Assessing patient awareness of rights and healthcare information: a cross-sectional study at JMF’s ACPM Medical College Dhule

INTRODUCTION

Informed patients play a crucial role in ensuring ethical and effective healthcare delivery. The concept of patient rights is fundamental in modern medicine, promoting transparency, informed decision-making, and equitable treatment. Globally, healthcare policies emphasize the protection of these rights, with organizations such as the World Health Organization (WHO) advocating for patient empowerment and legal safeguards.¹ In India, patient rights are legally protected through various frameworks, including Article 21 of the Indian Constitution, which guarantees the right to life and personal liberty, the Consumer Protection Act, and the Medical Council of India (MCI) Regulations, 2002.² Additionally, the MOHFW Patients' Rights Act (2018) outlines key rights such as access to medical records, informed consent, confidentiality, and non-discrimination.³ Despite these regulations, studies suggest that public awareness of patient rights remains alarmingly low, particularly in rural areas. The present study aims to assess the level of awareness among patients at JMF’s ACPM Medical College Dhule regarding their rights, treatment costs, and access to healthcare information. By identifying key areas where awareness is lacking, this study seeks to highlight the need for improved patient education programs, better hospital communication strategies, and stronger policy implementation.

METHODS

Study design

This was a cross-sectional study.

Study population

The study population consisted of patients seeking healthcare services at Outpatient Department at JMF’s (OPD) ACPM Medical College.

Study duration

The study was conducted over a period of 6 months (15 March 2024 to 13 September 2024).

Study flow

literature review-1 month, synopsis and study tool preparation-1-month, ethical approval-1 month, data collection-2 months, data analysis and report-1 month.

Inclusion criteria

Participants were eligible for inclusion if they met the criteria like aged 18 years or older, receiving healthcare services at JMF’s ACPM Medical College, provided informed consent to participate in the study

Exclusion criteria

Those who did not respond to more than 5 questions were excluded from the study.

Sampling technique

A systematic random sampling technique was used. Patients present in the hospital during the study period were invited to participate, ensuring a diverse sample from medicine and allied as well as surgery and allied departments

Sample size

Sample size was calculated by the following

n = z²p(1-p)/d²

n=Required sample size, z =confidence interval, d=margin of error, p=Estimated proportion, p value is considered 22.9% after referring study done in Tertiary care teaching hospital in Wardha.⁴ 84 subjects enrolled. Sampling interval=study population/ sample size.

300/84=3.54 (approximated to 4).

First subject randomly selected using random numbers between 1 to 5. Then every 4th subject was enrolled in the study.

Study instruments

A modified pre validated structured questionnaire by NABH (National Accredited Board of Hospitals) with 23 questions was used to assess patient awareness of their rights and healthcare information.

Data collection

Participants were approached in hospital settings during OPD hours (8 AM-1 PM) after their consultation with doctor and informed consent was obtained before data collection.

Privacy and confidentiality were maintained by interviewing them separately in injection waiting room. The questionnaire was administered through face-to-face interviews, especially for participants with limited literacy.

Measurement of variables

The knowledge level of patients was assessed by requesting respondents to answer questions about their knowledge of doctor information, treatment costs, health conditions, and patient rights.

Ethical consideration

Ethical clearance was obtained from the Ethical Committee of JMF'S ACPM Medical College, Dhule, Maharashtra, India. IEC 34/2024 / AC.

Data analysis

Descriptive statistics were utilized, and the analysis was conducted using Excel.

RESULTS

In a survey of 84 patients, significant gaps in awareness regarding their healthcare and rights were observed. While 23 patients (27.4%) knew their doctor’s name, the remaining 61 (72.6%) were unaware. Similarly, only 14 (16.7%) recognized their doctor’s qualifications, whereas 70 (83.3%) lacked this knowledge. Financial awareness was also limited. Just 22 patients (26.2%) knew the expected cost of their treatment, leaving 62 (73.8%) without this information. Awareness of personal health conditions was particularly low, with only 9 patients (10.7%) demonstrating adequate knowledge, compared to 75 (89.3%) who lacked understanding. Additionally, 17 patients (20.2%) had a choice in selecting their treatment, while 67 (79.8%) had no involvement in the decision-making process. Information about treatment and care plans reached 22 patients (26.2%), whereas 62 (73.8%) remained uninformed. Awareness of possible treatment complications was similar, with 22 patients (26.2%) informed and 62 (73.8%) unaware. However, knowledge of health prognosis was relatively higher, as 59 patients (70.2%) understood their condition, while 25 (29.8%) lacked awareness. Regarding patient rights, only 12 patients (14.3%) had seen a patient rights board displayed in the hospital, while 72 (85.7%) had never noticed it.

