Awareness of Patients’ rights in Clinical Services among Clients Attending the Outpatients Department at Mawenzi Regional Referral Hospital, Tanzania

Awareness of Patients’ rights in Clinical Services among Clients Attending the Outpatients Department at Mawenzi Regional Referral Hospital, Tanzania | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Awareness of Patients’ rights in Clinical Services among Clients Attending the Outpatients Department at Mawenzi Regional Referral Hospital, Tanzania Bahat Ernest, Joseph Ochieng, Betty Kwagala This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4141472/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Without the appropriate understanding of the patient’s rights, the healthcare team may at times be prone to various tendencies, such as failure to respect patient autonomy, such as acting in a paternalist manner, or making clinical decisions on behalf of the patient or family; another way it can occur includes cases in which not all options, risks or side effects may be appropriately disclosed. This study explored the awareness of patients’ rights to clinical services among clients attending the outpatient department at the Mawenzi Regional Referral Hospital. Methods: This was an exploratory cross-sectional study design that employed qualitative methods for data collection. The study was carried out among 34 clients attending the outpatient department at Mawenzi Regional Referral Hospital in the Kilimanjaro region, Tanzania: the medical unit, the Care and Treatment Clinic (CTC) unit, the gynecology unit, and the TB and leprosy unit. In-depth interviews were conducted with 20 participants, while 14 participants participated in group discussions. The data were analysed via inductive thematic analysis, which allowed the data to identify and determine the themes in this study, which were then presented in the form of extracts or quotes. Nvivo 12 software was used to support the data analysis. Results: The majority of the participants were aware of patients' rights. They cited patient rights such as the right to medical care, the right to information, the right to privacy, and the right to choices and dignity. The minority were not able to do so because of challenges such as information not reaching everyone in the community (information scarcity) and a language barrier. Conclusion: To increase awareness, there is a need for more sensitization of patients' rights through the client's service charter for health facilities and a relevant health policy to guide the implementation of patients' rights. Health Law Patients’ rights Clients Charter Right Introduction The oldest (more than 2,500 years old) medical code in the Hippocratic Corpus, otherwise known as the Hippocratic Oath, contains several elements that emphasize the commitment to the well-being of patients [ 1 ]. The Hippocratic Oath requires healthcare providers to exercise patients’ rights and provide care to patients to the best of their ability. Commonly established patients’ rights tend to derive from a core set of ethical principles, including autonomy of the patient, beneficence, nonmaleficence, justice, patient-provider fiduciary relationships, and inviolability of human life. In many situations, beliefs may directly conflict with one another when the legal standard does not exist; it remains the obligation of the healthcare provider to prioritize these principles to achieve an acceptable outcome for the patient [ 2 ]. Awareness of patients’ rights can bring about many advantages, such as increased quality of health care services, decreased costs, more prompt recovery, decreased length of stay in hospitals, lower risk of irreversible physical and spiritual damage, and more importantly, increased dignity of patients through informing them about their rights to participate in decision making [ 3 ]. A lack of respect for patients’ rights may lead to hazards to the security and health situation of patients [ 4 ]; in addition, a lack of respect may ruin the relationship between staff and patients, which consequently decreases the efficiency, effectiveness, and suitability of care for patients [ 5 ]. In Tanzania, a study by [ 6 ] conducted in Hai DC and Morogoro DC revealed that awareness of the right to access maternal health services was low among the studied population. This implies that the majority of the people are not aware of the patient’s rights, but studies are lacking in the general population who are clients, which brings out uncertainty about awareness of their rights. Therefore, this study aimed to explore the awareness of patients’ rights to clinical services among clients attending the outpatient department at the Mawenzi Regional Referral Hospital. Methods This was an exploratory cross-sectional study design that employed qualitative methods. The study was carried out among clients attending the outpatient department at Mawenzi Regional Referral Hospital in the Kilimanjaro region of Tanzania. These are the medical unit, care and treatment clinic (CTC) unit, gynecology unit, and tuberculosis and leprosy unit. The data were collected through in-depth interviews and group discussions adopted from different literature reviews on awareness of patients’ rights. The researcher integrated in-depth interviews and group discussions for the purpose of data completeness and confirmation [ 7 , 8 ]. The interview guides for the IDI and GD were pretested to determine if they adequately answered the research questions, and thereafter, the questions for the IDI and GD were revised accordingly. The data obtained from both instruments were rich and of good quality. In-depth interviews and group discussions were conducted among the individuals who were purposively selected based on their age, locality, and outpatient department attendance. Patients aged 18 years and older who were admitted to the outpatient department at MRRH were recruited for the IDI. For group discussions, the researcher organized three groups: the first group comprised six (6) participants, and the remaining two groups consisted of four (4) participants. The first group consisted of clients aged 18–39 years, the second group consisted of clients aged 40–59 years, and the third group consisted of clients aged 60 years and older. Participants recruited for IDI were not recruited for GD. The researcher first introduced himself to potential participants and provided them with information about the study and thereafter obtained written consent from each individual who was willing to participate in this study. Before the discussion, participants were asked to respect the privacy of other members by not disclosing any content discussed during the study. The researcher first introduced himself to potential participants and provided them with information about the study and thereafter obtained written consent from each individual who was willing to participate. Each interview took approximately 45 minutes, and group discussions took approximately 1 hour and 30 minutes and were audio-recorded after receiving permission from each participant. The audio recorder was protected by a password. The researcher used Swahili because the majority of people understood it, as suggested by [ 9 ]. In-depth interviews were conducted by the researcher; unlike in the group discussions, there were no field notes taken. The data were collected for eight (8) days: five (5) days for in-depth interviews, with four (4) participants interviewed each day for a total of twenty (20) participants, and three (3) days for three (3) group discussions, with one (1) group discussion conducted per day. Audio recordings for the in-depth interviews and group discussions were transcribed verbatim, then translated to English and analysed based on themes using Nvivo 12 software as described by [ 10 ]. Initial codes from the data were generated. These codes identified