Patients’ rights are integral to ensuring ethical and humane healthcare delivery. Understanding these rights helps promote patient-centered care and strengthens trust in healthcare systems. Although international frameworks outline patients’ rights comprehensively, Sri Lanka lacks specific legislative recognition and public awareness on the topic. This study aims to explore perspectives on patients’ rights in Sri Lanka and identify barriers and facilitators to their implementation.

A qualitative study was conducted at the National Hospital of Sri Lanka, involving individual interviews with twenty participants, including patients (n = 16) from diverse backgrounds and healthcare professionals (n = 4). The study used a generic qualitative inquiry using inductive thematic analysis. Open-ended interviews were transcribed, and key themes were identified based on participants’ descriptions of their experiences.

The study identified several key themes regarding patient rights: access to information and informed consent, respect and dignity, and quality of care. Patients were generally satisfied with the amount of information received, although healthcare providers desired more patient involvement in decision-making. Both patients and healthcare professionals stressed the importance of treating patients with respect and dignity. However, patients showed a tendency to defer to the expertise of doctors, placing less emphasis on informed consent and their own autonomy. Patients also expressed a right to high-quality care but experienced some delays and inefficiencies.

This study reveals both strengths and weaknesses in the implementation of patient rights within the Sri Lankan healthcare setting. A lack of formal recognition of patient rights and a cultural tendency for patients to trust doctors’ judgement over their own autonomy are key findings. This study highlights the need to improve patient empowerment and education to promote autonomy and shared decision making in their own care. Future studies should include larger, multi-center samples, to gain a more comprehensive understanding of patient rights in Sri Lanka. Importantly, this study advocates for national policy reform, including the development and adoption of an officially recognized Patient Rights Charter.

The concept of human rights encompasses how individuals should be treated by others, and patient rights form a specific extension of this principle within healthcare. Clearly defined patient rights help ensure standardized care across medical disciplines, uphold humanitarian values, and promote patient involvement in their healthcare journeys. This patient empowerment builds trust and confidence in health systems.

Modern medical ethics rest on four core principles—beneficence, autonomy, non-maleficence, and justice—which collectively form the foundation of patient rights [1]. These principles provide a moral framework for clinical decision-making and uphold the dignity of patients within the healthcare system. Beneficence refers to acting in the best interest of the patient, not only in diagnosis and treatment but also in addressing overall well-being. However, beneficence may occasionally conflict with patient autonomy, where a patient’s right to self-determination must be respected, even when their choices diverge from clinical advice [1].

Autonomy ensures that patients can make informed, voluntary decisions about their care, free from coercion. Respecting autonomy involves transparent communication, the right to refuse treatment, and honoring advance directives [1]. Non-maleficence, often summarized as “do no harm,” compels clinicians to minimize risks and prevent harm while pursuing beneficial outcomes. This includes full disclosure of treatment options, side effects, and alternatives to support informed choices [1].

The fiduciary relationship between patient and provider is built on trust and expertise. Physicians must navigate their interactions with patients in ways that can be paternalistic, informative, interpretive, or deliberative, depending on the situation and patient preference [1]. Distributive justice demands equitable access to healthcare services and resources, ensuring that patients with similar needs receive similar care.

The principle of sanctity of life continues to provoke ethical debate, especially with advancements in medical technology. Topics such as abortion, assisted dying, and neonatal care are shaped by evolving interpretations of when life begins and ends, and the relative weight of competing ethical principles. While international legal documents have shifted their language over time, the core issue remains how best to uphold human dignity in the face of complex moral choices [1].

Meanwhile, different countries interpret and operationalize these ethical tenets through their healthcare policies. For instance, a Canadian Medical Journal article categorizes patient rights into those in healthcare—such as informed consent, data access, and privacy—and those to healthcare, which imply a right to receive care, potentially raising expectations of entitlement [2]. These distinctions are critical in debates over universal healthcare and prioritization of limited medical resources.

Echoing these principles, an Egyptian study explored patient perspectives and highlighted rights including respectful treatment, clear communication, informed consent, hygiene and education, participation in care decisions, and redress of grievances [3]. These rights reinforce both ethical duties and the structural responsibilities of healthcare institutions in diverse cultural and systemic contexts.

