Multinational KAP Study: Patient Rights among Medical Students, 2023 ()
1. Introduction
The right to lead a healthy life is widely considered to be a fundamental human right ( Council of Europe Treaty Office, n.d. ). As such, promoting and assuring patients’ rights is an essential part of modern healthcare. In 1994, the World Health Organization (WHO) published a detailed declaration outlining the primary principles of patients’ rights in Europe ( World Health Organization, 1998 ).
According to the definition of the American Health Association, by considering patients’ rights, we mean observing their legal and logical physical, mental, spiritual and social needs that are compiled as standard medical rules and regulations and the medical team are responsible and obliged to implement and observe them ( Parsapoor et al., 2009 ).
All individuals need and use healthcare services throughout their lives, and hence the provision of health care services must be reasonably non-discriminatory and respectful of human rights and dignity ( Ahari et al., 2012 ). Patients’ rights are a set of norms derived from the bases and principles of medical ethics and human dignity, and professional commitments to patients are founded on these rights ( Shamsi et al., 2020 ; Olejarczyk & Young, 2021 ).
The Patients’ Rights Charter aims to ensure that human dignity is respected by protecting patient health, especially in medical emergencies without discrimination of race, age, sex, or financial status, and with the provision of respectful and quality care ( Ahari et al., 2012 ).
Medical ethics is defined as a structured system which aims to present appropriate strategies for solving the ethical problems in medical sciences and dentistry ( Larijani et al., 2005 ).
In all countries, laws are endorsed for adjusting the performance of health specialists ( Dogas, n.d. ). In fact, these laws have been enacted in order to support the members of the society against the inefficient specialists and, at the same time, accurately describe the performance of the qualified ones ( Dogas, n.d. ). Emphasis on the human rights in healthcare, particularly respecting the patients’ dignity, is of utmost importance in particularly when patients’ vulnerability exposes them to the violations ( Bandman & Bandman, n.d. ).
Today, the patients’ rights consist of both individual and social aspects. More emphasis has been put on care and treatment rights, sufficient social coverage, proper information on healthcare services, and the right to utilize the social developments. Moreover, economic signs, modern medicine, and patients’ expectations all affect the identification of the patients’ rights. Thus, it is quite necessary to develop principles to support the individuals in healthcare with emphasis on the patients’ rights ( Lenin & Giures, 1999 ).
On the other hand, lack of respect to patient rights may lead to hazards for security and health situation of patients, may decrease efficiency, effectiveness, and suitable care of patients ( Mastaneh & Mouseli, 2013 ).
Although Patients’ rights are a fundamental human rights and lack of respect to patient rights may lead to decreases efficiency, effectiveness, and suitable care of patients, we realized there is a international lack of its application in hospitals, specially from medical students. So assess knowledge, attitude and practise of patient right among medical students is the first step and corner stone to full this lack.
The study goal to assess knowledge, attitude and practise of patient right among medical students, to orient the efforts toward the manipulation factors influencing them. Also fill the gap of fewer recent studies about knowledge, attitude and practise of patient right among medical students, specially the multinational studies.
2. Materials & Methods
A descriptive cross-sectional community-based study was carried out in Sudan, Saudi Arabia, Egypt and Jordan. Targeted populations were all medical students in Sudan, Saudi Arabia, Egypt and Jordan. All medical students in Sudan, Saudi Arabia, Egypt and Jordan who showed willingness to participated were included. Medical students whom didn’t show willingness to participate were excluded.
Dependent variables were knowledge, attitude and practise of patient right among medical students. Independent variables were Sex, Age and educational level.
Sample size was calculated by using the equation:
n: Sample size
z: Standard deviation (1.96)
p: Proportion of population
q: Error sample (1 − p)
d: Degree of precision (0.05) ( Pourhoseingholi et al., 2013 )
n = (1.96)2 * 0.5 * 0.5/(0.05)2 = 385 [for each country].
