ORIGINAL RESEARCH article
Front. Public Health
Sec. Aging and Public Health
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1665368
Shared Decision-Making Among Older Adults with Multimorbidity in Kerala's Primary Care: A Qualitative Study Using the Socio-Ecological Model
Provisionally accepted
- 1Department of Applied Statistics and Data Science, Prasanna School of Public Health, Manipal academy of Higher Education, Manipal, India
- 2Department of Social And Health Innovation, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
- 3Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
- 4Department of Health Policy, Prasanna School Of Public Health, Manipal Academy of Higher Education, Manipal, Manipal, India
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Multimorbidity is an increasing public health challenge among older adults, particularly in Kerala, India. Shared decision-making (SDM) is central to person-centered care for this group, yet its implementation remains inconsistent in low-and middle-income countries (LMICs). This qualitative study explored the experiences and perspectives of older adults with multimorbidity regarding SDM in Kerala's primary care. Sixteen adults (aged 60+) were recruited from four primary health centers using purposive sampling. The Socio-Ecological Model guided the design and thematic analysis, examining SDM influences at individual, interpersonal, organizational, and sociocultural levels. Key findings revealed that individual barriers, such as limited health literacy and low self-efficacy, led to passive participation. Family members played a central role in healthcare interactions, sometimes facilitating but occasionally overshadowing patient voices. Organizational barriers, including high patient load and time constraints, limited SDM, while positive provider communication and continuity enabled engagement. Sociocultural factors included strong respect for medical authority and pluralistic health-seeking, with patients often reluctant to disclose alternative treatments to allopathic doctors. Exclusion from SDM was linked to dissatisfaction and poor adherence. Addressing these barriers and leveraging enablers will require coordinated efforts in communication, health literacy, family engagement, and culturally sensitive practice to advance person-centered care.
Keywords: older adults, multi-morbidity, shared decision-making, Person-centered care, treatment burden, health system, non-communicable disease
Received: 14 Jul 2025; Accepted: 02 Sep 2025.
Copyright: © 2025 AK, Kamath, Ashok, Kamath and Chandra Sekaran. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Varalakshmi Chandra Sekaran, Department of Health Policy, Prasanna School Of Public Health, Manipal Academy of Higher Education, Manipal, Manipal, India
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