Awareness of the right to confidentiality was even lower, with just 11 patients (13.1%) informed, leaving 73 (86.9%) unaware. Patient feedback collection was inadequate, as only 12 patients (14.6%) were asked for feedback, whereas 70 (85.4%) were never approached, and 2 did not respond. Financial transparency also showed deficiencies. Out of 83 patients, 14 (16.87%) received information about inpatient charges, while 69 (83.13%) remained uninformed, with one patient not responding. Similarly, 10 patients (11.9%) were aware of deposit charges, compared to 74 (88.1%) who lacked this knowledge. Awareness of insurance coverage was particularly low, with only 7 patients (8.3%) having insurance for their treatment, while 77 (91.7%) had none. Government healthcare schemes such as Ayushman Bharat were known to 22 patients (26.2%), whereas 62 (73.8%) were unfamiliar with these options. Awareness of medication and hospital facilities varied. While 27 patients (32.1%) knew the medications administered to them, 57 (67.9%) remained uninformed. Infection control awareness was also lacking, with only 22 patients (26.2%) aware of healthcare-associated infections and precautions, while 62 (73.8%) had no information on this aspect.

Nutritional guidance, however, was more widely provided, with 68 patients (81.93%) receiving dietary counseling, while 15 (18.07%) did not, and one patient did not respond. Patients were distributed across various medical departments 30 in Medicine and Allied specialties (including Dermatology), 19 in Obstetrics and Gynecology, 25 in Surgery and Allied specialties (including Orthopedics, ENT, Ophthalmology, and General Surgery), and 10 in Pediatrics. The time taken to receive healthcare services after registration varied: 59 patients (71.1%) were attended to within 10 minutes, 19 (22.9%) within 10 to 30 minutes, 4 (4.8%) within 30 to 60 minutes, and 2 (2.4%) waited for more than an hour.

Access to supportive healthcare services was also found to be limited. Among 83 patients, 24 (28.92%) reported easy access to a medical social worker, while 59 (71.08%) did not, with one patient not responding. Additionally, 73 patients (86.9%) had their relatives present during hospital visits, whereas 11 (13.1%) were without this support. Awareness of hospital facilities such as the canteen, washrooms, and a kids play area was high, with 78 patients (92.9%) familiar with these amenities, while 6 (7.1%) were unaware. These findings highlight the need for better patient education and communication regarding essential healthcare information and patient rights. Strengthening these areas can enhance patient experiences and empower individuals to make informed healthcare decisions.

DISCUSSION

Patient awareness regarding their healthcare rights and medical information is crucial for ensuring informed decision-making and better healthcare outcomes. Our study assessed the level of awareness among patients regarding various aspects of their medical care, including knowledge of their doctor’s identity, qualifications, treatment plans, costs, and rights. The findings revealed significant gaps in patient awareness, which align with or contrast against existing literature.

Doctor-related awareness

Our study found that only 27.4% of patients knew their doctor’s name, which is significantly lower than the 97.4% reported in a tertiary care hospital and the 95.9% found in a study specifically assessing patient awareness of their treating physician.^5,6 However, our findings align more closely with research conducted in an emergency department, where only 26% of patients could recognize their doctor.⁷ Similarly, awareness of a doctor's qualifications was low (16.7%) in our study, whereas studies conducted in tertiary hospitals reported higher recognition rates of 31.4%⁵ and 48.6% in an inpatient setting, indicating a significant disparity in patient awareness depending on the healthcare setting.⁸

Treatment cost and financial awareness

Understanding the financial aspects of treatment is crucial, yet only 73.8% of patients in our study were aware of their expected expenses. This level of awareness is much higher than what was observed among cancer patients in a previous study, where only 7.5% knew their costs⁹, highlighting the variation in awareness depending on the type of illness.

