1Department of Studies & Research, Directorate General of Planning & Studies, Ministry of Health, Al Buraimi, Oman; 2Department of Registration & Licensing, Directorate General of Nursing Affairs, Ministry of Health, Muscat, Oman; 3Renal Dialysis Unit, Sohar Hospital, Sohar, Oman; 4Department of Staff Development & Training, Al Nahdha Hospital, Muscat, Oman *Corresponding Author’s e-mails: aysha-alsaadi@hotmail.com الوعي بأمهية حقوق املرضى واإللتزام هبا عند األطباء واملمرضني يف عمان دراسة حتليلية مقطعية - عرضية يف مستويات خمتلفة من الرعاية الصحية عائ�صة نا�رص �ل�صاعدية، �صالح عمار �صليمان، ر�وية علي �ل�صبلية، فاطمة يعقوب �جلابرية abstract: Objectives: This study aimed to determine the extent to which physicians and nurses in Oman were aware of the importance of and adhere to patients’ rights and whether this differed according to role, nationality, position and institutional healthcare level. Methods: This analytical cross-sectional study was carried out between December 2015 and March 2016 at various governmental healthcare institutions in Oman. A self-administered questionnaire was distributed to 1,385 practitioners at all healthcare levels. Results: A total of 1,213 healthcare practitioners (response rate: 87.58%) completed the survey, of which 685 (56.47%) were nurses and 528 (43.53%) were physicians. Overall, awareness of the importance of patients’ rights was high (91.51%), although adherence to these rights in practice was low (63.81%). The right of the patient to be informed was considered least important and was least adhered to (81.2% and 56.39%). Nationality, role and institutional level were significantly associated with awareness (P = 0.002, 0.024 and 0.034, respectively). Non-Omani staff were significantly more likely than Omani staff to be aware of (odds ratio [OR] = 1.696; P = 0.032) and adhere to (OR = 2.769; P <0.001) patient rights. Furthermore, tertiary care staff were twice as likely as primary care staff to perceive the importance of patient rights (OR = 2.076; P = 0.019). While physicians were more likely than nurses to be aware of the importance of patient rights, this difference was not significant (OR = 1.516; P = 0.126). Conclusion: These findings may help inform measures to enhance awareness of and adherence to patients’ rights in Oman. Keywords: Medical Ethics; Patient Rights; Awareness; Adherence; Physicians; Nurses; Oman. امللخ�ص: الهدف: هدفت هذه �لدر��صة لتحديد مدى وعي �الأطباء و�ملمر�صني يف ُعمان باأهمية حقوق �ملر�صى و�الإلتز�م بها، وعما �إذ� كان ذلك �لوعي و�اللتز�م يتفاوت بتفاوت �لوظيفة و�جلن�صية و�لدور �لوظيفي وم�صتوى �لرعاية �ل�صحية للموؤ�ص�صة. الطريقة: �أجريت هذه �لدر��صة �لتحليلية �ملقطعية �لعر�صية يف �لفرتة ما بني دي�صمرب 2015م ومار�س 2016م يف موؤ�ص�صات رعاية �صحية حكومية خمتلفة بعمان. مت توزيع ��صتمار�ت ��صتبيان على 1,385 ممار�ًصا �صحيا على جميع م�صتويات �لرعاية �ل�صحية. النتائج: �صارك يف �ال�صتبيان 1,213 ممار�صا �صحيا )بلغ معدل �ال�صتجابة %87.58(، وك�ن منهم 685 )%56.47( من �ملمر�صني و�ملمر�صات، و 528 )%43.53( من �الأطباء. تبني �أن وعي �الأطباء و�ملمر�صني باأهمية حقوق �ملر�صى كان عاليا على وجه �لعموم )%91.51(، غري �أن مدى �اللتز�م بتلك �حلقوق يف و�قع �لعمل كان منخف�صا )63.81%(. �أحقية �ملري�س يف �حل�صول على �ملعلومات بالن�صبة لهم �أقل �أهمية من غريه، كما �أن �اللتز�م بذلك كان قليال )%81.2 و %56.39، على �لتو�يل(. ووجدت عالقة ذ�ت داللة �ح�صائية بني م�صتوى �إدر�ك �أهمية حقوق �ملر�صى وجن�صية مقدمي �لرعاية �ل�صحية ووظيفتهم وم�صتوى �لرعاية )P = 0.032( وكان م�صتوى �الدر�ك باأهمية حقوق �ملر�صى �أعلى بـ 1.696 مرة .)0.024 و 0.034، على �لتو�يل ،P = 0.002( ل�صحية للموؤ�ص�صة� لدى �الأطباء و�ملمر�صني من غري �لعمانيني عنه لدى �لعمانيني، فيما كان م�صتوى �اللتز�م بحقوق �ملر�صى لديهم �أكرب بــ 2.769 مرة، مقارنة بالكادر �ل�صحي �لعماين )P >0.001(. وباالإ�صافة �إىل ذلك، كان م�صتوى �الإدر�ك باأهمية حقوق �ملر�صى �أعلى مرتني ( 2.076 )لدى �لكادر �ل�صحي بامل�صتوى �لثالث من �لرعاية �ل�صحية عنه لدى �لعاملني مبر�كز �لرعاية �ل�صحية �الأولية )P = 0.019(. وكان �الأطباء �أكرث �إدر�كا من �ملمر�صني باأهمية حقوق �ملر�صى، غري �أن ذلك �الختالف ال يعتد به �ح�صائيا )OR = 1.516 ؛ P = 0.126(. اخلال�صة: قد ت�صاعد هذه �لنتائج يف تعزيز �لتد�بري �لر�مية �إىل زيادة �لوعي بحقوق �ملر�صى يف ُعمان و�اللتز�م بها. الكلمات املفتاحية: �أخالقيات �لطب؛ حقوق �ملر�صى؛ �الإدر�ك؛ �الإلتز�م؛ �الأطباء؛ �لتمري�س؛ ُعمان. Awareness of the Importance of and Adherence to Patients’ Rights Among Physicians and Nurses in Oman An analytical cross-sectional study across different levels of healthcare *Aisha N. Al-Saadi,1 Salah B. A. Slimane,2 Rawya A. Al-Shibli,3 Fatema Y. Al-Jabri4 Sultan Qaboos University Med J, August 2019, Vol. 19, Iss. 3, pp. e201–208, Epub. 