Experiences and ethical issues during shared decision-making in healthcare at rural health facilities in Uganda: An exploratory qualitative study

Experiences and ethical issues during shared decision-making in healthcare at rural health facilities in Uganda: An exploratory qualitative study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Experiences and ethical issues during shared decision-making in healthcare at rural health facilities in Uganda: An exploratory qualitative study Ranga Solomon Owino, Nelson K. Sewankambo, Olivia Kituuka, Paul Kutyabami This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4930541/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 27 Jan, 2025 Read the published version in BMC Medical Ethics → Version 1 posted 10 You are reading this latest preprint version Abstract Background: Shared decision-making in healthcare is a collaborative process where patients are supported to make informed decisions according to their preferences. Healthcare decisions affect patients' lives which necessitates patients to participate in decisions concerning their health. This study explored experiences and ethical issues related to shared decision-making in a rural healthcare setting. Methods: An exploratory qualitative study was conducted at Budumba Health Centre III and Butaleja Health Centre III in rural Eastern Uganda. In this study, 23 in-depth interviews were conducted among 12 healthcare providers and 11 patients. Data was analyzed thematically using NVivo-12 plus software. Results: Four themes emerged which included: experiences, challenges, strategies for improvement, and ethical issues. Patients at both facilities expressed the need to be involved in decision-making processes. However, many stressed that they are not engaged in decision-making about their health. Many healthcare providers noted that shared decision-making could improve patient prognosis but are faced with challenges related to low male involvement and the influence of cultural and religious practices, including myths and patriarchal attitudes which impact effective patient engagement. Ethical issues included concerns about informed consent, privacy and confidentiality, deception, and harm. This study highlighted the need for better sensitization of patients and comprehensive training for HCPs to minimize and resolve ethical issues that emerge during shared decision-making processes. Conclusions: There is a need for targeted interventions to enhance decision-making processes in rural healthcare including but not limited to developing shared decision-making manual and continuous training of healthcare providers to ethically engage patients. Further research is needed to explore larger facilities with a bigger scope including patients under 18 years of age and and their surrogates. Shared decision-making healthcare ethical issues patient autonomy healthcare provider Full Text Additional Declarations No competing interests reported. Supplementary Files Table1COREQChecklist.docx Tool1Interviewguideforhealthcareproviders.pdf Tool2Interviewguideforpatients.pdf Cite Share Download PDF Status: Published Journal Publication published 27 Jan, 2025 Read the published version in BMC Medical Ethics → Version 1 posted Editorial decision: Revision requested 10 Oct, 2024 Reviews received at journal 04 Oct, 2024 Reviewers agreed at journal 18 Sep, 2024 Reviews received at journal 16 Sep, 2024 Reviewers agreed at journal 11 Sep, 2024 Reviewers invited by journal 26 Aug, 2024 Submission checks completed at journal 19 Aug, 2024 Editor invited by journal 19 Aug, 2024 Editor assigned by journal 19 Aug, 2024 First submitted to journal 17 Aug, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4930541","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":353929481,"identity":"19af7964-2995-44cb-80ed-fb3095866b38","order_by":0,"name":"Ranga Solomon Owino","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA40lEQVRIiWNgGAWjYBADGTD5AYjZ2InUwgMiGGeAtDCTooUZQhJQat5+9vCLH39sePjFDh97bPNrmzwfMwPjh485uLXInMlLs+xtS+ORnJ2Wbpzbd9uwjZmBWXLmNtxaJBhyzAx4Gw7zGNzOMZPO7bnNCNTCxsyLTwv/GzPDP3+gWix7btsT1iKRY/yYhw2qheHH7UQitLwxY5aF+CVNsrfhdnIbM2Mzfr/w5xh/fPPHRo5fOvmYxI8/t23ntzcf/PARjxYgYJOAMxnbwGQDXvVAwPwBwf5DSPEoGAWjYBSMRAAATidJHhPsToEAAAAASUVORK5CYII=","orcid":"","institution":"Makerere University Lung Institute","correspondingAuthor":true,"prefix":"","firstName":"Ranga","middleName":"Solomon","lastName":"Owino","suffix":""},{"id":353929483,"identity":"411f65d6-377b-4f73-916d-eaf78ac25b08","order_by":1,"name":"Nelson K. Sewankambo","email":"","orcid":"","institution":"Makerere University","correspondingAuthor":false,"prefix":"","firstName":"Nelson","middleName":"K.","lastName":"Sewankambo","suffix":""},{"id":353929484,"identity":"1edfa877-69a7-4e28-9713-6e6da34f48dc","order_by":2,"name":"Olivia Kituuka","email":"","orcid":"","institution":"Makerere University","correspondingAuthor":false,"prefix":"","firstName":"Olivia","middleName":"","lastName":"Kituuka","suffix":""},{"id":353929487,"identity":"9f949189-f238-4a93-8da3-b0cdb1862831","order_by":3,"name":"Paul Kutyabami","email":"","orcid":"","institution":"Makerere University","correspondingAuthor":false,"prefix":"","firstName":"Paul","middleName":"","lastName":"Kutyabami","suffix":""}],"badges":[],"createdAt":"2024-08-17 15:53:27","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4930541/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4930541/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12910-025-01172-x","type":"published","date":"2025-01-27T15:58:08+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":75352053,"identity":"bd9fc1de-2c52-4fbe-a0d7-1653c41f428e","added_by":"auto","created_at":"2025-02-03 16:12:59","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":410279,"visible":true,"origin":"","legend":"","description":"","filename":"RangaSolomonO.ManuscriptBMCSubmission18.AUG.2024.