International definitions

Globally, patient rights are enshrined in various national frameworks. In the United Kingdom, the National Health Service (NHS) Constitution outlines comprehensive patient rights, including access to services free of charge, non-discrimination, dignified treatment by qualified professionals, and the right to privacy and confidentiality. Patients also have the right to be informed about treatment options and risks, to provide consent for physical examination, to access their own medical records, and to seek compensation if harmed due to negligence. Furthermore, complaints must be acknowledged within three working days and thoroughly investigated [4].

In the United States, the American Hospital Association’s Patient Bill of Rights, first introduced in 1973, shares many similarities with the NHS Constitution but includes additional provisions. These include the right to know the identity of healthcare providers, the financial implications of treatment, the right to formulate advance directives, and transparency about institutional relationships that may affect patient care. Patients also retain the right to decline participation in research activities. Saudi Arabia’s Patient Bill of Rights, enacted in 2006, underscores the right to respectful, culturally appropriate care and communication. It mandates informed consent, allows patients to refuse or modify treatment, and guarantees privacy and confidentiality. Unique to this framework is the stipulation that patients in the private sector must be informed of treatment costs in advance, reinforcing transparency in financial matters [5].

Local definitions

In Sri Lanka, the Sri Lanka Medical Council (SLMC) has published comprehensive guidelines on the ethical conduct expected of medical and dental practitioners. However, these guidelines do not explicitly address patient rights. Although a draft Charter of Patient Rights and Responsibilities exists, it has neither been debated in Parliament nor openly discussed with key stakeholders. As a result, public awareness of patient rights remains limited [6].

Many hospitals in developed countries have proactively established mechanisms to safeguard patient rights and address complaints. For instance, Toronto East General Hospital in Canada has implemented a code of patient rights and responsibilities that outlines fundamental entitlements such as access to information about one’s care, involvement in care decisions, and confidentiality of medical records [2]. However, the impartiality of these internal processes has been questioned, as their close ties to hospital administration and staff may limit independence in resolving grievances [2].

There is also a growing emphasis on shared decision-making in developed health systems, with patients now playing a more active role in their treatment choices. This involvement has been shown to enhance patient satisfaction and adherence to treatment plans [2].

In New Zealand, a study by Sheridan et al. highlighted how patients often felt unheard and wished for more personalized communication from healthcare providers. A lack of contextual understanding led to feelings of powerlessness, frustration, and non-concordance with care plans [7]. Similarly, in Taiwan, Yea-Pyng Lin and Yun-Fang Tsai explored nurses’ perspectives on patient dignity, identifying themes such as respect, protection of privacy, maintenance of body image, equitable treatment, and emotional support. Interestingly, the principle of beneficence—central to medical ethics—was not emphasized by participants [8].

In contrast, developing countries are at various stages of formalizing and enforcing patient rights. Egypt is among the few that have institutionalized patient rights through government policy. The Egyptian Ministry of Health and Population (MOHP) launched a Patient’s Bill of Rights in 2005 and made it a component of hospital accreditation standards. This initiative, enforced in all hospitals nationwide, emphasizes patient involvement in care and recognizes patients as critical informants in evaluating healthcare quality [3].

Participants in Egypt expressed that patient rights should ensure adequate and appropriate care, equality, accessibility, and a patient-centered approach. Barriers to these rights included dissatisfaction with caregivers and structural limitations within healthcare settings. Facilitators included the presence of a family member, responsive healthcare systems, and greater public awareness of patient rights. These insights were drawn from open-ended questions such as: “What is the meaning of patient rights for you?” and “Can you describe a time when your or a relative’s rights were respected or violated?”

In Iran, Eesa Mohammadi and Zohreh Vanaki conducted a study on the violation of hospitalized patients’ rights, identifying three main dimensions: Recession of care (absence of caregivers, delay or lack of necessary response), Receiving mechanical care (impersonal treatment, emotional detachment), Being disrespected (experiences of humiliation and aggression) [9].

Another Iranian study found that managerial and organizational policies significantly influence how patient dignity is maintained. Hospital policies were seen as key facilitators—or barriers—to upholding patient-centered care [10].

In Pakistan, a study revealed that many patients had limited or incorrect understanding of their rights. Among the 16 respondents, several had views that diverged significantly from the Charter of Patient Rights, indicating a critical need for public education and awareness [11].

One of the most important human rights is the right to live a healthy life. Hence, promoting and guaranteeing patients’ rights is a crucial component of healthcare. The World Health Organization (WHO) released a comprehensive declaration describing the fundamental tenants of patients’ rights in Europe in 1994.