5 Nov 19 Submitted 4 Dec 18 Revision Req. 9 Jan 19; Revision Recd. 23 Feb 19 Accepted 18 Mar 19 This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License. https://doi.org/10.18295/squmj.2019.19.03.005 clinical & basic research Advances in Knowledge - This study found that while awareness of the importance of patients’ rights was high among nurses and physicians in Oman, adherence to these rights in actual practice was low. - Non-Omani staff were significantly more likely to be aware of and adhere to patient rights in comparison to Omani staff. - Tertiary care staff were twice as likely to be aware of the importance of patient rights compared to staff from primary healthcare institutions. https://creativecommons.org/licenses/by-nd/4.0/ Awareness of the Importance of and Adherence to Patients’ Rights Among Physicians and Nurses in Oman An analytical cross-sectional study across different levels of healthcare e202 | SQU Medical Journal, August 2019, Volume 19, Issue 3 The right to lead a healthy life is widely considered to be a fundamental human right.1 As such, promoting and assuring patients’ rights is an essential part of modern healthcare. In 1994, the World Health Organization (WHO) published a detailed declaration outlining the primary principles of patients’ rights in Europe.2 In Oman, Royal Decree #26/75 acknowledges patients as individuals with human rights and assures all citizens of their right to equal access to free of charge healthcare.3 By 2050, the Omani Ministry of Health (MOH) aims to have a responsive, equitable and efficient healthcare system that not only offers evidence-based care but also satisfies patients and attends to their needs.4 Previous research has revealed that awareness of patient rights by healthcare providers positively influences patient satisfaction.5,6 Moreover, a lack of observance of these rights in clinical practice erodes trust between patients and healthcare professionals and can endanger the life and safety of the patient.6,7 While physicians have been reported to have better knowledge of patient rights compared to nurses, both groups demonstrate similar levels of adherence in actual practice.6,8–10 In Saudi Arabia, healthcare professionals working at primary healthcare institutions were found to have little knowledge regarding the rights of their patients; furthermore, a lack of knowledge of patients’ rights, lack of standards and the legal system were identified as being barriers to the observance of patient rights in practice.11 Patients’ rights are best protected when health- care workers are aware and conscious of these rights.12–14 As such, data are needed regarding current levels of awareness of the importance of patients’ rights. However, to the best of the authors’ knowledge, no study has yet been conducted in Oman on this topic. This study therefore aimed to determine levels of awareness of and adherence to patients’ rights among physicians and nurses in Oman and potential associations with role, nationality, position and institutional healthcare level. Such findings may help decision-makers to take necessary steps to improve educational measures in this regard and improve the implementation of patients’ rights in practice. Methods This analytical cross-sectional survey was carried out between December 2015 and March 2016 at various governmental institutions. Physicians and nurses were initially targeted as they constitute a large proportion of the healthcare workforce in Oman and usually spend more time performing routine daily tasks with patients compared to other health professionals. Of the 17,007 physicians and nurses working at MOH institutions, 9,750 (57.33%) are Omani nationals and 7,257 (42.67%) are expatriates.15 A proportional stratified sampling technique was used to access approximately 8% of this population, assuming a 95% confidence level and a margin of error of 3%. The final sample size was 1,385 participants, including 663 physicians (47.87%) and 722 nurses (52.13%) from all primary healthcare centres, nine secondary hospitals and three tertiary institutions in Oman. An online sample size calculator (Raosoft Inc., Seattle, Washington, USA) was initially used to calculate the sample size; subsequently, a proportional size approach was implemented to determine the precise number of healthcare professionals targeted at each institution. Data were collected from the participants using a two-part English self-reported questionnaire designed specifically for this study. The first section of the questionnaire collected demographic information, incl- uding