aspects of the data that appeared interesting to the researcher. The different codes generated were categorized into potential themes. The themes were defined and refined for analysis. Data coding was performed by a researcher and trained research assistant. The IDI and GD transcripts had the same questions, so they were not analysed separately. The data were analysed using inductive thematic analysis, which allowed the identification and identification of themes in this study. Ethical considerations The researcher obtained ethical approval from the School of Biomedical Sciences Research and Ethics Committee at Makerere University College of Health Sciences with approval number SBS2022-202 and the Tanzania National Health Research Ethics Committee (NatHREC) with approval number NIMR/HQ/R.8a/Vol.1X/4188. Written informed consent was obtained from all participants before they participated in the study. Participation in the study was voluntary, and participants were free to withdraw at any time without any consequence. Their confidentiality was maintained, their names were not attached to the information that was collected, and each participant was assigned a specialized notification number. Participants were compensated for their time. Results In the in-depth interviews, the total number of participants was 20. There were 10 males and 10 females. Most participants—eight (8)—ranged in age from 18 to 28. There were 9 married participants and 11 single participants. Sixteen (16) belonged to the Christian faith, while 4 were Muslims. There were 9 out of the 20 skilled participants. Eleven (11) had reached the college or university level, while 9 were below the college or university level. All participants were residents of Moshi municipality. In group discussions, the number of participants was 14. There were 6 participants in the first group, aged 18–39; 4 in the second group, aged 40–59; and 4 in the third group, aged 60 and above. Overall, in both groups, there were 5 males and 9 females. There were 11 married participants and 3 widows. Nine belonged to the Christian faith, while 5 were Muslims. There were 7 out of 14 skilled participants. Two had reached the college or university level, while 12 were below the college or university level. All participants were residents of Moshi municipality, as summarized in Table 1 below. As summarized in Table 1. Emerged Themes and Subthemes Two themes emerged with four subthemes from the in-depth interviews and group discussion transcripts. The first theme was awareness of patients' rights, with three subthemes: understanding patient rights, sources of patient rights, and patient and healthcare provider responsibilities. The second theme : barriers to the implementation of patients’ rights, with one subtheme: limited resources. Themes and subthemes are summarized in Table 2 below. Awareness of patients' rights Understanding of patient rights Most participants agreed that there are patient rights, and they were able to explain patient rights with examples. Depending on their understanding, some participants were able to provide detailed information, such as defining what patient rights are and giving examples. They highlighted several rights, such as the right to medical care, the right to information, the right to privacy, and the right to choices and dignity. Additionally, others linked patients’ rights with human rights and highlighted that patients’ rights are part of human rights. On the other hand, other participants were not able to provide such detailed information about patient rights, but they had an idea about them and agreed that they existed. Yes, patients have the right to receive the right care, such as medicine or the right treatment; they also have the right to choose what type of healthcare provider to serve them; they have the right to disclose their secrets to the healthcare provider; and they have the right not to disclose their secrets to the healthcare provider, who they are all patients' rights. (Participant 14). On the other hand, despite the display of the client service charter for healthcare at Mawenzi Regional Referral Hospital, most participants had no idea what a client service charter for health facilities was; it was their first time hearing about it. The few who had ideas about client service charters for health facilities mentioned that they had learned about such charters by reading hospital posters. No, I have never heard of it, but I would like to know. (Participant 20). This is not the first time I am hearing about it; I have heard about it, but I have not read it in detail, just briefly... (Participant 1 in GD 3). Sources of patient rights information Most of the participants were able to highlight ways in which they received information about patients' rights. They mentioned sources of information such as media, including television and radio programs, the internet or social networks, posters that are placed in health facilities, leaflets, attending schools or colleges, and education that is provided in health facilities. Additionally, participants highlighted several ways that can be used to convey information to enhance awareness about patient rights; they pointed out issues such as seminars or meetings, continuous education of the community, the use of media and social networks in educating people, and increased mobilization. In my case, I learned about the rights of patients through the media. There are times when health programs are aired on TV stations, although not always. I also learned by reading various magazines but also when I am in the hospital, we are aware of our rights because we go for treatment, and we read the posters that are located in the hospitals. (Participant 1 in GD 2). There should be specialized units that provide education to patients or clients, and information about patients' rights should be put on social networks that will educate people about the rights of patients. However, there should also be posters in the hospital, and since there are TVs in most hospitals, there must be special programs that show the rights of patients and health workers. (Participant 10). Patients’ and healthcare providers’ responsibilities Some participants agreed and were able to highlight their duties as patients as well as the duties of healthcare workers. Most participants mentioned their duties, such as following hospital rules and instructions, expressing themselves to the health care provider when they arrive at health care facilities, and being responsible for incurring the costs of treatment. On the other hand, some of the participants highlighted the duties of the health care workers and mentioned duties such as following the required procedures while treating the patients, providing all necessary information to the patients, providing instructions to the patients, and taking care of and providing education to the patients so that patients can understand their rights. The patients’ responsibilities included following hospital procedures, taking medication on time, respecting other patients, and following the doctor's instructions. (Participant 12). ... I should be guided in an orderly and loving way, and I should be given good instructions, good advice, and among things. (Participant 6 in GD 1). Barriers to the implementation of patients’ rights Limited resources Most participants agreed that most of the patients’ rights are well implemented by healthcare workers in healthcare facilities, but there are some patients’ rights that are not well implemented because of the different limitations they are able to overcome. They mentioned issues such as a limited number of healthcare workers providing patients’ rights education to patients. Some are implemented, for example, the right to be treated, as well as some that are not implemented due to patients or clients not knowing their rights because even