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Hospitalized Patients Awareness of Their Rights in Saudi Governmental Hospital

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Middle-East Journal of Scientific Research 11 (3): 329-335, 2012
ISSN 1990-9233
© IDOSI Publications, 2012

Hospitalized Patients Awareness of Their Rights

in Saudi Governmental Hospital

Alyah M. Almoajel

Department of Community Health Sciences,

Applied Medical Sciences College, King Saud University, Riyadh, Saudi Arabia

Abstract: Aim: To determine the level of awareness of patients’ rights among hospitalized patients. Methods:
A questionnaire survey was conducted among patients at a governmental hospital. Results: Most patients did
not know about the patients’ bill of rights, even though they are spontaneously practicing their rights.
Conclusion: In the studied Saudi hospital, there was a lack of patients' awareness regarding the patients' rights.

Key words: Patient’s Rights % Awareness of patients' rights % Human Rights

INTRODUCTION participate in decision-making. Proposed procedures or

Patients’ rights, is recently introduced term in health
sciences literature and practice and has become an
important part of modern health care practice. Patients
now are much more aware of what they expect from health
care professionals, when they enter the health care
environment.
Global developments impacting on social, economic,
cultural, political and ethical affairs have also affected our
understanding of what is meant by ‘human rights’.
However, the fundamental reason for the importance
attached to patients’ rights and the corresponding
increase in legislation, is that respecting patients’ rights
is an essential part of providing good healthcare [1-6].
There have been many declarations defining the
importance of the right to lead a healthy life [7-9]. such as
The Lisbon Declaration of World Doctors
Association[10], was the first study to look specifically at
patients’ rights. The World Health Organization
published a detailed document (A Declaration on the
Promotion of Patients’ Rights in Europe) stating the
principles and strategies of patients’ rights in Amsterdam
(28-29 March1994). Finland(1992), The Netherlands,
Lithuania (1996), Denmark (1998), Norway (2000) and
France (2002) have all drawn up legislation covering
patients’ rights [5-6, 11-13].
Today, concerns about the patients choice, respect
for their values and preferences and access to health care
are becoming more complex. Patients expectations are
higher and they want the best. They want to actively
treatments and their various alternatives. General
awareness of human rights has been on the rise [14].
Many countries have guaranteed patients' rights to
process for resolving dissatisfactions with health care
providers. The United States, for example, since
November 1997 have included an aspiration statement in
the Consumer Bill of Rights regarding this issue
(President's Advisory Commission on Consumer
Protection ). Other countries, such as Sweden, the United
Kingdom, Italy, Spain and New Zealand also have a
specific legislation regarding patient's protection and
safety [15-16].
In Iran; the quality of care is very important, such as
patient's satisfaction, patient's empowerment and patient's
treatment, also the access to health personnel and to
regular sources of care and convenient services are
important in medical care services [17-19].
To provide ethical health care, it is important to
consider patients’ rights as mentioned in different
patients’ bills of rights or charters published in each
country. Cultural differences, however, play an important
role in individual attitudes and perceptions of rights in
general and patients’ rights in particular. As culture and
socio-economic contexts create different barriers and
facilitators to respecting patients’ rights, a World Health
Organization research group on patients’ rights and
citizens’ empowerment suggested that each country
should articulate its concerns and priorities according to
its own cultural and social needs to promote and protect
patients’ rights [20].