role, gender, years of experience, institutional level, position and nationality. The second part was designed to evaluate awareness of the importance of patients’ rights and frequency of observing these rights in clinical practice. As the official Oman Patient Rights Charter was not yet developed, 40 principles outlined in the WHO declaration on the promotion of patients’ rights in Europe were utilised.2,16 These items were divided into six domains: (1) respect and appreciation; (2) sufficient and timely information; (3) consent; (4) privacy and confidentiality; (5) care and treatment; and (6) partic- ipation in healthcare plan. Participants rated the imp- ortance of each item on a five-point Likert scale, with scores of 1–5 being unimportant, slightly important, moderately important, important and very important, respectively. Adherence to each item was similarly measured on a five-point Likert scale, with scores of 1–5 indicating never, rarely, often, daily and always, respectively. The questionnaire was tested for content validity and relevance by a senior expert at the MOH and all necessary modifications were implemented. The internal consistency of the tool was verified, with alpha coefficients of 0.92 and 0.94 for the importance and frequency of adherence subscales, respectively. A pilot Application to Patient Care - The findings of this study may help decision-makers formulate strategies to educate both healthcare providers and patients on this topic and ensure that such rights are observed in clinical practice. This would result in a radical improvement in the provision of healthcare in Oman and enhance patient safety and satisfaction. Aisha N. Al-Saadi, Salah B. A. Slimane, Rawya A. Al-Shibli and Fatema Y. Al-Jabri Clinical and Basic Research | e203 study of the survey was conducted in August 2015 with 49 healthcare professionals working in primary and secondary institutions in Al Buraimi Governorate. The final version of the questionnaire took into consid- eration the comments of the pilot group with regards to intelligibility, clarity and language. The questionn- aires were then distributed to participants by the head of the nursing department at each healthcare institution. Completed questionnaires were returned anonymously to confidential boxes placed in the office of the head of department. Data were analysed using the Statistical Package for the Social Sciences (SPSS), Version 20.0 (IBM Corp, Armonk, New York, USA). Prior to analysis, the raw data were processed for incompleteness, duplication and inaccuracy before being cleaned; moreover, some variables were combined (including total importance and adherence scores) for ease of analysis. Results were presented using descriptive statistics in the form of freq- uencies, percentages, means and standard deviations. A Chi-squared test and logistic regression model were used to assess the association between importance and adherence scores and demographic characteristics. The level of statistical significance was set at P <0.05. This study was approved by the Research Ethical Review & Approval Committee of the MOH. All participants filled a written informed consent form that accompanied each questionnaire along with a covering letter explaining the purpose and voluntary nature of the study and assuring the respondents’ anonymity. Results A total of 1,213 healthcare practitioners (response rate: 87.58%) took part in the study, of which 685 were nurses (56.47%) and 528 were physicians (43.53%). More than half were of Omani nationality (53.5%) and the majority were female (68.51%). A total of 679 healthcare practitioners were clinicians (55.98%), 141 had managerial responsibilities (11.62%) and 393 held both positions (32.4%). Participants had varying Figure 1: Overall frequency of perceived importance of and adherence to patients’ rights among physicians and nurses working at governmental healthcare institutions in Oman (N = 1,213). Table 1: Demographic characteristics of physicians and nurses working at governmental healthcare institutions in Oman (N = 1,213) Characteristic n (%) Gender Male 382 (31.49) Female 831 (68.51) Nationality Omani 649 (53.5) Non-Omani 564 (46.5) Role Nurse 685 (56.47) Physician 528 (43.53) Position Clinician 679 (55.98) Management 141 (11.62) Both 393 (32.4) Years of experience ≤5 266 (21.93) 6–10 328 (27.04) >10 619 (51.03) Institutional level Primary 489 (40.31) Secondary 386 (31.82) Tertiary 338 (27.87) Figure 2: Perceived importance of each patients’ rights domain among physicians and nurses working at governmental healthcare institutions in