the doctors are few to teach patients their rights. (Participant 4 in GD 1). Other participants highlighted the shortage of information as one of the challenges; they suggested that despite being provided with information, it is not enough and cannot reach everyone in society, especially those living in rural areas, and because people are not living in the same area, sometimes it is difficult to gather and educate them about patient rights. In addition, the information given is sufficient to a certain extent. However, there are limitations for other people; for example, people living in rural areas do not receive enough information. (Participant 1 in GD 3). However, there is a challenge that may arise because not all people live in the same place. Therefore, it is good for the government to find a good way to reach all people and provide them with good education about the rights of patients. (Participant 3). Many participants highlighted financial concerns. The financial situation can help to enhance awareness of patients' rights. They suggested that funds could help educate the community about their patients’ rights through different programs. They highlighted that limited funds or a lack of funds can lead to complaints and a lack of satisfaction because patients' rights are not fulfilled. Others noted that sometimes they are required to pay some amount of money that they do not have, even though they have health insurance. On the other hand, other participants suggested that patients who are financially unable should be given priority in healthcare facilities. ... I use the NHIF card, and you can go to the pharmacy, but you are told that a certain type of medicine is not available. I have already paid for it, but you are told to go buy it with cash. Sometimes you're sick, and you do not have the money to buy those medicines with cash. This brings complaints because my needs as a patient are not fulfilled, but those with cash will buy, so we differ. (Participant 1 in GD 3). I would like to be well treated. For example, those who do not have financial ability should be given priority because people are different and do not have the same economy. Some people are unable to pay for their treatment, which causes people of low status to suffer and, in the end, not receive good services. (Participant 20). Discussion This study explored the awareness of patients’ rights to clinical services among clients attending the outpatient department at the Mawenzi Regional Referral Hospital. The study findings clearly show that the majority of the participants were aware of patients' rights. Many participants were able to explain the meaning of patients' rights and their responsibilities with examples, which were all correct. All participants were residents of Moshi municipality and had access to more information than people residing in rural areas. In terms of education level, most participants were at the secondary and college levels, where they learned about patient rights in different learning institutions and were also able to read posters and leaflets while in healthcare facilities. This finding is similar to that of a study by [ 11 ] involving 350 patients admitted to the wards of a tertiary care teaching hospital in India, where more than half of the participants were aware of their rights. On the other hand, a minority of the participants did not know what patients' rights were because of challenges such as information scarcity (information not reaching everyone in the community) and a language barrier. This finding is similar to that of a study by Maliki et al. (2014) involving patients attending 16 primary healthcare centres in Basra City, Iraq, where only 28% of the patients were aware of their rights. The findings of this study suggest that awareness of patient rights depends on the provision of patient rights information and the language used in sensitization. One of the patient's rights is to receive comprehensive and complete information from healthcare providers [ 12 ]. However, there are also several other sources of patient rights information, such as educational programmes provided by relevant authorities; media, such as TV, radio, and social networks; seminars; posters; and leaflets. In this study, a few participants reported receiving less information about patients' rights and not reaching many places. The findings suggest that if patients fail to obtain enough information through these sources, they are likely to be unaware of their rights. Therefore, there is a need to increase sensitization to reach many people, especially in rural areas. Language barriers can impact patient rights awareness if clients are unfamiliar with the language used in sensitization. Despite the display of the client service charter in Mawenzi Region Referral Hospital, the findings suggest that the majority of participants were not aware of the client service charter for healthcare facilities because of its language, despite being aware of the patient's rights. Good communication plays a significant role in the building of trust and respect in a patient-health professional relationship [ 13 ] and in facilitating quality care and informing and educating recipients of that care [ 14 ]. Language barriers have consequences for linguistic minorities' accessibility and quality of healthcare [ 15 – 17 ]. The findings of this study highlight the need to use simplified language in the sensitization of clients' charters for health facilities so that everyone can understand. The findings of this study suggest that limited awareness of patients' rights can cause violations of patients' rights, including corruption and the beating of patients when they arrive at healthcare facilities. On the other hand, awareness of patients' rights can result in improved healthcare quality and increased patient dignity by informing patients of their right to participate in decision-making [ 5 ]. Patients can demand their rights when they are violated. Healthcare providers can be accountable for health concerns at doctor‒patient interfaces [ 18 ]. Healthcare systems around the world are struggling with limited resources for the prevailing healthcare needs [ 19 , 20 ]. Participants suggested that limited resources at the micro and macro levels can impact awareness of patients’ rights. At the micro level, fulfilling these rights can be challenged by shortcomings, such as accessing better treatment and information. The findings suggest that there is a scarcity of information about patients’ rights that does not reach many people in the community. People living in rural areas have less access to information technology and media, which are critical in informing the community about patients’ rights [ 21 ]. Patients in higher economic strata choose better ward categories, resulting in better information assimilation from healthcare workers as a result of a lesser workload burden on healthcare providers [ 11 ]. At the macro level, limited resources such as funds can hinder the implementation of different sensitization programmes about patients' rights and contribute to having fewer healthcare providers, which impacts awareness of patients’ rights because the government can fail to employ enough competent healthcare providers who can educate patients about their rights. A shortage of healthcare providers in Africa is undermining access to better healthcare services [ 22 ]. Evidence shows that healthcare providers' ability to explain, listen to, and empathize with patients’ feelings may have a significant effect on disease outcomes [ 23 – 25 ]. Patients’ rights are best protected when healthcare providers are aware and conscious of these rights [ 26 – 28 ]. In the healthcare system, decision-making dilemmas arise when the need for medical resources cannot be met [ 29 ]. Additionally, there can be violations of patient rights because of limited