Additionally, knowledge of inpatient charges (16.9%) and deposit charges (11.9%) was particularly low compared to studies conducted in settings where more than 80% of patients were informed.⁵

Health condition, treatment choices, and patient rights

In our study, 89.3% of patients were aware of their health condition, which is comparable to the 85.7% reported in tertiary care hospitals.⁵ However, this is still significantly higher than the awareness levels found in studies conducted in Iran (60.3%) and Ethiopia (61.8%), suggesting that awareness of one's diagnosis varies across regions and healthcare systems.^10,11

When it came to choosing their treatment, only 20.7% of our respondents felt they had a say in their medical decisions. In contrast, international studies have reported greater autonomy, with patient involvement rates ranging from 37% in a study in Lithuania to 51% in a descriptive study.^12,13 This reflects differences in patient empowerment and shared decision-making across various healthcare settings.

One of the most concerning findings was the lack of awareness regarding patient rights. Only 13.3% of patients in our study knew about their right to confidentiality, a figure much lower than the 69% awareness level reported in a study from Saudi Arabia.¹⁴ Similarly, awareness of patient rights boards was minimal, with only 14.3% of patients knowing about such resources, compared to 54.3% in studies conducted in tertiary hospitals⁵. This indicates a significant gap in patient education regarding their rights.

Understanding treatment plans and prognosis

Patient involvement in treatment planning was found to be lacking, with 73.5% of patients in our study stating they were not informed about their plan of care. This figure is notably higher than the 52.8%–53% of uninformed patients reported in studies from Ethiopia and Saudi Arabia, suggesting a need for better communication between healthcare providers and patients.^11,14

Additionally, only 26.2% of patients in our study were aware of possible treatment complications. In contrast, previous research has reported much higher awareness levels, reaching up to 76.6%, demonstrating a disparity in how well patients are informed about potential risks.¹⁴

Awareness of prognosis was moderate, with 70.2% of patients in our study having some understanding of their condition’s outlook. This is similar to Ethiopia’s reported 68.4% but lower than the 87.7% awareness level observed in tertiary hospitals, again pointing to differences in patient education across healthcare settings.^5,11

Healthcare infections and preventive measures

Hospital-acquired infections are a significant concern, yet only 23.6% of patients in our study were informed about healthcare-associated infections (HAIs) and their prevention.

Awareness levels in previous studies have varied, with research in tertiary hospitals reporting 37.7% awareness and other settings showing figures as high as 68.7%.^5,15 Our findings align with studies on surgical patients, where awareness of nosocomial infections was found to be as low as 26%, suggesting that information on infection control may not always be effectively communicated to patients.¹⁶

Dietary counseling and feedback mechanisms

One positive finding in our study was that 81.9% of patients reported receiving dietary counseling, a significantly higher rate than the 37.7% reported in tertiary hospitals. This suggests that nutritional guidance is being emphasized more in our setting.⁵

However, very few patients (12.2%) were asked to provide feedback regarding their treatment, a stark contrast to previous studies in tertiary hospitals (52.3%); and the 62.6% of patients in primary healthcare centers in Riyadh, Saudi Arabia, who were given the opportunity to share their experiences. This highlights an area where patient engagement could be significantly improved.^5,17

Longitudinal and prospective analytical studies are recommended to strengthen the findings from our study with increasing sample size.

CONCLUSION

The study reveals a significant gap in patient awareness regarding their rights and healthcare costs. To address this issue, targeted educational interventions and improved communication between healthcare providers and patients are necessary to bridge the knowledge gap.

Recommendations

Implementing educational programs to enhance patient awareness about their rights. Strengthening communication strategies between healthcare providers and patients. Introducing policies that ensure transparency in treatment costs and patient rights. Conducting further research to evaluate the impact of awareness initiatives. Patient's right chart should be displayed at various locations in hospital.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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