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Table of Contents
Year : 2022  |  Volume : 5  |  Issue : 3  |  Page : 247-253

Patient bill of rights knowledge and perceived practice among females visiting a patient safety event at King Saud University

1 Department of Family and Community Medicine, College of Medicine; King Saud University Medical City; Prince Sattam Bin Abdulaziz Research Chair for Epidemiology and Public Health, Department of Family and Community Medicine, College of Medicine, Riyadh, Kingdom of Saudi Arabia
2 Department of Family and Community Medicine, College of Medicine; King Saud University Medical City, Riyadh, Kingdom of Saudi Arabia
3 King Saud University Medical City; Department of Physiology, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
4 College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia

Date of Submission08-Nov-2021
Date of Decision01-Jan-2022
Date of Acceptance13-Jan-2022
Date of Web Publication08-Jul-2022

Correspondence Address:
Rufaidah Mohammad Dabbagh
Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh
Kingdom of Saudi Arabia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jnsm.jnsm_141_21

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Objectives: This study aimed to assess the level of knowledge about the patient bill of rights (PBR) among visitors of the King Saud University (KSU) “Patient Safety Day” event and the associated demographic features, to measure the level at which these PBR items were observed among the visitors during their medical care experiences, and to assess the perception of the importance of the PBR items from the participants' perspectives. Materials and Methods: A cross-sectional survey among visitors of the KSU “Patient Safety Day” event was conducted, using interview-based questionnaires. The questionnaire was adapted from the items assessed in previous studies exploring knowledge of PBR. All analyses were conducted using a statistical analysis system. Results: Around 198 individuals participated in the surveys (response = 95.2%) and the majority of them were students. Only 28.6% of them reported being aware of the PBR mainly from hospital posters (27.3%) and by a treating physician (1.8%). Results of the survey did not yield significant associations between the knowledge of PBR and each of the levels of completed education and participant status. The faculty and staff had greater odds of knowing about PBR compared to the students (odds ratio = 1.93, 95% confidence interval = 0.60, 6.00). Conclusion: The study showed that only about a quarter of the participants reported being aware of the PBR. This necessitates increasing the efforts of health-care facilities to educate their patients about PBR. Hospital posters may be the best way to introduce these PBR to patients. However, this does not replace the need for direct communication about PBR by treating health-care teams.

Keywords: Healthcare, patient bill of rights, patient-centeredness, patient safety, satisfaction

How to cite this article:
Dabbagh RM, Alyousefi NA, Alrowais NA, Alduraywish SA, Saja M, Alwatban L, Al-Qahtani S, Al-Nomi A. Patient bill of rights knowledge and perceived practice among females visiting a patient safety event at King Saud University. J Nat Sci Med 2022;5:247-53

How to cite this URL:
Dabbagh RM, Alyousefi NA, Alrowais NA, Alduraywish SA, Saja M, Alwatban L, Al-Qahtani S, Al-Nomi A. Patient bill of rights knowledge and perceived practice among females visiting a patient safety event at King Saud University. J Nat Sci Med [serial online] 2022 [cited 2022 Aug 11];5:247-53. Available from: https://www.jnsmonline.org/text.asp?2022/5/3/247/350296

  Introduction Top

Good health and education are two fundamental aspects that promote the growth of human societies. Ensuring good health requires establishing rules and regulations that govern the way they are administered and practiced. Moreover, access to the highest standard of health care is considered an essential right for every human being.[1] One of the requirements to ensure good practice in health-care systems is awareness of both sides: the health-care provider and the recipient, about their rights and responsibilities.

In line with this notion, the General Directorate of the Patient Relations Program at the Ministry of Health in Saudi Arabia has published their first Patients' Bill of Rights and Responsibilities (PBR) in 2006, which was revised in 2011.[2] It comprises 12 items pertaining to respect, autonomy, confidentiality, and other basic health-care treatment rights [Table 1]. This PBR should be strictly implemented at any health-care center.[2] Learning and applying the ethical principles in these rights by both patients and physicians is essential for providing patients with the highest level of quality in care. Most importantly, involving patients in their medical care decisions can improve patient satisfaction, improve patient compliance to treatment, produce favorable health outcomes, and ultimately reduce health costs in the community.[3]
Table 1: The patients' bill of rights and responsibilities in Saudi Arabia

