Factors Correlating to Women's Involvement in Shared Decision-Making Following Caesarean Sections in Amhara Region Referral Hospitals, Ethiopia, 2023

Factors Correlating to Women's Involvement in Shared Decision-Making Following Caesarean Sections in Amhara Region Referral Hospitals, Ethiopia, 2023 | 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 Factors Correlating to Women's Involvement in Shared Decision-Making Following Caesarean Sections in Amhara Region Referral Hospitals, Ethiopia, 2023 Tigist SEID, Wassie yazie This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4067330/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction: - "Shared decision-making" refers to a collaborative approach to healthcare that elevates the bar for medical judgments. However, not much research has been done on Ethiopian women's involvement in shared decision-making after cesarean sections. Objective: Factors correlating to women's involvement in shared decision-making following cesarean sections in Amhara region referral hospitals, Ethiopia, 2023. Methods: The institutional-based cross-sectional study design was directed amongst participants who underwent a cesarean section at Amhara region referral hospitals from June 1 to 30, 2023. A total of 398 postnatal mothers were included through a systematic random sampling method. The files were composed of a semi-structured interview-guided questionnaire. After checking for completeness, data were coded and entered into EPI INFO version 7 and analyzed using SPSS version 23. Multivariable logistics regression analysis was used to identify factors associated with women's involvement in shared decision-making. Statistical significance was declared at a P-value of < 0.05. Result : Around, 382 women were included making a response rate of 95.97%. The overall prevalence of mothers' involvement in shared decision-making was (35.3%) with a mean of 3.62 and std. deviation of 2.484. %. respondents who had ANC contact4 and above (AOR=2.046, 95% CI: 1.19, 3.493), having information about shared decisions (AOR=2.34, 95% CI: 1.13, 4.83), and respondents who had information about cesarean section (AOR=7.9, 95% CI: 3.71, 17.19) were factors significantly associated with involvement in shared decision-making. Conclusion and recommendation: - when compared to other studies, the outcome of these investigations was low participation in decision-making had a significant impact on knowing about shared decisions and knowledge about cesarean sections. Consequently, it is critical to focus on raising women's understanding of shared decision-making to improve patient satisfaction and care quality. Referral hospitals and the Amhara Region health office collaborate to improve collaborative decision-making. shared decision-making associated factors women cesarean section Amhara region Ethiopia Figures Figure 1 INTRODUCTION A cesarean section delivery is a medical technique in which the uterus and belly are incised to deliver the baby when vaginal delivery is not feasible, safe, or poses a risk to the mother's or the child's health, it is carried out. moms, family members, and medical professionals must decide on this treatment( 1 ). When faced with the task of making decisions, patients and clinicians share the best available evidence in a process known as "shared decision-making," which helps patients decide on options that align with their values and the best available science. patients are assisted in making well-informed choices through this two-way process( 2 , 3 ). Women differ in their attitudes and concepts around chemotherapy. Some believe that CSs are done on indolent women, or that they put the mother and child in danger, some believe that CSs are solitary operations carried out to preserve the lives of expectant mothers and their babies ( 4 – 6 ). The World Health Organization suggests that the rate of cesarean sections should be between 10% and 15%, however, the current global rate is 21%. When performed without a clear reason, cesarean sections do not provide any additional benefits to the mother or the child; rather, they increase the risk of wound infection, urinary tract infection after discharge, blood loss, fever, and death in cesarean mothers, as well as low Apgar scores and neonatal complications in newborns, they also lengthen hospital stays ( 7 – 11 ). Involving a mother in the decision-making process is one of the requirements for a positive childbirth experience. According to WHO guidelines and recommendations on intrapartum care, effective communication with healthcare providers to accomplish this is a crucial component of patient-centered care in clinical practice ( 12 – 15 ). Shared decision-making is a way to increase information regularity in healthcare services however, deficiency of knowledge flow to patients from physicians during healthcare service provision can create distrust in health provider-patient relationships, and lack of information regularity in healthcare services is often associated with misconduct, dissatisfaction, costly and low-quality services ( 15 – 17 ). The patient has the right to obtain clear, honest, and extensive information in a manner and language understandable to the patient, about all proposed procedures, whether diagnostic, preventive, curative, rehabilitative, or therapeutic. the person who will perform the procedure shall provide the patient with his or her name and credentials, the possibility of mortality risk or serious side effects, problems associated with recovery, and the likelihood of success and reasonable risks involved( 18 ). Involvement in decision-making has a constructive impact on their childbirth experience. decision-making is an essential element of feeling in control for most women ( 19 ). According to ACOG ethical obligations of informed consent require that an obstetrician-gynecologist gives the patient passable, precise, and understandable information and that the patient can understand and reason through this information and is free to ask questions and to make an intentional and voluntary choice, which may include refusal of care or treatment. shared decision-making is a patient-centered, individualized approach to the informed consent process that involves discussion of the benefits and risks of available treatment options in the context of a patient's values and priorities( 20 ). some informed consent challenges are universal to medicine, whereas other challenges arise more commonly in obstetrics and gynecology than in other specialty areas( 21 ). The patient is not exposed to any procedure without the patient's written informed consent ( 18 ). Even if patients have the right to decide on the choice of treatment and surgical procedures, the shared decision-making practice is very low in developing countries, including Ethiopia, which leads to patient dissatisfaction with healthcare services ( 22 – 24 ). different studies have shown that involvement in decision-making increases patient satisfaction( 25 ). An increase in patient satisfaction has a role in increasing institutional delivery rates and a decrease in maternal and neonatal morbidity and mortality( 23 , 26 ). some factors affect involvement in shared decision-making like counseling skills of health care providers, and having adequate time for decision-making( 24 ), the maternal mortality rate in Ethiopia is very high so shared decision-making practices increase patient satisfaction and decrease maternal and neonatal complications. As far as our findings there are no studies conducted in the Amhara region about shared decision-making and associated factors that lead to the client being dissatisfied with the services and it violates the right of the patient as well as it is important to accept the complication related to the cesarean section. Knowing the status of women's participation in shared decision-making practice provides clues for policymakers and different stakeholders to improve services and enhance patient satisfaction. Nonetheless, little study has been done on Ethiopian women who had cesarean sections and their participation in shared decision-making the study aimed to assess the status of women's involvement in shared decision-making and associated factors among women who underwent a cesarean section in Ethiopia at Amhara region referral hospitals. Method Study design and period An institution-based cross-sectional study was conducted in Amhara region referral hospitals from June 1 to 30, 2023, in North West Ethiopia, 2023. Amhara regional state is one of the eleven regional states in Ethiopia which is found between 11° 30' 00" N latitude & 38° 30' 00" E longitude in the northwestern part of Ethiopia. Amhara is one of Ethiopia’s largest regions; it has 12 zones, three city administrations, and 180 woredas (139 rural and 41 urban). According to the Ethiopian Central Statistics Agency, the region has a projected population of 21.5 million people, about 80 percent of whom are rural farmers. Two decades ago, Amhara had only nine public hospitals and 140 health centers, which was insufficient to meet the demand of the region’s then 14.8 million residents. In addition, service coverage and quality were low. Today, the region has 80 hospitals (7 referrals, 2 general, and 73 primaries), 847 health centers, and 3,342 health posts. As in other regions of Ethiopia, Amhara’s healthcare system was unable to modernize and provide quality health services due to many challenges. There are 8 referral hospitals including the University of Gondar Teaching Referral Hospital (UOGRH), Felege Hiwot Referral Hospital (FRH), Dessie Referral Hospital (DRH), Debremarkos Referral Hospital (DMRH), Debre tabor referral hospital and Debrebirhan referral hospital (DBRH), Tibebegion teaching and referral hospital (TGTRH) each of them assumed to serve 5 million peoples. On average 300 healthcare providers were found from each hospital. Sample size determination & sampling procedures Sample size determination The sample size is determined using a single population proportion formula. a previous study conducted at selected public hospitals in the Sidama region, south, Ethiopia to assess women's involvement in shared decision-making and associated factors among women who underwent a cesarean section was 37.9%( 27 ). A 95% confidence level was used in this study, and by assuming a margin of error of 5%. Taking non-response rates of 10% into account, the final sample size was 398. \(n=\frac{(Z\alpha /2{)}^{2}*p(1-p)}{{d}^{2}}\) Where; n = required sample size α = level of significant z = standard normal distribution curve value for 95% confidence level = 1.96 P = proportion of Shared Decision-making (37.9%) d = margin of error be tolerated (d = 0.05) Therefore, n= \(\frac{\left(1.96{)}^{2}\text{*}0.379\right(1-0.379)}{(0.05{)}^{2}}\) n= \(\frac{3.8416\text{*}0.379\left(0.621\right)}{0.0025}\) =361.6 With a 10% non-response rate = 398 Source Population and study population All women who underwent cesarean delivery at Amhara region referral hospitals were the source populations, and the study populations were women who underwent cesarean delivery at selected hospitals during the