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

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.