resources. Thus, there is a need for the government to allocate enough resources to ensure the implementation of patients’ rights. Conclusion Participants were aware of patients' rights. Sources of patient rights information and the availability and responsibilities of healthcare providers were factors that influenced awareness of patient rights. To raise awareness, there is a need for more sensitization of patients' rights through the client's service charter of health facilities, and there should be a relevant health policy to guide the implementation of patients' rights. Limitations The study involved a variety of people with varying feelings, perceptions, and problems, which posed one of the researcher's challenges in gathering sufficient information about the study. Three focus group discussions with six participants in each group were intended to be conducted, but the number of participants who were willing to consent to participate in the focus group discussions in this study was minimal, which contributed to the low intended number of participants for the focus group discussions. In this regard, it was difficult to recruit six participants in each group to conduct a focused group discussion. Since the majority were afraid to participate because of issues such as being recorded during the discussion, thinking that the researcher was a journalist and wanted to investigate something, and others claiming to have less time to participate, this contributed to the limited number of participants intended for the focus group discussions. Therefore, the researcher opted for group discussions with four participants instead of conducting a focused group discussion. On the other hand, questions in IDI and GD were designed in a way that allowed the participants to develop some positive feelings toward the researcher while also using polite language that solved the problems and had the English questions translated into Swahili. To acknowledge the role of the researcher in this study, issues related to reflexivity were handled by building a rapport between the research team and the participants to avoid circumstances such as anger and loss of concentration during the study, but there was also transparency during the presentation of the results. On the other hand, social desirability bias was handled by probing questions. Abbreviations GD: Group Discussion, IDI: In-Depth Interview, WMA: World Medical Association, TV: Television, DC: District Council. Declarations Authors’ contributions GB developed the data collection tools. JO and BK read and approved this study. Funding This study was self-funded. Availability of data materials The data sources are available upon request. A request can be made to the corresponding author at [email protected] . 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Hojjatoleslami, Knowledge of students about Patient Rights and its relationship with some factors in Iran. Procedia-Social and Behavioral Sciences, 2012. 31 : p. 345-348. Bruun, H., et al., Ethical challenges experienced by prehospital emergency personnel: a practice-based model of analysis. BMC medical ethics, 2022. 23 (1): p. 1-14. Tables Tables 1 and 2 are available in the Supplementary Files section. Additional Declarations The authors declare no competing interests. Supplementary Files Tables.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4141472","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":282128561,"identity":"d2062935-180a-444e-b8cf-49ab95771216","order_by":0,"name":"Bahat Ernest","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/klEQVRIiWNgGAWjYBACAwYeOJvxQUIFkGJmbiCs5QCYycxs8OAMiGYkXgub5MM2sG34tZiznz34+UPFvTx+/vMHJBLn1UbztwO1/KjYhlOLZU9essSBM8XFkjOSGQwStx3PnXGYsYGx58xt3A47kGMgcbAtIXHDDWaGhMRtx3IbgFqYGdvwaDn/xvjHwX8JifvPH2Y4kDjnWO58glpu5JhJHGwA2sKQzNiQ2FCTu4GQFssZb8wszhxLSJxxI9mYIeHYgdyNQC0H8fnFnD/H+EZFTUJif//B5z9/1NTlzjt/+OCDHxW4taCDw2DyANHqgaCOFMWjYBSMglEwQgAAQmZkAMxEZe8AAAAASUVORK5CYII=","orcid":"","institution":"Makerere University","correspondingAuthor":true,"prefix":"","firstName":"Bahat","middleName":"","lastName":"Ernest","suffix":""},{"id":282129844,"identity":"c33550ee-8377-4504-9630-fe0c01cfeae7","order_by":1,"name":"Joseph Ochieng","email":"","orcid":"","institution":"Makerere University","correspondingAuthor":false,"prefix":"","firstName":"Joseph","middleName":"","lastName":"Ochieng","suffix":""},{"id":282129845,"identity":"d95d36cf-2a34-47a7-a474-e1f664ebfed6","order_by":2,"name":"Betty Kwagala","email":"","orcid":"","institution":"Makerere University","correspondingAuthor":false,"prefix":"","firstName":"Betty","middleName":"","lastName":"Kwagala","suffix":""}],"badges":[],"createdAt":"2024-03-21 07:18:30","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-4141472/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4141472/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":53231386,"identity":"65ccd885-89bd-43c1-912f-6f1927a2316c","added_by":"auto","created_at":"2024-03-22 07:37:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":295356,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4141472/v1/42cd3434-4766-45be-aaaa-341596044f14.pdf"},{"id":53231071,"identity":"b25a9bb6-b837-4093-a432-c22c1a1e8ec5","added_by":"auto","created_at":"2024-03-22 07:29:44","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":18720,"visible":true,"origin":"","legend":"","description":"","filename":"Tables.docx","url":"https://assets-eu.researchsquare.com/files/rs-4141472/v1/760c5c0af81d93757eb7e738.docx"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eAwareness of Patients’ rights in Clinical Services among Clients Attending the Outpatients Department at Mawenzi Regional Referral Hospital, Tanzania\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe oldest (more than 2,500 years old) medical code in the Hippocratic Corpus, otherwise known as the Hippocratic Oath, contains several elements that emphasize the commitment to the well-being of patients [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The Hippocratic Oath requires healthcare providers to exercise patients\u0026rsquo; rights and provide care to patients to the best of their ability. Commonly established patients\u0026rsquo; rights tend to derive from a core set of ethical principles, including autonomy of the patient, beneficence, nonmaleficence, justice, patient-provider fiduciary relationships, and inviolability of human life. In many situations, beliefs may directly conflict with one another when the legal standard does not exist; it remains the obligation of the healthcare provider to prioritize these principles to achieve an acceptable outcome for the patient [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Awareness of patients\u0026rsquo; rights can bring about many advantages, such as increased quality of health care services, decreased costs, more prompt recovery, decreased length of stay in hospitals, lower risk of irreversible physical and spiritual damage, and more importantly, increased dignity of patients through informing them about their rights to participate in decision making [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. A lack of respect for patients\u0026rsquo; rights may lead to hazards to the security and health situation of patients [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]; in addition, a lack of respect may ruin the relationship between staff and patients, which consequently decreases the efficiency, effectiveness, and suitability of care for patients [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In Tanzania, a study by [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] conducted in Hai DC and Morogoro DC revealed that awareness of the right to access maternal health services was low among the studied population. This implies that the majority of the people are not aware of the patient\u0026rsquo;s rights, but studies are lacking in the general population who are clients, which brings out uncertainty about awareness of their rights. Therefore, this study aimed to explore the awareness of patients\u0026rsquo; rights to clinical services among clients attending the outpatient department at the Mawenzi Regional Referral Hospital.