In Sri Lanka, while limited data exist from a few surveys assessing patient satisfaction with government health services, there has been no qualitative research exploring the concept of patients’ rights. A qualitative approach would offer valuable insights into the lived experiences of patients, their families, and healthcare providers. It would also help uncover the key barriers and enablers in implementing patients’ rights within the local healthcare system. Therefore, the primary objective of our study was to identify themes related to patients’ rights among individuals from diverse backgrounds in Sri Lanka.

A qualitative study was conducted in the National Hospital of Sri Lanka (NHSL), which is the largest tertiary care hospital in the country, which gets referrals from all over the country and provides treatment to a variety of patients from diverse socioeconomic backgrounds.

Purposeful sampling was used to select participants for the study. A total of twenty individuals were interviewed, comprising sixteen patients and four healthcare providers. Among the healthcare professionals, two were consultants, one was a house officer, and one was a medical officer. These four doctors were chosen based on their level of direct patient involvement. House officers and medical officers typically spend the most time with patients in the wards, providing day-to-day care, while consultants generally interact with patients for shorter periods, focusing primarily on communicating management plans. This selection allowed the study to capture perspectives on patient rights from doctors with both continuous and limited patient contact.

To capture diverse patient perspectives, participants were purposively selected to represent different socioeconomic and demographic backgrounds. Patients were categorized by age (with 60 years as the cutoff, aligning with the national retirement age), income (above or below LKR 100,000 per month), and education level (completion of O/Ls as the threshold). This approach ensured the inclusion of voices from both younger and older adults, individuals from low- and high-income groups, and those with varying levels of education. Two patients from each demographic group were selected. Participants were approached within relevant healthcare settings and had no prior relationship with the interviewer. All interviews were conducted one-on-one. The detailed profiles of the interviewees are provided in Annexure 2.

Although a phenomenological orientation guided the interviews to explore participants’ experiences, the study design and analysis more closely reflect a generic qualitative inquiry using inductive thematic analysis to identify patterns and themes related to perceptions of patient rights [12].

The questions mentioned in Annexure 1 formed the basis for the interviews.

Open-ended questions were posed to participants, and their responses were audio-recorded and transcribed by the interviewer for analysis. Additionally, the researchers observed and documented participants’ behaviors and expressions related to the discussed phenomena. Based on these transcripts, key themes regarding patients’ perceptions of their rights were identified and categorized by 2 independent members of the research team. The interviews lasted a duration of 15–30 min.

Informed consent was obtained from all participants prior to the interviews. Participants were informed that the research team was independent from the healthcare providers responsible for their care. Only basic demographic information—such as age, income, and education level—was collected, while personally identifiable details were not recorded. Participants were assured that all responses would be anonymized and that no information would be published that could reveal their identities.

Patient interviews were conducted by medical students (both male and female) who had grown up within Sri Lanka’s universal healthcare system and were thus familiar with its structure, strengths, and limitations. Their prior exposure to a broad range of patients during clinical rotations enabled a natural rapport and contextual understanding that enriched the interview process. Patients were generally more comfortable and open when speaking with medical students, who tend to spend more time at the bedside and engage more informally, fostering a sense of trust and ease that facilitated candid conversations.

The data analysis for this study followed a generic qualitative inquiry using inductive thematic analysis. This approach explores the perspectives and experiences of participants regarding patient rights. The open-ended interviews were transcribed for analysis. Emerging themes and patterns were identified directly from the data, allowing concepts to be grounded in participant narratives. These themes were then organized and interpreted in relation to the participants’ diverse backgrounds and roles within the healthcare setting.

Patients emphasized the importance of receiving clear and comprehensible information regarding their diagnosis, treatment options, and potential risks. They appreciated communication that was simple and patient-friendly. However, they preferred not to be overwhelmed with excessive information at once and instead placed their trust in the healthcare provider’s ability to make the right decisions. Across all socio-economic backgrounds, patients did not stress the importance of informed consent, expressing satisfaction with the level of explanation given and showing little inclination to probe deeper into treatment plans.

“The doctors are the ones who are educated and are capable of treating patients, and they know more than me when it comes to my treatment, so I trust them to make the best decision for me.”– Ward patient.

Many echoed similar sentiments, preferring that doctors guide their treatment decisions after a cordial discussion, particularly among elderly patients:

“Good… accepting and appreciating our decision and input… good… They can do what they like best after discussing cordially with the patient… that is what is best for the patient.”– Elderly patient, high income, low education.

