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Understanding client, family and health provider perceptions of shared decision-making (SDM) in adolescent substance use interventions could help to understand the mechanisms through which SDM is achieved and to design interventions to improve implementation and outcomes. To identify perceptions among patients/parents, providers and family members regarding the efficacy and meaningfulness of a SDM-based adolescent substance use intervention. Semi-structured interviews with adolescents and their parents/caregivers were conducted before (6th week) and after (8th week) the intervention. Adolescent perceptions of the intervention were captured in focus groups at 6 and 8 weeks. The research team developed a qualitative coding framework and applied the framework to data to develop emergent themes. Eighty-six participants were interviewed in total (50 adolescents, 16 parents and 10 providers) and 38 adolescents (24 girls and 14 boys) were in the focus groups. Most adolescents and parents/caregivers expressed strong perceptions of the benefits of SDM compared to traditional clinical care. This did not appear to be the case among the providers. There was a lack of shared understanding between stakeholders regarding the mechanism through which SDM works. Quality coaching was identified as an important mediator between the therapeutic alliance and perceived effectiveness of the intervention. Perceived effectiveness was associated with positive outcomes and improved functioning. Shared decision-making, informed by a coaching approach, is effective in the treatment of adolescent substance use problems and may help to improve outcomes. Stakeholders may have different perspectives of effectiveness and how it works. Providing more information about the mechanisms through which SDM works and the impacts of SDM on outcomes in adolescents’ own words could be an important next step in improving implementation of such interventions.Q:
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