data collection period. Inclusion and exclusion criteria All women who underwent a cesarean section at the time of data collection after waiting from they wake up from anesthesia were included whereas mothers who were referred from another health center for better management before exiting from the post-cesarean ward were excluded. Study variables Dependent Women’s involvement in shared decision-making. Independent Sociodemographic factors : age, education, residence, marital status, occupation, income. Source of information : mass media Obstetrics factors : gravidity, parity, ANC follow-up, previous history of cesarean section. Service-related factors : explanation of the procedure, provision of adequate information, the language of informed consent, the timing of consent, and adequate time. Operational definition Patient involvement in decision-making:- involvement of the women/patients in decision-making about different treatment methods which includes sharing information, feelings, and signs and accepting health team instructions ( 30 ). Shared decision-making - contains nine items. Respondents who scored the mean and above value from the nine questions were considered as having involvement in shared decision-making whereas respondents who scored below the mean value were considered as not. The overall involvement of shared decision-making of the respondents was assessed by summing up the correct answers to individual questions and the mean score was taken as a cut point( 31 ). Explanation of the procedure and provision of adequate information: - consent is taken after explaining everything in easy language/mother language or explaining everything in easily understandable language including another mode of delivery options, time of the procedures taken said effect of anesthesia medication advantage or benefit of the procedure. The timing of consent;- was consent taken the day before the date of surgery, on the day of surgery, immediately before surgery, or on the operation table. Sampling technique and procedure Of eight referral hospitals, five hospitals were selected by using the lottery method namely Debretabor Referal Hospital, Felege Hiwot Referral Hospital (FRH), Debre Birhan Referral Hospital (DBRH), Woldiya Referral Hospital (DRH), and Debre Markos Referral Hospitals (DMRH). The final sample size of 398 was allocated to all selected hospitals based on the two-monthly average number of women who underwent a cesarean section in each institution for the year 2022 in each facility. Finally, a systematic random sampling technique was used to select study participants from the mothers who underwent a cesarean section in selected hospitals until the required sample size at each hospital was obtained. The sampling interval k = 2 was calculated by dividing the source population by the total sample size and this interval was used in all hospitals to select study participants ( Fig. 1 ). Data collection tool and procedure The questionnaire was developed after reviewing different literature ( 28 , 29 , 30 ) some amendment was made based on the objective of the study. Was prepared in the English version. Translated to the local language (Amharic) and re-translated again to English by language experts to ensure consistency. The components of the questionnaires were demographic information, obstetric factors, healthcare providers, and facility-related factors. Data were collected by interview-guided semi-structured questionnaires. Data collectors were 5 BSC nurses and 5 BSC midwives on each site. Two supervisors (public health experts) were assigned to supervise the data collectors. Data quality Assurance To maintain the quality of data first structured questionnaire was prepared after an extensive search and review of relevant studies on the issue. The questionnaire was translated into the local language (Amharic) to facilitate communication. Supervisors and data collectors were trained for two days on how to collect data, study overviews, questionnaires, and other related activities during data collection. In addition, the questionnaire was pretested on 5% (20 mothers) of the total sample size outside the study area at Tibebe Gion Referral Hospital. Difficult questions were revised and modified. Daily supervision of the data collection process was maintained, throughout the data collection period. Supervisors checked study sites daily and received filled questionnaires after checking their completeness. Data Processing and analysis Before data processing, the data was checked for completeness and internal consistency. Data were coded and entered using EPI info version 7.2 and exported to SPSS version 23 for analysis. Analysis was verified using descriptive interpretation for the socio-economic characteristics of the study participants using frequencies and other summary statistics. Binary logistic regression was used to measure the association of each covariate with the outcome variable. Factors that were associated with the outcome variable at a 0.25 percent significance level were included in the multivariable logistic regression analysis to control the potential confounders. The result of the final model was presented, in terms of adjusted odd ratio (AOR) and 95% confidence intervals (CI). Statistical significance was taken, at a P-value less than 0.05. Result In this study, 16 questionnaires were rejected due to incomplete information, and 382 were analyzed making a response rate of 95.97%. The majority of the participants were found in the age group of 21 to 25 years. Regarding marital status, married, Amhara in ethnicity, orthodox followers, and rural residents account for around (40.1%, 89.3%, 95%, 95.5%, and 65.2%) respectively. Regarding educational status majority of the mothers can read and write (43.5%) and have primary school attended. Around 51.8% of the respondent's income level was within the range of 1000 to 1500 ETB. See Table 1 . Table 1 Demographic characteristics status among respondents during a cesarean section among mothers in Amhara region referral hospitals, Ethiopia 2023 (n = 382). Variable Characteristics Number Percentage (%) Age 21 to 25 yrs. 153 40.1 26 to 30 yrs. 103 27.0 31 to 35 yrs. 70 18.3 36 to 40 yrs. 50 13.1 > 41 yrs. 6 1.6 Marital status Married 341 89.3 Unmarried 41 10.7 Religion Orthodox 363 95.0 Others 19 5.0 Ethnicity Amhara 365 95.5 Others 17 4.5 Resident Rural 249 65.2 Urban 133 34.8 Mother educational status unable to read and write 53 13.9 able to read and write 166 43.5 primary school 38 9.9 secondary school 40 10.5 College and above 85 22.3 Income 1500 ETB 125 32.7 Table 2 -Source of information to assess shared decision-making during a cesarean section among mothers in Amhara region referral hospitals, Ethiopia 2023 (n = 382). The majority of the respondents attend mass media utilization, participate in the women’s development team, and have attended coffee ceremonies in the neighborhood which account for 57.9% and 55.2 respectively( See Table 2 ). Variable Characteristics Number Percentage (%) Mass media utilization No 161 42.1 Yes 221 57.9 Did you participate in the women’s development team? no 171 44.8 yes 211 55.2 Have you coffee ceremony in your neighborhood? no 171 44.8 yes 211 55.2 Obstetric characteristics Regarding maternal obstetrics and reproductive history, more than 54.2% of the respondents had para four and above. Nearly ninety-eight percent (97.6%) of the study participants had a history of ANC follow-up. Regarding the place of visit, more than 70% of the respondents attended the governmental health institution of the mothers 57.9% had four and above ANC visits. About fifty-five percent (54.5%) of the respondents had information during the ANC follow-up about shared decision-making during labor for a mode of delivery ( Table 3 ). Table 3 -Obstetric characteristics to assess shared decision-making during a cesarean section among mothers in Amhara region referral hospitals, Ethiopia 2023 (n = 382). Variable Characteristics Number Percentage (%) Parity 4 207 54.2 ANC follow-up? No 9 2.4 Yes 373 97.6 place of ANC visit Governmental health institution 294 77.0 Private health institution 88 23.0 How many times did you receive ANC service? 4 228 59.7 Did you have information during the ANC follow-up about shared decision-making during labor for a mode of delivery? no 174 45.5 yes 208 54.5 Do you have a history of previous cesarean sections? no 334 87.4 yes 48 12.6 Type of current cesarean section emergency 287 75.1 elective 95 24.9 Services-related factors Regarding the timing of consent majority of the respondents mentioned that consent was taken immediately before surgery 53.4% and 68.8% didn't have adequate information about CS (Table 4 ). Table 4 Services-related factors to assess shared decision-making during a cesarean section among mothers in Amhara region referral hospitals, Ethiopia 2023 (n = 382). Variable Characteristics Number Percentage (%) Was consent taken after explaining everything in easy language/Mather language? No 175 45.8 Yes 207 54.2 Before the procedure did you feel you had adequate time to decide to have a CS? No 304 79.6 Yes 78 20.4 Timing of consent The day before the date of surgery 23 6.0 On the day of surgery 68 17.8 Immediately before surgery 204 53.4 On the operation table 87 22.8 Consent requested by whom? Ob-GYN specialist 36 9.4 General practitioner/resident 55 14.4 IESO 31 8.1 Midwifery 260 68.1 Before the procedure did you feel you had adequate information about CS? No 263 68.8 Yes 119 31.2 Shared decision-making The majority of the respondents mentioned that healthcare providers talked about c/s indication and healthcare providers there thought about CS 67.5%, and 65.4% respectively but 67.5% and 55.8% of respondents mentioned that healthcare providers didn't explain different modes of birth, didn’t explain the benefits and risks of CS. 57.6% and 62.3% of the respondents mentioned that healthcare providers didn’t decide together about CS and reached on an agreement how to proceed with the procedure(Table 5 ). The overall status of women's involvement in shared decision-making among the mothers was 135 (35.3%) with a mean of 3.62 with a Std. deviation of 2.484. Table 5 Shared decision-making during a cesarean section among mothers in Amhara region referral hospitals, Ethiopia 2023 (n = 382). Variable Characteristics Number Percentage (%) Did healthcare providers tell about c/s indication? No 124 32.5 Yes 258 67.5 Did healthcare providers ask you thought about c/s? No 250 65.4 Yes 132 34.6 Did healthcare providers explain different modes of birth for treating your obstetrics condition? No 124 32.5 Yes 258 67.5 Did healthcare providers explain the benefits and risks of CS? No 213 55.8 Yes 169 44.2 Did healthcare providers help you to understand all the information about the procedure? No 213 55.8 Yes 169 44.2 Did healthcare providers ask which mode of delivery option you prefer? No 298 78.0 Yes 84 22.0 Did healthcare providers thoroughly weigh the different modes of delivery options? No 155 40.6 Yes 227 59.4 Did you and the healthcare providers decide together about CS? No 220 57.6 Yes 162 42.4 Did you and The healthcare