Patient involvement in the biopsychosocial integrated primary care model: A qualitative study in three health districts of South Kivu, Democratic Republic of Congo

According to the World Health Organization, involving patient in healthcare provision and decision-making about their health is a key factor in ensuring healthcare quality. This study explores patients' involvement in choosing their care strategies, their responsibility for holistic care, and their ability to support biopsychosocial model of care. This qualitative research was conducted in three health districts in South Kivu province, eastern Democratic Republic of Congo, which benefit from interventions on chronic disease management. From February to April 2024, 27 individual interviews were conducted with members of chronic disease clubs in 6 health areas using a tool inspired by the International Alliance of Patients' Organizations' Declaration of Patient-Centered Care. The content of the interviews was analyzed using an Inductive Content Analysis approach. Five categories emerged from the interviews regarding patient involvement in the biopsychosocial model of care. Patients' participation in care revealed collaborative rapport between them and providers, the partnership, and the patient Clubs' involvement in community activities (home visits, awareness-raising). Patients' empowerment and decision-making were observed through their responsibility for care, their choice of treatment options, and the role of Clubs in care planning. Patient support systems included their preventive and promotional activities, the adaptation of care to their needs, the entourage, the Clubs, and their psychologist. Patient education and lessons learned from caregivers fostered behavior change, objectified by the development of skills (cognitive, social, and emotional). Suggestions formulated are mainly concentrated on humanizing care and services, and psycho-financial support for patients. Healthcare systems should consider all five dimensions identified in this study when defining policies and integrating biopsychosocial care. Strengthening these elements across the individual, provider, and community levels can enhance holistic patient involvement, promote self-management, and improve the quality and accessibility of care for chronic disease management in resource-limited settings.