Oman (N = 1,213). Awareness of the Importance of and Adherence to Patients’ Rights Among Physicians and Nurses in Oman An analytical cross-sectional study across different levels of healthcare e204 | SQU Medical Journal, August 2019, Volume 19, Issue 3 degrees of experience, ranging from ≤5 years (21.93%) to >10 years (51.03%). Overall, 40.31%, 31.82% and 27.87% worked in primary, secondary and tertiary healthcare centres, respectively [Table 1]. Overall, there was a high level of perception of the importance of patient rights among physicians and nurses (91.51%), although actual adherence was low (63.81%) [Figure 1]. The domain of patients’ rights per- ceived to be most important was respect and appreciation (97.53%), while the least important domain was the patients’ right to be informed (81.2%) [Figure 2]. Similarly, the domain of respect and appreciation reflected the highest level of adherence (85.66%), while the domain least adhered to was that of sufficient and timely information (56.39%) [Figure 3]. In terms of specific rights, 1,077 nurses and physicians (88.79%) rated a patient’s right to be treated with dignity as being very important. The provision of honest care to dying patients was the right most frequently observed in clinical practice (71.81%). Nationality, role and institutional level were signif- icantly associated with perception of the importance of patients’ rights (P = 0.002, 0.024 and 0.034, respectively). There was also a significant relationship between adher- ence to patients’ rights and nationality (P <0.001) [Table 2]. In the logistic regression analysis, nationality remained Figure 3: Frequency of adherence to each patients’ rights domain among physicians and nurses working at governmental healthcare institutions in Oman (N = 1,213). Table 2: Associations between levels of awareness of the importance of and adherence to patients’ rights status and demo- graphic characteristics among physicians and nurses working at governmental healthcare institutions in Oman (N = 1,213) Characteristic n (%) P value n (%) P value Importance Adherence Yes No Yes No Gender Male 354 (92.67) 28 (7.33) 0.325 248 (64.92) 134 (35.08) 0.585 Female 756 (90.97) 75 (9.03) 526 (63.3) 305 (36.7) Nationality Omani 579 (89.21) 70 (10.79) 0.002 353 (54.39) 296 (45.61) <0.001 Non-Omani 531 (94.15) 33 (5.85) 421 (74.65) 143 (25.35) Role Nurse 616 (89.93) 69 (10.07) 0.024 429 (62.63) 256 (37.37) 0.330 Physician 494 (93.56) 34 (6.44) 345 (65.34) 183 (34.66) Position Clinician 626 (92.19) 53 (7.81) 0.626 435 (64.06) 244 (35.94) 0.643Management 128 (90.78) 13 (9.22) 94 (66.67) 47 (33.33) Both 356 (90.59) 37 (9.41) 245 (62.34) 148 (37.66) Years of experience ≤5 242 (90.98) 24 (9.02) 0.936 170 (63.91) 96 (36.09) 0.1306–10 301 (91.77) 27 (8.23) 195 (59.45) 133 (40.55) >10 567 (91.6) 52 (8.4) 409 (66.07) 210 (33.93) Institutional level Primary 438 (89.57) 51 (10.43) 0.034 321 (65.64) 168 (34.36) 0.279Secondary 352 (91.19) 34 (8.81) 234 (60.62) 152 (39.38) Tertiary 320 (94.67) 18 (5.33) 219 (64.79) 119 (35.21) Aisha N. Al-Saadi, Salah B. A. Slimane, Rawya A. Al-Shibli and Fatema Y. Al-Jabri Clinical and Basic Research | e205 a significant predictor, with non-Omani practitioners significantly more likely to be aware of the importance of patient rights (odds ratio [OR] = 1.696; P = 0.032) and more likely to adhere to these rights (OR = 2.769; P <0.001) in comparison to Omani staff. In addition, staff working at tertiary care centres were twice as likely to be aware of the importance of patient rights compared with those working in primary healthcare institutions (OR = 2.076; P = 0.019), although there was no significant difference in terms of adherence (OR = 0.848; P = 0.664). While physicians were more likely than nurses to be aware of the importance of patient rights, this difference was not significant (OR =1.516; P = 0.126) [Table 3]. Discussion From a patient’s perspective, the attitude and behaviour of their healthcare provider is the most important criterion to evaluate the quality of healthcare services rendered.10,17 Awareness of and adherence to patients’ rights therefore help to promote and sustain an effective relationship between patients and healthcare staff.2 As such, the importance of patients’ rights should be valued highly by all personnel in healthcare institutions. The current study was conducted in order to determine the extent to which physicians and nurses in Oman were aware of and adhere to various internationally accepted patient rights and potential associations with role, nationality, position and healthcare institutional