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis was an exploratory cross-sectional study design that employed qualitative methods. The study was carried out among clients attending the outpatient department at Mawenzi Regional Referral Hospital in the Kilimanjaro region of Tanzania. These are the medical unit, care and treatment clinic (CTC) unit, gynecology unit, and tuberculosis and leprosy unit. The data were collected through in-depth interviews and group discussions adopted from different literature reviews on awareness of patients\u0026rsquo; rights. The researcher integrated in-depth interviews and group discussions for the purpose of data completeness and confirmation [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The interview guides for the IDI and GD were pretested to determine if they adequately answered the research questions, and thereafter, the questions for the IDI and GD were revised accordingly. The data obtained from both instruments were rich and of good quality.\u003c/p\u003e \u003cp\u003eIn-depth interviews and group discussions were conducted among the individuals who were purposively selected based on their age, locality, and outpatient department attendance. Patients aged 18 years and older who were admitted to the outpatient department at MRRH were recruited for the IDI. For group discussions, the researcher organized three groups: the first group comprised six (6) participants, and the remaining two groups consisted of four (4) participants. The first group consisted of clients aged 18\u0026ndash;39 years, the second group consisted of clients aged 40\u0026ndash;59 years, and the third group consisted of clients aged 60 years and older. Participants recruited for IDI were not recruited for GD. The researcher first introduced himself to potential participants and provided them with information about the study and thereafter obtained written consent from each individual who was willing to participate in this study. Before the discussion, participants were asked to respect the privacy of other members by not disclosing any content discussed during the study.\u003c/p\u003e \u003cp\u003eThe researcher first introduced himself to potential participants and provided them with information about the study and thereafter obtained written consent from each individual who was willing to participate. Each interview took approximately 45 minutes, and group discussions took approximately 1 hour and 30 minutes and were audio-recorded after receiving permission from each participant. The audio recorder was protected by a password. The researcher used Swahili because the majority of people understood it, as suggested by [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. In-depth interviews were conducted by the researcher; unlike in the group discussions, there were no field notes taken. The data were collected for eight (8) days: five (5) days for in-depth interviews, with four (4) participants interviewed each day for a total of twenty (20) participants, and three (3) days for three (3) group discussions, with one (1) group discussion conducted per day.\u003c/p\u003e \u003cp\u003eAudio recordings for the in-depth interviews and group discussions were transcribed verbatim, then translated to English and analysed based on themes using Nvivo 12 software as described by [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Initial codes from the data were generated. These codes identified aspects of the data that appeared interesting to the researcher. The different codes generated were categorized into potential themes. The themes were defined and refined for analysis. Data coding was performed by a researcher and trained research assistant. The IDI and GD transcripts had the same questions, so they were not analysed separately. The data were analysed using inductive thematic analysis, which allowed the identification and identification of themes in this study.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eEthical considerations\u003c/h2\u003e \u003cp\u003e The researcher obtained ethical approval from the School of Biomedical Sciences Research and Ethics Committee at Makerere University College of Health Sciences with approval number SBS2022-202 and the Tanzania National Health Research Ethics Committee (NatHREC) with approval number NIMR/HQ/R.8a/Vol.1X/4188. Written informed consent was obtained from all participants before they participated in the study. Participation in the study was voluntary, and participants were free to withdraw at any time without any consequence. Their confidentiality was maintained, their names were not attached to the information that was collected, and each participant was assigned a specialized notification number. Participants were compensated for their time.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eIn the in-depth interviews, the total number of participants was 20. There were 10 males and 10 females. Most participants\u0026mdash;eight (8)\u0026mdash;ranged in age from 18 to 28. There were 9 married participants and 11 single participants. Sixteen (16) belonged to the Christian faith, while 4 were Muslims. There were 9 out of the 20 skilled participants. Eleven (11) had reached the college or university level, while 9 were below the college or university level. All participants were residents of Moshi municipality.\u003c/p\u003e\n\u003cp\u003eIn group discussions, the number of participants was 14. There were 6 participants in the first group, aged 18\u0026ndash;39; 4 in the second group, aged 40\u0026ndash;59; and 4 in the third group, aged 60 and above. Overall, in both groups, there were 5 males and 9 females. There were 11 married participants and 3 widows. Nine belonged to the Christian faith, while 5 were Muslims. There were 7 out of 14 skilled participants. Two had reached the college or university level, while 12 were below the college or university level. All participants were residents of Moshi municipality, as summarized in Table\u0026nbsp;1 below. As summarized in Table\u0026nbsp;1.\u003c/p\u003e\n\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\n\u003cdiv id=\"Sec19\" class=\"Section3\"\u003e\n\u003ch2\u003eEmerged Themes and Subthemes\u003c/h2\u003e\n\u003cp\u003eTwo themes emerged with four subthemes from the in-depth interviews and group discussion transcripts. \u003cspan class=\"BoldUnderline\"\u003eThe first theme\u003c/span\u003e was awareness of patients' rights, with three subthemes: understanding patient rights, sources of patient rights, and patient and healthcare provider responsibilities. \u003cstrong\u003eThe second theme\u003c/strong\u003e: barriers to the implementation of patients\u0026rsquo; rights, with one subtheme: limited resources. Themes and subthemes are summarized in Table\u0026nbsp;2 below.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\n\u003cdiv id=\"Sec21\" class=\"Section3\"\u003e\n\u003ch2\u003eAwareness of patients' rights\u003c/h2\u003e\n\u003cdiv id=\"Sec22\" class=\"Section4\"\u003e\n\u003ch2\u003eUnderstanding of patient rights\u003c/h2\u003e\n\u003cp\u003eMost participants agreed that there are patient rights, and they were able to explain patient rights with examples. Depending on their understanding, some participants were able to provide detailed information, such as defining what patient rights are and giving examples. They highlighted several rights, such as the right to medical care, the right to information, the right to privacy, and the right to choices and dignity. Additionally, others linked patients\u0026rsquo; rights with human rights and highlighted that patients\u0026rsquo; rights are part of human rights. On the other hand, other participants were not able to provide such detailed information about patient rights, but they had an idea about them and agreed that they existed.