Human dignity and respect in health care means treating individuals with honor, privacy, and empathy, valuing their autonomy and preferences [1]. In healthcare, dignity is an inherent and unassailable value intrinsic to all individuals, shaped by the amalgamation of patients' values, beliefs, culture, and morality [2]. Respectful care for human dignity is an essential element for health care providers, which increases positive relationships among health care [3, 4]. It is essential to provide quality health care service within the healthcare system [5]. Many patients complain of improper medication administration from the nurse, missing elective surgery from surgeons, neglecting referral clinic from an internist, and improper dispensary from a pharmacist [6]. Such likes of patients and clients complaints trigger the issue of respectful human dignity practice in health care service in a clinical setting. Human dignity and respect in health care involve patient-centered care, privacy and confidential care, dignified and equitable care, being free from harm and mistreatment, and effective communication [7]. Ensuring the preservation of human dignity during illness is vital, as it directly influences an individual’s self-esteem and overall quality of life [8]. Disrespectful care remains prevalent in low and middle-income countries [9]. Compassionate and respectful care can help a patient recover fast from a major illness, better manage chronic conditions, reduce client anxiety and stress, and is crucial for effective medical outcomes [10]. Medical care services dissatisfaction is increasing due to the scarcity of respectful care, particularly dissatisfaction with the lack of humanity in healthcare [11]. A lack of respectful health care may cause patients to avoid treatment adherence and fail to accept medical advice from their care providers [12]. Disrespectful health care delivery may be one factor that leads to failures in health care [13]. Disrespecting care causes patients to be irritable and colleagues to affect standards of care [14]. Inadequately respectful health care and lack of humanity may cause emotional harm to patients and supporters [15]. Disrespecting health care is a multifaceted and complex social problem, and it often persists despite firm commitments to respectful service provision [16]. Inadequate respect for human dignity in health care leads to negative feelings such as fear, disbelief, shock and denial, anger, hatred, apathy, sadness, and frustration and ultimately has undeniable effects on patients’ health [17, 18].

Though compassionate and respectful health care is the backbone of the healthcare sector and client satisfaction, it is not easy to provide [19]. Emotional harms can be as long-standing and troubling as physical harms for patients and families [15].

There are different studies on respectful health care service from a patient perspective, but studies are limited to wards from the perspective of health care providers. Studies revealed that most of the patients and clients have complaints about poor health service, so this study intended to assess health professionals' insight towards respectful health care delivery and the factors that affect the care provision.

The study was employed in hospitals found in the South Gondar Zone from March 18 to April 18, 2024. There were 9 primary hospitals and one referral hospital (Debre Tabor Referral Hospital). The primary hospitals included Addis Zemen Primary Hospital, Ebinat Primary Hospital, Nefas Mewcha Primary Hospital, Mekane Yesus Primary Hospital, Andabet Primary Hospital, Simada Primary Hospital, Dr. Ambachew Mekonnen Memorial Primary Hospital, Woreta Primary Hospital, Dera Primary Hospital. There were a total of 1177 healthcare providers in these hospitals.

A cross-sectional study design was conducted to assess the provision from March 18 to April 18, 2024, among all healthcare providers who worked in South Gondar Zone hospitals.

Inclusion criteria

The study includes all health professionals who were present during the data collection period.

Exclusion criteria

We exclude guest health professionals and health professionals who were not permanently employed to avoid duplication.

Sample size determination

The sample size was calculated by using a single population proportion formula with a 95% confidence level, a 5% margin of error, and a proportion of previously studied compassionate, respectful care implementation at the north, the prevalence of CRC 46.2% [6], and by considering a 10% non-response rate, the final sample size was 420.

Sampling technique and procedure

First, proportional allocation is employed based on the number of HCPs in each hospital to determine the number of study participants in that hospital. Then By using the list of health care providers from each hospital, the required sample was drawn by a simple random sampling method.