level. In the present study, nurses and physicians in Oman demonstrated a high level of awareness of the importance of patients’ rights; however, adherence to these rights in actual practice was fairly low. Ducinskiene et al. revealed similar results, in which physicians and nurses in Lithuania were well-informed regarding patients’ rights but did not always take them into consideration in practice.18 Similarly, Sheikhtaheri et al. found that nurses’ awareness of the patients’ bill of rights in Iran was acceptable, while observance in clinical practice was subpar.9 As noted by Farzianpour et al., awareness of patients’ rights does not necessarily guarantee that such rights are observed in practice.5 These findings indicate that other factors apart from staff awareness and knowledge may need to be looked at in order to promote the observation of patients’ rights in clinical practice. Moreover, these results indicate that healthcare providers do not implement all patients’ rights in practice; therefore, it is vital to devise strategies to improve adherence levels. There was little variation in the current study in terms of the perceived importance of each of the six domains of patients’ rights, suggesting that nurses and physicians in Oman consider all domains to be important. Overall, the most important domain was respect and appreciation, particularly the patients’ right to be treated with dignity. Other studies conducted in Saudi Arabia and Iraq have reported similar results in which the most important rights were those that emanated from the care and respect domains.19,20 This could be due to the fact that patient rights included in this domain are deemed elemental human rights and constitute a fundamental part of the treatment process. In contrast, the current study found that the least important domain was related to the patient’s right to information; moreover, this domain was also least adhered to in clinical practice. Failure to observe this right is commonly reported in the international literature.21–23 In Ducinskiene et al.’s study, only half of the participating physicians agreed that informing patients of their diagnosis, medical results and treat- ment methods was a necessary right.18 In Singapore, a survey of medical professionals found that staff did not routinely inform patients of the benefits of their Table 3: Logistic regression analysis of associations between awareness of the importance of and adherence to patients’ rights status among physicians and nurses working at governmental healthcare institutions in Oman (N = 1,213) Variable Importance Adherence OR (95% CI) P value OR (95% CI) P value Gender (female versus male) 1.262 (0.734–2.171) 0.401 1.090 (0.872–1.626) 0.273 Nationality (Omani versus non-Omani) 1.696 (1.047–2.746) 0.032 2.769 (2.102–3.648) <0.001 Role (physician versus nurse) 1.516 (0.889–2.585) 0.126 1.197 (0.885–1.619) 0.244 Position (both clinician and MGT versus MGT alone) 1.136 (0.565–2.284) 0.970 1.045 (0.674–1.617) 0.994 Position (clinician versus MGT) 1.315 (0.666–2.598) 0.372 1.089 (0.716–1.656) 0.655 Years of experience (>10 versus 1–5 years) 1.103 (0.652–1.865) 0.984 1.057 (0.771–1.451) 0.237 Years of experience (6–10 versus 1–5 years) 1.205 (0.672–2.160) 0.568 0.829 (0.587–1.171) 0.125 Institutional level (secondary versus primary) 1.178 (0.740–1.875) 0.392 0.812 (0.610–1.082) 0.349 Institutional level (tertiary versus primary) 2.076 (1.175–3.670) 0.019 0.848 (0.624–1.150) 0.664 OR = odds ratio; CI = confidence interval; MGT = management. Awareness of the Importance of and Adherence to Patients’ Rights Among Physicians and Nurses in Oman An analytical cross-sectional study across different levels of healthcare e206 | SQU Medical Journal, August 2019, Volume 19, Issue 3 proposed treatment or of their available treatment options.24 Nekoei Moghaddam et al. and Sabzevari et al. similarly found that the patient right least adhered to was the right to receive adequate and appropriate information.25,26 Reasons for neglecting this right might include a lack of awareness or reluctance to recognise this right by healthcare providers. Accordingly, there is a need for increased educational efforts aimed at healthcare professionals, with particular emphasis on the patient’s right to the provision of sufficient and timely information. The current study observed significant positive associations between awareness of the importance of patients’ rights and the nationality, role and institutional level of the healthcare providers. In particular, nationality remained a significant predictor during