Exploring Patient Involvement in Treatment Decision-Making for Diabetic Retinopathy: A COM-B Model-Based Cross-Sectional Survey

Ling Xu,1,2 Haili Zhang,1,2 Yan Shen,2 JingYan Pu,3 Qing Wu,1 Lan Chen2 1School of Nursing, Shanghai Jiao Tong University, Shanghai, People’s Republic of China; 2Department of Nursing, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 3Intensive Care Unit, Jiangqiao Hospital, Shanghai, People’s Republic of ChinaCorrespondence: Lan Chen, Department of Nursing, Shanghai General Hospital, Shanghai, People’s Republic of China, 200080, Email [email protected] Qing Wu, School of Nursing, Shanghai Jiao Tong University, Shanghai, 200025, People’s Republic of China, Email [email protected]: Patient involvement in treatment decision-making has increasingly been emphasized in the healthcare system. However, research on patient involvement in treatment decision-making for diabetic retinopathy (DR) remains scarce in China. Guided by the Capability-Opportunity-Motivation-Behavior (COM-B) model, this study aimed to explore the current status and influencing factors of patient involvement in treatment decision-making for DR.Methods: This cross-sectional study recruited 336 patients with DR by convenience sampling from a tertiary hospital in Shanghai, China. The All Aspects of Health Literacy Scale (AAHLS), Social Support Rating Scale (SSRS), Facilitation of Patient Involvement Scale (FPIS), Decision Self-Efficacy Scale (DSES), and Patient Expectation for Participation in Medical Decision-making Scale (PEPMDS) were used to evaluate health literacy, social support, ophthalmologist facilitation of patient involvement, decision self-efficacy, and need for decision-making involvement, respectively. The Control Preference Scale (CPS) was used to assess patients’ actual involvement roles in treatment decision-making. Descriptive statistics, univariate, and unordered multinomial logistic regression analyses were conducted.Results: Among the 336 patients with DR, 21.1% reported an active role, 30.7% a collaborative role, and 48.2% a passive role. Compared to passive roles, younger age, higher income, lower ophthalmologist facilitation, and higher need for deliberation were associated with a higher likelihood of adopting active roles; higher income, greater critical health literacy, higher ophthalmologist facilitation, and higher need for deliberation increased the likelihood of adopting collaborative roles. Compared to active roles, collaborative roles were significantly associated with older age, higher objective support, and higher ophthalmologist facilitation.Conclusion: This study demonstrates that passive involvement remains the predominant decision-making role among DR patients in China. Promoting patient involvement in decision-making is therefore imperative and calls for strategies that enhance health literacy, strengthen ophthalmologist facilitation and objective support, and address the need for deliberation. Future research could develop and evaluate integrated interventions informed by these COM-B components.Keywords: diabetic retinopathy, patient involvement in treatment decision-making, COM-B