Even when they had concerns, patients were primarily focused on long-term implications rather than the technical details of their management:

“Whenever we have problems, the doctors and nurses explain to me what it is. But what I’m more worried about is how it’ll affect me long term—whether I can continue to work or not, and whether it will be a problem to me in the future.”– Young patient, low income, high education.

Routine procedures were well explained and generally well received. Patients felt reassured by these interactions, even if they didn’t consider the information critical:

“They explain why they take blood before they do so and also elaborated on the condition I have and consoled me as well. The information honestly doesn’t matter as much because the healthcare workers know what’s best for us.”– Young adult, low income, high education.

“They explain to us why they draw blood and do certain tests. I was just taken to do a chest X-ray and they explained to me why I need it.”– Elderly patient, low income, low education.

While patients were generally satisfied with the communication they received, healthcare providers themselves expressed concern about the limited patient engagement in treatment discussions. This disconnect can, in part, be understood through Foucault’s concept of the medical gaze, which describes how biomedical systems position patients as passive subjects under clinical observation, reinforcing hierarchical power dynamics that discourage active participation [12]. In contrast, healthcare professionals in this study expressed a desire to move away from this model, advocating for greater patient involvement and autonomy. This aligns with Freire’s theory of empowerment, which emphasizes dialogue, critical consciousness, and the co-construction of knowledge as essential for meaningful engagement [13]. Providers highlighted the need for patients to feel safe asking questions and contributing to decisions about their care, suggesting an aspiration to foster a more egalitarian and participatory healthcare environment.

“We should equally involve them in providing better treatment or at least treat them with care and respect because they deserve it as well. They shouldn’t think that they’re afraid of any doctor. They should be able to ask questions without fear or judgment that they are uneducated or uninformed.”– Intern House Officer, medical ward.

“Their input or their influence on the management and follow-up is important.”– Consultant.

“But one thing which is very important is to get the patient involved because at the end of the day, it’s the patient who is the receiver. They just have to think about it, give them time to think about it if they can’t make up their decision then and there, then come back to us and get them involved. Get them involved more.”– Consultant.

“I think we’re very poor communicators, so we don’t really talk much. And well to be fair, I think our patients also don’t want to know much, you know? Unlike the West where they would come, having gone through the net, they know everything and they just ask you so many questions. And our patients don’t really ask questions, and they don’t want to know a lot”– Consultant.

Patients consistently emphasized the importance of being treated with respect and dignity by healthcare professionals. For them, this meant being approached with kindness, compassion, and a humane attitude—particularly during moments of vulnerability. Healthcare professionals echoed this sentiment, underscoring the ethical and emotional imperative of treating all patients with dignity.

“All patients are alike. All of them are in some sort of pain. So they should be treated the same way—with kindness. This is the job of the healthcare personnel. And from what I have seen, it happens that way.”– Clinic patient.

“The first priority is the patient. The second is the treatment—after relieving the patient mentally and making them happy. It’s not good to treat someone after hurting them mentally and physically. Kindness is something that can’t be bought with any amount of money.”– Elderly patient, high income, high education.

Some patients, particularly those from vulnerable groups, described a sense of helplessness in their interactions with the healthcare system and emphasized the need for empathy rather than judgment.

“From the side of the patient… I don’t need to lie… we are helpless. So it’s better if they treat us kindly without shouting and blaming us.”– Elderly patient, high income, low education.

Other patients expressed deep appreciation for the compassion shown by healthcare workers, highlighting that their expectations for kindness were met or exceeded.

“They try their best to treat us the way we expect them to treat us. We expect them to treat us kindly—and for me, that’s exactly what they gave. Kindness.”– Young patient, low income, high education.

“I expect them to be nice to us and give adequate medication for our conditions. They do that well. They even bring the medicine to us and are very kind. All of the healthcare workers are like that.”– Elderly patient, low income, low education.

Healthcare professionals, too, acknowledged the importance of preserving patient dignity and emphasized the need for mutual respect and empathy in care delivery.

“Dignity is very important. We should look at patients as equals when we talk to them or manage their care. Whether we step down or up, we should engage them at their level—only then will they open up and come to a better understanding of their illness.”– Consultant.

Patients strongly affirmed their right to receive high-quality medical care, irrespective of their socio-economic background. They expected timely, appropriate, and respectful treatment, and emphasized the importance of equitable care delivery without discrimination.

“They do their jobs well. But the only problem is, certain aspects of treatments are delayed. I’ve been on a waiting list to put a stent for six years… That is something that needs to be improved.”– Clinic patient.