Corresponding Author: Alyah M Almoajel, Department of Community Health Sciences, Applied Medical Sciences College,
King Saud University, Riyadh, Saudi Arabia.
329
 Middle-East J. Sci. Res., 11 (3): 329-335, 2012
Quality care of patients means satisfaction with
facilities given by the hospital. As health facilities, food,
nutrition, sanitations and clean drinking water and
medicine given in time by the nurse, also satisfaction of
the hospital environment, availability of food products
supply, post-operative care facility and cleanliness.
Which has been observed on patients satisfaction and
quality of treatment in a governmental hospital in Pakistan
[21].
In Saudi Arabia, The Ministry of Health published a
patients’ bill of rights in 2001,The patient bill of rights as
a written document is available in most Saudi health care
organizations, but many patients and their families may
not be aware of their rights that have been granted by the
Saudi government through policies and regulations of the
Ministry of health [22].
The social system in Saudi Arabia is very supportive
for patients and their families and in most hospitals
patients have access to free health care services.
However, there has been little discussion on how patients
rights are practiced in such health care systems.
Most bills of rights, including the Saudi, are
concerned with informed consent, autonomy,
confidentiality and privacy. Professionals are expected to
respect patients’ rights, but if they are not familiar with
the contents of the bills of rights, or what they imply,
problems can arise.
In Saudi Arabia, it was very difficult to find a research
study that examined the patients' rights. Only one study
was conducted by Al Bishi in 2004. This study was
performed in order to investigate the awareness of
patients’ rights in Saudi Arabia.
MATERIAL AND METHODS
This was cross-sectional descriptive questionnaire
survey, investigating awareness of rights among
hospitalized patients.
The study sample consists of 250 hospitalized
patients from King Saud Medical City in the middle
province in Saudi Arabia, it is the largest governmental
hospital that is under the Saudi Ministry of health which
there are 600 bed.
An initial pilot study was carried with 15 patients in
the hospital, who were asked to feedback information
regarding whether the questionnaire worked well, there
was only one negative comment related to the
questionnaire, which was that it was too long, which
showed the validity, the easy to use format and
330
understanding of the questions. The patient duration
should have been hospitalized for at least three days, to
enable them to exercise their rights.
The sample was selected purposively from different
wards and all the data was collected by a trained research
nurse, patients were approached in person and
provided with a brief description and aim of the study.
Their consent was obtained before they were asked to
answer the questionnaire.
Each question required a yes, no, or to some extent.
The questionnaire consisted of two parts, the first part
was information regarding the patients demographics; and
the second part consists information about awareness of
patient rights.
Patients were asked whether they were aware of their
rights such as autonomy, privacy, confidentiality.
All patients recruited into the study were fully
conscious and able to give a consent. Unstable patients,
pediatric patients and patients from the intensive care
unit, coronary care unit and high dependency wards were
excluded.
Statistical Analysis: Statistical analysis was done using
the statistical package for social sciences version
11(SPSS). Mean and frequency were used to describe
the items of the questionnaire. Chi-Square (X2) test was
used to compare the proportions among the various
groups and a p- value of > 0.05 was taken to be
statistically significant.
RESULTS
A total of 250 patients were surveyed, Table 1 lists
the demographic profile of the study population. The
majority of participants were female, aged from 20 to 39,
Saudi, married, living in Riyadh city. Half of study
participants were with under Elementary education level.
Their economic level was less than 5000SR and most of
them had spent more than two weeks in the hospital.
Table 2 shows the awareness of patient about their
rights; 25.2% of respondents don’t know about that they
have rights and half of them are aware about more than 6
rights (Table 3).
Table 4 shows that the source of information was
from nurses or they read it as a poster.
From Table 5, it was found that there were significant
differences for all the expressions for the list of patient's
rights in the governmental hospital in Riyadh at the level
of significance (0.01). It is the highest level of significance
 Middle-East J. Sci. Res., 11 (3): 329-335, 2012

Table 1: Demographic profile of all participated patients in the study Table 1: Continue
Characteristics NO % of patients Characteristics NO % of patients
Gender Length of stay in the hospital
Male 38 15.2 Less than one week 45 18
Female 212 84.8 Week to two weeks 80 32
2 weeks to one month 59 23
Age
More than one month 66 26
Less than 20 47 18.8
Number of hospitalization admission
From 20-39 78 31.2
Non 104 41.6
From 40-59 69 27.6 Once 50 20
Over 60 59 22.4 Twice 39 15.6
Nationality 3 times 32 12.8
Saudi 176 70.4 More than 3 times 25 10
Non Saudi 74 29.6
Social Status Table 2: Awareness of patient about their rights
Married 144 57.6 Are you aware that there is special bill
Unmarried 71 28.4 of patients rights in the hospital Number %
Widow 33 13.2 Yes 63 25.2
Diverse 2 0.8 No 187 74.8
Place of residency
Table 3: Distribution for those who are aware of patients rights
Inside Riyadh 202 80.8
How many rights you are aware of Number %
Outside Riyadh 48 19.2
1-3 20 31.75
Educational level
4-6 24 38.1
Literacy 112 44.8
7-10 19 30.16
Elementary 40 16
Total number of patients who are aware of patients rights 63 100%
Intermediate 31 12.4
High school 50 20
Table 4: Distribution for those who are aware of patients rights according to
University and above 17 6.8 the source of awareness of patients rights
Economic level Source of awareness of patients rights Number %
Less than 5000 178 71.2 The nurse explained it to me 21 33.33
From 5000-10000 48 19.2 My doctor explained it to me 15 23.81
more than 10000-15000 11 4.4 I read it as a poster 20 31.75
more than 15000 2 0.8 My relative read it to me 7 11.11
not mentioned 11 4.4 Total number of patients who are aware of patients rights 63 100%