logistic regression analysis, with non-Omani staff 1.7-times more likely to perceive the importance of patients’ rights and 2.8-times more likely to adhere to these rights compared to Omani staff. The reason for this finding is unknown; however, it may be that some of the non-Omani staff had previously received additional education or training regarding patients’ rights in other countries. Awareness of the importance of patients’ rights also differed signif- icantly according to institutional level, with patients’ rights twice as likely to be perceived as important by tertiary compared to primary healthcare workers. A previous study conducted in Oman reported patient dissatisfaction with patient-provider interactions in primary healthcare, including an unfriendly/unwelcoming tone, lack of privacy during consultation, poor attention/ eye contact, lack of encouragement to ask questions and an inability to participate in medical dialogue.27 In terms of role, while physicians in the present study had significantly higher levels of awareness compared to nurses, there was no significant difference in terms of adherence; moreover, this factor was not significant during the logistic regression analysis. Previous research conducted in developing countries has indicated lower levels of awareness of patients’ rights among nurses compared to doctors, with studies conducted in Turkey, India and Egypt reporting moderate levels of awareness among the former.6,10,28–30 The current study found no significant associations between years of experience and either perception of the importance of or adherence to patients’ rights. In contrast, other researchers have reported significantly higher levels of awareness among those with longer work experience.31,32 In addition, there were no significant differences in the present study in terms of position and gender. This finding is in agreement with previous research from Iran which reported no relationship between gender and awareness of patients’ rights.33 Unfortunately, when patients feel their rights are being violated, they may seek alternative mechanisms to meet their needs, such as attending emergency departments with primary healthcare problems or relying on self-management or self-medication to treat common medical conditions.34,35 Such health-seeking behaviours can have serious implications, not only on the individual’s health, but also on the healthcare system as a whole. Therefore, healthcare professionals’ knowledge of and implementation of patients’ rights should be evaluated regularly; moreover, continuous education on this subject should be provided. Barriers to a lack of adherence to patients’ rights among physicians and nurses may include a lack of knowledge, poor attitudes and job-related factors such as low salaries, stress/burnout and long working hours.8,14 In addition, healthcare professionals may also be faced with insufficient standards and a lack of necessary hospital equipment and staff.11,36,37 It is therefore important that such barriers be identified and appropriate strat- egies put in place in Oman in order to ensure that patient rights are adequately observed. This study was subject to certain limitations. Due to the lack of previous studies on this topic in Oman, the findings could not be compared with those of similar national research. Similarly, the authors could not benefit from other researchers’ experiences when designing the questionnaire. Moreover, this study was conducted prior to the development and publication of the official Patient Rights Charter by the MOH in Oman.15 Future studies are therefore recommended to evaluate healthcare providers’ awareness of and attitudes towards the rights outlined in this official charter at governmental hospitals, health centres and psychiatric hospitals in Oman. In addition, further research is necessary to determine barriers to the implementation of patients’ rights in Oman so that appropriate strategies can be developed to overcome them. Conclusion Nurses and physicians in Oman demonstrated a high level of awareness of the importance of patients’ rights; however, actual adherence to these rights in practice was low. Non-Omani staff were found to have significantly higher levels of awareness of and adherence to patients’ rights compared to Omani staff. Additionally, tertiary hospital staff were twice as likely to perceive patients’ rights to be important compared to primary healthcare practitioners. Strategies are needed to ensure that patient rights are adequately recognised and protected in Oman. Aisha N. Al-Saadi, Salah B. A. Slimane, Rawya A. Al-Shibli and Fatema Y. Al-Jabri Clinical and Basic Research | e207 c o n f l i c t o f i n t e r e s t The authors declare no conflicts of interest. f u n d i n g No funding was received for this study. References 1. Council of Europe Treaty Office. Details of treaty No.005: Convention for the protection of human rights and fundamental freedoms. From: http://conventions.coe.int/treaty/en/Treaties/ Html/005.html Accessed: Feb 2019. 