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In Saudi Arabia, few studies have assessed patient awareness of their medical conditions or awareness of patients and physicians about PBR. In 2005, a study assessed the awareness of 501 patients about diagnosis and complications of their disease.[4] Around 64.1% of these patients knew their diagnosis, whereas only 20% knew the complications.[4] Another study conducted at primary health-care centers found that 21% of patients and 66.1% of primary health-care staff were aware about the existence of PBR.[5] When the extent of implementation of items in the bill of rights was assessed, patients on an average had a lower perception that these were implemented compared to the hospital staff. A similar study conducted in Riyadh by Halawany et al. showed that despite adequate knowledge on patients' rights, patients reported that these rights were not adequately observed at their treating centers.[6] Additionally, there was a positive association between patient education and practicing the right for filing medical complaints, and the right for shared decision-making in treatment.[6] In Almadinah Almonawarah, 52.3% of patients visiting private and public sector hospitals reported knowing about PBR. Interestingly, most of these patients learned about PBR from posters in the attended hospitals.[7] Other studies have assessed the knowledge of PBR among health-care students. Surprisingly, a study conducted among students of applied medical sciences found that 92% of the students surveyed did not know any of the 12 items on the PBR.[8]

Educating the public about PBR is important for improving the provision of health care in the community. As accessibility to patient health counseling lacks in many hospitals in Saudi Arabia, especially when it comes to treatment,[9] educating patients about PBR becomes necessary. Although previous studies attempted to assess patients' knowledge about PBR, most have assessed the knowledge in terms of overall knowledge scores that are difficult to interpret, with a minimal assessment of the association of demographic characteristics with the awareness about PBR. Addressing the awareness of individuals about PBR can help in directing efforts toward the need to provide better methods for educating patients about their rights by involving them in shared decision-making and improving the quality of health-care services in the community.

The aim of this study was three-fold. First, we aimed to measure the percentage of knowledge about PBR among visitors of the King Saud University (KSU) “Patient Safety Day” event and the demographic features associated with this knowledge. Second, we measured the level at which these PBR items were observed among the visitors during their medical care experiences. Third, we assessed the perception of the importance of the PBR items from the participants' perspectives.

  Materials and Methods Top

Study population and setting

In March 2019, KSU female campus organized a “Patient Safety Day” event. This was a 2-day event that took place on March 17 and March 18, 2019. The event was directed to students, faculty, and staff at KSU females' campus to educate them about patient safety. As part of the organizing committee, we took the opportunity to conduct the current study, addressing PBR, an important aspect of patient safety. We conducted a cross-sectional survey among visitors of this event, using interview-based questionnaires. We included any females visiting the event from students, faculty, or staff. Because the event was exclusively held at the female campus, all male KSU students, faculty, and staff were excluded. Additionally, because the questionnaires were only administered in Arabic or English, we excluded individuals who did not speak these two languages.

Sample size and sampling technique

Anticipating that the majority of people visiting the patient safety event would most probably be KSU students, we used an estimate for student's knowledge about PBR as our priority. According to a previous Saudi study, only 8% of students from health-care fields knew about the PBR items.[8] Thus, assuming a confidence interval (CI) width of 5%, a proportion of 8%, a confidence level of 95%, and a response rate of 55%, the estimated sample size was 208. We applied a convenience sampling technique for this study. Data collectors approached individuals at the entry point to the Patient Safety Day exhibit until the sample size was achieved.

Study tool and variables

The study tool was adapted from the items assessed in previous Saudi studies exploring knowledge of PBR.[6],[7],[8] The questionnaire was constructed in English, translated to Arabic, and then back-translated to English to ensure language accuracy. The questionnaire consisted of two parts. The first part included questions about personal characteristics, including age, the participant's status (student, faculty or staff, and visitor), and the level of completed education. It also inquired about whether the participant had a recent health-care facility visit and the knowledge about the medical condition, treatment, and complications, if present. The second part addressed knowledge about PBR and the source of knowledge. Knowledge about PBR was assessed by the question: “Have you ever heard about the PBR?” Participants who answered “yes” were coded as having knowledge about PBR.

In addition, the participants were asked to provide their level of agreement with observing items in the PBR in their health-care facility on a 5-point Likert scale (from strongly agree to strongly disagree). The items were rephrased into statements to make them clearer to participants. Finally, they were asked to rank the 12 items of PBR from most important to least important according to their perspectives.

