ORIGINAL ARTICLE |
https://doi.org/10.5005/jp-journals-11010-1104 |
Understanding Awareness of Patient Rights: A Cross-sectional Survey among Healthcare Workers, Patients, and Attendees
1–6Department of Respiratory Medicine, Maharishi Markandeshwar Medical College and Hospital, Maharishi Markandeshwar University, Solan, Himachal Pradesh, India
Corresponding Author: Arjun Kumar, Department of Respiratory Medicine, Maharishi Markandeshwer Medical College and Hospital, Solan, Himachal Pradesh, India, Phone: +91 8054809188, e-mail: aknlnegi@gmail.com
Received: 21 February 2024; Accepted: 10 April 2024; Published on: 18 June 2024
ABSTRACT
Introduction: In this modern era of medical science, “patient’s rights” have become a pivotal component of the healthcare system. There are increasing gaps between patients’ expectations and the delivery of quality care. Therefore, knowledge of “patient’s rights” among patients has received crucial value in medical science.
Aim and objective: To assess the knowledge of “patient’s rights” among healthcare workers, patients, and their attendants.
Materials and methods: This was a cross-sectional survey conducted among the healthcare workers, patients, and their attendants admitted to the Department of Respiratory Medicine, Maharishi Markandeshwar Medical College and Hospital, Maharishi Markandeshwar University, Solan, Himachal Pradesh, India, for a duration of 6 months from January to June 2023. We assessed 300 participants’ knowledge of “patient’s rights” based upon a standard questionnaire totaling 18 questions acquired from the “patient charter” Ministry of Health and Family Welfare (MoHFW) Government of India. Correct answers to >14 out of 18 questions were considered good knowledge.
Results: Out of 300 participants, 156 (52%) were healthcare workers, and 144 (48%) were patients and their attendants. Overall, 96 (32%) participants were having poor knowledge of “patient’s rights.” The majority, 60 (41.7%) of patients and their attendants, have poor knowledge of “patient’s rights.” The lower level of education status was associated with poor knowledge of “patient’s rights” among patients and attendants (p = 0.0024). The lower level of socioeconomic status was associated with poor knowledge of “patient’s rights” (p = 0.0352).
Conclusion: Our study noted poor knowledge about the “patient’s rights,” especially among the patients and attendants followed by medical students and nurses. Appropriate steps are needed to improve awareness among patients and healthcare providers.
How to cite this article: Kumar A, Janmeja AK, Singh B, et al. Understanding Awareness of Patient Rights: A Cross-sectional Survey among Healthcare Workers, Patients, and Attendees. Indian J Respir Care 2024;13(2):91–94.
Source of support: Nil
Conflict of interest: None
Keywords: Attendants, Healthcare workers, Knowledge, Patient rights
INTRODUCTION
With incredible advances in medical science, “patient’s rights” have become a pivotal component of the healthcare system. There is a rapid change in the atmosphere of modern healthcare practice, and the relationship between the patient and doctor has been affected by many factors. Uneducated patients, especially in resource-limited nations, are more vulnerable than those in developed societies.1 Universal Declaration of Human Rights was established by the United Nations in 1948 and has been executed worldwide.2 Main components of “patient’s rights” are patient’s safety, satisfaction, well-informed treatment, confidentiality, respect, dignity, informed consent, and patient privacy.3 Patient awareness about knowledge of their medical problem and rights builds an effective patient–doctor relationship and trust. Well-informed patients are better aware of their disease’s condition, ongoing treatment, estimated treatment cost, risk–benefit ratio, and prognosis of the disease. Due to increasing gaps between patients’ beliefs and outcomes of quality care, “patient’s rights” have gained a crucial role in the modern era of medical science. Patients’ rights may differ according to the country and social or cultural factors of the area. Most nations have setup orders or charters for “patient’s rights” and have already implemented them.4 However, in 2002, the Medical Council of India published a Code of Ethics Regulations, which deals with the “patient’s rights,” responsibilities, and duties of healthcare professionals for better patient care.5 Recently, the Ministry of Health and Family Welfare (MoHFW) and the National Human Rights Commission released the charter of patients’ rights enumerating “patient’s rights” in India.6 One Indian study reported that 28–97.4% of participants had good knowledge about the “patient’s rights” among the patients. They recommend the urgent need for effective measures to be taken to enhance the knowledge among patients and healthcare providers.7
It seems obvious that a lack of awareness about the “patient’s rights” among patients and healthcare workers may lead to poor quality care of patients and can generate mistrust toward the healthcare system.3,4,7 Hence, we planned to do a survey to assess knowledge of “patient’s rights” among healthcare workers, patients, and their attendants at Maharishi Markandeshwar Medical College and Hospital, Himachal Pradesh, India.
