Co-producing adult attention-deficit/hyperactivity disorder (ADHD) care in South Africa: A patient-centred framework for agency, trust, satisfaction and continuity

Abstract

Background: Despite advances in diagnostics and pharmacological interventions, adults with attention-deficit/hyperactivity disorder (ADHD) experience poor mental health outcomes in South Africa. Patient involvement in psychiatric care remains inconsistent, and co-production has yet to be explored for improved continuity, adherence, and satisfaction. Aim: This study explored how adults with ADHD perceive their involvement in psychiatric care to inform co-production practices for clinicians. Setting: Participants were recruited via the South African Society of Psychiatrists (SASOP) ADHD Special Interest Group (SIG). Methods: This qualitative study explored how adults with ADHD perceive their involvement in psychiatric care. Thirteen adults formally diagnosed with ADHD were purposively sampled. Semi-structured interviews, guided by the SERVPERF model, were conducted online and analysed thematically using ATLAS.ti (version 24.2.1 [32295]; ATLAS.ti Scientific Software Development GmbH, Berlin, Germany). Results: The proposed patient-centred care framework is based on four identified themes: (1) patient agency enhances engagement when decision-making is shared and treatment options are clearly explained; (2) trust in provider expertise and empathy influence adherence and comfort with treatment plans; (3) satisfaction increases with personalised, responsive care, particularly during medication adjustments and follow-up; and (4) continuity of care and timely access foster sustained engagement, while inconsistent communication leads to frustration and dropout. Together, these dynamics form a relational framework for the co-production of care. Conclusion: Patient involvement in ADHD care is relational and influenced by trust, effective communication, and continuity of care. Where co-production was present, patients experienced improved outcomes. Contribution: This study emphasises integrating co-production into psychiatric practice through structured involvement strategies, improved continuity, and relational training for healthcare providers.