providers reach on an agreement how to proceed with the procedure? No 144 37.7 Yes 238 62.3 Factors associated with women's involvement in decision-making during a cesarean section Both bivariate and multivariate analyses showed a statistically significant association with ANC contact, Information about shared decisions, and Information about cesarean section. Respondents who had ANC contact4 and above (AOR = 2.046, 95% CI: 1.19, 3.493), Respondents who had information about shared decisions (AOR = 2.34, 95% CI: 1.13, 4.83), and Respondents who had information about cesarean section (AOR = 7.9, 95% CI: 3.71, 17.19) were factors significantly associated with women's Involvement in shared decision-making (Table 6 ). Table 6 Factors associated with Bivariable and Multivariable logistic regression analysis of independent variable for women's involvement in decision-making during a cesarean section in Amhara region referral hospitals, Ethiopia 2023 (n = 382). Variable Category OR (95% CI) A0R (95%CI) Involved in decision-making NO YES Resident Rural 172 77 1 1 Urban 75 58 1.727(1.118,2.670) * 1.306(.720,2.369) ANC contact ≤ 4 108 46 1 1 > 4 139 89 1.503(.972,2.324) * 2.046(1.19,3.493)** Adequate time for decisions No 221 83 1 1 Yes 26 52 5.325(3.122,9.085) * 1.034(.450,2.375) Information about shared decisions No 132 42 1 1 Yes 115 93 2.542(1.634,3.954)* 2.34(1.13,4.83)** Information about cesarean section No 206 57 1 1 Yes 41 78 6.87(4.261,11.095)* 7.9(3.71,17.19)** Mass media exposure No 117 44 1 1 Yes 130 91 1.861(1.201,2.885)* .897(.397,2.025) Discussion The overall status of women's involvement in shared decision-making among mothers was 135 (35.3%) with a mean of 3.62 with a std. deviation of 2.484. this finding is lower than the studies conducted in Sidama region public hospitals, south Ethiopia, Dar-ul-sehat Hospital, Karachi, and sub-Saharan Africa ( 27 , 29 , 31 , 32 ). this variation might be due to the difference between the study design, sample size, and sociodemographic status. The variation might be due to sampling technique difference as a non-probability type of purposive sampling was used -ul-Sehat Hospital, Karachi ( 29 ). it might be due to the difference in the educational status of the mother, a study conducted in Sub-Saharan Africa shows that the majority of the participants 65.4%of mothers' secondary school completed, were as in our study majority of the mothers were able to read, and write (43.5%) ( 32 ). the finding of this study is also supported by previous studies of women who did not have a college degree and have low participation in shared decision-making practice during labor and delivery. In this study in both bivariate and multivariate analyses, the result showed a statistically significant association with ANC contact, having information about decision-making, and information about cesarean section. respondents who had ANC contact more than 4 and above were two times more likely to be involved in shared decision-making than those who had less than four ANC contacts (AOR = 2.046, 95% CI: 1.19, 3.493) and respondents who had information about shared decision-making have two times more likely to involve shared decision-making than those who had not (AOR = 2.34, 95% CI: 1.13, 4.83). the possible explanation might be having more ANC contact may create spaces or places to have information about the rights of the patient regarding medical procedures and information about shared decision-making that help the participants to decide the care given by health care providers and patients have the right to refuse and participate about any medical care( 33 ). Respondents who had information about cesarean section were eight times more likely to be involved than the others (AOR = 7.9, 95% CI: 3.71, 17.19). This finding is supported by another study of those women who know cesarean section is more likely involved in decision-making than others ( 27 , 34 , 35 ). The possible justification might be mothers may have /get awareness and a good perception of the possible mode of delivery during ANC contact and from their previous experience. Conclusion and recommendation women's involvement in shared decision-making was low compared with other studies. Therefore, providing attention to enhance women’s awareness about Involvement in shared decision-making is very important to increase patient satisfaction and improve the quality of care. Amhara region health office works together with referral hospitals to enhance women's involvement in shared decision-making. Declarations Ethics approval and consent : An ethical clearance letter was obtained from the ethical review committee of the Department of Midwifery Debre Tabor University, College of Medicine and Health Sciences with ethical approval number DT/091/21/186115 to the concerned office. Also, the purpose, procedures of the study, advantages, and disadvantages were told to the participants. Participants have been informed that they have the right to withdraw at any time. Any information given from participants was kept confidential and participants did not write any personal identification such as name, and phone cell number. Finally, written informed consent was obtained before data collection. Availability of data and material : the data sets collected and analyzed for the current study are available from the corresponding author and can be obtained at a reasonable request. Competing interests : The authors declare no competing interests Funding : This research received no specific funding from any funding agency in the public, profitable, or not-for-profit sectors. Author’s contribution TS: conception and design, acquisition of data, analysis, and interpretation of data revised the subsequent drafts of the manuscript, final approval of the version to be published WY: conception and design, acquisition of data, analysis, and interpretation of data, drafting the article, critical revision of the article, final approval of the version to be published Acknowledgment: We would like to thank Debre Tabor University for its ethical letter. Our gratitude is also great to all data collectors and study participants. References Safrin S. The c-section epidemic: What's tort reform got to do with it. U Ill L Rev. 2018:747. Smith MA. The role of shared decision-making in patient-centered care and orthopedics. Orthopaedic Nursing. 2016;35(3):144-9. Natalie Joseph-Williams Implementing shared decision making in the NHS: lessons from the MAGIC programme 18 April 2017. Egbodo, Orokpo Christopher. Awareness, Attitudes, and Perception of Antenatal Patients to Caesarean Section: The Jos, Nigeria Experience 2018. Rishworth A, Bisung E, Luginaah I. "It's Like a Disease": Women's perceptions of cesarean sections in Ghana's Upper West Region. Women and birth. 2016;29(6):e119-e25. Litorp H, Mgaya A, Kidanto HL, Johnsdotter S, Essén B. 'What about the mother?' Women's and caregivers׳ perspectives on cesarean birth in a low-resource setting with rising cesarean section rates. Midwifery. 2015;31(7):713-20. WHO statement on cesarean section rates 2015. Betran AP, Ye J, Moller AB, Souza JP, Zhang J. Trends and projections of cesarean section rates: global and regional estimates. BMJ Glob Health. 2021;6(6). Hanna Moon, MD. Maternal and neonatal morbidities associated with cesarean delivery without labor compared with induction of labor around term 2022. Herstad L, Klungsøyr K, Skjærven R, Tanbo T, Forsén L, Åbyholm T, et al. Elective cesarean section or not? Maternal age and risk of adverse outcomes at term: a population-based registry study of low-risk primiparous women. BMC Pregnancy Childbirth 2016;16:230. Mascarello KC, Horta BL, Silveira MF. Maternal complications and cesarean section without indication: systematic review and meta-analysis 2017;51:105. WHO recommendations on intrapartum care for a positive childbirth experience: World Health Organization; 2018. Shakibazadeh E, Namadian M, Bohren MA, Vogel JP, Rashidian A, Nogueira Pileggi V, et al. Respectful care during childbirth in health facilities globally: a qualitative evidence synthesis. BJOG: An International Journal of Obstetrics & Gynaecology. 2018;125(8):932-42. Anke J.M. Oerlemans, et al. Learning shared decision-making in clinical practice. May 2021. Begley K, Daly D, Panda S, Begley C. Shared decision‐making in maternity care: Acknowledging and overcoming epistemic defeaters. Journal of Evaluation in Clinical Practice, 2019;25(6):1113-20. Janet Davey Integrated Health Care and Value Co-Creation: A Beneficial Fusion to Improve Patient Outcomes and Service Efficacy. July 6, 2021. Laugesen J, Hassanein K, Yuan Y. The impact of Internet health information on patient compliance: a research model and an empirical study. Journal of medical Internet research. 2015;17(6):e143. Olejarczyk JP 1, Young M 1. Patient Rights and Ethics. Mar 2019. Moran PS, Daly D, Wuytack F, Carroll M, Turner M, Normand C, et al. Predictors of choice of public and private maternity care among nulliparous women in Ireland, and implications for maternity care and birth experience. Health Policy. 2020;124(5):556-62. Hasstedt K. Unbiased information on and referral for all pregnancy options are essential to informed consent in reproductive health care. Guttmacher Policy Review. 2018;21(1):5. Ryan GL, Brandi K. Informed consent and shared decision making in obstetrics and gynecology. Obstetrics and Gynecology. 2021;137(2):E34-E41. Alsulamy N, Lee A, Thokala P, Alessa T. What influences the implementation of shared decision making: an umbrella review. Patient education and counseling. 2020;103(12):2400-7. Asabu MD, Altaseb DK. The trends of women’s autonomy in health care decision making and associated factors in Ethiopia: evidence from 2005, 2011 and 2016 DHS data. BMC Women's Health. 2021;21:1-9. López-Toribio M, Bravo P, Llupià A. Exploring women’s experiences of participation in shared decision-making during childbirth: a qualitative study at a reference hospital in Spain. BMC Pregnancy and Childbirth. 2021;21(1):1-12. Falk M, Nelson M, Blomberg M. The impact of obstetric interventions and complications on women's satisfaction with childbirth in a population-based cohort study including 16,000 women. BMC pregnancy and childbirth. 2019;19(1):1-9. Debela AB, Mekuria M, Kolola T, Bala ET, Deriba BS. Maternal satisfaction and factors associated with institutional delivery care in central Ethiopia: a mixed study. Patient preference and adherence. 2021:387-98. Getu Wondimu M, Dadhi AE, Gesisa HI, Feyisa GT, Yohannes Kassa Z. Women’s Involvement in Decision-Making and Associated Factors Among Women Who Underwent a Caesarean Section in Sidama Region, South Ethiopia: Cross-Sectional Study. International Journal of Women's Health. 2023:813-2 Irina Pokhilenko. Relationship between trust and patient involvement in medical decision-making: A cross-sectional study: August 26, 2021. Husain A, Naseem A. Women involvement in decision making to have a cesarean section and their postpartum satisfaction. Journal of the Dow University of Health Sciences (JDUHS). 2018;12(2):48-52. Fumagalli S, Colciago E, Antolini L, Perego S, Fiorasi M, Fossati V, et al. Women's decision-making about mode of birth after a previous cesarean section. British Journal of Midwifery. 