MATERIALS AND METHODS
This was a cross-sectional survey conducted among the healthcare workers, patients, and their attendants admitted to the Department of Respiratory Medicine, Maharishi Markandeshwar Medical College and Hospital, Maharishi Markandeshwar University, Solan, Himachal Pradesh, India, a tertiary care center of North India.
The total duration of the study was 6 months, from January to June 2023. All the participants above 18 years old and willing to participate in the study were included. The study was approved by the Institutional Review Board and Ethics Committee of Maharishi Markandeshwar Medical College and Hospital, Himachal Pradesh, India, on 2nd January 2023, with suggestions to follow strict confidentiality of participants of the study, ethical approval number (MMMCH/IEC/23/745).
Sample Size
The sample size was calculated at 300, assuming (%) the frequency of outcome factor in the population (p) 50 ± 5, 95% confidence level, acceptable difference—if 5%, d = 0.05, and a design effect of 1.
Data Collection
The participants who had given consent for the study and fulfilled inclusion and exclusion criteria were included consecutively as the study population. Baseline demographic characteristics, including the education status of the study participants, were recorded. Each participant was interviewed face-to-face with the help of a standard semi-structured questionnaire totaling 18 questions (yes/no) acquired from MoHFW, the charter of patient rights.6 Pretests of the questionnaire were conducted before it was used in a full-scale survey, and all required changes were made. Each participants were provided with an explanation of the description of rights and associated duty bearers. Every right response on the questionnaire received a score of 1, and every wrong response received a score of 0. Based on the outcomes, the labels were assigned, and the final score (out of 18) was calculated. Good knowledge was defined as answering >14 out of 18 questions correctly (>80%), whereas low knowledge was defined as answering ≤14 correctly (≤80%).
Data Processing and Analysis
For analysis, the gathered data were imported into Statistical Package for the Social Sciences version 20. Categorical variables were shown as an absolute count and percentage, whereas continuous variables were shown as mean ± standard deviation (SD). The student’s t-test was used for group analysis on the basis of education level and socioeconomic status. The significance thresholds for categorical data were determined using the Chi-squared test, while the t-test was employed to compare continuous data. The p-values below 0.05 were regarded significant.
RESULTS
Out of 300 participants in this study, there were 156 (52%) healthcare workers, including 72 (46.1%) nurses, 48 (30.7%) doctors, 36 (23.2%) medical students, and 144 (48%) patients and their attendants. The median age was 38.5 ± 42 interquartile range (IQR) years. A total of 166 (55.3%) were female and 134 (44.7%) were male. The demographic profiles of subjects are given in Table 1. The majority 98 (62.8%) of healthcare workers had high school education. Out of 144 patients and attendants, 56 (38.9%) completed elementary education, 45 (31.2%) had high school education, and 21 (14.5%) had no formal education. The lower level of education status was associated with poor knowledge of “patient’s rights,” (p = 0.0024). The majority, 79 (26.3%) of participants, belong to lower middle-class families, followed by upper lower 78 (26%) and lower class 56 (18.7%). The lower level of socioeconomic status was associated with poor knowledge of “patient’s rights” (p = 0.0352) (Table 1). Only a few 102 (34%) participants were aware of “patient’s rights” (via news, social media, posters, video, lectures, or training). Responses regarding the knowledge of the “patient’s rights” among the participants are shown in Table 2. Overall, 96 (32%) participants had poor knowledge of “patient’s rights.” Knowledge of “patient’s rights” among the participants in different groups are depicted in Figure 1.