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003eYes, patients have the right to receive the right care, such as medicine or the right treatment; they also have the right to choose what type of healthcare provider to serve them; they have the right to disclose their secrets to the healthcare provider; and they have the right not to disclose their secrets to the healthcare provider, who they are all patients' rights. (Participant 14).\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eOn the other hand, despite the display of the client service charter for healthcare at Mawenzi Regional Referral Hospital, most participants had no idea what a client service charter for health facilities was; it was their first time hearing about it. The few who had ideas about client service charters for health facilities mentioned that they had learned about such charters by reading hospital posters.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003eNo, I have never heard of it, but I would like to know. (Participant 20).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThis is not the first time I am hearing about it; I have heard about it, but I have not read it in detail, just briefly... (Participant 1 in GD 3).\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec23\" class=\"Section3\"\u003e\n\u003ch2\u003eSources of patient rights information\u003c/h2\u003e\n\u003cp\u003eMost of the participants were able to highlight ways in which they received information about patients' rights. They mentioned sources of information such as media, including television and radio programs, the internet or social networks, posters that are placed in health facilities, leaflets, attending schools or colleges, and education that is provided in health facilities. Additionally, participants highlighted several ways that can be used to convey information to enhance awareness about patient rights; they pointed out issues such as seminars or meetings, continuous education of the community, the use of media and social networks in educating people, and increased mobilization.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003eIn my case, I learned about the rights of patients through the media. There are times when health programs are aired on TV stations, although not always. I also learned by reading various magazines but also when I am in the hospital, we are aware of our rights because we go for treatment, and we read the posters that are located in the hospitals. (Participant 1 in GD 2).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThere should be specialized units that provide education to patients or clients, and information about patients' rights should be put on social networks that will educate people about the rights of patients. However, there should also be posters in the hospital, and since there are TVs in most hospitals, there must be special programs that show the rights of patients and health workers. (Participant 10).\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec24\" class=\"Section3\"\u003e\n\u003ch2\u003ePatients\u0026rsquo; and healthcare providers\u0026rsquo; responsibilities\u003c/h2\u003e\n\u003cp\u003eSome participants agreed and were able to highlight their duties as patients as well as the duties of healthcare workers. Most participants mentioned their duties, such as following hospital rules and instructions, expressing themselves to the health care provider when they arrive at health care facilities, and being responsible for incurring the costs of treatment. On the other hand, some of the participants highlighted the duties of the health care workers and mentioned duties such as following the required procedures while treating the patients, providing all necessary information to the patients, providing instructions to the patients, and taking care of and providing education to the patients so that patients can understand their rights.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003eThe patients\u0026rsquo; responsibilities included following hospital procedures, taking medication on time, respecting other patients, and following the doctor's instructions. (Participant 12).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e... \u003cem\u003eI should be guided in an orderly and loving way, and I should be given good instructions, good advice, and among things. (Participant 6 in GD 1).\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec25\" class=\"Section3\"\u003e\n\u003ch2\u003eBarriers to the implementation of patients\u0026rsquo; rights\u003c/h2\u003e\n\u003cdiv id=\"Sec26\" class=\"Section4\"\u003e\n\u003ch2\u003eLimited resources\u003c/h2\u003e\n\u003cp\u003eMost participants agreed that most of the patients\u0026rsquo; rights are well implemented by healthcare workers in healthcare facilities, but there are some patients\u0026rsquo; rights that are not well implemented because of the different limitations they are able to overcome. They mentioned issues such as a limited number of healthcare workers providing patients\u0026rsquo; rights education to patients.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003eSome are implemented, for example, the right to be treated, as well as some that are not implemented due to patients or clients not knowing their rights because even the doctors are few to teach patients their rights. (Participant 4 in GD 1).\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eOther participants highlighted the shortage of information as one of the challenges; they suggested that despite being provided with information, it is not enough and cannot reach everyone in society, especially those living in rural areas, and because people are not living in the same area, sometimes it is difficult to gather and educate them about patient rights.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003eIn addition, the information given is sufficient to a certain extent. However, there are limitations for other people; for example, people living in rural areas do not receive enough information. (Participant 1 in GD 3).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eHowever, there is a challenge that may arise because not all people live in the same place. Therefore, it is good for the government to find a good way to reach all people and provide them with good education about the rights of patients. (Participant 3).\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eMany participants highlighted financial concerns. The financial situation can help to enhance awareness of patients' rights. They suggested that funds could help educate the community about their patients\u0026rsquo; rights through different programs. They highlighted that limited funds or a lack of funds can lead to complaints and a lack of satisfaction because patients' rights are not fulfilled. Others noted that sometimes they are required to pay some amount of money that they do not have, even though they have health insurance. On the other hand, other participants suggested that patients who are financially unable should be given priority in healthcare facilities.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e... \u003cem\u003eI use the NHIF card, and you can go to the pharmacy, but you are told that a certain type of medicine is not available. I have already paid for it, but you are told to go buy it with cash. Sometimes you're sick, and you do not have the money to buy those medicines with cash. This brings complaints because my needs as a patient are not fulfilled, but those with cash will buy, so we differ. (Participant 1 in GD 3).