2020;28(2):104-13. Attanasio LB, Kozhimannil KB, Kjerulff KH. Factors influencing women’s perceptions of shared decision making during labor and delivery: Results from a large-scale cohort study of first childbirth. Patient education and counseling. 2018;101(6):1130-6. Nnaji G, Okafor C. Women's Involvement in the Decision to be Delivered by Cesarean Section in Sub-Saharan Africa. Nigerian Journal of Medicine. 2012;21(2):150-5. Olejarczyk JP, Young M. Patient rights and ethics. 2019. Bam V, Lomotey AY, Diji AK-A, Budu HI, Bamfo-Ennin D, Mireku G. Factors influencing decision-making to accept elective cesarean section: A descriptive cross-sectional study. Heliyon. 2021;7(8). Gebrehiwot H, Estifanos N, Zenebe Y, Anbesaw T. Patient perception of informed consent and its associated factors among surgical patients attending public hospitals in Dessie City administration, Northeast Ethiopia. Critical Care Research and Practice. 2022;2022. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted 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-4067330","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":278719746,"identity":"a1d021fc-0e4f-413a-ace4-4cd6bc5d9935","order_by":0,"name":"Tigist SEID","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA40lEQVRIiWNgGAWjYDACZgaGAyCajSH5AANjAxE6eMBaEkBa0hKI1AImE0BEjgFxWuzZ2S8e/PmjTo6PPeebxM8dNnIM7IePbsDvMJ6CwzwJh43ZeN5uk+w9k2bMwJOWdoOAloTDDAkHEtskcrdJ8LYdTmyQ4DEjqOXgj4S6+jaJnGeSf4nTwn7gAE8CcwKbRA6bNHG2HOZhOMyTdtiwjeeZsbVsWxrQUwT8wt5//PHHHzZ18vLtyQ9vvm2zkeNnP3wMrxagPQYwFosEiGTDrxxszwMYi/kDYdWjYBSMglEwEgEAEEtHYs5mSCQAAAAASUVORK5CYII=","orcid":"","institution":"Debre Tabor University","correspondingAuthor":true,"prefix":"","firstName":"Tigist","middleName":"","lastName":"SEID","suffix":""},{"id":278719747,"identity":"01132c61-de8f-4ff1-9a2b-91c55d4709f8","order_by":1,"name":"Wassie yazie","email":"","orcid":"","institution":"Debre Tabor University","correspondingAuthor":false,"prefix":"","firstName":"Wassie","middleName":"","lastName":"yazie","suffix":""}],"badges":[],"createdAt":"2024-03-10 19:19:52","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4067330/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4067330/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":52625548,"identity":"dccbe811-e38a-4521-9b17-4aeaca8bf73e","added_by":"auto","created_at":"2024-03-13 17:38:33","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":482820,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eSchemes presentation of the sampling procedure Amhara region referral hospitals, Ethiopia 2023\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4067330/v1/6c41d569b03d52d7676bf289.jpeg"},{"id":53950935,"identity":"02ab4e95-d92a-422c-ba12-bfc16fce617d","added_by":"auto","created_at":"2024-04-02 15:52:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":657039,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4067330/v1/00bf8056-d263-4521-bd8e-8f968268a0d3.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Factors Correlating to Women's Involvement in Shared Decision-Making Following Caesarean Sections in Amhara Region Referral Hospitals, Ethiopia, 2023","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eA cesarean section delivery is a medical technique in which the uterus and belly are incised to deliver the baby when vaginal delivery is not feasible, safe, or poses a risk to the mother's or the child's health, it is carried out. moms, family members, and medical professionals must decide on this treatment(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWhen faced with the task of making decisions, patients and clinicians share the best available evidence in a process known as \"shared decision-making,\" which helps patients decide on options that align with their values and the best available science. patients are assisted in making well-informed choices through this two-way process(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Women differ in their attitudes and concepts around chemotherapy. Some believe that CSs are done on indolent women, or that they put the mother and child in danger, some believe that CSs are solitary operations carried out to preserve the lives of expectant mothers and their babies (\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe World Health Organization suggests that the rate of cesarean sections should be between 10% and 15%, however, the current global rate is 21%. When performed without a clear reason, cesarean sections do not provide any additional benefits to the mother or the child; rather, they increase the risk of wound infection, urinary tract infection after discharge, blood loss, fever, and death in cesarean mothers, as well as low Apgar scores and neonatal complications in newborns, they also lengthen hospital stays (\u003cspan additionalcitationids=\"CR8 CR9 CR10\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eInvolving a mother in the decision-making process is one of the requirements for a positive childbirth experience. According to WHO guidelines and recommendations on intrapartum care, effective communication with healthcare providers to accomplish this is a crucial component of patient-centered care in clinical practice (\u003cspan additionalcitationids=\"CR13 CR14\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eShared decision-making is a way to increase information regularity in healthcare services however, deficiency of knowledge flow to patients from physicians during healthcare service provision can create distrust in health provider-patient relationships, and lack of information regularity in healthcare services is often associated with misconduct, dissatisfaction, costly and low-quality services (\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe patient has the right to obtain clear, honest, and extensive information in a manner and language understandable to the patient, about all proposed procedures, whether diagnostic, preventive, curative, rehabilitative, or therapeutic. the person who will perform the procedure shall provide the patient with his or her name and credentials, the possibility of mortality risk or serious side effects, problems associated with recovery, and the likelihood of success and reasonable risks involved(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Involvement in decision-making has a constructive impact on their childbirth experience. decision-making is an essential element of feeling in control for most women (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e According to ACOG ethical obligations of informed consent require that an obstetrician-gynecologist gives the patient passable, precise, and understandable information and that the patient can understand and reason through this information and is free to ask questions and to make an intentional and voluntary choice, which may include refusal of care or treatment. shared decision-making is a patient-centered, individualized approach to the informed consent process that involves discussion of the benefits and risks of available treatment options in the context of a patient's values and priorities(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). some informed consent challenges are universal to medicine, whereas other challenges arise more commonly in obstetrics and gynecology than in other specialty areas(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe patient is not exposed to any procedure without the patient's written informed consent (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Even if patients have the right to decide on the choice of treatment and surgical procedures, the shared decision-making practice is very low in developing countries, including Ethiopia, which leads to patient dissatisfaction with healthcare services (\u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). different studies have shown that involvement in decision-making increases patient satisfaction(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). An increase in patient satisfaction has a role in increasing institutional delivery rates and a decrease in maternal and neonatal morbidity and mortality(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). some factors affect involvement in shared decision-making like counseling skills of health care providers, and having adequate time for decision-making(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e), the maternal mortality rate in Ethiopia is very high so shared decision-making practices increase patient satisfaction and decrease maternal and neonatal complications. As far as our findings there are no studies conducted in the Amhara region about shared decision-making and associated factors that lead to the client being dissatisfied with the services and it violates the right of the patient as well as it is important to accept the complication related to the cesarean section. Knowing the status of women's participation in shared decision-making practice provides clues for policymakers and different stakeholders to improve services and enhance patient satisfaction. Nonetheless, little study has been done on Ethiopian women who had cesarean sections and their participation in shared decision-making the study aimed to assess the status of women's involvement in shared decision-making and associated factors among women who underwent a cesarean section in Ethiopia at Amhara region referral hospitals.\u003c/p\u003e"},{"header":"Method","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and period\u003c/h2\u003e \u003cp\u003eAn institution-based cross-sectional study was conducted in Amhara region referral hospitals from June 1 to 30, 2023, in North West Ethiopia, 2023. Amhara regional state is one of the eleven regional states in Ethiopia which is found between 11° 30' 00\" N latitude \u0026amp; 38° 30' 00\" E longitude in the northwestern part of Ethiopia.\u003c/p\u003e \u003cp\u003eAmhara is one of Ethiopia’s largest regions; it has 12 zones, three city administrations, and 180 woredas (139 rural and 41 urban). According to the Ethiopian Central Statistics Agency, the region has a projected population of 21.5\u0026nbsp;million people, about 80 percent of whom are rural farmers. Two decades ago, Amhara had only nine public hospitals and 140 health centers, which was insufficient to meet the demand of the region’s then 14.8\u0026nbsp;million residents. In addition, service coverage and quality were low. Today, the region has 80 hospitals (7 referrals, 2 general, and 73 primaries), 847 health centers, and 3,342 health posts. As in other regions of Ethiopia, Amhara’s healthcare system was unable to modernize and provide quality health services due to many challenges.\u003c/p\u003e \u003cp\u003eThere are 8 referral hospitals including the University of Gondar Teaching Referral Hospital (UOGRH), Felege Hiwot Referral Hospital (FRH), Dessie Referral Hospital (DRH), Debremarkos Referral Hospital (DMRH), Debre tabor referral hospital and Debrebirhan referral hospital (DBRH), Tibebegion teaching and referral hospital (TGTRH) each of them assumed to serve 5\u0026nbsp;million peoples. On average 300 healthcare providers were found from each hospital.