Despite such systemic delays, many patients expressed overall satisfaction with the care they received, especially praising the attentiveness and kindness of healthcare staff.

“Yeah, everyone in the staff—especially the doctors and healthcare workers—are nice to me. They treat me well, they tend to me whenever I need something, they answer my questions. And the consultant is really nice and spends a lot of time with the patients. Overall, the experience is very satisfactory.”– Ward patient (low income, high education, old age).

Some patients noted that while their personal experiences were positive, consistency in service delivery across shifts and staff could be improved:

“There is no issue with the way they treat us… but it’s better if everyone serves the same way all the time. We won’t have someone with us during the entire stay, neh… so it’s better if they don’t emphasise even small mistakes that we do.”– Elderly patient, high income, low education.

The notion of fairness and non-discriminatory care was a recurring theme, with several patients affirming that healthcare providers treated all patients equally, regardless of background.

“From what I’ve seen, all the patients in the ward are being treated alike as expected, regardless of their social background. The doctors, nurses, attendants—all of them are the same. They treat people equally. They don’t hurt anyone’s feelings. And I’m satisfied with the way they treat us.”– Young patient, high income, high education.

“I don’t think income or social status matters to them. They treat everyone with kindness. I’m very grateful for the free healthcare system in Sri Lanka. I’m a heart patient. All the treatment I’ve received was free from the very beginning, and I wasn’t treated badly just because the medication was free. I haven’t seen any other patients being treated badly either.”– Young age, low income, low education.

Across all demographic groups, patients expressed satisfaction with the level of information they received, placing significant trust in their doctors’ decisions. Interestingly, a higher level of education did not correspond to a greater demand for detailed information or involvement in decision-making—patients across the board were content with the explanations provided and did not emphasise informed consent as a priority.

The most consistently valued theme, regardless of age, income, or education level, was the need to be treated with respect, dignity, and kindness. This emerged as the most important patient right across all interviews, underscoring the cultural and emotional significance of humane care in the Sri Lankan context.

Patients also reported high satisfaction with the overall quality of care received. There was no indication of discrimination based on demographic factors such as age, socioeconomic status, or educational background, suggesting a generally equitable experience within the healthcare system. The following table (Table 1) shows the key insights on the themes emphasised by the participants.

The findings of this study highlight the multifaceted nature of patient rights within the Sri Lankan healthcare system, emphasizing both achievements and areas that need improvement. Several key themes, such as access to information and informed consent, respect and dignity, and quality of care, emerged from the perspectives of patients and healthcare providers.

A distinct divergence was noted between patient and healthcare provider perspectives on information-sharing. While patients reported satisfaction with the information provided, healthcare providers—particularly doctors—expressed a desire for more active patient involvement. This paradox underscores a culturally embedded hierarchical doctor-patient relationship, where deference to medical authority is normalized and even expected. The findings resonate with Foucault’s concept of the medical gaze, wherein authority resides with the provider, and the patient’s subjectivity is often subordinated to clinical judgement. However, doctors expressed their concern with regard to this and wanted patients to be more involved in their care, so that they could provide holistic care for the patient and to treat the patient as a human being with an illness and to not just treat the disease.

In contrast to Western models that prioritize shared decision-making and informed consent [1, 2], patients in Sri Lanka demonstrated a high level of trust in healthcare providers, often viewing them as ultimate decision-makers. Even among highly educated participants, there was little expectation to challenge or co-direct their treatment. This may reflect lower medical literacy, cultural reverence for authority, and collectivist norms that prioritize group harmony over individual autonomy [14]. As Freire’s theory of empowerment suggests, without dialogic engagement and critical consciousness, patients are unlikely to assert their agency in care decisions. Encouragingly, healthcare professionals are concerned about this and are pushing for more patient education and empowerment in their patient interaction to have a dialogue to involve patients more in their own care.

This was the most prominent and consistently valued theme across all demographic groups. Patients repeatedly emphasized the importance of kindness, humane treatment, and emotional sensitivity from healthcare staff. Healthcare professionals echoed this view, recognizing respect and empathy as essential to therapeutic relationships. This theme is particularly relevant in resource-limited settings where even when material conditions fall short, interpersonal conduct can significantly shape patient satisfaction and health-seeking behavior [5, 6].