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eI would like to be well treated. For example, those who do not have financial ability should be given priority because people are different and do not have the same economy. Some people are unable to pay for their treatment, which causes people of low status to suffer and, in the end, not receive good services. (Participant 20).\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study explored the awareness of patients\u0026rsquo; rights to clinical services among clients attending the outpatient department at the Mawenzi Regional Referral Hospital. The study findings clearly show that the majority of the participants were aware of patients' rights. Many participants were able to explain the meaning of patients' rights and their responsibilities with examples, which were all correct. All participants were residents of Moshi municipality and had access to more information than people residing in rural areas.\u003c/p\u003e \u003cp\u003eIn terms of education level, most participants were at the secondary and college levels, where they learned about patient rights in different learning institutions and were also able to read posters and leaflets while in healthcare facilities. This finding is similar to that of a study by [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] involving 350 patients admitted to the wards of a tertiary care teaching hospital in India, where more than half of the participants were aware of their rights.\u003c/p\u003e \u003cp\u003eOn the other hand, a minority of the participants did not know what patients' rights were because of challenges such as information scarcity (information not reaching everyone in the community) and a language barrier. This finding is similar to that of a study by Maliki et al. (2014) involving patients attending 16 primary healthcare centres in Basra City, Iraq, where only 28% of the patients were aware of their rights.\u003c/p\u003e \u003cp\u003eThe findings of this study suggest that awareness of patient rights depends on the provision of patient rights information and the language used in sensitization. One of the patient's rights is to receive comprehensive and complete information from healthcare providers [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. However, there are also several other sources of patient rights information, such as educational programmes provided by relevant authorities; media, such as TV, radio, and social networks; seminars; posters; and leaflets.\u003c/p\u003e \u003cp\u003eIn this study, a few participants reported receiving less information about patients' rights and not reaching many places. The findings suggest that if patients fail to obtain enough information through these sources, they are likely to be unaware of their rights. Therefore, there is a need to increase sensitization to reach many people, especially in rural areas.\u003c/p\u003e \u003cp\u003eLanguage barriers can impact patient rights awareness if clients are unfamiliar with the language used in sensitization. Despite the display of the client service charter in Mawenzi Region Referral Hospital, the findings suggest that the majority of participants were not aware of the client service charter for healthcare facilities because of its language, despite being aware of the patient's rights. Good communication plays a significant role in the building of trust and respect in a patient-health professional relationship [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] and in facilitating quality care and informing and educating recipients of that care [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Language barriers have consequences for linguistic minorities' accessibility and quality of healthcare [\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The findings of this study highlight the need to use simplified language in the sensitization of clients' charters for health facilities so that everyone can understand.\u003c/p\u003e \u003cp\u003eThe findings of this study suggest that limited awareness of patients' rights can cause violations of patients' rights, including corruption and the beating of patients when they arrive at healthcare facilities. On the other hand, awareness of patients' rights can result in improved healthcare quality and increased patient dignity by informing patients of their right to participate in decision-making [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Patients can demand their rights when they are violated. Healthcare providers can be accountable for health concerns at doctor‒patient interfaces [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHealthcare systems around the world are struggling with limited resources for the prevailing healthcare needs [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Participants suggested that limited resources at the micro and macro levels can impact awareness of patients\u0026rsquo; rights. At the micro level, fulfilling these rights can be challenged by shortcomings, such as accessing better treatment and information.\u003c/p\u003e \u003cp\u003eThe findings suggest that there is a scarcity of information about patients\u0026rsquo; rights that does not reach many people in the community. People living in rural areas have less access to information technology and media, which are critical in informing the community about patients\u0026rsquo; rights [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Patients in higher economic strata choose better ward categories, resulting in better information assimilation from healthcare workers as a result of a lesser workload burden on healthcare providers [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAt the macro level, limited resources such as funds can hinder the implementation of different sensitization programmes about patients' rights and contribute to having fewer healthcare providers, which impacts awareness of patients\u0026rsquo; rights because the government can fail to employ enough competent healthcare providers who can educate patients about their rights. A shortage of healthcare providers in Africa is undermining access to better healthcare services [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Evidence shows that healthcare providers' ability to explain, listen to, and empathize with patients\u0026rsquo; feelings may have a significant effect on disease outcomes [\u003cspan additionalcitationids=\"CR24\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePatients\u0026rsquo; rights are best protected when healthcare providers are aware and conscious of these rights [\u003cspan additionalcitationids=\"CR27\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. In the healthcare system, decision-making dilemmas arise when the need for medical resources cannot be met [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Additionally, there can be violations of patient rights because of limited resources. Thus, there is a need for the government to allocate enough resources to ensure the implementation of patients\u0026rsquo; rights.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eParticipants were aware of patients' rights. Sources of patient rights information and the availability and responsibilities of healthcare providers were factors that influenced awareness of patient rights. To raise awareness, there is a need for more sensitization of patients' rights through the client's service charter of health facilities, and there should be a relevant health policy to guide the implementation of patients' rights.\u003c/p\u003e "},{"header":"Limitations","content":"\u003cp\u003eThe study involved a variety of people with varying feelings, perceptions, and problems, which posed one of the researcher's challenges in gathering sufficient information about the study. Three focus group discussions with six participants in each group were intended to be conducted, but the number of participants who were willing to consent to participate in the focus group discussions in this study was minimal, which contributed to the low intended number of participants for the focus group discussions.