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4930541/v1_covered_6ecb5bdb-0624-4777-a392-be598bb5cb78.pdf"},{"id":64581187,"identity":"9ae58e47-9ccc-413f-8995-c2e9dc954d0a","added_by":"auto","created_at":"2024-09-16 06:20:59","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":25246,"visible":true,"origin":"","legend":"","description":"","filename":"Table1COREQChecklist.docx","url":"https://assets-eu.researchsquare.com/files/rs-4930541/v1/0f31a1c64181ec4b9e0216cd.docx"},{"id":64581186,"identity":"cf91f6e1-5b97-41fc-8186-8d98c53b638b","added_by":"auto","created_at":"2024-09-16 06:20:59","extension":"pdf","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":108844,"visible":true,"origin":"","legend":"","description":"","filename":"Tool1Interviewguideforhealthcareproviders.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4930541/v1/3fe2f9eb99171e8b02ab2e2b.pdf"},{"id":64581188,"identity":"56b1cd39-bdf9-4630-86c7-240ebba50222","added_by":"auto","created_at":"2024-09-16 06:20:59","extension":"pdf","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":106942,"visible":true,"origin":"","legend":"","description":"","filename":"Tool2Interviewguideforpatients.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4930541/v1/8269612f7d13e3daee85dfc7.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Experiences and ethical issues during shared decision-making in healthcare at rural health facilities in Uganda: An exploratory qualitative study","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-ethics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meth","sideBox":"Learn more about [BMC Medical Ethics](http://bmcmedethics.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meth/default.aspx","title":"BMC Medical Ethics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Shared decision-making, healthcare, ethical issues, patient, autonomy, healthcare provider","lastPublishedDoi":"10.21203/rs.3.rs-4930541/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4930541/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Shared decision-making in healthcare is a collaborative process where patients are supported to make informed decisions according to their preferences. Healthcare decisions affect patients' lives which necessitates patients to participate in decisions concerning their health. This study explored experiences and ethical issues related to shared decision-making in a rural healthcare setting.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e An exploratory qualitative study was conducted at Budumba Health Centre III and Butaleja Health Centre III in rural Eastern Uganda. In this study, 23 in-depth interviews were conducted among 12 healthcare providers and 11 patients. Data was analyzed thematically using NVivo-12 plus software.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Four themes emerged which included: experiences, challenges, strategies for improvement, and ethical issues. Patients at both facilities expressed the need to be involved in decision-making processes. However, many stressed that they are not engaged in decision-making about their health. Many healthcare providers noted that shared decision-making could improve patient prognosis but are faced with challenges related to low male involvement and the influence of cultural and religious practices, including myths and patriarchal attitudes which impact effective patient engagement.\u003c/p\u003e\n\u003cp\u003eEthical issues included concerns about informed consent, privacy and confidentiality, deception, and harm. This study highlighted the need for better sensitization of patients and comprehensive training for HCPs to minimize and resolve ethical issues that emerge during shared decision-making processes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e There is a need for targeted interventions to enhance decision-making processes in rural healthcare including but not limited to developing shared decision-making manual and continuous training of healthcare providers to ethically engage patients. Further research is needed to explore larger facilities with a bigger scope including patients under 18 years of age and and their surrogates.\u003c/p\u003e","manuscriptTitle":"Experiences and ethical issues during shared decision-making in healthcare at rural health facilities in Uganda: An exploratory qualitative study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-09-16 06:20:54","doi":"10.21203/rs.3.rs-4930541/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-10-10T07:21:39+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-10-04T15:58:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"262232820126272099507333105825098717423","date":"2024-09-18T04:01:16+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-16T20:27:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"206608541410978960678010601618964816681","date":"2024-09-11T07:07:25+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-08-26T09:32:37+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-08-19T10:41:40+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-08-19T06:11:11+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-08-19T06:09:34+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Ethics","date":"2024-08-17T15:52:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-ethics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meth","sideBox":"Learn more about [BMC Medical Ethics](http://bmcmedethics.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meth/default.aspx","title":"BMC Medical Ethics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8d9357f1-3695-4727-a93f-8a3215342ef5","owner":[],"postedDate":"September 16th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-02-03T16:10:00+00:00","versionOfRecord":{"articleIdentity":"rs-4930541","link":"https://doi.org/10.1186/s12910-025-01172-x","journal":{"identity":"bmc-medical-ethics","isVorOnly":false,"title":"BMC Medical Ethics"},"publishedOn":"2025-01-27 15:58:08","publishedOnDateReadable":"January 27th, 2025"},"versionCreatedAt":"2024-09-16 06:20:54","video":"","vorDoi":"10.1186/s12910-025-01172-x","vorDoiUrl":"https://doi.org/10.1186/s12910-025-01172-x","workflowStages":[]},"version":"v1","identity":"rs-4930541","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4930541","identity":"rs-4930541","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}