For all countries: 385 * 4 = 1540.
A probability simple random technique was used. The data was collected by online self administrated questionnaire, the questionnaire was designed by the researchers from the literature review and given to the experts and professors in the related field and its validity and reliability was confirmed. Finally, the questionnaire was given to the students whom were willing to take part in the research. The questionnaire consists of:
· General characteristic: sex, age and level of education.
· Knowledge of patient rights questions—five questions.
· Attitude towards patient rights questions—five questions.
· Practice of patient rights questions—five questions. “APPENDIX”
The questionnaire answer score by: 2 for Correct answer, 1 for Sometimes or Neutral, 0 for Incorrect answer.
The data was analyzed by SPSS version 25 descriptive analysis, Pearson chi-square test of significance was conducted to determine the statistical significance. A P value < 0.05 level was considered statistically significant knowledge, attitude and practise score Indicators were: high knowledge, attitude or practise = 8 - 10 of total score. Moderate knowledge, attitude or practise = 6 or 7 of total score. Low knowledge, attitude or practise < 6 of total score.
3. Results
3.1. General Characteristics of the Study Participants
Out of 1540 questionnaires were taken from medical students, 385 questionnaires from each country (Sudan, Saudi Arabia, Egypt and Jordan).
Regarding medical students sex were male: 20.3%, 43.4%, 51.4%, 26.8% in Sudan, Saudi Arabia, Egypt and Jordan respectively. Female were: 79.7%, 56.9%, 48.6%, 73.2% in Sudan, Saudi Arabia, Egypt and Jordan respectively. In all countries male were 35.5% and female were 64.5% “Table 1”.
The majority of the medical students age were between 22-25 years in Sudan (53.8%) and between 18 - 21 years in Saudi Arabia, Egypt and Jordan (44.7%, 53.0%, 64.9% respectively). In all countries the majority were between 18 - 21 years (50.1%) then 22 - 25 years (39.8%) after that more than 25 years (5.5%) and the least were less than 18 years (4.6% ) “Table 1”.
In medical students educational level the majority were in the sixth year in Sudan and Saudi Arabia (23.6%, 19.2% respectively) and in the first year in Egypt (20.8%) and in the second year in Jordan (40.8%). In all countries the majority were in the second year (22.4%) and the least number were in the first year (14.7%) “Table 1”.
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Table 1. Shows distribution of sociodemographic characteristics of medical students in Sudan, Saudi Arabia, Egypt and Jordan in 2023 (n = 385 (for each country), 1540 for all counties).
3.2. Assessment of Medical Students Knowledge
In is a patient right to be treated with respect, consideration, and dignity, medical students said the right answer “ Agree” were 93.0%, 90.9%, 96.1%, 83.9%, and 91.0% in Sudan, Saudi Arabia, Egypt, Jordan and all countries respectively “Table 2”.
In is a patient right to select the medical team taking care of him, medical students said the right answer “Agree” were 65.5%, 55.6%, 79.7%, 60.3% and 65.3% in Sudan, Saudi Arabia, Egypt, Jordan and all countries respectively “Table 2”.
In is a patient right to receive information from his medical provider concerning his illness, condition, treatment, including possible side effects, and plans for his care, medical students said the right answer “ Agree” were 87.8%, 81.6%, 93.0%, 80.5% and 85.7% in Sudan, Saudi Arabia, Egypt, Jordan and all countries respectively “Table 2”.
In is a patient right to have his privacy respected, medical students said the right answer “ Agree” were 94.3%, 77.1%, 94.3%, 79.2% and 86.2% in Sudan, Saudi Arabia, Egypt, Jordan and all countries respectively “Table 2”.
In is a patient right to agree to or refuse any health care service and to be informed of medical consequences of services refused, medical students said the
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Table 2. Shows distribution of medical students knowledge characteristics in Sudan, Saudi Arabia, Egypt and Jordan in 2023 (n = 385 (for each country), 1540 for all counties).
right answer “Agree” were 75.1%, 74.0%, 38.2%, 74.8% and 65.5% in Sudan, Saudi Arabia, Egypt, Jordan and all countries respectively “Table 2”.