While patients were broadly satisfied with the quality of care and appreciated the dedication of staff, systemic inefficiencies—such as long wait times and procedural delays—were a notable concern. For instance, a patient reported a six-year delay for a stent placement, highlighting significant issues in resource allocation and service delivery. These challenges intersect with structural limitations in Sri Lanka’s public health system, which, despite its commitment to universal care, lacks mechanisms to ensure timely and equitable treatment distribution.

The principle of distributive justice is challenged in such contexts. Unlike countries with robust systems for equitable allocation (e.g., NHS in the UK), Sri Lanka’s system struggles with funding, workforce shortages, and centralized service delivery. These issues disproportionately affect vulnerable groups, even though patients often do not perceive overt discrimination—possibly due to normalized expectations and a general culture of gratitude for free healthcare.

Sri Lanka lacks a formally enacted Patient Rights Charter, which significantly undermines patient empowerment and institutional accountability. Although the Sri Lanka Medical Council (SLMC) has published ethical guidelines, the absence of legal frameworks and public awareness means these rights are not consistently enforced or demanded. In contrast, nations like the US and UK have legislated frameworks that support patient advocacy, partly due to sustained public health education and institutional reform.

To bridge this gap, policy interventions must focus on both legal reform and educational campaigns aimed at patients and providers. Embedding patient rights into practice requires not only legal structures but also a cultural shift towards recognizing patients as partners in their care. This may be achieved by promoting health literacy, reforming medical curricula, and introducing patient feedback systems as part of quality assurance.

Notable limitations of this study is the sample size involving only twenty participants at a single center (the National Hospital of Sri Lanka), and while purposive sampling ensured diverse demographics, the findings may not be fully generalizable to all health care settings in Sri Lanka as a whole, especially in peripheral and rural settings.

Another limitation of this study stems from the use of a Generic Qualitative Inquiry approach with inductive thematic analysis. While this methodology offers flexibility and is useful for exploring diverse perspectives, it lacks a clear theoretical or epistemological foundation, which may limit the depth of interpretation.

This study provides valuable insights into the lived experiences and perspectives of patients and healthcare professionals regarding patient rights in Sri Lanka. The themes of access to information, respect and dignity, informed consent, and quality of care were central to these narratives.

Patients expressed satisfaction with the information received but demonstrated limited desire for deeper involvement in medical decisions, reflecting both cultural norms and systemic practices. Healthcare providers, on the other hand, emphasized the need for more patient engagement to optimize care outcomes. This reveals a key area for intervention: aligning expectations through communication and health education.

Respectful treatment emerged as the most critical and universally emphasized right, underscoring the emotional and cultural value of kindness in patient care. The healthcare system’s commitment to universal access was appreciated, but delays and inefficiencies in treatment delivery raised concerns about equitable resource allocation.

A crucial gap remains the absence of a formally recognized Patient Rights Charter. Addressing this through policy reform and public engagement is essential to enhance patient empowerment and system accountability. Ultimately, frameworks for patient rights must be culturally grounded yet progressively aligned with global standards of participatory and rights-based care.

Further studies are needed to explore these dynamics at scale and to develop actionable, context-sensitive strategies that uphold patient rights across all levels of healthcare in Sri Lanka.

NHS:

National health service

NHSL:

National hospital of Sri Lanka

PBR:

Patient’s bill of rights

SLMC:

Sri lanka medical council

UK:

United kingdom

WHO:

World health organization

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DS contributed to the conception of the study, formulated the questionnaire, conducted interviews, transcribed interviews, analyzed the data, drafted the manuscript and revised it. SW contributed to the conception of the study, formulated the questionnaire, conducted interviews, transcribed interviews, analyzed the data and drafted the manuscript.PW formulated the questionnaire, conducted interviews, transcribed interviews and analyzed the data.UW, SE, AH conducted interviews, transcribed interviews.NC contributed to analysis of the data, substantively revised the manuscript and supervised the study.SJ contributed to the conception of the study, formulated the questionnaire, and supervised the study.All authors reviewed the manuscript.

Correspondence to Deedat Safeer.

Informed consent was obtained from the participants before conducting the interview. The participants were informed that the research team is independent of the team that’s providing them with healthcare and that their personal identification information will only be used by the research team to identify their demographic factors. They were also informed that the results of the study would be anonymized before publishing. The project was conducted in compliance with the Declaration of Helsinki. The project was approved by the Ethics Review Committee of the Faculty of Medicine, University of Colombo under Protocol Number EC-23-031.

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The authors declare no competing interests.

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