Data collection tool

The data were collected by using a structured questionnaire that was adapted from the Ethiopian National CRC participants training manual [6]. The data collection instrument was prepared in English and translated to Amharic by healthcare providers and academicians. The pre-test was done at 21 (5%) at Adis Alem Hospital. The tool includes socio-demographic data of participants, professional factors, and organizational factors, which are the associated factors, and the final focus is on the respectful care practice (14 items). The outcome of respectful care was measured using a five-point Likert scale. A total respectful care score was calculated, each subscale’s median was taken, and a total median was computed and considered a cutoff point. A score greater than or equal to the median was considered a good respectful care practice, and less than the median score was considered a poor respectful care practice. The attitude was measured by 8 items using a five-point scale, and the median was taken as a cutoff point to dichotomize as favorable attitude (1) unfavorable attitude (0). An attitude score greater than or equal to the median is considered a favorable attitude [3].

Data collection procedures

Six BSc nurses, one health officer, and one laboratory technician facilitated the data collection for quantitative questionnaires after training on data collection procedures and instruments. The data collectors distributed the self-administered questionnaires to the respondents to fill them out.

For data collection, a total of 8 BSC nurses, one HO, and one laboratory technician were recruited, six as data collectors and two as supervisors. Training was given to each of them on the meaning of every item of the questionnaire and the techniques of data collection, such as ways of greeting and ways of taking consent. Training was given for one day for data collectors and two days for supervisors to carefully monitor the data collection process and check the completeness of data during data collection time, and the codes were given to the questionnaires. Before the actual data collection pretest was conducted, 5% of the sample size was out of the study area at Adis Alem Primary Hospital to evaluate the clarity of questions, the validity of the instrument, and the reaction of respondents to the questions.

Data processing and analysis procedure

Data were first tested and coded. Then entered into Epi data version 3.1 and exported to Statistical Package for Social Sciences (SPSS) version 26 for analysis. Multicollinearity between independent variables was checked using the correlation coefficient to prevent distortion model estimation, and all independent variables have < 0.7 correlation coefficients. The variable that had a p-value < 0.25 in binary logistic regression became a candidate for multivariate logistic regression. The Homer and Lemeshow's test was checked for model goodness of fit. During the analyses, a 0.05 P-value and 95% confidence interval (CI) were used. Factors with a p-value < 0.05 were considered as predictors of the outcome variable.

From the calculated sample size, a total of 410 healthcare providers’ were participants in this study with a response rate of 97.6%. The participants’ ages ranged from 22 to 55 years, with a median age of 28 years with 4 IQR (Table 1).

Of the total respondents, about 26 (6.3%) respondents did not greet their patients properly, and 96% (23.4%) of health professionals didn’t introduce themselves to their clients (Table 2). In general, the implementation of respectful care among health care providers was 215 (52.4%) with a 95% CI (47.6%—57.6%) (Fig. 1).

Level of implementation of respectful care among healthcare providers in South Gondar hospitals, 2024

Full size image

In this study, the majorities of participants were nurses, BSc holders, and had less than 5 years of work experience. In an aspect of educational status, 28.5% were diploma, 69% were degree, and 2.4% were masters. Of the total participants, 61.5% of respondents had CRC training, and 55.4% had a favorable attitude toward CRC (Table 3).

Educational curriculum was the highest reported organizational factor for the implementation of compassionate and respectful care, followed by poor organizational infrastructure. Of the total participants 337(82.2%) respondents reported the absence of pre-service CRC training incorporating an educational curriculum and the majority of the participants reported that there was no CRC protocol in their work area, no regular evaluation and monitoring system, and no strong CRC committee in their organization (Table 4).

Variables with a P value less than or equal to 0.25 in bivariate analysis were entered into multivariable logistic regression. After multivariable regression analysis was done. Three variables are associated with the dependent variable. These were monthly income, professional attitude, and CRC training (Table 5).

Respectful human dignity health care service is one of the most important means for ensuring quality health care service. Thus, this study is unique from the previous studies because it aimed to assess the respectful healthcare service and its associated factors based on the healthcare provider’s perspective instead of the patients and clients experience. In this study, respectful health care practice was 52.4%, which is better than the finding in North Shewa, which is 46.2% [20]. However, the practice was less than the study conducted all over Ethiopia [10]. This difference may be explained by the settings, tools, and methodology used in the studies, and it may be due to practice improvement due to the positive effect of training provision.

