Barriers and facilitators to shared decision‐making in child and youth mental health: Exploring young person and parent perspectives using the Theoretical Domains Framework

AbstractObjectiveYoung people and parents want to be more active in treatment decisions. Using the Theoretical Domains Framework (TDF), which segments behaviour change into barriers and facilitators across fourteen domains, the aim of this study is to explore the barriers and facilitators to shared decision‐making (SDM) from young people and their parents’ perspectives.MethodThe sample comprised nine young people who presented with internalising difficulties and ten parents of young people with internalising difficulties across two sites in England. Interviews were conducted, and transcripts were analysed using a deductive thematic analysis.ResultsOverall, 15 barriers to and facilitators for SDM in child and youth mental health were identified. Under capability, these included an awareness of SDM, forgetting discussions or not asking questions, clinician listening skills and communication skills. For opportunity, these included the availability of treatment options, availability of understandable resources, staff shortages, the environment being conducive to SDM, and if the school, or parents of young people, facilitated decisions. For motivation, these included whether SDM was thought to empower individuals, result in better treatment, or individuals making the ‘wrong’ decision, as well as whether individuals felt capable to be involved in treatment decision‐making, whether young people lacked capacity, and whether they could make decisions due to enhanced emotional states.ConclusionsBarriers and facilitators across capability, opportunity and motivation were identified. Interventions which target these barriers and facilitators may facilitate young people and their parents’ involvement in decision‐making.