Data collection

Data were collected via face-to-face surveys conducted by trained data collectors. The surveys were administered through tablets, using Survey Monkey© (SurveyMonkey Inc., San Mateo, California, USA). These were administered in Arabic or English, depending on the preference of the participant.

Ethical considerations

The procedures followed in this study were in accordance with the ethical standards of the “KSU College of Medicine Research Center Institutional Review Board” (ref. no. 19/0290/IRB; project no. E-19-3747; and approval date: 11/3/2019). Participants were verbally consented to participate after being informed about the study. Participation was voluntary, and data were collected anonymously. All data were handled with strict confidentiality.

Data analysis

Frequencies were calculated for categorical variables and mean and standard deviation (std) were calculated for age. We estimated the frequencies for knowing about the medical condition, treatment, and medical condition complications. We also estimated the prevalence of hearing about the PBR and reported 95% CI. Additionally, the source of knowledge of PBR was estimated. We assessed the association between odds for knowing about PBR (yes vs. no) and personal characteristics, using multivariate logistic regression analysis, for which we reported odds ratios and 95% CIs. Finally, we estimated the frequencies for observing each of the items on the PBR and the items that were ranked as “most important” by participants. All analyses were conducted using Statistical Analysis System.

  Results Top

A total of 198 individuals participated in the survey (response rate = 95.2%). The vast majority were students (85.9%), as this was an activity conducted at their campus. Thus, the mean age of the participants was 22.6 years (std = 4.8). A total of 181 participants had recently had a medical facility visit, during which 71.8% knew their medical condition and 88.4% had the condition explained to them by the treating physician [Table 2]. One-hundred and fourteen (68.5%) participants reported that they had been prescribed some sort of medication for the medical condition, while only 48.3% were aware of the complications of that medical condition.
Table 2: Characteristics of participants attending the King Saud University Patient Safety Day event, 2019 (n=198)

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Only 28.6% of the participants (95% CI = 22.3%, 34.9%) reported knowing about PBR. Of these, 27.3% reported learning about it from hospital posters, whereas only 1.8% were informed about it by a treating physician [Figure 1].
Figure 1: Reported sources of knowledge about the patients' bill of rights among participants visiting the Patient Safety Day event, 2019

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When the association of knowledge about PBR with both levels of completed education and participant status was assessed, none of these variables were significantly associated with PBR [Table 3]. Nevertheless, the data implied that faculty and staff (odds ratio [OR] = 1.93, 95% CI = 0.60, 6.00) as well as visitors (OR = 1.11, 95% CI = 0.23, 5.35) had greater odds for knowing about PBR compared to that of the students.
Table 3: Association of knowledge about the patients' bill of rights with participant status and level of education

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When examining the perceptions of individuals toward observing the PBR items during their medical visit, it was disappointing to see that only 33.1% of the participants agreed (agreed or strongly agreed) with the notion of being informed about the PBR. On the other hand, 81.2% agreed with being informed about their medical condition, while 74.6% agreed with feeling protected and safe [Figure 2].
Figure 2: Perceptions of participants toward observing the items on the patients' bill of rights during their recent medical visit

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The top five PBR items that were ranked as the highest priority from the participants' perspectives were getting access to health care (40.4%), knowing patients' and family's rights and responsibilities (29.3%), feeling respected and appreciated (25.3%), having patient's information privacy and confidentiality maintained (22.7%), and feeling that the treatment and management are safe (19.2%) [Figure 3].
Figure 3: Perceptions of participants toward the patients' bill of rights items that should be of top priority

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  Discussion Top

Lack of awareness of patients' rights may affect the quality of care and health outcomes. Previous studies showed that patients and health-care providers in Saudi Arabia are not well informed about these rights.[1],[4],[6],[9] The noteworthy findings from the current study can be summarized in the following points. First, among the participants visiting the “Patient Safety Event,” 28.6% knew about PBR. Second, the most common mean by which they were introduced to PBR was through hospital posters (27.3%). Third, the right to access to health care was the top-ranked item on the PBR according to the perceptions of the participants.