3.3. Assessment of Medical Students Attitude
In if the patient asked to be transferred to another health facility, will you accept?, medical students said the right answer “Yes” were 59.5%, 75.6%, 49.0%, 62.3% and 61.7% in Sudan, Saudi Arabia, Egypt, Jordan and all countries respectively “Table 3”.
In if the patient asked for another doctor to treat him, will you accept?, medical students said the right answer “Yes” were 80.8%, 63.1%, 57.1%, 61.6% and 65.6% in Sudan, Saudi Arabia, Egypt, Jordan and all countries respectively “Table 3”.
In if the patient asked for full medical information about his illness, will you give them?, medical students said the right answer “Yes” were 78.2%, 74.8%, 88.1%, 70.1% and 77.8% in Sudan, Saudi Arabia, Egypt, Jordan and all countries respectively “Table 3”.
In if the patient asked to conceal vital information from other relatives and other health worker, will you accept?, medical students said the right answer “Yes” were 46.2%, 53.8%, 45.7%, 51.9% and 49.4% in Sudan, Saudi Arabia,
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Table 3. Shows distribution of medical students attitude characteristics in Sudan, Saudi Arabia, Egypt and Jordan in 2023 (n = 385 (for each country), 1540 for all counties).
Egypt, Jordan and all countries respectively “Table 3”.
In if the patient asked not allow student to examine him or look at his medical record, will you see his medical record?, medical students said the right answer “No” were 29.6%, 24.7%, 58.4%, 19.7% and 33.1% in Sudan, Saudi Arabia, Egypt, Jordan and all countries respectively “Table 3”.
3.4. Assessment of Medical Students Practise
In do you tell the patients your full name and that you are a student?, medical students said the right answer “Yes” were 74.8%, 82.9%, 82.6%, 68.6% and 77.2% in Sudan, Saudi Arabia, Egypt, Jordan and all countries respectively “Table 4”.
In do you tell the patients their examination findings or diagnosis?, medical students said the right answer “Yes” were 55.6%, 64.7%, 87.8%, 57.4% and 66.4% in Sudan, Saudi Arabia, Egypt, Jordan and all countries respectively “Table 4”.
In do you examine the patients males and females equally?, medical students said the right answer “Yes” were 61.3%, 51.2%, 82.9%, 68.1% and 65.8% in Sudan, Saudi Arabia, Egypt, Jordan and all countries respectively “Table 4”.
In if a different gender patient asked not to be examined by you, will you examine them anyway?, medical students said the right answer “No” were 74.0%, 50.1%, 56.9%, 51.9% and 58.2% in Sudan, Saudi Arabia, Egypt, Jordan and all
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Table 4. Shows distribution of medical students practise characteristics in Sudan, Saudi Arabia, Egypt and Jordan in 2023 (n = 385 (for each country), 1540 for all counties).
countries respectively “Table 4”.
In do you tell your friends about patients you saw at rounds?, medical students said the right answer “No” were 39.5%, 58.7%, 66.8%, 29.9% and 48.7% in Sudan, Saudi Arabia, Egypt, Jordan and all countries respectively “Table 4”.
3.5. Overall Score of Assessment of the Mother Knowledge and Practise and Child Health
The assessment of the medical students knowledge:
· High knowledge were 88.1%, 80.0%, 92.5%, 78.4% and 84.7% in Sudan, Saudi Arabia, Egypt, Jordan and all countries respectively “Table 5”.
· Moderate knowledge were 9.1%, 14.3%, 5.7%, 15.3% and 11.1% in Sudan, Saudi Arabia, Egypt, Jordan and all countries respectively “Table 5”.