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eSample size determination \u0026amp; sampling procedures\u003c/h2\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003eSample size determination\u003c/h2\u003e \u003cp\u003eThe sample size is determined using a single population proportion formula. a previous study conducted at selected public hospitals in the Sidama region, south, Ethiopia to assess women's involvement in shared decision-making and associated factors among women who underwent a cesarean section was 37.9%(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). A 95% confidence level was used in this study, and by assuming a margin of error of 5%. Taking non-response rates of 10% into account, the final sample size was 398.\u003c/p\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cspan class=\"InlineEquation\"\u003e \u003cspan class=\"mathinline\"\u003e\\(n=\\frac{(Z\\alpha /2{)}^{2}*p(1-p)}{{d}^{2}}\\)\u003c/span\u003e \u003c/span\u003e Where;\u003c/p\u003e\u003cp\u003en = required sample size\u003c/p\u003e\u003cp\u003eα = level of significant\u003c/p\u003e\u003cp\u003ez = standard normal distribution curve value for 95% confidence level = 1.96\u003c/p\u003e\u003cp\u003eP = proportion of Shared Decision-making (37.9%)\u003c/p\u003e\u003cp\u003ed = margin of error be tolerated (d = 0.05)\u003c/p\u003e\u003cp\u003eTherefore, n=\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\frac{\\left(1.96{)}^{2}\\text{*}0.379\\right(1-0.379)}{(0.05{)}^{2}}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\u003cp\u003en=\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\frac{3.8416\\text{*}0.379\\left(0.621\\right)}{0.0025}\\)\u003c/span\u003e\u003c/span\u003e=361.6\u003c/p\u003e\u003cp\u003eWith a 10% non-response rate = 398\u003c/p\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eSource Population and study population\u003c/h2\u003e \u003cp\u003eAll women who underwent cesarean delivery at Amhara region referral hospitals were the source populations, and the study populations were women who underwent cesarean delivery at selected hospitals during the data collection period.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eInclusion and exclusion criteria\u003c/h2\u003e \u003cp\u003eAll women who underwent a cesarean section at the time of data collection after waiting from they wake up from anesthesia were included whereas mothers who were referred from another health center for better management before exiting from the post-cesarean ward were excluded.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStudy variables\u003c/h2\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003eDependent\u003c/h2\u003e \u003cp\u003eWomen’s involvement in shared decision-making.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eIndependent\u003c/h2\u003e \u003cp\u003e \u003c/p\u003e\u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eSociodemographic factors\u003c/b\u003e: age, education, residence, marital status, occupation, income.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eSource of information\u003c/b\u003e: mass media\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eObstetrics factors\u003c/b\u003e: gravidity, parity, ANC follow-up, previous history of cesarean section.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eService-related factors\u003c/b\u003e: explanation of the procedure, provision of adequate information, the language of informed consent, the timing of consent, and adequate time.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003cp\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eOperational definition\u003c/h2\u003e \u003cp\u003e \u003cb\u003ePatient involvement in decision-making:-\u003c/b\u003e involvement of the women/patients in decision-making about different treatment methods which includes sharing information, feelings, and signs and accepting health team instructions (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eShared decision-making\u003c/strong\u003e \u003c/p\u003e\u003cp\u003e- contains nine items. Respondents who scored the mean and above value from the nine questions were considered as having involvement in shared decision-making whereas respondents who scored below the mean value were considered as not. The overall involvement of shared decision-making of the respondents was assessed by summing up the correct answers to individual questions and the mean score was taken as a cut point(\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003e \u003cb\u003eExplanation of the procedure and provision of adequate information: -\u003c/b\u003e consent is taken after explaining everything in easy language/mother language or explaining everything in easily understandable language including another mode of delivery options, time of the procedures taken said effect of anesthesia medication advantage or benefit of the procedure.\u003c/p\u003e \u003cp\u003e \u003cb\u003eThe timing of consent;-\u003c/b\u003ewas consent taken the day before the date of surgery, on the day of surgery, immediately before surgery, or on the operation table.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eSampling technique and procedure\u003c/h2\u003e \u003cp\u003eOf eight referral hospitals, five hospitals were selected by using the lottery method namely Debretabor Referal Hospital, Felege Hiwot Referral Hospital (FRH), Debre Birhan Referral Hospital (DBRH), Woldiya Referral Hospital (DRH), and Debre Markos Referral Hospitals (DMRH). The final sample size of 398 was allocated to all selected hospitals based on the two-monthly average number of women who underwent a cesarean section in each institution for the year 2022 in each facility. Finally, a systematic random sampling technique was used to select study participants from the mothers who underwent a cesarean section in selected hospitals until the required sample size at each hospital was obtained. The sampling interval k = 2 was calculated by dividing the source population by the total sample size and this interval was used in all hospitals to select study participants \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eData collection tool and procedure\u003c/h2\u003e \u003cp\u003eThe questionnaire was developed after reviewing different literature (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e) some amendment was made based on the objective of the study. Was prepared in the English version. Translated to the local language (Amharic) and re-translated again to English by language experts to ensure consistency. The components of the questionnaires were demographic information, obstetric factors, healthcare providers, and facility-related factors. Data were collected by interview-guided semi-structured questionnaires. Data collectors were 5 BSC nurses and 5 BSC midwives on each site. Two supervisors (public health experts) were assigned to supervise the data collectors.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eData quality Assurance\u003c/h2\u003e \u003cp\u003eTo maintain the quality of data first structured questionnaire was prepared after an extensive search and review of relevant studies on the issue. The questionnaire was translated into the local language (Amharic) to facilitate communication. Supervisors and data collectors were trained for two days on how to collect data, study overviews, questionnaires, and other related activities during data collection.\u003c/p\u003e \u003cp\u003eIn addition, the questionnaire was pretested on 5% (20 mothers) of the total sample size outside the study area at Tibebe Gion Referral Hospital. Difficult questions were revised and modified. Daily supervision of the data collection process was maintained, throughout the data collection period. Supervisors checked study sites daily and received filled questionnaires after checking their completeness.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eData Processing and analysis\u003c/h2\u003e \u003cp\u003eBefore data processing, the data was checked for completeness and internal consistency. Data were coded and entered using EPI info version 7.2 and exported to SPSS version 23 for analysis. Analysis was verified using descriptive interpretation for the socio-economic characteristics of the study participants using frequencies and other summary statistics. Binary logistic regression was used to measure the association of each covariate with the outcome variable. Factors that were associated with the outcome variable at a 0.25 percent significance level were included in the multivariable logistic regression analysis to control the potential confounders. The result of the final model was presented, in terms of adjusted odd ratio (AOR) and 95% confidence intervals (CI). Statistical significance was taken, at a P-value less than 0.05.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" type=\"Results\" class=\"Section2\"\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003c/div\u003e"},{"header":"Result","content":"\u003cp\u003eIn this study, 16 questionnaires were rejected due to incomplete information, and 382 were analyzed making a response rate of 95.97%. The majority of the participants were found in the age group of 21 to 25 years. Regarding marital status, married, Amhara in ethnicity, orthodox followers, and rural residents account for around (40.1%, 89.3%, 95%, 95.5%, and 65.2%) respectively. Regarding educational status majority of the mothers can read and write (43.5%) and have primary school attended. Around 51.8% of the respondent's income level was within the range of 1000 to 1500 ETB. \u003cb\u003eSee\u003c/b\u003e Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic characteristics status among respondents during a cesarean section among mothers in Amhara region referral hospitals, Ethiopia 2023 (n = 382).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eVariable\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eCharacteristics\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eNumber\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ePercentage (%)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 to 25 yrs.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e153\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e40.1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26 to 30 yrs.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e103\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e27.0\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31 to 35 yrs.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18.3\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36 to 40 yrs.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13.1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt; 41 yrs.