| Characteristics | N = 300 n (%) | p -value§ | |
|---|---|---|---|
| Age (year) | 18–34 | 108 (36) | 0.8703 |
| 35–44 | 89 (29.6) | ||
| 45–60 | 50 (16.6) | ||
| >60 | 53 (17.6) | ||
| Gender | Male | 134 (44.7) | 0.3213 |
| Female | 166 (55.3) | ||
| Education level | No formal education | 26 (8.7) | 0.0865 |
| Elementary education | 98 (32.6) | ||
| High school education | 62 (20.7) | ||
| Graduate | 81 (27) | ||
| Postgraduate | 33 (11) | ||
| Socioeconomic status | Upper class | 35 (11.7) | 0.0352* |
| Upper middle class | 52 (17.3) | ||
| Lower middle class | 79 (26.3) | ||
| Upper lower | 78 (26) | ||
| Lower | 56 (18.7) | ||
| Do you know about “patients rights” charter? | Yes | 102 (34) | |
| No | 198 (66) | ||
§, association between demographic variables and poor knowledge of patients rights; *, significant (p-value < 0.05)
| Serial number | Questions | Correct responses for each question | p-value | |
|---|---|---|---|---|
| Healthcare workers N = 156 | Patients and attendants N = 144 | |||
| n (%) | n (%) | |||
| 1 | Right to information | 134 (85.9) | 112 (77.8) | 0.3641 |
| 2 | Right to access records and reports | 126 (80.7) | 67 (46.5) | 0.0162* |
| 3 | Right to emergency medical care | 138 (88.5) | 106 (73.6) | 0.0724 |
| 4 | Right to informed consent | 142 (91) | 105 (72.9) | 0.0563 |
| 5 | Right to confidentiality, human dignity, and privacy | 129 (82.7) | 98 (68) | 0.0658 |
| 6 | Right to second opinion | 130 (83.3) | 102 (70.8) | 0.0548 |
| 7 | Right to transparency in rates and care according to prescribed rates wherever relevant | 146 (93.5) | 117 (81.2) | 0.0745 |
| 8 | Right to nondiscrimination | 156 (98) | 136 (94.4) | 0.2147 |
| 9 | Right to safety and quality care according to standards | 136 (87.2) | 105 (72.9) | 0.0654 |
| 10 | Right to choose alternative treatment options if available | 125 (80.1) | 83 (57.6) | 0.0468* |
| 11 | Right to choose source for obtaining medicines or tests | 129 (82.7) | 102 (70.8) | 0.1241 |
| 12 | Right to proper referral and transfer, which is free from perverse commercial influences | 132 (84.6) | 79 (54.9) | 0.0312* |
| 13 | Right to protection for patients involved in clinical trials | 127 (81) | 108 (75) | 0.0754 |
| 14 | Right to protection of participants involved in biomedical and health research | 131 (83.9) | 109 (75.6) | 0.0868 |
| 15 | Right to take discharge of patient, or receive body of deceased from hospital | 123 (78.8) | 103 (71.5) | 0.1263 |
| 16 | Right to patient education | 129 (82.7) | 106 (73.6) | 0.0624 |
| 17 | Right to be heard and seek redressal | 122 (78.2) | 92 (63.9) | 0.0547 |
| 18 | Right to refuse treatment | 121 (77.5) | 101 (70.1) | 0.1023 |
| Mean (SD) final score | 12 ± 4.3 | 9 ± 3.8 | ||
| Good response (>14 correct answers) | 120 (76.9) | 84 (58.3) | ||
| Poor response (<14 correct answers) | 36 (23) | 60 (41.7) | ||
*, significant (p-value < 0.05)
Fig. 1: Knowledge of “patient’s rights” among participants
Subgroup Analysis
The total final score (mean ± SD) of healthcare workers and patients and their attendant groups were 12 ± 4.3 and 9 ± 3.8, respectively. The majority, 60 (41.7%) of patients and their attendants have poor knowledge of “patient’s rights” (Table 2). However, only 36 (23%) healthcare workers were having poor knowledge of “patient’s rights.” A comparison between the two subgroups regarding the knowledge “patient’s rights” based on the questionnaire is depicted in Table 2. Only a few 67 (46.5%) patients and attendants were aware of the patient’s right to access records and reports (p = 0.0162). Only 83 (57.6%) patients and attendants were aware of the patient’s right to choose alternative treatment options if available (p = 0.0468). A total of 79 (54%) patients and attendants were aware of the patient’s right to proper referral and transfer (p = 0.0312).