2. World Health Organization Regional Office for Europe. A declaration on the promotion of patients’ rights in Europe: European consultation on the rights of patients, Amsterdam 28-30 March 1994. From: www.who.int/genomics/public/eu_ declaration1994.pdf Accessed: Feb 2019. 3. World Health Organization Regional Health Systems Observatory. Health system profile: Oman. From: http://apps.who.int/medici nedocs/documents/s17304e/s17304e.pdf Accessed: Feb 2019. 4. Oman Ministry of Health. Content resources: Health vision 2050. From: www.moh.gov.om/en/web/directorate-general-of- planning/resources Accessed: Feb 2019. 5. Farzianpour F, Rahimi Foroushani A, Shahidi Sadeghi N, Ansari Nosrati S. Relationship between’ patient’s rights charter’ and patients’ satisfaction in gynecological hospitals. BMC Health Serv Res 2016; 16:476. https://doi.org/10.1186/s12913-016-1679-9. 6. Mohammad Nejad E, Begjani J, Abotalebi G, Salari A, Ehsani SR. Nurses awareness of patients rights in a teaching hospital. J Med Ethics Hist Med 2011; 4:2. 7. Ozdemir MH, Ergönen TA, Sönmez E, Can IO, Salacin S. The approach taken by the physicians working at educational hospitals in Izmir towards patient rights. Patient Educ Couns 2006; 61:87–91. https://doi.org/10.1016/j.pec.2005.02.013. 8. Al-Muammar SA, Gari DMK. Doctors’ knowledge of patients’ rights at King Fahd Hospital of the University. J Family Comm- unity Med 2017; 24:106–10. 9. Sheikhtaheri A, Jabali MS, Dehaghi ZH. Nurses’ knowledge and performance of the patients’ bill of rights. Nurs Ethics 2016; 23:866–76. https://doi.org/10.1177/0969733015584967. 10. Uçar M. Ethical aspects of health services in the military context. TAF Prev Med Bull 2005; 4:37–45. 11. Albishi AA. The Saudi patients’, physicians’, and nurses’ perceptions of and lived experience with patients’ rights in Saudi Arabia: Qualitative phenomenological study. PhD thesis, 2004, George Manson University, Fairfax, Virginia, USA. 12. Ghodsi Z, Hojjatoleslami S. Knowledge of students about patient rights and its relationship with some factors in Iran. Procedia Soc Behav Sci 2012; 31:345–8. https://doi.org/10.1016/j.sbspro.2 011.12.065. 13. Iltanen, S, Leino-Kilpi H, Puukka P, Suhonen R. Knowledge about patients’ rights among professionals in public health care in Finland. Scand J Caring Sci 2012; 26:436–48. https://doi. org/10.1111/j.1471-6712.2011.00945.x. 14. Alghanim SA. Assessing knowledge of the patient bill of rights in central Saudi Arabia: A survey of primary health care providers and recipients. Ann Saudi Med 2012; 32:151–5. https://doi.org/10.5144/0256-4947.2012.151. 15. Department of Health Information & Statistics. Annual Health Report 2012 Chapter Four. Oman: Ministry of Health. Pp. 5–7. 16. Times of Oman. Patients’ rights and duties document launched in Oman. From: https://timesofoman.com/article/95002 Accessed: Feb 2019. 17. Zebiene E, Razgauskas E, Basys V, Baubiniene A, Gurevicius R, Padaiga Z, et al. Meeting patient’s expectations in primary care consultations in Lithuania. Int J Qual Health Care 2004; 16:83–9. https://doi.org/10.1093/intqhc/mzh006. 18. Ducinskiene D, Vladickiene J, Kalediene R, Haapala I. Awareness and practice of patient’s rights law in Lithuania. BMC Int Health Hum Rights 2006; 6:10. https://doi.org/10.1186/1472- 698X-6-10. 19. Saleh HA, Khereldeen MM. Physicians’ perception towards patients’ rights in two governmental hospitals in Mecca, KSA. Int J Pure Appl Sci Technol 2013; 17:37–47. 20. Khalaf SK, Al-Asadi JN, Abed AH, Shami SA, Al-Shamry H. Knowledge and attitudes towards patient’s rights among health care providers in primary care health centers in Basrah. Int J Med Pharm Sci 2014; 4:7–14. 21. Changole J, Bandawe C, Makanani B, Nkanaunena K, Taulo F, Malunga E, et al. Patients’ satisfaction with reproductive health services at Gogo Chatinkha Maternity Unit, Queen Elizabeth Central Hospital, Blantyre, Malawi. Malawi Med J 2010; 22:5–9. https://doi.org/10.4314/mmj.v22i1.55899. 22. Kuzu N, Ergin A, Zencir M. Patients’ awareness of their rights in a developing country. Public Health 2006; 120:290–6. https://doi.org/10.1016/j.puhe.2005.10.014. 