· Low knowledge were 2.9%, 5.7%, 1.8%, 6.2% and 4.2% in Sudan, Saudi Arabia, Egypt, Jordan and all countries respectively “Table 5”.
The assessment of the medical students attitude:
· High attitude were 51.7%, 50.4%, 53.8%, 40.5% and 49.1% in Sudan, Saudi Arabia, Egypt, Jordan and all countries respectively “Table 5”.
· Moderate attitude were 35.6%, 35.6%, 37.9%, 35.3% and 36.1% in Sudan, Saudi Arabia, Egypt, Jordan and all countries respectively “Table 5”.
· Low attitude were 12.7%, 14.0%, 8.3%, 24.2% and 14.8% in Sudan, Saudi Arabia, Egypt, Jordan and all countries respectively “Table 5”.
The assessment of the medical students practise:
· High practise were 51.2%, 48.6%, 73.5%, 39.0% and 53.1% in Sudan, Saudi Arabia, Egypt, Jordan and all countries respectively “Table 5”.
· Moderate practise were 34.5%, 34.5%, 19.2%, 37.4% and 31.4% in Sudan, Saudi Arabia, Egypt, Jordan and all countries respectively “Table 5”.
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Table 5. Shows distribution of medical students knowledge, attitude and practise score characteristics in Sudan, Saudi Arabia, Egypt and Jordan in 2023 (n = 385 (for each country), 1540 for all counties).
· Low practise were 14.3%, 16.9%, 7.3%, 23.6% and 15.5% in Sudan, Saudi Arabia, Egypt, Jordan and all countries respectively “Table 5”.
3.6. Cross Tabulation of the Participant’s Characteristics
A bivariate analysis of medical students knowledge, attitude and practice with sex, age and educational level was done. In this analysis Pearson chi-square test of significance was conducted to determine the statistical significance between medical students knowledge, attitude and practice with sex, age and educational level. The results in “Table 6” indicate:
· knowledge:
1) Knowledge and sex: significant relationship in Saudi Arabia, Jordan and all countries (P value: 0.001, <0.001, <0.001 respectively).
2) Knowledge and age: significant relationship in Egypt, Jordan and all countries (P value: 0.003, <0.001, <0.001 respectively).
3) Knowledge * educational level: significant relationship in Sudan, Egypt, Jordan and all countries (P value: 0.010, 0.002, 0.029, <0.001 respectively).
· Attitude:
1) Attitude and sex: significant relationship in Egypt and all countries (P
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Table 6. Shows Chi-square test and P value of crosstabulation of medical students knowledge, attitude and practise score with sex, age and educational level characteristics in Sudan, Saudi Arabia, Egypt, Jordan and all countries in 2023 (n = 385 (for each country), 1540 for all countries).
value: 0.005, 0.020 respectively).
2) Attitude and age: significant relationship in Sudan, Egypt, Jordan and all countries (P value: 0.017, <0.039, 0.005, <0.001 respectively).
3) Attitude and educational level: significant relationship in Sudan, Saudi Arabia and all countries (P value: 0.001, <0.048, <0.001 respectively).
· Practise:
1) Practise and sex: significant relationship in Saudi Arabia, Jordan and all countries (P value: 0.021, 0.001, <0.001 respectively).
2) Practise and age: significant relationship in Saudi Arabia, Egypt, Jordan and all countries (P value: 0.014, <0.001, <0.001, <0.001 respectively).
3) Practise and educational level: significant relationship in Saudi Arabia, Egypt, Jordan and all countries (P value: 0.043, <0.001, <0.001, 0.015 respectively).
4. Discussion
All individuals need and use healthcare services throughout their lives, and hence the provision of health care services must be reasonably non-discriminatory and respectful of human rights and dignity Patients’ rights are a set of norms derived from the bases and principles of medical ethics and human dignity, and professional commitments to patients are founded on these rights.
