Introduction: Insecticide treated bed nets are the most reliable and cost effective tool to use in the prevention of malaria. This study explored the usage patterns and decision making processes; on the consistent use of the insecticide treated bed net. Methodology: A mixed method study that used the multi stage sampling technique in the selection of study districts and households. The target population was residents of the upper east region of Ghana. The study used data from three key informant interviews conducted with District Malaria Control Officers and a structured survey for households in three administrative Districts in the Upper East Region. Results: The study identified; nature of the weather, season of the year, relative temperature, relative humidity, education, access to the ITN, number of persons living in the household and the belief and understanding of the household head to influence patterns of behaviour and decision making processes in the use of the insecticide treated bed net. Conclusions: Behaviour change communication methods should be adopted in educating the public on the measures to ensure sustained usage of the ITN in the region and to prioritize the vulnerable populations in the use of the ITN. Specific malaria bed net campaign massages should target male or household heads that made the decision on who sleeps under the insecticide treated bed net.