23. Vaskooei Eshkevari K, Karimi M, Asnaashari H, Kohan N. The assessment of observing patients’ rights in Tehran University of Medical Sciences’ hospitals. J Med Ethics His Med 2009; 2:47–54. 24. Tay CSK. Recent developments in informed consent: The basis of modern medical ethics. Int J Rheum Dis 2005; 8:165–70. https://doi.org/10.1111/j.1479-8077.2005.00143.x. 25. Nekoei Moghaddam M, Amiresmaeili M, Ghobaninia R, Sharifi T, Tabatabaie SS. Awareness of patients’ rights charter and respecting it from the perspective of patients and nurses: A study of limited surgical centers in Kerman City, 2013. Bioeth J 2014; 4:31–56. 26. Sabzevari A, Kiani MA, Saeidi M, Jafari SA, Kianifar H, Ahanchian H, et al. Evaluation of patients’ rights observance according to patients’ rights charter in educational hospitals affiliated to Mashhad University of Medical Sciences: Medical staffs’ views. Electron Physician 2016; 8:3102–9. https://doi. org/10.19082/3102. 27. Abdulhadi N, Al Shafaee M, Freudenthal S, Ostenson CG, Wahlström R. Patient-provider interaction from the perspec- tives of type 2 diabetes patients in Muscat, Oman: A qualitative study. BMC Health Serv Res 2007; 7:162. https://doi.org/10.1 186/1472-6963-7-162. 28. Büken NO, Büken E. Emerging health sector problems affecting patient rights in Turkey. Nurs Ethics 2004; 11:610–24. https:// doi.org/10.1191/0969733004ne742oa. 29. Abou Zeina HA, El Nouman AA, Zayed MA, Hifnawy T, El Shabrawy EM, El Tahlawy E. Patients’ rights: A hospital survey in south Egypt. J Empir Res Hum Res Ethics 2013; 8:46–52. https://doi.org/10.1525/jer.2013.8.3.46. 30. Kumari K, Kumari V, Bishnoi AK. An exploratory study to assess the knowledge, expressed practices and barriers in protection of patients’ rights among nurses at MMIMS&R Hospital, Mullana, Ambala. IOSR J Nurs Health Sci 2013; 2:55–60. https://doi. org/10.9790/1959-0255560. 31. Parsapoor A, Mohammad K, Afzali HM, Ala’eddini F, Larijani B. Unsatisfied patient’s rights: A survey on the views of patients, nurses and physicians. J Med Ethics Hist Med 2012; 5:4. 32. Abu Saq IH, Al-Hutaylah NM, Al-Shahrani MA, Abualiat ZM, Al-Qahtani AM, Al-Shaybah FH, et al. Assessment of primary health care physicians’ awareness about patients’ rights. Med J Cairo Univ 2017; 85:651–5. https://doi.org/10.1186/s12913-016-1679-9 https://doi.org/10.1016/j.pec.2005.02.013 https://doi.org/10.1177/0969733015584967 https://doi.org/10.1016/j.sbspro.2011.12.065 https://doi.org/10.1016/j.sbspro.2011.12.065 https://doi.org/10.1111/j.1471-6712.2011.00945.x https://doi.org/10.1111/j.1471-6712.2011.00945.x https://doi.org/10.5144/0256-4947.2012.151 https://doi.org/10.1093/intqhc/mzh006 https://doi.org/10.1186/1472-698X-6-10 https://doi.org/10.1186/1472-698X-6-10 https://doi.org/10.4314/mmj.v22i1.55899 https://doi.org/10.1016/j.puhe.2005.10.014 https://doi.org/10.1111/j.1479-8077.2005.00143.x https://doi.org/10.19082/3102 https://doi.org/10.19082/3102 https://doi.org/10.1186/1472-6963-7-162 https://doi.org/10.1186/1472-6963-7-162 https://doi.org/10.1191/0969733004ne742oa https://doi.org/10.1191/0969733004ne742oa https://doi.org/10.1525/jer.2013.8.3.46 https://doi.org/10.9790/1959-0255560 https://doi.org/10.9790/1959-0255560 Awareness of the Importance of and Adherence to Patients’ Rights Among Physicians and Nurses in Oman An analytical cross-sectional study across different levels of healthcare e208 | SQU Medical Journal, August 2019, Volume 19, Issue 3 33. Arbabisarjou A, Zare S, Shahrakipour M, Kadkhodaie A. The rate of nurses’ awareness about patient’s bill of rights in teaching hospitals affiliated to the Zahedan University of Medical Sciences in 2016. Int J Med Res Health Sci 2016; 9S:620–4. 34. Rehmani R, Norain A. Trends in emergency department utilization in a hospital in the Eastern region of Saudi Arabia. Saudi Med J 2007; 28:236–40. 35. Panda A, Pradhan S, Mohapatro G, Kshatri JS. Predictors of over-the-counter medication: A cross-sectional Indian study. Perspect Clin Res 2017; 8:79–84. https://doi.org/10.4103/2229- 3485.203043. 36. Kagoya HR, Kibuule D, Mitonga-Kabwebwe H, Ekirapa-Kiracho E, Ssempebwa JC. Awareness of, responsiveness to and practice of patients’ rights at Uganda’s national referral hospital. Afr J Prim Health Care Fam Med 2013; 5:491. https://doi.org/10.4 102/phcfm.v5i1.491. 37. Anbari Z, Mohammadi M, Taheri M. Satisfying patients’ rights in Iran: Providing effective strategies. Iran J Nurs Midwifery Res 2015; 20:184–9. https://doi.org/10.4103/2229-3485.203043 https://doi.org/10.4103/2229-3485.203043 https://doi.org/10.4102/phcfm.v5i1.491 https://doi.org/10.4102/phcfm.v5i1.491