In this study, healthcare providers who had a favorable attitude towards compassionate and respectful care were significantly associated with better respectful care provision than those who had unfavorable attitudes. This may be due to a positive attitude that can increase the provision of patient-centered care, consistency of high caring performance, and guarantee patient satisfaction. Findings in England revealed that attitudes are of crucial importance in nursing, helping us to understand how people perceive issues and processes in care and determine what they deem important, good, relevant, and appropriate to provide collaborative and patient-centered care [21]. The attitudes and behaviors of maternal health care providers are an important element of quality maternal health care. Lack of respectful care from providers, such as doctors and midwives, may lead to dissatisfaction with the health system, diminishing the likelihood of seeking antenatal care [22]. This finding is in line with a study conducted in North Shewa, Ethiopia [20].

In this study, healthcare providers who got CRC training had better respectful practices than those not trained in CRC. They may be having training to improve health professionals’ knowledge, attitude, and skills and can assist to increase mental health resilience and improve patient care. Training improved the participants’ awareness of the rights of clients and patients [23]. Studies showed training health professionals in quality improvement has the potential to positively impact attitudes, knowledge, and behaviors [24]. Incorporating training into pre-service and in-service training of providers will help advance global efforts to promote RMC [25]. In this study, those with a salary ≥ 5000 birr had better respectful care than those whose monthly salary is < 5000 birr. Low salaries may decrease healthcare providers' job satisfaction and performance motivation and make them irritable and negligent. Study findings in sub-Saharan Africa revealed pay and income of health workers affect health care and health systems in many ways. Relatively low pay can cause dissatisfaction, loss of motivation, and migration towards higher-earning jobs [25]. Similarly, findings of the Journal of Healthcare Management reported that rewarding healthcare providers who expand their focus from solely delivering a highly technical set of services that improve the patients’ health to creating an atmosphere that makes hospitalization more humane and respectful of patients’ values and preferences [26].

In this study, about half of healthcare providers had good, respectful healthcare practices. Though a minimal improvement from the previous, the implementation of respectful healthcare was found still not satisfactory. Professional attitude towards respectful health care service, training and salary were significantly associated with respectful health care service. Since respectful care is at the heart of quality health service, healthcare providers should give emphasis and implement according to standards by participate in ongoing training and for developing positive attitude and improving skill.. In addition to the Ministry of Health different stakeholders should give attention to respectful healthcare service by motivating health care providers, providing training to increase knowledge and to improve the positive attitude of providers, including pre-service training that should be incorporated into the educational curriculum at the college or university level, and students should join the profession based on interest. And it is recommended for future researchers to conduct observational studies in order to minimize the bias and it is also recommended qualitative methods to determine experience of health care provider in depth.

This facility-based primary study has a potential limitation, which is that it is conducted on health professionals with self-administered questions, commonly affected by social desirability bias.

AOR:

Adjusted Odds Ratio

COR:

Crude Odds Ratio

CRC:

Compassionate and Respectful Care

HCP:

Health Care provider

HP:

Health Professional

RMC:

Respectful maternity care

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GK and MW participated in the conception and design of the study, obtaining funding, acquisition, analysis, and interpretation of the data, and drafting the manuscript. YE and GD participated in the conception, and design of the study, obtaining funding and revising the manuscript critically. YA and TD participated in the conception, and design of the study, analysis, and interpretation of data.

Correspondence to Gebrie kassaw Yirga.

The study was carried out after a letter of approval was obtained from the ethical review committee of Debre tabor University College of Medicine and Health Sciences according to the declarations of Helsinki. A formal letter was provided to selected hospitals in south Gondar hospitals preceding data collection.

Informed verbal consent was obtained from each participant’s anonymity, participation in interviews, and record of their voice. Data was used only for the purpose of study and was not used for other purposes.

Not applicable.

The authors declare no competing interests.

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