Table 5: Patients awareness of their rights

Yes to some extent No
-------------- ------------------- -------------- Chi- Square
The patient has the right for the following: F % F % F % Mean and Sig. Arrange
1. To receive compassionate and respectful care. 754 75.4 144 14.4 102 10.2 2.65 799** 3
2. To be cared for by qualified competent staff and to
be seen by specialized consultant. 1468 73.4 294 14.7 238 11.9 2.62 1447.2** 4
3. To be kept fully informed of his \ her diagnosis and treatment plan. 261 26.1 105 10.5 634 63.4 1.63 443.3** 10
4. To receive all necessary information to allow informed consent
to be given for all medical interventions. 1117 74.47 201 13.4 182 12.13 2.62 1142.4** 4
5. To be informed of the effects on his\ her health
if he\ she refuse treatment. 203 81.2 20 8 27 10.8 2.70 258.1** 2
6. To be able to comment on and discuss the care
and service he\she is receiving. 352 70.4 71 14.2 77 15.4 2.55 309.2** 6
7. To be assured of privacy and confidentiality with regard
to medical and social information. 803 80.3 112 11.2 85 8.5 2.72 993.7** 1
8. To be able to refuse to take part in any proposed research.
such refusal or withdrawal will have no effect on care delivered. 370 29.6 734 58.72 146 11.68 2.18 422.7** 9
9. To be discharged as recommended by the doctor with appropriate
medications, follow up appointment and required educations\
information. 532 53.2 349 34.9 119 11.9 2.41 257** 8
10. To be provided with a medical report summarizing his\her
medical condition and course during admission. 266 53.2 192 38.4 42 8.4 2.45 156.3** 7
The Total 6126 61.26 2222 22.22 1652 16.52 2.45
* P- Value (0.05), ** P- Value (0.01).