This multinational descriptive cross-sectional community-based study was carried out among 1540 medical students by using simple random technique to assess knowledge attitude and practise of patient rights among medical students in Sudan, Saudi Arabia, Egypt and Jordan. The students were asked about their knowledge, attitude and practise of patient rights by online self-administrative questionnaire and the data was analyzed by SSPS version 25.
In general medical students had high knowledge, high attitude and high practise in all countries were 84.7%, 49.1% and 53.1% respectively.
Most of medical students sex were female (64.5%), this was similar to a study was conduct by Tabei et al. (2013) that found the majority of them was female (78.4%). The majority of medical students age were ranges between 18 - 21 years (50.1%) and The majority of medical students education level were the second year (22.4%).
In medical students knowledge the majority were high knowledge (1305 students, 84.7%) then moderate knowledge (171 students, 11.1%) and the least number was low knowledge (64 students, 4.2%) this was difference to Mohamed et al. (2012) study that found the majority had unsatisfactory knowledge. This difference can be due to the comparable study with small sample size and in one hospital only. In addition the study was similar to Tabei et al. (2013) study that shows 71% of the students were acquainted with the patients’ rights. Medical students knowledge were highest among Egypt students (92.5%) followed by Sudan students (88.1%) then Saudi Arabia students (80.0%) and the least number in Jordan students (78.4%).
In medical students attitude the majority were high attitude (756 students, 49.1%) then moderate attitude (556 students, 36.1%) and the least number was low attitude (228 students, 14.8%) This might be due they haven’t been fully responsible for a patient before. Medical students attitude were highest among Egypt students (53.8%) followed by Sudan students (51.7%) then Saudi Arabia students (50.4%) and the least number in Jordan students (40.5%).
In medical students practise the majority were high practise (817 students, 53.1%) then moderate practise (484 students, 31.4%) and the least number was low practise (239 students, 15.5%) this was difference to Mohamed et al. (2012) study that found the majority had unsatisfactory practise. This difference can be due to the comparable study with small sample size and in one hospital only. Medical students practise were highest among Egypt students (73.5%) followed by Sudan students (51.2%) then Saudi Arabia students (48.6%) and the least number in Jordan students (39.0%).
5. Limitations
There was a problem to reach to all medical students and give us their attention to participate in the study, so a lot of time required for data collection.
6. Recommendation
We recommended universities, ministry of health, ministry of high education and government to adopt appropriate strategies and programme in medical ethics for medical student since first year and observe medical students practise towards patients in clinical years.
7. Conclusion
The majority of participants were female (78.4%), ranging in age between 18 - 21 years (50.1%) and in second year education level (22.4%).
The majority of medical students knowledge, attitude and practise score, were high knowledge, attitude and practise. There was significant relationship (P value < 0.05) between age, sex and educational level with knowledge, attitude and practise among medical students in all countries.
The research finding among medical students was good and with additional education, good monitoring and guiding the result will be higher.
Acknowledgments
We are sincerely indebted to the support of our families and supervisors.
Ethical Consideration
The participants were informed about details of the research and informed consent was obtained in the questionnaire. The responses were kept completely confidential and used only for the purpose of the research.
Funding
This study was funded independently by the authors.
Appendix
Questionnaire
Multinational KAP Study: Patient Rights among Medical Students, 2023.
We are group of researcher from Sudan, Saudi Arabia, Egypt and Jordan. We confirm that all answers written in this questionnaire will be treated with confidentiality and only used for research purposes. Please answer the following questions regarding your knowledge, attitude and practice about patient rights. Please give as the true answers as possible as you can for the best research results, also keep in mind that this is not mandatory but your contribution is warmly appreciated.
1. Are you agree to participate in this study? I Agree ____________
2. Sex: Male _______________ Female _________________
3. Educational level: First year____________ Second year_____________ Third year_______________
Forth year___________ Fifth year_______________ Sixth year________________
A. Knowledge
B. Attitude
C. Practise
Thank you