Exploring factors influencing discharge against medical advice (DAMA) from teaching hospitals in Mazandaran province, Iran: a qualitative study

Discharge against medical advice (DAMA) is a complex healthcare challenge associated with incomplete treatment and potentially adverse outcomes. This study aimed to explore factors influencing DAMA in teaching hospitals in Mazandaran Province, Iran, by examining and integrating the perspectives of patients and healthcare providers. This qualitative study was conducted between January and June 2025 using conventional content analysis. Participants included 20 patients who intended to leave against medical advice and 30 healthcare providers selected through purposive sampling. Data were collected through semi-structured interviews and analyzed using Graneheim and Lundman’s approach. Patients’ experiences were grouped into three themes: multilayered life pressures, unpleasant hospitalization experiences, and perceptions of illness and risk. Healthcare providers identified three themes: the multifactorial nature of DAMA within the regional context, health system inadequacies in teaching hospitals, and ethical and professional challenges. Both groups identified economic difficulties and communication problems, but they interpreted these factors differently. Patients emphasized family, occupational, and hospitalization-related pressures, whereas providers emphasized workload, fragmented care, organizational limitations, and ethical tensions. Integrating the two perspectives suggests that DAMA emerges through interactions among individual, relational, cultural, socioeconomic, and organizational factors. The findings provide context-specific insight into DAMA by demonstrating how patient experiences and healthcare-system conditions may contribute to the same discharge decision. The study may inform future patient-centered and organizational approaches, although the effectiveness of specific interventions requires further evaluation.