About a quarter of the participants reported knowing the PBR. This low proportion reported in our study is comparable to what was previously reported in the Kingdom.[8],[10],[11] Similar rates have also been reported in other countries. For example, a study in Turkey reported that 63% of the patients are not aware of their health-related rights.[12] A different study in Spain reported that only 20% of patients visiting the health facility have knowledge about their rights.[13] The low proportion reported among Saudi populations may be related to the possible negligence by our local health practitioners on one hand and the patients themselves on the other hand. However, the overall knowledge among this population, of whom the majority were students, was indeed higher than what was previously reported among students in the Saudi literature (8%).[8]

It was alarming to see that more than 20% of the participants in this study did not know about their medical conditions during their most recent visit to the health facility. This is concerning as it may result in poor compliance with health advice and medication consumption, leading to poor health outcomes. Previous Saudi and international studies reported higher proportions of patients being well-informed about their medical conditions. In 2008, Al-Khowaiter et al. reported that 64.1% of their patients were well informed about their diagnoses.[4] In Malaysia, the proportion was even higher (84%).[14] Similar proportions have been reported in India.[15]

KSU faculty and staff were more knowledgeable about PBR than students. This may be related to their older age and extended life experiences. The positive correlation between age and knowledge was also suggested by another Saudi study.[4] A similar study conducted in Poland also found low awareness about patients' rights among young adults.[16] However, one Egyptian study reported a negative correlation between increasing age and knowledge about patient's rights.[17]

Although the source of knowledge about the PBR varied considerably, hospital posters seemed to be the most prevalent source. This conflicted with another Saudi study that suggested that posters were the source of PBR knowledge for only 16.2% of the participants, who were medical students and interns.[18] Moreover, in Egypt, most patients are educated about their rights by their physicians (50.8%).[17] If patients in our community attribute most of their knowledge about PBR to the posters, this may reflect the lack of the role of health-care providers in directly conveying this knowledge to patients. It may also be related to the lack of knowledge about PBR among the health professionals themselves. The latter was suggested in a study conducted in the Eastern province of the Kingdom in 2017, where only 41% of the physicians sampled from that hospital were aware of PBR.[9] Local research suggests that 56% to 73% of the students believe that patients and their relatives should be informed by health professionals about their rights in order to improve patient outcomes.[11],[19]

The current study provides some insights about the awareness of PBR among our KSU female community. It shed some light about the low proportion of knowledge about patients' rights in addition to the need for education and empowerment of patients for the ultimate goal of improving health outcomes. However, our study was not free of limitations. First, the sample represented a special female population who was visiting a health educational event, and their perceptions may not be representative of the entire KSU community. Thus, it may be useful for future researchers to compare the level of knowledge between men and women, by selecting a more generalizable sample. Second, we only conducted the study on “patients” and were not able to capture the health professionals' perceptions about their contribution to improving patients' rights literacy. Furthermore, future qualitative assessment of patients' attitudes toward practicing their rights while navigating through the health-care system is important for directing health-care policies toward best methods for empowering patients and improving their capability in shared decision-making.

  Conclusion Top

Although many years have passed since the publication and enforcement of PBR at health-care organizations in the Kingdom, knowledge about these rights is still lacking in the community, and particularly among the young female adult population. Health practitioners may be neglectful about the awareness of their patients. As a result, they may have forgotten their important role in educating their patients about these rights. Each practitioner at the health organization is accountable for ensuring that patients are educated about their rights and are well-informed about their diagnoses and care management. They should also encourage patients and empower them to be proactive in the decision-making process. This is fundamental for improving patient satisfaction and population health outcomes.


We would like to thank the Deanship for Student Affairs at the King Saud University College of Medicine Campus for their facilitation of conducting the Patient Safety Event. We would also like to acknowledge Dr. Futoon Alnemri, Dr. Nuha Alhumaid, and Dr. Ibtihal Almeshawi for their contribution in the sampling of participants and data collection. We are extremely grateful to Professor Fatimah Al-Haidar, the Vice Dean for the College of Medicine at the time of the event, for her oversight of this health promotion event and her continuous encouragement and support.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

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Al-Khowaiter SS, Al-Maawi AM, Al-Obaidy MS, Al-Ali AS, Al-Rukban MO, Al-Sedrani YA, et al. Patients awareness of their medical conditions in multi-specialty outpatient clinics in Saudi Arabia. Saudi Med J 2008;29:1797-801.  Back to cited text no. 4
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  [Figure 1], [Figure 2], [Figure 3]

  [Table 1], [Table 2], [Table 3]


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