331
 Middle-East J. Sci. Res., 11 (3): 329-335, 2012
and the researcher found that most of these differences
for the benefit of choice (Yes) except two statements,
firstly (To be kept fully informed of his \ her diagnosis and
treatment plan) differences then for the choice (No) and
the second statement (To be able to refuse to take part in
any proposed research, such refusal or withdrawal will
have no effect on care delivered) differences then in favor
of choice (to some extent).
This means that most of the sample of patients agreed
with most of the expressions for the patient's rights in the
governmental hospital in Riyadh, except as the previous
two terms are explained.
It is clear from the above table that the arithmetic
mean of the expressions for the bill of patient rights
confined between (1.63, 2.72), mostly located opposite the
degree (Yes), that is the respondents agree with most
of the expressions for the list of patient's rights, except the
two statements (To be able to refuse to take part in any
proposed research, such refusal or withdrawal will have
no effect on care delivered) with average arithmetic (2.18)
for (to some extent) and the second (To be kept fully
informed of his \ her diagnosis and treatment plan)
average arithmetic (1.63) for the choice (No), meaning that
the respondents agree with the statements of the list of
patient's rights, except for the two statements on one to
some extent is (To be able to refuse to take part in any
proposed research such refusal or withdrawal will have
no effect on care delivered) and the second statement
(To be kept fully informed of his \ her diagnosis and
treatment plan) do not agree with them and this is
completely in line with the results of X2.
The statements for the bill of patient rights can be
arranged, according to the arithmetic average downward
as follows:
C To be assured of privacy and confidentiality with
regard to medical and social information.
C To be informed of the effects on his\ her health if he\
she refuse treatment.
C To receive compassionate and respectful care.
C To be cared for by qualified competent staff and to
be seen by specialized consultant.
C To receive all necessary information to allow
informed consent to be given for all medical
interventions.
C To be able to comment on and discuss the care and
service he\she is receiving.
To be provided with a medical report summarizing
his\her medical condition and course during
admission.
332
C To be discharged as recommended by the doctor
with appropriate medications, follow up appointment
and required educations \information.
C To be able to refuse to take part in any proposed
research such refusal or withdrawal will have no
effect on care delivered.
C To be kept fully informed of his \ her diagnosis and
treatment plan.
DISCUSSION
Implementation of patients’ rights should not be
something that restricts the practice of medicine. Rather,
it can both contribute to the improvement of healthcare
practices and achieve an equal distribution of
responsibility between patient, physician and nurse.
However, this study found that, most patients did not
know that the Saudi Ministry of Health had published a
patients’ bill of rights. Previous report from Turkey states
that only 23% of patients were able to recognize their
rights and this showed significant differences related to
educational level categories [23]. In a study conducted in
Greece, the right to confidentiality was not considered as
a right of privacy and many patients allowed their doctors
to make decisions; 84% of patients were not aware of
legislation. It was also stated that 60% of patients did not
have any idea about their rights [24]. Another study
found that 60% of patients were not aware of the
European Convention of Human Rights [25].This also was
reported by Fotaki in A study resulted that many of the
respondents having little or no information about patient
rights [26].
Additionally, in Iran some reported studies indicated
low level awareness of patients rights [27-29].
In contrast, Kuzu showed that few patients knew
about the regulation on patients’ rights in developing
countries [30].
Giugliani study revealed an increase with time in the
number of complaints for medical issues in a university
hospital, as well as an increase in the perception of a
medical error after the passing of a law regarding patients'
rights in France [31].
Many patients seem to have limited awareness of the
legal Implications of signing or not signing consent forms
and they do not recognize written consent as primarily
serving their interests [32].
In Changole et al. study, half of the patients who
participated in the study had never heard of any patients
rights anywhere. This finding may indicate how the health
care system has neglected such an important legal issue.
 Middle-East J. Sci. Res., 11 (3): 329-335, 2012
No single poster on patients rights was available on the
walls of the unit and no lesson were given to patients
concerning their rights [33].
In Sutherland study, most of the patients who
participated in this study felt that they had actively
sought information, yet a majority preferred to relinquish
the decision making role. These results are at odds with a
philosophy of care which advocates a consistent
unvarying dedication to the promotion of patient
autonomy and self determination [34].
All previously discussed studies in the above
paragraphs showed that patients rights such as,
confidentiality, legal implications of signing or not
signing consent forms indicates a need for extensive
education of patients and health care professionals
concerning patients rights.
In the study carried out by Al Bishi (2004), he was
concerned with this concept in a multidimensional way in
Saudi Arabia, exploring the patients’, physicians’ and
nurses’ lived experiences with patients’ rights. He found
that meeting the patients’ caring needs, is core concept
for the meaning of patients’ rights in Saudi Arabia.
He also found the lack of knowledge about the rights, lack
of standard of practice among the hospitals and the
impact of service pressure and subsequent lack of holistic
care, are barriers to patients’ rights practice in Saudi
Arabia [35].
This indicated that the process of informing
healthcare providers and recipients has not been
successfully implemented. The media plays a significant
role in making people aware of their rights, but this
requires planning at a high level of healthcare
management systems. Informing the public about their
rights as patients is part of promoting public
awareness of human rights, which are important
aspects of the Saudi Islamic culture. Using this context,
Saudi Arabia would be more likely to adopt patients’
rights practice.
Successfully by referring to its valuable social and
cultural traditions, as well as utilizing international
experiences. Even though, most of patients are aware and
practicing their rights.
Even though, implementation and actualization of
standards in hospitals require certain infrastructures such
as better knowledge on the part of managers regarding
quality improvement and using hospital information
system (HIS) and patient safety [36].
One limitation of this study is that this study
was conducted among inpatients from a single
hospital; hence the results generalizability to Saudi
Arabia is doubtful.
333
Recommendations: Implementation of patients’ rights
only seems possible when people who provide or receive
health care and institutions where health care is provided,
have reached the desired levels of information and
consciousness. Implementation of these rights should not
be considered the responsibility of healthcare
professionals alone.
Information and opportunities to learn about issues
such as the definition and reinforcement of patients’
rights should be available to every- one, not just health-
care professionals or patients (Human Rights Education
Associates, 2000). Mass communication media, health-
care institutions, educational institutions, medical
companies, political parties and religious groups should
all have an important role to play in the reinforcement of
patients’ rights.
The findings of the study suggests that appropriate
measures have to be taken from a national perspective in
order to enhance the quality of health care practice,
control and eliminate the factors that lead to violation of
patients rights and educate the public about their rights.
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