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.6\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e341\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e89.3\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnmarried\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10.7\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eReligion\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOrthodox\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e363\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e95.0\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.0\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEthnicity\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAmhara\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e365\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e95.5\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.5\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eResident\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e249\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e65.2\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e133\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e34.8\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eMother educational status\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eunable to read and write\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13.9\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eable to read and write\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e166\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e43.5\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eprimary school\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.9\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003esecondary school\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10.5\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCollege and above\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e22.3\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eIncome\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt; 1000 ETB\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15.4\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1000 to 1500 ETB\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e198\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e51.8\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt; 1500 ETB\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e125\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e32.7\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003e-Source of information to assess shared decision-making during a cesarean section among mothers in Amhara region referral hospitals, Ethiopia 2023 (n = 382).\u003c/b\u003e The majority of the respondents attend mass media utilization, participate in the women’s development team, and have attended coffee ceremonies in the neighborhood which account for 57.9% and 55.2 respectively( \u003cb\u003eSee\u003c/b\u003e Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMass media utilization\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e161\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e42.1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e221\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e57.9\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDid you participate in the women’s development team?\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e171\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e44.8\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e211\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e55.2\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHave you coffee ceremony in your neighborhood?\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e171\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e44.8\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e211\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e55.2\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003ch2\u003eObstetric characteristics\u003c/h2\u003e\u003cp\u003eRegarding maternal obstetrics and reproductive history, more than 54.2% of the respondents had para four and above. Nearly ninety-eight percent (97.6%) of the study participants had a history of ANC follow-up. Regarding the place of visit, more than 70% of the respondents attended the governmental health institution of the mothers 57.9% had four and above ANC visits. About fifty-five percent (54.5%) of the respondents had information during the ANC follow-up about shared decision-making during labor for a mode of delivery \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e-Obstetric characteristics to assess shared decision-making during a cesarean section among mothers in Amhara region referral hospitals, Ethiopia 2023 (n = 382).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eParity\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt; 4\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e175\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e45.8\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt; 4\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e207\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e54.2\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eANC follow-up?\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e373\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e97.6\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eplace of ANC visit\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGovernmental health institution\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e294\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e77.0\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrivate health institution\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23.0\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHow many times did you receive ANC service?\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt; 4\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e154\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e40.3\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt; 4\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e228\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e59.7\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDid you have information during the ANC follow-up about shared decision-making during labor for a mode of delivery?\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e174\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e45.5\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e208\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e54.5\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDo you have a history of previous cesarean sections?\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e334\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e87.4\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12.6\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eType of current cesarean section\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eemergency\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e287\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e75.1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eelective\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24.9\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003ch2\u003eServices-related factors\u003c/h2\u003e\u003cp\u003eRegarding the timing of consent majority of the respondents mentioned that consent was taken immediately before surgery 53.4% and 68.8% didn't have adequate information about CS (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eServices-related factors to assess shared decision-making during a cesarean section among mothers in Amhara region referral hospitals, Ethiopia 2023 (n = 382).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eWas consent taken after explaining everything in easy language/Mather language?\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e175\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e45.8\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e207\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e54.2\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBefore the procedure did you feel you had adequate time to decide to have a CS?\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e304\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e79.6\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20.4\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eTiming of consent\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe day before the date of surgery\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.0\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOn the day of surgery\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17.8\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eImmediately before surgery\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e204\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e53.4\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOn the operation table\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e87\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e22.8\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eConsent requested by whom?\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOb-GYN specialist\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.4\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGeneral practitioner/resident\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14.4\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIESO\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMidwifery\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e260\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e68.1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBefore the procedure did you feel you had adequate information about CS?\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e263\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e68.8\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e119\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e31.2\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003ch2\u003eShared decision-making\u003c/h2\u003e\u003cp\u003eThe majority of the respondents mentioned that healthcare providers talked about c/s indication and healthcare providers there thought about CS 67.5%, and 65.4% respectively but 67.5% and 55.8% of respondents mentioned that healthcare providers didn't explain different modes of birth, didn’t explain the benefits and risks of CS. 57.6% and 62.3% of the respondents mentioned that healthcare providers didn’t decide together about CS and reached on an agreement how to proceed with the procedure(Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e The overall status of women's involvement in shared decision-making among the mothers was 135 (35.3%) with a mean of 3.62 with a Std. deviation of 2.484.\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eShared decision-making during a cesarean section among mothers in Amhara region referral hospitals, Ethiopia 2023 (n = 382).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDid healthcare providers tell about c/s indication?\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e124\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e32.5\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e258\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e67.5\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDid healthcare providers ask you thought about c/s?