ความสัมพันธ์ระหว่างทัศนคติและความพร้อมต่อการมีส่วนร่วมในการรักษาและกระบวนการมีส่วนร่วมตัดสินใจในบริการ เพื่อการลดน้ำหนัก ในคลินิกเอกชน จังหวัดเชียงใหม่

Abstract

Obesity and overweight are one of the important health problems worldwide as they can lead to other chronic diseases. Controlling or losing weight can help prevent the problem. This study was aimed to explore the shared decision making (SDM) process in weight loss consultation, attitudes towards SDM and readiness to participate in SDM process in one of a private clinic in Chiang Mai. The study group was 190 adult patients with their first time visit for consultation. This cross-sectional analytical study apply the Krantz Health Opinion Survey to measure attitudes toward information need and involvement in SDM; Control preference scales to measure readiness to participate in SDM, and modified Option scale to measure SDM process during the consultation. The study found that SDM seldom occur in consultation and when SDM apply, most of them were in the step of information sharing (mean score 17.28+5.61/52) rather than the deliberation step (2.19+1.42/8) and the making decision step (4.60+1.78/12). However, the study group had positive attitudes towards SDM (3.98+1.21/9) and receiving health information (3.23+0.76/7). Two-third (74.7%) of them were ready to participate in SDM (had shared role) and 17.9% had active role for SDM. All 3 clinic providers also had shared role.

Factors found related to positive attitudes towards SDM include overweight group (high BMI) (p=0.015), SDM process (r=0.3, p<0.001) and passive role in SDM (p<0.001). Factors related to readiness to participate in SDM as ‘active role’ included having comorbidity (p=0.037), lower income group (p=0.005), single (p=0.033), no job (<0.001), and lower or BMI standard (p=0.042). On the other hand, surprisingly, ‘passive role’ was related to positive attitudes towards SDM (p<0.001) and higher SDM process (p=0.045). Factors related to SDM process included positive attitudes towards SDM and passive role. No relationship was found between demographic data and SDM process. This study highlights the lack of SDM process in weight loss consultation in a private clinic in Chiang Mai. However, since most of the patients had positive attitudes towards SDM and also had active and shared role for SDM, there are opportunities to include more aspects of SDM in the future services. Further studies can explore more on the unclear relationships between attitudes, readiness, and SDM process.