspects of the work. KDD is the author responsible for the overall content as the guarantor.
Funding The author(s) received no specific funding for this work from any organisation. Jimma University provided material support (but not financial support) as part of academic activities for the author (KDD).
Disclaimer This organisation had no role in designing the study, data collection, analysis, interpretation of the result, writing the manuscript or submitting it for publication.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.