\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e250\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e65.4\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e132\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e34.6\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDid healthcare providers explain different modes of birth for treating your obstetrics condition?\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e124\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e32.5\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e258\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e67.5\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDid healthcare providers explain the benefits and risks of CS?\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e213\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e55.8\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e169\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e44.2\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDid healthcare providers help you to understand all the information about the procedure?\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e213\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e55.8\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e169\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e44.2\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDid healthcare providers ask which mode of delivery option you prefer?\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e298\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e78.0\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e22.0\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDid healthcare providers thoroughly weigh the different modes of delivery options?\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e155\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e40.6\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e227\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e59.4\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDid you and the healthcare providers decide together about CS?\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e220\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e57.6\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e162\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e42.4\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDid you and The healthcare providers reach on an agreement how to proceed with the procedure?\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e144\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e37.7\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e238\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e62.3\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003ch2\u003eFactors associated with women's involvement in decision-making during a cesarean section\u003c/h2\u003e\u003cp\u003eBoth bivariate and multivariate analyses showed a statistically significant association with ANC contact, Information about shared decisions, and Information about cesarean section. Respondents who had ANC contact4 and above (AOR = 2.046, 95% CI: 1.19, 3.493), Respondents who had information about shared decisions (AOR = 2.34, 95% CI: 1.13, 4.83), and Respondents who had information about cesarean section (AOR = 7.9, 95% CI: 3.71, 17.19) were factors significantly associated with women's Involvement in shared decision-making (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFactors associated with Bivariable and Multivariable logistic regression analysis of independent variable for women's involvement in decision-making during a cesarean section in Amhara region referral hospitals, Ethiopia 2023 (n = 382).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003c/colgroup\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eOR (95% CI)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eA0R (95%CI)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e\u003cb\u003eInvolved in decision-making\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eNO\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eYES\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eResident\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e172\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.727(1.118,2.670) *\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.306(.720,2.369)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eANC contact\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e≤\u003c/span\u003e 4\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e108\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt; 4\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e139\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e89\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.503(.972,2.324) *\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.046(1.19,3.493)**\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAdequate time for decisions\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e221\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.325(3.122,9.085) *\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.034(.450,2.375)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eInformation about shared decisions\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e132\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e115\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e93\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.542(1.634,3.954)*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.34(1.13,4.83)**\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eInformation about cesarean section\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e206\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.87(4.261,11.095)*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7.9(3.71,17.19)**\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMass media exposure\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e117\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e130\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.861(1.201,2.885)*\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.897(.397,2.025)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe overall status of women's involvement in shared decision-making among mothers was 135 (35.3%) with a mean of 3.62 with a std. deviation of 2.484. this finding is lower than the studies conducted in Sidama region public hospitals, south Ethiopia, Dar-ul-sehat Hospital, Karachi, and sub-Saharan Africa (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). this variation might be due to the difference between the study design, sample size, and sociodemographic status. The variation might be due to sampling technique difference as a non-probability type of purposive sampling was used -ul-Sehat Hospital, Karachi (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). it might be due to the difference in the educational status of the mother, a study conducted in Sub-Saharan Africa shows that the majority of the participants 65.4%of mothers' secondary school completed, were as in our study majority of the mothers were able to read, and write (43.5%) (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). the finding of this study is also supported by previous studies of women who did not have a college degree and have low participation in shared decision-making practice during labor and delivery.\u003c/p\u003e \u003cp\u003eIn this study in both bivariate and multivariate analyses, the result showed a statistically significant association with ANC contact, having information about decision-making, and information about cesarean section. respondents who had ANC contact more than 4 and above were two times more likely to be involved in shared decision-making than those who had less than four ANC contacts (AOR = 2.046, 95% CI: 1.19, 3.493) and respondents who had information about shared decision-making have two times more likely to involve shared decision-making than those who had not (AOR = 2.34, 95% CI: 1.13, 4.83). the possible explanation might be having more ANC contact may create spaces or places to have information about the rights of the patient regarding medical procedures and information about shared decision-making that help the participants to decide the care given by health care providers and patients have the right to refuse and participate about any medical care(\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). Respondents who had information about cesarean section were eight times more likely to be involved than the others (AOR = 7.9, 95% CI: 3.71, 17.19). This finding is supported by another study of those women who know cesarean section is more likely involved in decision-making than others (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). The possible justification might be mothers may have /get awareness and a good perception of the possible mode of delivery during ANC contact and from their previous experience.\u003c/p\u003e \u003cp\u003e\u003c/p\u003e"},{"header":"Conclusion and recommendation","content":"\u003cp\u003ewomen's involvement in shared decision-making was low compared with other studies. Therefore, providing attention to enhance women’s awareness about Involvement in shared decision-making is very important to increase patient satisfaction and improve the quality of care. Amhara region health office works together with referral hospitals to enhance women's involvement in shared decision-making.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAn ethical clearance letter was obtained from the ethical review committee of the Department of Midwifery Debre Tabor University, College of Medicine and Health Sciences\u0026nbsp;with ethical approval number DT/091/21/186115 to the concerned office. Also, the purpose, procedures of the study, advantages, and disadvantages were told to the participants. Participants have been informed that they have the right to withdraw at any time.\u003c/p\u003e\n\u003cp\u003eAny information given from participants was kept confidential and participants did not write any personal identification such as name, and phone cell number. Finally,\u0026nbsp;written informed consent was obtained before data collection.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e: the data sets collected and analyzed for the current study are available from the corresponding author and can be obtained at a reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e The authors declare no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eThis research received no specific funding from any funding agency in the public, profitable, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTS:\u003c/strong\u003e conception and design, acquisition of data, analysis, and interpretation of data revised the subsequent drafts of the manuscript, final approval of the version to be published\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWY:\u003c/strong\u003e conception and design, acquisition of data, analysis, and interpretation of data, drafting the article, critical revision of the article, final approval of the version to be published\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank Debre Tabor University for its ethical letter. Our gratitude is also great to all data collectors and study participants.