DISCUSSION
The knowledge of “patient’s rights” among the patients and attendants was poor. However, the mean scores for “patient rights” among the doctors and nurses were highest in our study. Similarly, Ghalche et al.8 also demonstrated higher mean scores of knowledge about patients’ rights for doctors in their study. Overall, 96 (32%) participants had poor knowledge of “patient’s rights” in the present study. Similarly, a study conducted in Iran reported that 35.6% of participants had poor knowledge about patients’ rights.8 Studies conducted in Turkey also reported poor knowledge about patients’ rights among patients and healthcare professionals.9,10
Another similar study conducted on patients’ undergoing surgery in Iran reported that 45.2% of patients had good knowledge about the patient’s rights charter, and only 6.4% had poor knowledge.11 Multiple factors may be leading to poor knowledge about patients’ rights in these studies, including low education status, poor socioeconomic conditions, and lack of awareness among healthcare professionals and other stakeholders in the healthcare system. In the present study, a lower level of socioeconomic status was associated with poor knowledge of “patient’s rights” (p = 0.0352). On the contrary, a study done by Ranjbar et al. in 2010 reported a significant negative correlation between knowledge and age (p = 0.003), gender (p = 0.042), and educational level (p = 0.008).12 Our study did not find any correlation between knowledge and age, gender, and education level. In the present study, only a few 102 (34%) participants were aware of the “patient’s rights” charter. However, a study done by Ghanem et al.,13 showed that 48% of the respondents were aware of the patient rights charter. Another similar study conducted in Ethiopia reported that 47% of participants had an awareness of the patient rights charter, which was higher than our study.14 Main sources of information about the patient’s rights charter in various studies across the world, including India, were mass media, physicians, and nurses.14-17
In the present study, only a few 67 (46.5%) patients and attendants were aware of the patient’s “right to access records and reports” (p = 0.0162). This is a major concern in resource-limited countries like India, where most patients spend their earnings on the same investigations in different hospitals. These results also confirm that there are lots of problems that need to be corrected on the ground level to improve patient care in the healthcare system. According to the World Medical Association, every patient is entitled to seek medical service with self-dignity and without any discrimination.18
Only 83 (57.6%) patients and attendants were aware of the patient’s right to choose alternative treatment options if available (p = 0.0468) in the present study. Well-informed patients about ongoing treatment, alternative treatment options, and estimated treatment costs are more likely to be satisfied and ethical than uninformed patients.
A few limitations of our study include the limited sample size and the fact that it was conducted at a single center. Future research is needed with larger sample sizes of the study population from multiple centers for more generalized results.
CONCLUSION
Results of the present study showed poor knowledge about the “patients’ rights,” especially among the patients and attendants followed by medical students, nurses, and doctors. The lower level of socioeconomic status was associated with poor knowledge of “patient’s rights.” Gaps of knowledge about the “patient’s rights” among patients and healthcare workers may lead to poor quality care of patients and can generate mistrust toward the healthcare system. Hence, all health providers should be taught about “patients’ rights.” Further, all the patients should be made well aware of the “patient’s rights” charter via newspaper, social media, posters, videos, etc.
ORCID
Arjun Kumar https://orcid.org/0000-0002-5581-6176
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