\u003c/p\u003e\u003cp\u003e In this regard, it was difficult to recruit six participants in each group to conduct a focused group discussion. Since the majority were afraid to participate because of issues such as being recorded during the discussion, thinking that the researcher was a journalist and wanted to investigate something, and others claiming to have less time to participate, this contributed to the limited number of participants intended for the focus group discussions.\u003c/p\u003e\u003cp\u003e Therefore, the researcher opted for group discussions with four participants instead of conducting a focused group discussion. On the other hand, questions in IDI and GD were designed in a way that allowed the participants to develop some positive feelings toward the researcher while also using polite language that solved the problems and had the English questions translated into Swahili. To acknowledge the role of the researcher in this study, issues related to reflexivity were handled by building a rapport between the research team and the participants to avoid circumstances such as anger and loss of concentration during the study, but there was also transparency during the presentation of the results. On the other hand, social desirability bias was handled by probing questions.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eGD: Group Discussion, IDI: In-Depth Interview, WMA: World Medical Association, TV: Television, DC: District Council.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGB developed the data collection tools. JO and BK read and approved this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was self-funded.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data sources are available upon request. A request can be made to the corresponding author at [email protected].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe are grateful to the researchers who participated in this study, the Mawenzi Regional Referral Hospital Administration and the research participants at Mawenzi Regional Referral Hospital.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author declares no competing interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eVeatch, R., \u003cem\u003eMedical Ethics: An Introduction\u003c/em\u003e. Vol. 2nd Edition. 1997, Boston: Jones and Bartlett Publishers.\u003c/li\u003e\n\u003cli\u003eOlejarczyk, J.P. and M. 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Bowen, \u003cem\u003eImpact of Language Barriers on Quality of Care and Patient Safety for Official Language Minority Francophones in Canada.\u003c/em\u003e J Patient Exp, 2019. \u003cstrong\u003e6\u003c/strong\u003e(1): p. 24-32.\u003c/li\u003e\n\u003cli\u003eOu, L., J. Chen, and K. Hillman, \u003cem\u003eHealth services utilization disparities between English speaking and non-English speaking background Australian infants.\u003c/em\u003e BMC public health, 2010. \u003cstrong\u003e10\u003c/strong\u003e: p. 182.\u003c/li\u003e\n\u003cli\u003eMathew, M., et al., \u003cem\u003eTowards understanding accountability for physicians practice in India.\u003c/em\u003e Asian Journal of Psychiatry, 2023. \u003cstrong\u003e82\u003c/strong\u003e: p. 103505.\u003c/li\u003e\n\u003cli\u003eBrennan, P.F. and I. 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S123-5.\u003c/li\u003e\n\u003cli\u003eAlghanim, S.A., \u003cem\u003eAssessing knowledge of the patient bill of rights in central Saudi Arabia: a survey of primary health care providers and recipients.\u003c/em\u003e Annals of Saudi medicine, 2012. \u003cstrong\u003e32\u003c/strong\u003e(2): p. 151-155.\u003c/li\u003e\n\u003cli\u003eIltanen, S., et al., \u003cem\u003eKnowledge about patients\u0026rsquo; rights among professionals in public health care in Finland.\u003c/em\u003e Scandinavian journal of caring sciences, 2012. \u003cstrong\u003e26\u003c/strong\u003e(3): p. 436-448.\u003c/li\u003e\n\u003cli\u003eGhodsi, Z. and S. Hojjatoleslami, \u003cem\u003eKnowledge of students about Patient Rights and its relationship with some factors in Iran.\u003c/em\u003e Procedia-Social and Behavioral Sciences, 2012. \u003cstrong\u003e31\u003c/strong\u003e: p. 345-348.\u003c/li\u003e\n\u003cli\u003eBruun, H., et al., \u003cem\u003eEthical challenges experienced by prehospital emergency personnel: a practice-based model of analysis.\u003c/em\u003e BMC medical ethics, 2022. \u003cstrong\u003e23\u003c/strong\u003e(1): p. 1-14.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 and 2 are available in the Supplementary Files section.\u003c/p\u003e "}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Makerere University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Patients’ rights, Clients, Charter, Right","lastPublishedDoi":"10.21203/rs.3.rs-4141472/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4141472/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eWithout the appropriate understanding of the patient\u0026rsquo;s rights, the healthcare team may at times be prone to various tendencies, such as failure to respect patient autonomy, such as acting in a paternalist manner, or making clinical decisions on behalf of the patient or family; another way it can occur includes cases in which not all options, risks or side effects may be appropriately disclosed. This study explored the awareness of patients\u0026rsquo; rights to clinical services among clients attending the outpatient department at the Mawenzi Regional Referral Hospital.\u003c/p\u003e \u003cp\u003eMethods: This was an exploratory cross-sectional study design that employed qualitative methods for data collection. The study was carried out among 34 clients attending the outpatient department at Mawenzi Regional Referral Hospital in the Kilimanjaro region, Tanzania: the medical unit, the Care and Treatment Clinic (CTC) unit, the gynecology unit, and the TB and leprosy unit. In-depth interviews were conducted with 20 participants, while 14 participants participated in group discussions. The data were analysed via inductive thematic analysis, which allowed the data to identify and determine the themes in this study, which were then presented in the form of extracts or quotes. Nvivo 12 software was used to support the data analysis.\u003c/p\u003e \u003cp\u003eResults: The majority of the participants were aware of patients' rights. They cited patient rights such as the right to medical care, the right to information, the right to privacy, and the right to choices and dignity. The minority were not able to do so because of challenges such as information not reaching everyone in the community (information scarcity) and a language barrier.\u003c/p\u003e \u003cp\u003eConclusion: To increase awareness, there is a need for more sensitization of patients' rights through the client's service charter for health facilities and a relevant health policy to guide the implementation of patients' rights.\u003c/p\u003e","manuscriptTitle":"Awareness of Patients’ rights in Clinical Services among Clients Attending the Outpatients Department at Mawenzi Regional Referral Hospital, Tanzania","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-22 07:29:39","doi":"10.21203/rs.3.rs-4141472/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"390f7de1-afe0-4aba-96d2-b5033a5c4a1e","owner":[],"postedDate":"March 22nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":29705844,"name":"Health Law"}],"tags":[],"updatedAt":"2024-03-22T07:29:39+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-22 07:29:39","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4141472","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4141472","identity":"rs-4141472","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}