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSafrin S. The c-section epidemic: What\u0026apos;s tort reform got to do with it. U Ill L Rev. 2018:747.\u003c/li\u003e\n\u003cli\u003eSmith MA. The role of shared decision-making in patient-centered care and orthopedics. Orthopaedic Nursing. 2016;35(3):144-9.\u003c/li\u003e\n\u003cli\u003eNatalie Joseph-Williams Implementing shared decision making in the NHS: lessons from the MAGIC programme 18 April 2017.\u003c/li\u003e\n\u003cli\u003eEgbodo, Orokpo Christopher. Awareness, Attitudes, and Perception of Antenatal Patients to Caesarean Section: The Jos, Nigeria Experience 2018.\u003c/li\u003e\n\u003cli\u003eRishworth A, Bisung E, Luginaah I. \u0026quot;It\u0026apos;s Like a Disease\u0026quot;: Women\u0026apos;s perceptions of cesarean sections in Ghana\u0026apos;s Upper West Region. Women and birth. 2016;29(6):e119-e25.\u003c/li\u003e\n\u003cli\u003eLitorp H, Mgaya A, Kidanto HL, Johnsdotter S, Ess\u0026eacute;n B. \u0026apos;What about the mother?\u0026apos; Women\u0026apos;s and caregivers׳ perspectives on cesarean birth in a low-resource setting with rising cesarean section rates. Midwifery. 2015;31(7):713-20.\u003c/li\u003e\n\u003cli\u003eWHO statement on cesarean section rates 2015.\u003c/li\u003e\n\u003cli\u003eBetran AP, Ye J, Moller AB, Souza JP, Zhang J. Trends and projections of cesarean section rates: global and regional estimates. BMJ Glob Health. 2021;6(6).\u003c/li\u003e\n\u003cli\u003eHanna Moon, MD. Maternal and neonatal morbidities associated with cesarean delivery without labor compared with induction of labor around term 2022.\u003c/li\u003e\n\u003cli\u003eHerstad L, Klungs\u0026oslash;yr K, Skj\u0026aelig;rven R, Tanbo T, Fors\u0026eacute;n L, \u0026Aring;byholm T, et al. Elective cesarean section or not? Maternal age and risk of adverse outcomes at term: a population-based registry study of low-risk primiparous women. BMC Pregnancy Childbirth 2016;16:230.\u003c/li\u003e\n\u003cli\u003eMascarello KC, Horta BL, Silveira MF. Maternal complications and cesarean section without indication: systematic review and meta-analysis 2017;51:105.\u003c/li\u003e\n\u003cli\u003eWHO recommendations on intrapartum care for a positive childbirth experience: World Health Organization; 2018.\u003c/li\u003e\n\u003cli\u003eShakibazadeh E, Namadian M, Bohren MA, Vogel JP, Rashidian A, Nogueira Pileggi V, et al. Respectful care during childbirth in health facilities globally: a qualitative evidence synthesis. BJOG: An International Journal of Obstetrics \u0026amp; Gynaecology. 2018;125(8):932-42.\u003c/li\u003e\n\u003cli\u003eAnke J.M. Oerlemans, et al. Learning shared decision-making in clinical practice. May 2021.\u003c/li\u003e\n\u003cli\u003eBegley K, Daly D, Panda S, Begley C. Shared decision‐making in maternity care: Acknowledging and overcoming epistemic defeaters. Journal of Evaluation in Clinical Practice, 2019;25(6):1113-20.\u003c/li\u003e\n\u003cli\u003eJanet Davey Integrated Health Care and Value Co-Creation: A Beneficial Fusion to Improve Patient Outcomes and Service Efficacy. July 6, 2021.\u003c/li\u003e\n\u003cli\u003eLaugesen J, Hassanein K, Yuan Y. The impact of Internet health information on patient compliance: a research model and an empirical study. Journal of medical Internet research. 2015;17(6):e143.\u003c/li\u003e\n\u003cli\u003e\u003cu\u003eOlejarczyk JP\u003c/u\u003e 1, Young M 1. Patient Rights and Ethics. Mar 2019.\u003c/li\u003e\n\u003cli\u003eMoran PS, Daly D, Wuytack F, Carroll M, Turner M, Normand C, et al. Predictors of choice of public and private maternity care among nulliparous women in Ireland, and implications for maternity care and birth experience. Health Policy. 2020;124(5):556-62.\u003c/li\u003e\n\u003cli\u003eHasstedt K. Unbiased information on and referral for all pregnancy options are essential to informed consent in reproductive health care. Guttmacher Policy Review. 2018;21(1):5.\u003c/li\u003e\n\u003cli\u003eRyan GL, Brandi K. Informed consent and shared decision making in obstetrics and gynecology. Obstetrics and Gynecology. 2021;137(2):E34-E41.\u003c/li\u003e\n\u003cli\u003eAlsulamy N, Lee A, Thokala P, Alessa T. What influences the implementation of shared decision making: an umbrella review. Patient education and counseling. 2020;103(12):2400-7.\u003c/li\u003e\n\u003cli\u003eAsabu MD, Altaseb DK. The trends of women\u0026rsquo;s autonomy in health care decision making and associated factors in Ethiopia: evidence from 2005, 2011 and 2016 DHS data. BMC Women\u0026apos;s Health. 2021;21:1-9.\u003c/li\u003e\n\u003cli\u003eL\u0026oacute;pez-Toribio M, Bravo P, Llupi\u0026agrave; A. Exploring women\u0026rsquo;s experiences of participation in shared decision-making during childbirth: a qualitative study at a reference hospital in Spain. BMC Pregnancy and Childbirth. 2021;21(1):1-12.\u003c/li\u003e\n\u003cli\u003eFalk M, Nelson M, Blomberg M. The impact of obstetric interventions and complications on women\u0026apos;s satisfaction with childbirth in a population-based cohort study including 16,000 women. BMC pregnancy and childbirth. 2019;19(1):1-9.\u003c/li\u003e\n\u003cli\u003eDebela AB, Mekuria M, Kolola T, Bala ET, Deriba BS. Maternal satisfaction and factors associated with institutional delivery care in central Ethiopia: a mixed study. Patient preference and adherence. 2021:387-98.\u003c/li\u003e\n\u003cli\u003eGetu Wondimu M, Dadhi AE, Gesisa HI, Feyisa GT, Yohannes Kassa Z. Women\u0026rsquo;s Involvement in Decision-Making and Associated Factors Among Women Who Underwent a Caesarean Section in Sidama Region, South Ethiopia: Cross-Sectional Study. International Journal of Women\u0026apos;s Health. 2023:813-2\u003c/li\u003e\n\u003cli\u003eIrina Pokhilenko. Relationship between trust and patient involvement in medical decision-making: A cross-sectional study: August 26, 2021.\u003c/li\u003e\n\u003cli\u003eHusain A, Naseem A. Women involvement in decision making to have a cesarean section and their postpartum satisfaction. Journal of the Dow University of Health Sciences (JDUHS). 2018;12(2):48-52.\u003c/li\u003e\n\u003cli\u003eFumagalli S, Colciago E, Antolini L, Perego S, Fiorasi M, Fossati V, et al. Women\u0026apos;s decision-making about mode of birth after a previous cesarean section. British Journal of Midwifery. 2020;28(2):104-13.\u003c/li\u003e\n\u003cli\u003eAttanasio LB, Kozhimannil KB, Kjerulff KH. Factors influencing women\u0026rsquo;s perceptions of shared decision making during labor and delivery: Results from a large-scale cohort study of first childbirth. Patient education and counseling. 2018;101(6):1130-6.\u003c/li\u003e\n\u003cli\u003eNnaji G, Okafor C. Women\u0026apos;s Involvement in the Decision to be Delivered by Cesarean Section in Sub-Saharan Africa. Nigerian Journal of Medicine. 2012;21(2):150-5.\u003c/li\u003e\n\u003cli\u003eOlejarczyk JP, Young M. Patient rights and ethics. 2019.\u003c/li\u003e\n\u003cli\u003eBam V, Lomotey AY, Diji AK-A, Budu HI, Bamfo-Ennin D, Mireku G. Factors influencing decision-making to accept elective cesarean section: A descriptive cross-sectional study. Heliyon. 2021;7(8).\u003c/li\u003e\n\u003cli\u003eGebrehiwot H, Estifanos N, Zenebe Y, Anbesaw T. Patient perception of informed consent and its associated factors among surgical patients attending public hospitals in Dessie City administration, Northeast Ethiopia. Critical Care Research and Practice. 2022;2022.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"shared decision-making, associated factors, women, cesarean section, Amhara region, Ethiopia","lastPublishedDoi":"10.21203/rs.3.rs-4067330/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4067330/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction: -\u003c/strong\u003e \"Shared decision-making\" refers to a collaborative approach to healthcare that elevates the bar for medical judgments. However, not much research has been done on Ethiopian women's involvement in shared decision-making after cesarean sections.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e Factors correlating to women's involvement in shared decision-making following cesarean sections in Amhara region referral hospitals, Ethiopia, 2023.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e The institutional-based cross-sectional study design was directed amongst participants who underwent a cesarean section at Amhara region referral hospitals from June 1 to 30, 2023. A total of 398 postnatal mothers were included through a systematic random sampling method. The files were composed of a semi-structured interview-guided questionnaire. After checking for completeness, data were coded and entered into EPI INFO version 7 and analyzed using SPSS version 23. Multivariable logistics regression analysis was used to identify factors associated with women's involvement in shared decision-making. Statistical significance was declared at a P-value of \u0026lt; 0.05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResult\u003c/strong\u003e: Around, 382 women were included making a response rate of 95.97%. The overall prevalence of mothers' involvement in shared decision-making was (35.3%) with a mean of 3.62 and std. deviation of 2.484. %. respondents who had ANC contact4 and above (AOR=2.046, 95% CI: 1.19, 3.493), having information about shared decisions (AOR=2.34, 95% CI: 1.13, 4.83), and respondents who had information about cesarean section (AOR=7.9, 95% CI: 3.71, 17.19) were factors significantly associated with involvement in shared decision-making.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion and recommendation: -\u003c/strong\u003e when compared to other studies, the outcome of these investigations was low participation in decision-making had a significant impact on knowing about shared decisions and knowledge about cesarean sections. Consequently, it is critical to focus on raising women's understanding of shared decision-making to improve patient satisfaction and care quality. Referral hospitals and the Amhara Region health office collaborate to improve collaborative decision-making.\u003c/p\u003e","manuscriptTitle":"Factors Correlating to Women's Involvement in Shared Decision-Making Following Caesarean Sections in Amhara Region Referral Hospitals, Ethiopia, 2023","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-13 17:38:29","doi":"10.21203/rs.3.rs-4067330/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"27dace58-dd5e-4721-b1cf-e82dfac1265f","owner":[],"postedDate":"March 13th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-04-02T15:44:29+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-13 17:38:29","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4067330","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4067330","identity":"rs-4067330","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}