Health System Factors Shaping Doctor–Patient Communication in Epilepsy Care: A Qualitative Study Across Levels of Care in India

Background: Doctor–patient communication is often studied at an interpersonal level; however, it is embedded within broader health system structures. This study explores how system-level factors shape doctor–patient communication in clinical settings across levels of epilepsy care within India’s public health system. Methods: A qualitative study was conducted across a tertiary care center (All India Institute of Medical Sciences [AIIMS], New Delhi, India) and primary and secondary care settings in Hamirpur, Himachal Pradesh, India. In-depth interviews with 40 participants were done (15 people with epilepsy, 15 caregivers, and 10 health care providers). Data were analyzed thematically using an inductive–deductive approach informed by a health systems framework. Results: Four key themes were identified: (1) Service factors shaping communication depth: High workload and limited human resources curtailed consultation time, restricting relational and informational aspects of care, while better provider capacity and drug availability supported trust-building. (2) Governance and accountability influencing communication: Lack of protocols and weak coordination led to fragmented, repetitive interactions and inconsistent information. Strengthening coordinated care pathways and improving documentation emerged as ways to standardize communication and ensure continuity of care. (3) Clinic infrastructure and environment: Limited privacy in consultation spaces, overcrowded clinics with long waiting times, and suboptimal physical layouts shaped communication quality by constraining confidential, focused, and patient-centered interactions. (4) Sociocultural dynamics at the patient–system interface: Rushed busy clinics and limited provider training reduced the ability to address stigma and cultural beliefs, reinforcing fragmented care-seeking and reliance on informal or traditional healers. Conclusion: The findings indicate that doctor–patient communication is shaped by how care is organized and delivered, including workload pressures, referral systems, and clinic-level service arrangements. Future efforts should focus on integrating communication quality into health system strengthening initiatives to enable patient-centered care. Funding: This research was supported by Wellcome DBT Clinical Research Training Program Fellowship under STOP Epilepsy CRC (IA/TSG/20/1/600061). Publication History Article published online: 15 July 2026 © 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/) Thieme Medical and Scientific Publishers Private Limited A-13A, Graphix Tower 1, 6th floor, Sector 62, Noida 201309, Uttar Pradesh, India